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Meloni A, Maffei E, Clemente A, De Gori C, Occhipinti M, Positano V, Berti S, La Grutta L, Saba L, Cau R, Bossone E, Mantini C, Cavaliere C, Punzo B, Celi S, Cademartiri F. Spectral Photon-Counting Computed Tomography: Technical Principles and Applications in the Assessment of Cardiovascular Diseases. J Clin Med 2024; 13:2359. [PMID: 38673632 PMCID: PMC11051476 DOI: 10.3390/jcm13082359] [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: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Spectral Photon-Counting Computed Tomography (SPCCT) represents a groundbreaking advancement in X-ray imaging technology. The core innovation of SPCCT lies in its photon-counting detectors, which can count the exact number of incoming x-ray photons and individually measure their energy. The first part of this review summarizes the key elements of SPCCT technology, such as energy binning, energy weighting, and material decomposition. Its energy-discriminating ability represents the key to the increase in the contrast between different tissues, the elimination of the electronic noise, and the correction of beam-hardening artifacts. Material decomposition provides valuable insights into specific elements' composition, concentration, and distribution. The capability of SPCCT to operate in three or more energy regimes allows for the differentiation of several contrast agents, facilitating quantitative assessments of elements with specific energy thresholds within the diagnostic energy range. The second part of this review provides a brief overview of the applications of SPCCT in the assessment of various cardiovascular disease processes. SPCCT can support the study of myocardial blood perfusion and enable enhanced tissue characterization and the identification of contrast agents, in a manner that was previously unattainable.
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Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.)
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Erica Maffei
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Alberto Clemente
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Carmelo De Gori
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Mariaelena Occhipinti
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Vicenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.)
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Ludovico La Grutta
- Department of Radiology, University Hospital “P. Giaccone”, 90127 Palermo, Italy;
| | - Luca Saba
- Department of Radiology, University Hospital of Cagliari, 09042 Monserrato (CA), Italy; (L.S.); (R.C.)
| | - Riccardo Cau
- Department of Radiology, University Hospital of Cagliari, 09042 Monserrato (CA), Italy; (L.S.); (R.C.)
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy;
| | - Cesare Mantini
- Department of Radiology, “G. D’Annunzio” University, 66100 Chieti, Italy;
| | - Carlo Cavaliere
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Bruna Punzo
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Simona Celi
- BioCardioLab, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
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Patel P, Emrich T, Schoepf UJ, Mehta V, Bayer RR, von Assen M, Giovagnoli V, Jeudy J, Varga-Szemes A, White C. Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia. J Thorac Imaging 2023; 38:212-225. [PMID: 34029280 DOI: 10.1097/rti.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
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Affiliation(s)
- Pratik Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Varun Mehta
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard R Bayer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Marly von Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA
| | - Vincent Giovagnoli
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Charles White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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Boccalini S, Si-Mohamed S, Matzuzzi M, Tillier M, Rotzinger DC, Revel D, Boussel L, Douek P. Effect of contrast material injection protocol on first-pass myocardial perfusion assessed by dual-energy dual-layer computed tomography. Quant Imaging Med Surg 2022; 12:3903-3916. [PMID: 35782242 PMCID: PMC9246727 DOI: 10.21037/qims-21-809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/09/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND Dual-energy dual-layer computed tomography (CT) scanners can provide useful tools, such as iodine maps and virtual monochromatic images (VMI), for the evaluation of myocardial perfusion defects. Data about the influence of acquisition protocols and normal values are still lacking. METHODS Clinically indicated coronary CT-angiographies performed between January-October 2018 in a single university hospital with dual-energy dual-layer CT (DE-DLCT) and different injection protocols were retrospectively evaluated. The two protocols were: 35 mL in patients <80 kg and 0.5 mL/kg in patients >80 kg at 2.5 mL/s (group A) or double contrast dose at 5 mL/s (group B). Patients with coronary stenosis >50% were excluded. Regions of interest were manually drawn on 16 myocardial segments and iodine concentration was measured in mg/mL. Signal-to-noise, contrast-to-noise ratios (CNR) and image noise were measured on conventional images and VMI. RESULTS A total of 30 patients were included for each protocol. With iodine concentrations of 1.38±0.41 mg/mL for protocol A and 2.07±0.73 mg/mL for protocol B, the two groups were significantly different (P<0.001). No significant iodine concentration differences were found between the 16 segments (P=0.47 and P=0.09 for group A and B respectively), between basal, mid and apical segments for group A and B (P=0.28 and P=0.12 for group A and B respectively) and between wall regions for group A (P=0.06 on normalised data). In group B, iodine concentration was significantly different between three wall regions [highest values for the lateral wall, median =2.03 (1.06) mg/mL]. Post-hoc analysis showed highest contrast-to-noise and signal-to-noise in VMI at 40 eV (P<0.05). CONCLUSIONS Iodine concentration in left ventricular myocardium of patients without significant coronary artery stenosis varied depending on the injection protocol and appeared more heterogeneous in different wall regions at faster injection rate and greater iodine load. Signal-to-noise and contrast-to-noise gradually improved when decreasing VMI energy, although at the expenses of higher noise, demonstrating the potential of DE-DLCT to enhance objective image quality.
