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Jung Y, Lee H, Jun H, Cho S. Evaluation of Motion Artifact Correction Technique for Cone-Beam Computed Tomography Image Considering Blood Vessel Geometry. J Clin Med 2024; 13:2253. [PMID: 38673526 PMCID: PMC11050711 DOI: 10.3390/jcm13082253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In this study, we present a quantitative method to evaluate the motion artifact correction (MAC) technique through the morphological analysis of blood vessels in the images before and after MAC. Methods: Cone-beam computed tomography (CBCT) scans of 37 patients who underwent transcatheter chemoembolization were obtained, and images were reconstructed with and without the MAC technique. First, two interventional radiologists selected the blood vessels corrected by MAC. We devised a motion-corrected index (MCI) metric that analyzed the morphology of blood vessels in 3D space using information on the centerline of blood vessels, and the blood vessels selected by the interventional radiologists were quantitatively evaluated using MCI. In addition, these blood vessels were qualitatively evaluated by two interventional radiologists. To validate the effectiveness of the devised MCI, we compared the MCI values in a blood vessel corrected by MAC and one non-corrected by MAC. Results: The visual evaluation revealed that motion correction was found in the images of 23 of 37 patients (62.2%), and a performance evaluation of MAC was performed with 54 blood vessels in 23 patients. The visual grading analysis score was 1.56 ± 0.57 (radiologist 1) and 1.56 ± 0.63 (radiologist 2), and the proposed MCI was 0.67 ± 0.11, indicating that the vascular morphology was well corrected by the MAC. Conclusions: We verified that our proposed method is useful for evaluating the MAC technique of CBCT, and the MAC technique can correct the blood vessels distorted by the patient's movement and respiration.
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Affiliation(s)
- Yunsub Jung
- Department of Materials and Production, Aalborg University, 9220 Aalborg East, Denmark;
| | - Ho Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Hoyong Jun
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul 03760, Republic of Korea;
| | - Soobuem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul 03760, Republic of Korea;
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Diller GP, Gerwing M, Boroni Grazioli S, De-Torres-Alba F, Radke RM, Vormbrock J, Baumgartner H, Kaleschke G, Orwat S. Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients. J Clin Med 2024; 13:631. [PMID: 38276138 PMCID: PMC10816478 DOI: 10.3390/jcm13020631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Coronary CT angiography (CCTA) may detect coronary artery disease (CAD) in transcatheter aortic valve implantation (TAVI) patients and may obviate invasive coronary angiography (ICA) in selected patients. We assessed the diagnostic accuracy of CCTA for detecting CAD in TAVI patients based on published data. METHODS Meta-analysis and meta-regression were performed based on a comprehensive electronic search, including relevant studies assessing the diagnostic accuracy of CCTA in the setting of TAVI patients compared to ICA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated on a patient and per segment level. RESULTS Overall, 27 studies (total of 7458 patients) were included. On the patient level, the CCTA's pooled sensitivity and NPV were 95% (95% CI: 93-97%) and 97% (95% CI: 95-98%), respectively, while the specificity and PPV were at 73% (95% CI: 62-82%) and 64% (95% CI: 57-71%), respectively. On the segmental coronary vessel level, the sensitivity and NPV were 90% (95% CI: 79-96%) and 98% (95% CI: 97-99%). CONCLUSIONS This meta-analysis highlights CCTA's potential as a first-line diagnostic tool although its limited PPV and specificity may pose challenges when interpreting heavily calcified arteries. This study underscores the need for further research and protocol standardization in this area.
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Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Mirjam Gerwing
- Clinic of Radiology, University Hospital Muenster, 48149 Muenster, Germany
| | - Simona Boroni Grazioli
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Fernando De-Torres-Alba
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Robert M. Radke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Julia Vormbrock
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Gerrit Kaleschke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
| | - Stefan Orwat
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany (G.K.); (S.O.)