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Affiliation(s)
- Sara Boccalini
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- Univerisity Claude Bernard Lyon 1, Lyon, France
| | - Salim Si-Mohamed
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Maxime Matzuzzi
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - Manon Tillier
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - David C. Rotzinger
- Department of Radiology, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Didier Revel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Loic Boussel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Philippe Douek
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
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Charyyev S, Wang T, Lei Y, Ghavidel B, Beitler JJ, McDonald M, Curran WJ, Liu T, Zhou J, Yang X. Learning-based synthetic dual energy CT imaging from single energy CT for stopping power ratio calculation in proton radiation therapy. Br J Radiol 2022; 95:20210644. [PMID: 34709948 PMCID: PMC8722254 DOI: 10.1259/bjr.20210644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Dual energy CT (DECT) has been shown to estimate stopping power ratio (SPR) map with a higher accuracy than conventional single energy CT (SECT) by obtaining the energy dependence of photon interactions. This work presents a learning-based method to synthesize DECT images from SECT image for proton radiotherapy. METHODS The proposed method uses a residual attention generative adversarial network. Residual blocks with attention gates were used to force the model to focus on the difference between DECT images and SECT images. To evaluate the accuracy of the method, we retrospectively investigated 70 head-and-neck cancer patients whose DECT and SECT scans were acquired simultaneously. The model was trained to generate both a high and low energy DECT image based on a SECT image. The generated synthetic low and high DECT images were evaluated against the true DECT images using leave-one-out cross-validation. To evaluate our method in the context of a practical application, we generated SPR maps from synthetic DECT (sDECT) using a dual-energy based stoichiometric method and compared the SPR maps to those generated from DECT. A dosimetric comparison for dose obtained from DECT was performed against that derived from sDECT. RESULTS The mean of mean absolute error, peak signal-to-noise ratio and normalized cross-correlation for the synthetic high and low energy CT images was 36.9 HU, 29.3 dB, 0.96 and 35.8 HU, 29.2 dB, and 0.96, respectively. The corresponding SPR maps generated from synthetic DECT showed an average normalized mean square deviation of about 1% with reduced noise level and artifacts than those from original DECT. Dose-volume histogram (DVH) metrics for the clinical target volume agree within 1% between the DECT and sDECT calculated dose. CONCLUSION Our method synthesized accurate DECT images and showed a potential feasibility for proton SPR map generation. ADVANCES IN KNOWLEDGE This study investigated a learning-based method to synthesize DECT images from SECT image for proton radiotherapy.
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Affiliation(s)
- Serdar Charyyev
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Beth Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mark McDonald
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Tarkowski P, Czekajska-Chehab E. Dual-Energy Heart CT: Beyond Better Angiography-Review. J Clin Med 2021; 10:jcm10215193. [PMID: 34768713 PMCID: PMC8584316 DOI: 10.3390/jcm10215193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/30/2022] Open
Abstract
Heart CT has undergone substantial development from the use of calcium scores performed on electron beam CT to modern 256+-row CT scanners. The latest big step in its evolution was the invention of dual-energy scanners with much greater capabilities than just performing better ECG-gated angio-CT. In this review, we present the unique features of dual-energy CT in heart diagnostics.
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Saleh M, Tan TC. Dual-phase computed tomography imaging in acute chest pain: emerging protocols and potential future implications. Eur Heart J Case Rep 2021; 5:ytab178. [PMID: 33987525 PMCID: PMC8107293 DOI: 10.1093/ehjcr/ytab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Mahdi Saleh
- Department of Radiology, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| | - Timothy C Tan
- School of Medicine, 30, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown NSW 2560, Australia
- Department of Cardiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road Westmead NSW 2145, Australia
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Punzo B, Cavaliere C, Maffei E, Bossone E, Saba L, Cademartiri F. Narrative review of cardiac computed tomography perfusion: insights into static rest perfusion. Cardiovasc Diagn Ther 2021; 10:1946-1953. [PMID: 33381436 DOI: 10.21037/cdt-20-552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac or left ventricular perfusion performed with cardiac computed tomography (CCT) is a developing method that may have the potential to complete in a very straight forward way the assessment of ischemic heart disease by means of CT. Myocardial CT perfusion (CTP) can be achieved with a single static scan during the first-pass of the iodinate contrast agent, with the monoenergetic or dual-energy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents. Several methods can be performed, and we focused on static perfusion. CTP may serve as a useful adjunct to coronary CT angiography (CTA) to improve specificity of detecting myocardial ischemia. Technological advances will reduce the radiation dose of myocardial CTP, such as low tube voltage imaging or new reconstruction algorithms, making it a more viable clinical option. The advantages of static first-pass non-stress perfusion are several; the main one is that it can be done to each and every patient who undergoes CCT for the assessment of coronary artery tree. Future advances in CTP will likely improve the diagnostic accuracy of CTP + CTA, and will better estimate the severity of ischemia Therefore, it is simple and comprehensive. However, it has several limitations. In this review we will discuss the technique with its advantages and limitations.
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Affiliation(s)
- Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
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Omarov YA, Sukhinina TS, Veselova TN, Shakhnovich RM, Zhukova NS, Merkulova IN, Pevzner DV, Ternovoy SK, Staroverov II. [Possibilities of Stress Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Ischemic Heart Disease]. ACTA ACUST UNITED AC 2020; 60:122-131. [PMID: 33228515 DOI: 10.18087/cardio.2020.10.n1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
Computed tomography angiography (CT-angiography, CTA) allows noninvasive visualization of coronary arteries (CA). This method is highly sensitive in detecting coronary atherosclerosis. However, standard CTA does not allow evaluation of the hemodynamic significance of found CA stenoses, which requires additional functional tests for detection of myocardial ischemia. This review focuses on possibilities of clinical use, limitations, technical aspects, and prospects of a combination of CT-angiography and CT myocardial perfusion imaging in diagnostics of ischemic heart disease.
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Affiliation(s)
- Y A Omarov
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - T S Sukhinina
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - T N Veselova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - R M Shakhnovich
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - N S Zhukova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - I N Merkulova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - D V Pevzner
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - S K Ternovoy
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow; First Moscow State Medical University, Sechenov Moscow State Medical University (Sechenov University), Moscow
| | - I I Staroverov
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
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Peper J, Suchá D, Swaans M, Leiner T. Functional cardiac CT-Going beyond Anatomical Evaluation of Coronary Artery Disease with Cine CT, CT-FFR, CT Perfusion and Machine Learning. Br J Radiol 2020; 93:20200349. [PMID: 32783626 DOI: 10.1259/bjr.20200349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this review is to provide an overview of different functional cardiac CT techniques which can be used to supplement assessment of the coronary arteries to establish the significance of coronary artery stenoses. We focus on cine-CT, CT-FFR, CT-myocardial perfusion and how developments in machine learning can supplement these techniques.
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Affiliation(s)
- Joyce Peper
- Department of Cardiology, St. Antonius Hospital Koekoekslaan 1, Nieuwegein, the Netherlands.,Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Dominika Suchá
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital Koekoekslaan 1, Nieuwegein, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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Prasad Reddy KV, Singhal M, Vijayvergiya R, Sood A, Khandelwal N. Role of DECT in coronary artery disease: a comparative study with ICA and SPECT. ACTA ACUST UNITED AC 2020; 26:420-428. [PMID: 32755875 DOI: 10.5152/dir.2020.18569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Earlier imaging techniques for coronary artery disease (CAD) focused primarily on either morphological or functional assessment of CAD. However, dual-energy computed tomography (DECT) can be used to assess myocardial blood supply both morphologically and functionally. We aimed to evaluate the diagnostic accuracy of DECT in detecting morphological and functional components of CAD, using invasive coronary angiography (ICA) and single photon emission computed tomography (SPECT) as reference standards. METHODS Twenty-five patients with known or suspicious CAD and scheduled for ICA were investigated by DECT and SPECT. DECT was performed during the resting state using retrospective electrocardiography (ECG) gating. CT coronary angiography and perfusion images were generated from the same raw data. All patients were evaluated for significant stenosis (≥50%) on both ICA and DECT coronary angiography, and for myocardial perfusion defects on SPECT and DECT perfusion. Comparison was done between ICA and DECT coronary angiography for detection of significant stenosis and between SPECT and DECT perfusion for detecting myocardial perfusion defects. RESULTS Using ICA as reference standard, sensitivity, specificity, and accuracy of DECT coronary angiography in detecting ≥50% stenosis of coronary artery lumen were 81.6%, 97.8%, and 95.0%, respectively, by segment-based analysis and 92.1%, 96.1%, and 93.7%, respectively, by vessel-based analysis. Using SPECT as the reference standard, the sensitivity, specificity, and accuracy of DECT perfusion in detecting myocardial perfusion defects were 70.4%, 86.4%, and 80.6%, respectively, on per-segment analysis and 90.7%, 66.6%, and 84.7%, respectively, on per-territorial basis. CONCLUSION DECT accurately detected coronary artery stenosis and myocardial ischemia using ICA and SPECT as reference standards. In the same scan, DECT can accurately provide integrative imaging of coronary artery morphology and myocardial perfusion.
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Affiliation(s)
- Kamireddy V Prasad Reddy
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
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Kay FU. Dual-energy CT and coronary imaging. Cardiovasc Diagn Ther 2020; 10:1090-1107. [PMID: 32968662 PMCID: PMC7487394 DOI: 10.21037/cdt.2020.04.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy computed tomography has been proposed for enhancing the evaluation of coronary artery disease in many fronts. However, the clinical translation of such applications has followed a slower pace of clinical translation. This paper will review the evidence supporting the use of dual-energy computed tomography in coronary artery disease (CAD) and provide some practical illustrations, while underscoring the challenges and gaps in knowledge that have contributed to this phenomenon.