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Chamberlin JH, Baruah D, Smith C, McGuire A, Maisuria D, Kabakus IM. Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review. Semin Roentgenol 2024; 59:7-19. [PMID: 38388099 DOI: 10.1053/j.ro.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Jordan H Chamberlin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
| | - Carter Smith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Aaron McGuire
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhruw Maisuria
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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Cour A, Burel J, Garnier M, Durand E, Demeyere M, Dacher JN. CT annulus sizing prior to transcatheter aortic valve replacement (TAVR): evaluation of free-breathing versus breath-holding acquisition. Eur Radiol 2023; 33:8521-8527. [PMID: 37470824 DOI: 10.1007/s00330-023-09913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To assess feasibility and accuracy of aortic annulus measurements using cardiac computed tomography angiography (CTA) performed during free-breathing prior to transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS Sixty consecutive TAVR candidates underwent free-breathing wide-detector cardiac CTA, followed by a percutaneous valve replacement. For each, a theoretical valve size was suggested through CT measurements of the annulus, then compared to the size of the actual implanted transcatheter heart valve (THV). The procedural success and the 30-day outcomes were collected. Image quality of the annulus was also studied according to subjective and objective criteria. Data of a control group of 60 patients previously evaluated on breath-holding were also evaluated. RESULTS A total of 120 patients (mean age, 83 years ± 7, 60 men) were evaluated. All CT acquisitions provided sufficient image quality allowing precise annulus measurements. Mean attenuation (p < 0.001) and image noise (p = 0.01) were higher in the free-breathing group, while image quality was comparable (p = 0.36). The agreement rate between CT-suggested valve size and THV implanted size was comparable, estimated at 87% (κ = 0.79, 95%CI 0.566, 0.908) on free-breathing vs. 82% (κ = 0.78, 95%CI 0.634, 0.904) on breath-holding. The procedure was successful for all patients without increase in 30-day mortality or adverse events. CONCLUSIONS Free-breathing cardiac CTA allows accurate aortic annulus measurements without compromising image quality or patients' outcome after TAVR. Elderly patients experiencing dyspnea, discomfort, or hearing loss that could prevent proper breath-holding should not be excluded from CT prior to TAVR. CLINICAL RELEVANCE STATEMENT To decrease elderly patients' discomfort, MDCT evaluation prior to transcatheter aortic valve replacement (TAVR) may be performed on quiet breathing with no significant impact on the outcome. KEY POINTS • Adhering to CT breathing commands can be challenging for patients with dyspnea, hearing impairment, agitation, or pulmonary diseases. • Free-breathing cardiac CT may be an alternative to breath-holding for patients unable to follow the breathing commands. • Wide-detector CT acquisition on free-breathing does not impair annulus measurements and prosthesis sizing in patients scheduled for TAVR.
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Affiliation(s)
- Adrien Cour
- Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France
| | - Julien Burel
- Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France
| | - Matthieu Garnier
- Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France
| | - Eric Durand
- Department of Cardiology, CHU Rouen, 37 Boulevard Gambetta, F-76000, Rouen, France
- Normandie Univ, UNIROUEN INSERM U1096, F-76000, Rouen, France
| | - Matthieu Demeyere
- Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France
| | - Jean-Nicolas Dacher
- Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France.
- Normandie Univ, UNIROUEN INSERM U1096, F-76000, Rouen, France.
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Renker M, Schoepf UJ, Kim WK. Combined CT Coronary Artery Assessment and TAVI Planning. Diagnostics (Basel) 2023; 13:diagnostics13071327. [PMID: 37046545 PMCID: PMC10093468 DOI: 10.3390/diagnostics13071327] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
| | - U. Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Won Keun Kim
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus Liebig University Giessen, 35392 Giessen, Germany
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Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Radiol 2022; 32:5189-5200. [PMID: 35192010 PMCID: PMC9279258 DOI: 10.1007/s00330-022-08603-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/02/2022] [Accepted: 01/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) for the evaluation of obstructive coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). METHODS EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting accuracy of CCTA for the evaluation of obstructive CAD compared with invasive coronary angiography (ICA) as the reference standard. QUADAS-2 tool was used to assess the risk of bias. A bivariate random effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive ( + LR) and negative (-LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were evaluated. Prospero registration number: CRD42021252527. RESULTS Fourteen studies (2533 patients) were included. In the intention-to-diagnose patient-level analysis, sensitivity and specificity for CCTA were 97% (95% CI: 94-98%) and 68% (95% CI: 56-68%), respectively, and + LR and -LR were 3.0 (95% CI: 2.1-4.3) and 0.05 (95% CI: 0.03 - 0.09), with DOR equal to 60 (95% CI: 30-121). The area under the HSROC curve was 0.96 (95% CI: 0.94-0.98). No significant difference in sensitivity was found between single-heartbeat and other CT scanners (96% (95% CI: 90 - 99%) vs. 97% (95% CI: 94-98%) respectively; p = 0.37), whereas the specificity of single-heartbeat scanners was higher (82% (95% CI: 66-92%) vs. 60% (95% CI: 46 - 72%) respectively; p < 0.0001). Routine CCTA in the pre-TAVI workup could save 41% (95% CI: 34 - 47%) of ICAs if a disease prevalence of 40% is assumed. CONCLUSIONS CCTA proved an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI; the use of single-heartbeat CT scanners can further improve these findings. KEY POINTS • CCTA proved to have an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI. • Routine CCTA in the pre-TAVI workup could save more than 40% of ICAs. • Single-heartbeat CT scanners had higher specificity than others in the assessment of obstructive CAD in patients referred for TAVI.
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