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Affiliation(s)
- Fernando Uliana Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Han D, Shah S, Lee JH, Elmore K, Gransar H, Danad I, Kumar V, Raman S, Hartaigh BÓ, Dunham S, Lin FY, Min JK. An approach to evaluate myocardial perfusion defect assessment for projection-based DECT: A phantom study. Clin Imaging 2020; 63:10-15. [DOI: 10.1016/j.clinimag.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
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McCollough CH, Boedeker K, Cody D, Duan X, Flohr T, Halliburton SS, Hsieh J, Layman RR, Pelc NJ. Principles and applications of multienergy CT: Report of AAPM Task Group 291. Med Phys 2020; 47:e881-e912. [DOI: 10.1002/mp.14157] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Kirsten Boedeker
- Canon (formerly Toshiba) Medical Systems Corporation 1440 Warnall Ave Los Angeles CA 90024 USA
| | - Dianna Cody
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Xinhui Duan
- Southwestern Medical Center University of Texas 5323 Harry Hines Blvd Dallas TX 75390‐9071 USA
| | - Thomas Flohr
- Siemens Healthcare GmbH Siemensstr. 3 Forchheim BY 91031 Germany
| | | | - Jiang Hsieh
- GE Healthcare Technologies 3000 N. Grandview Blvd. W-1190 Waukesha WI 53188 USA
| | - Rick R. Layman
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Norbert J. Pelc
- Stanford University 443 Via Ortega, Room 203 Stanford CA 94305‐4125 USA
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Society of cardiovascular computed tomography expert consensus document on myocardial computed tomography perfusion imaging. J Cardiovasc Comput Tomogr 2020; 14:87-100. [DOI: 10.1016/j.jcct.2019.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
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Taron J, Foldyna B, Eslami P, Hoffmann U, Nikolaou K, Bamberg F. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. ROFO-FORTSCHR RONTG 2019; 191:817-826. [PMID: 31250415 PMCID: PMC6839890 DOI: 10.1055/a-0924-5883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rapid improvement of scanner and postprocessing technology as well as the introduction of minimally invasive procedures requiring preoperative imaging have led to the broad utilization of cardiac computed tomography (CT) beyond coronary CT angiography (CTA). METHOD This review article presents an overview of recent literature on cardiac CT. The goal is to summarize the current guidelines on performing cardiac CT and to list established as well as emerging techniques with a special focus on extracoronary applications. RESULTS AND CONCLUSION Most recent guidelines for the appropriate use of cardiac CT include the evaluation of coronary artery disease, cardiac morphology, intra- and extracardiac structures, and functional and structural assessment of the myocardium under certain conditions. Besides coronary CTA, novel applications such as the calculation of a CT-derived fractional flow reserve (CT-FFR), assessment of myocardial function and perfusion imaging, as well as pre-interventional planning in valvular heart disease or prior pulmonary vein ablation in atrial fibrillation are becoming increasingly important. Especially these extracoronary applications are of growing interest in the field of cardiac CT and are expected to be gradually implemented in the daily clinical routine. KEY POINTS · Coronary artery imaging remains the main indication for cardiac CT. · Novel computational fluid dynamics allow the calculation of a CT-derived fractional flow reserve in patients with known or suspected coronary artery disease. · Cardiac CT delivers information on left ventricular volume as well as myocardial function and perfusion. · CT is the cardinal element for pre-interventional planning in transcatheter valve implantation and pulmonary vein isolation. CITATION FORMAT · Taron J, Foldyna B, Eslami P et al. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. Fortschr Röntgenstr 2019; 191: 817 - 826.
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Affiliation(s)
- Jana Taron
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Borek Foldyna
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Parastou Eslami
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Poulter R, Wood DA, Starovoytov A, Smith S, Chitsaz M, Mayo J. Quantified dual energy computed tomography perfusion imaging using myocardial iodine concentration: Validation using CT derived myocardial blood flow and invasive fractional flow reserve in a porcine model. J Cardiovasc Comput Tomogr 2019; 13:86-91. [DOI: 10.1016/j.jcct.2019.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 01/07/2023]
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Wang T, Ghavidel BB, Beitler JJ, Tang X, Lei Y, Curran WJ, Liu T, Yang X. Optimal virtual monoenergetic image in "TwinBeam" dual-energy CT for organs-at-risk delineation based on contrast-noise-ratio in head-and-neck radiotherapy. J Appl Clin Med Phys 2019; 20:121-128. [PMID: 30693665 PMCID: PMC6370994 DOI: 10.1002/acm2.12539] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Dual-energy computed tomography (DECT) using TwinBeam CT (TBCT) is a new option for radiation oncology simulators. TBCT scanning provides virtual monoenergetic images which are attractive in treatment planning since lower energies offer better contrast for soft tissues, and higher energies reduce noise. A protocol is needed to achieve optimal performance of this feature. In this study, we investigated the TBCT scan schema with the head-and-neck radiotherapy workflow at our clinic and selected the optimal energy with best contrast-noise-ratio (CNR) in organs-at-risks (OARs) delineation for head-and-neck treatment planning. METHODS AND MATERIALS We synthesized monochromatic images from 40 keV to 190 keV at 5 keV increments from data acquired by TBCT. We collected the Hounsfield unit (HU) numbers of OARs (brainstem, mandible, spinal cord, and parotid glands), the HU numbers of marginal regions outside OARs, and the noise levels for each monochromatic image. We then calculated the CNR for the different OARs at each energy level to generate a serial of spectral curves for each OAR. Based on these spectral curves of CNR, the mono-energy corresponding to the max CNR was identified for each OAR of each patient. RESULTS Computed tomography scans of ten patients by TBCT were used to test the optimal monoenergetic image for the CNR of OAR. Based on the maximized CNR, the optimal energy values were 78.5 ± 5.3 keV for the brainstem, 78.0 ± 4.2 keV for the mandible, 78.5 ± 5.7 keV for the parotid glands, and 78.5 ± 5.3 keV for the spinal cord. Overall, the optimal energy for the maximum CNR of these OARs in head-and-neck cancer patients was 80 keV. CONCLUSION We have proposed a clinically feasible protocol that selects the optimal energy level of the virtual monoenergetic image in TBCT for OAR delineation based on the CNR in head-and-neck OAR. This protocol can be applied in TBCT simulation.
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Affiliation(s)
- Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Beth Bradshaw Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
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Iodine quantification based on rest / stress perfusion dual energy CT to differentiate ischemic, infarcted and normal myocardium. Eur J Radiol 2019; 112:136-143. [PMID: 30777202 DOI: 10.1016/j.ejrad.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/06/2018] [Accepted: 01/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the potential of rest-stress DECT iodine quantification to discriminate between normal, ischemic, and infarcted myocardium. METHODS Patients who underwent rest-stress DECT on a 2nd generation dual-source system and cardiac magnetic resonance (CMR) were retrospectively included from a prospective study cohort. CMR was performed to identify ischemic and infarcted myocardium and categorize patients into ischemic, infarcted, and control groups. Controls were analyzed on a per-slice and per-segment basis. Regions of interest (ROIs) were placed in ischemic and infarcted areas based on CMR. Additionally, ROIs were placed in the septal area to assess normal and remote myocardium. RESULTS We included 42 patients: 10 ischemic, 17 infarcted, and 15 controls. Iodine concentrations showed no significant between segments in controls. Iodine concentrations for normal myocardium increased significantly from rest to stress (median 3.7 mg/mL (interquartile range 3.5-3.9) vs. 4.5 mg/mL (4.3-4.9)) (p < 0.001). Iodine concentrations in diseased myocardium were significantly lower than in normal myocardium; 1.3 mg/mL (0.9-1.8) and 0.6 mg/mL (0.4-0.8) at rest and stress in ischemic myocardium, and 0.3 mg/mL (0.3-0.5) and 0.5 mg/mL (0.5-0.7) at rest and stress in infarcted myocardium (p < 0.005 and p < 0.001). At rest only, iodine concentrations were significantly lower in infarcted vs. ischemic myocardium (p < 0.001). The optimal threshold for differentiating diseased from normal myocardium was 2.5 mg/mL and 2.1 mg/mL for rest and stress (AUC 1.00). To discriminate ischemic from infarcted myocardium, the optimal threshold was 1.0 mg/ml (AUC 0.944) at rest. CONCLUSION DECT iodine concentration from rest-stress imaging can potentially differentiate between normal, ischemic, and infarcted myocardium.
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Abstract
Computed tomography is an established tool in the assessment of cardiac anatomy and function. As demonstrated by single photon emission computed tomography, positron emission tomography, and magnetic resonance, the noninvasive evaluation of coronary hemodynamics is an important step in guiding clinical management. Nevertheless, no single modality has been shown to accurately quantify coronary artery stenosis, evaluate an atherosclerotic plaque's composition for embolic risk stratification, and assess myocardial perfusion. Although not a novel technology, dual-energy computed tomography has undergone significant advancements that have increased interest in this modality's potential clinical cardiac applications. Albeit still in the early stages of development, one can expect additional clinical studies to further develop this important tool for cardiac imaging as more institutions acquire dual-energy compatible scanners.
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Affiliation(s)
- Matthew Lempel
- From the Department of Medicine, Yale-Waterbury Hospital, Waterbury, CT
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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So A, Wisenberg G, Teefy P, Yadegari A, Bagur R, Hadway J, Morrison L, MacDonald A, Gaskin D, Butler J, Biernaski H, Skanes S, Park SD, Islam A, Hsieh J, Lee TY. Functional CT assessment of extravascular contrast distribution volume and myocardial perfusion in acute myocardial infarction. Int J Cardiol 2018; 266:15-23. [DOI: 10.1016/j.ijcard.2018.02.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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21
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Danad I, Cho I, Elmore K, Schulman-Marcus J, ó Hartaigh B, Stuijfzand WJ, Carrascosa P, Min JK. Comparative diagnostic accuracy of dual-energy CT myocardial perfusion imaging by monochromatic energy versus material decomposition methods. Clin Imaging 2018; 50:1-4. [DOI: 10.1016/j.clinimag.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/12/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022]
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Ramsey BC, Fentanes E, Choi AD, Branch KR, Thomas DM. Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11:16. [PMID: 29963220 PMCID: PMC5984644 DOI: 10.1007/s12410-018-9456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states. RECENT FINDINGS CCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics. SUMMARY CTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.
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Affiliation(s)
- Bryan C. Ramsey
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
| | - Emilio Fentanes
- Cardiology Division, Department of Medicine, Tripler Army Medical Center, Honolulu, HI USA
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC USA
| | | | - Dustin M. Thomas
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
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Sun K, Han R, Zhao R, Bai S, Wang J, Hu J, Lu B. Evaluation of dual energy computed tomography iodine mapping within the myocardial blood pool for detection of acute myocardial infarction: correlation with histopathological findings in a porcine model. Br J Radiol 2018; 91:20170569. [PMID: 29688745 DOI: 10.1259/bjr.20170569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We assessed the diagnostic value of "one-step" dual energy CT (DECT) in combination with coronary CT angiography and iodine mapping within the myocardial blood pool in detecting acute myocardial infarction (AMI). METHODS Five minipigs were subjected to transcatheter embolization of coronary artery with a gelatin sponge to induce AMI. Arterial-phase myocardial DECT imaging was carried out 1 h before and 24 h after embolism of the coronary. Color-coded iodine maps were used to evaluate myocardial blood pool deficits in the 17-segment model. Myocardial DECT imaging 24 h after MI induction was used for final comparison with post-mortem histology. RESULTS We found a sensitivity of 95.55% and a specificity of 95%, respectively, for AMI detection by DECT-based iodine mapping within the myocardial blood pool. The dose-length product values were 219.4 ± 60.9 mGy.cm (172-321 mGy.cm) and the effective radiation dose was 5.7 ± 1.5 mSv (4.4-8.3 mSv). CONCLUSION This experimental study demonstrated that DECT-based iodine mapping shows a high value for the detection of myocardial perfusion defects in the first-pass myocardial perfusion. Hybrid heart images obtained by coronary CT angiography and DECT-based iodine mapping may yield valuable data and help clinicians accurately identify cases requiring further treatment after AMI. Advances in knowledge: This study demonstrated that DECT-based iodine mapping is a promising new technique for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.
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Affiliation(s)
- Kai Sun
- 1 Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.,2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Ruijuan Han
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Ruiping Zhao
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Shuancheng Bai
- 2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Junyan Wang
- 2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Jiang Hu
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Bin Lu
- 1 Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Rajiah P, Maroules CD. Myocardial ischemia testing with computed tomography: emerging strategies. Cardiovasc Diagn Ther 2017; 7:475-488. [PMID: 29255691 DOI: 10.21037/cdt.2017.09.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although cardiac computed tomography (CT) has high negative predictive value to exclude obstructive coronary artery disease (CAD), particularly in the low to intermediate risk population, it has low specificity in the diagnosis of ischemia-inducing lesions. This inability to predict hemodynamically significant stenosis hampers the ability of CT to be an effective gatekeeper for invasive angiography and to guide appropriate revascularization. Recent advances in CT technology have resulted in the development of multiple techniques to provide hemodynamic information and detect lesion-specific ischemia, namely CT perfusion (CTP), CT-derived fractional flow reserve (CT-FFR) and coronary transluminal attenuation gradient (TAG). In this article, we provide a perspective on these emerging CT techniques in the evaluation of myocardial ischemia.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
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Zhang H, Zeng D, Lin J, Zhang H, Bian Z, Huang J, Gao Y, Zhang S, Zhang H, Feng Q, Liang Z, Chen W, Ma J. Iterative reconstruction for dual energy CT with an average image-induced nonlocal means regularization. Phys Med Biol 2017; 62:5556-5574. [PMID: 28471750 PMCID: PMC5497789 DOI: 10.1088/1361-6560/aa7122] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Reducing radiation dose in dual energy computed tomography (DECT) is highly desirable but it may lead to excessive noise in the filtered backprojection (FBP) reconstructed DECT images, which can inevitably increase the diagnostic uncertainty. To obtain clinically acceptable DECT images from low-mAs acquisitions, in this work we develop a novel scheme based on measurement of DECT data. In this scheme, inspired by the success of edge-preserving non-local means (NLM) filtering in CT imaging and the intrinsic characteristics underlying DECT images, i.e. global correlation and non-local similarity, an averaged image induced NLM-based (aviNLM) regularization is incorporated into the penalized weighted least-squares (PWLS) framework. Specifically, the presented NLM-based regularization is designed by averaging the acquired DECT images, which takes the image similarity within the two energies into consideration. In addition, the weighted least-squares term takes into account DECT data-dependent variance. For simplicity, the presented scheme was termed as 'PWLS-aviNLM'. The performance of the presented PWLS-aviNLM algorithm was validated and evaluated on digital phantom, physical phantom and patient data. The extensive experiments validated that the presented PWLS-aviNLM algorithm outperforms the FBP, PWLS-TV and PWLS-NLM algorithms quantitatively. More importantly, it delivers the best qualitative results with the finest details and the fewest noise-induced artifacts, due to the aviNLM regularization learned from DECT images. This study demonstrated the feasibility and efficacy of the presented PWLS-aviNLM algorithm to improve the DECT reconstruction and resulting material decomposition.
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Affiliation(s)
- Houjin Zhang
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Dong Zeng
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Jiahui Lin
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Hao Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA
| | - Zhaoying Bian
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Jing Huang
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Yuanyuan Gao
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Shanli Zhang
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hua Zhang
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Qianjin Feng
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Zhengrong Liang
- Departments of Radiology and Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794 USA
| | - Wufan Chen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University Guangzhou, Guangdong 510515, China
| | - Jianhua Ma
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, China
- Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Guangzhou 510515, China
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Myocardial CT Perfusion: A Review of Current Modalities, Technology, and Clinical Performance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Han R, Sun K, Lu B, Zhao R, Li K, Yang X. Diagnostic accuracy of coronary CT angiography combined with dual-energy myocardial perfusion imaging for detection of myocardial infarction. Exp Ther Med 2017; 14:207-213. [PMID: 28672916 PMCID: PMC5488534 DOI: 10.3892/etm.2017.4485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/10/2016] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic accuracy of second generation dual-energy computed tomography (DECT) myocardial perfusion imaging for the detection of myocardial infarction (MI) in patients with suspected MI. In total, 56 patients underwent DECT. Among those, 40 patients had MI that was detected by catheter coronary angiography and cardiac troponin I elevation and evolution of acute MI detected by electrocardiogram changes. The diagnostic accuracy, including the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of MI were evaluated, as well as the coronary image quality of coronary artery and radiation dose. The sensitivity, specificity, PPV and NPV for the detection of MI were 95.0, 97.0, 86.4 and 98.9%, respectively. Moreover, the image quality was rated excellent (score 1) in 90.2% (515/571), good (score 2) in 6.5% (37/571), adequate (score 3) in 1.9% (11/571) and non-diagnostic (score 4) in 1.4% (8/571) of the coronary segments. The effective radiation dose was on average 6.1±1.5 mSv (3.1–10.9 mSv). Therefore, combined DE iodine maps and coronary CT angiography using the DECT may provide a high diagnostic accuracy for detecting MI with lower radiation exposure in patients with suspected MI.
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Affiliation(s)
- Ruijuan Han
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Kai Sun
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R. China
| | - Bin Lu
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R. China
| | - Ruiping Zhao
- Department of Cardiology, Baotou Central Hospital, Baotou, Inner Mongolia 014040, P.R. China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Xinchun Yang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Abstract
Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide. Although invasive coronary angiography has previously been the gold standard in establishing the diagnosis of CAD, there is a growing shift to more appropriately use the cardiac catheterization laboratory to perform interventional procedures once a diagnosis of CAD has been established by noninvasive imaging modalities rather than using it primarily as a diagnostic facility to confirm or refute CAD. With ongoing technological advancements, noninvasive imaging plays a pre-eminent role in not only diagnosing CAD but also informing the choice of appropriate therapies, establishing prognosis, all while containing costs and providing value-based care. Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging. These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. This review will discuss their advantages and limitations and their usage in the diagnostic pathway for patients with CAD. We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia. Recognizing that clinicians have a multitude of tests to choose from, we provide an underpinning of the principles of ischemia detection by these various modalities, focusing on anatomy vs physiology, the database justifying their use, their prognostic capabilities and lastly, their appropriate and judicious use in this era of patient-centered, cost-effective imaging.
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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CT myocardial perfusion imaging: current status and future perspectives. Int J Cardiovasc Imaging 2017; 33:1009-1020. [DOI: 10.1007/s10554-017-1102-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
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Diagnostic accuracy of CT for the detection of left ventricular myocardial fibrosis in various myocardial diseases. Int J Cardiol 2017; 228:375-379. [DOI: 10.1016/j.ijcard.2016.11.140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/21/2022]
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 3. J Comput Assist Tomogr 2017; 41:1-7. [DOI: 10.1097/rct.0000000000000538] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury. J Comput Assist Tomogr 2017; 41:354-359. [DOI: 10.1097/rct.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pontone G, Muscogiuri G, Andreini D, Guaricci AI, Guglielmo M, Mushtaq S, Baggiano A, Conte E, Beltrama V, Annoni A, Formenti A, Mancini E, Rabbat MG, Pepi M. The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:74. [DOI: 10.1007/s11936-016-0493-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Myocardial perfusion imaging with dual energy CT. Eur J Radiol 2016; 85:1914-1921. [DOI: 10.1016/j.ejrad.2016.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 12/31/2022]
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Aghayev A, Murphy DJ, Keraliya AR, Steigner ML. Recent developments in the use of computed tomography scanners in coronary artery imaging. Expert Rev Med Devices 2016; 13:545-53. [PMID: 27140944 DOI: 10.1080/17434440.2016.1184968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Within the past decade, substantial evolution of Coronary CT Angiography (CCTA) has affected evaluation and management of coronary artery disease. In particular, technical advancement of hardware technology and image reconstruction of CT scanners have played an important role in this context making it possible to acquire abundant data with excellent temporal and spatial resolution within a shorter scan time. In addition, a concern related to the high radiation exposure in the initial noninvasive coronary artery imaging has triggered improvement in dose reduction techniques. AREAS COVERED In this review article, we have focused on recent technological developments in CT scanners and the impact of these developments on CCTA parameters. Expert Commentary: CCTA plays an important role in coronary artery disease management, and technical development of the CT scanners can be expected to address and remedy technical limitations.
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Affiliation(s)
- Ayaz Aghayev
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - David J Murphy
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Abhishek R Keraliya
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Michael L Steigner
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
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Cardiovascular Imaging: The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:557-70. [PMID: 25985464 DOI: 10.1097/rli.0000000000000164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.
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Lee JH, Han D, Danad I, Hartaigh BÓ, Lin FY, Min JK. Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography. J Cardiovasc Ultrasound 2016; 24:7-17. [PMID: 27081438 PMCID: PMC4828419 DOI: 10.4250/jcu.2016.24.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023] Open
Abstract
Coronary artery disease (CAD) is the leading cause of mortality worldwide, and various cardiovascular imaging modalities have been introduced for the purpose of diagnosing and determining the severity of CAD. More recently, advances in computed tomography (CT) technology have contributed to the widespread clinical application of cardiac CT for accurate and noninvasive evaluation of CAD. In this review, we focus on imaging assessment of CAD based upon CT, which includes coronary artery calcium screening, coronary CT angiography, myocardial CT perfusion, and fractional flow reserve CT. Further, we provide a discussion regarding the potential implications, benefits and limitations, as well as the possible future directions according to each modality.
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Affiliation(s)
- Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Donghee Han
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Ibrahim Danad
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.; Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.; Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
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Danad I, Fayad ZA, Willemink MJ, Min JK. New Applications of Cardiac Computed Tomography: Dual-Energy, Spectral, and Molecular CT Imaging. JACC Cardiovasc Imaging 2016; 8:710-23. [PMID: 26068288 DOI: 10.1016/j.jcmg.2015.03.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 01/16/2023]
Abstract
Computed tomography (CT) has evolved into a powerful diagnostic tool, and it is impossible to imagine current clinical practice without CT imaging. Because of its widespread availability, ease of clinical application, superb sensitivity for the detection of coronary artery disease, and noninvasive nature, CT has become a valuable tool within the armamentarium of cardiologists. In the past few years, numerous technological advances in CT have occurred, including dual-energy CT, spectral CT, and CT-based molecular imaging. By harnessing the advances in technology, cardiac CT has advanced beyond the mere evaluation of coronary stenosis to an imaging tool that permits accurate plaque characterization, assessment of myocardial perfusion, and even probing of molecular processes that are involved in coronary atherosclerosis. Novel innovations in CT contrast agents and pre-clinical spectral CT devices have paved the way for CT-based molecular imaging.
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Affiliation(s)
- Ibrahim Danad
- Department of Radiology, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin J Willemink
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - James K Min
- Department of Radiology, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York.
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Delgado Sánchez-Gracián C, Oca Pernas R, Trinidad López C, Santos Armentia E, Vaamonde Liste A, Vázquez Caamaño M, Tardáguila de la Fuente G. Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol 2015; 26:3199-207. [PMID: 26699372 DOI: 10.1007/s00330-015-4128-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference. METHODS This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium. RESULTS In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p < 0.001) between normal (2.56 ± 0.66 mg/mL), ischemic (1.98 ± 0.36 mg/dL) and infarcted segments (1.35 ± 0.57 mg/mL). A myocardium iodine concentration of 2.1 mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75 %, specificity 73.6 %, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814). CONCLUSION Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium. KEY POINTS • DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter. • A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S. • Myocardial iodine concentration may be useful in the assessment of patients with CAD.
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Affiliation(s)
| | - Roque Oca Pernas
- Radiology Department, Povisa Hospital, Salamanca, 36211, Vigo, Pontevedra, Spain.
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Danad I, Ó Hartaigh B, Min JK. Dual-energy computed tomography for detection of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:1345-56. [PMID: 26549789 DOI: 10.1586/14779072.2015.1102055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent technological advances in computed tomography (CT) technology have fulfilled the prerequisites for the cardiac application of dual-energy CT (DECT) imaging. By exploiting the unique characteristics of materials when exposed to two different x-ray energies, DECT holds great promise for the diagnosis and management of coronary artery disease. It allows for the assessment of myocardial perfusion to discern the hemodynamic significance of coronary disease and possesses high accuracy for the detection and characterization of coronary plaques, while facilitating reductions in radiation dose. As such, DECT enabled cardiac CT to advance beyond the mere detection of coronary stenosis expanding its role in the evaluation and management of coronary atherosclerosis.
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Affiliation(s)
- Ibrahim Danad
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
| | - Bríain Ó Hartaigh
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
| | - James K Min
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
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McLaughlin PD, Mallinson P, Lourenco P, Nicolaou S. Dual-Energy Computed Tomography: Advantages in the Acute Setting. Radiol Clin North Am 2015; 53:619-38, vii. [PMID: 26046502 DOI: 10.1016/j.rcl.2015.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this article is to inform and update emergency radiologists in respect of the clinically relevant benefits that dual-energy computed tomography (CT) contributes over conventional single-energy CT in the emergency setting using practical imaging examples. Particular emphasis will be placed on acute gout, bone marrow edema, acute renal colic, acute cardiovascular and neurovascular emergencies aswell as characterization of abdominal incidentalomas. The relevant scientific literature will be summarized and limitations of the technique also will be emphasized to provide the reader with a rounded concept of the current state of technology.
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Affiliation(s)
- Patrick D McLaughlin
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada.
| | - Paul Mallinson
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
| | - Pedro Lourenco
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver V5Z 1M9, Canada
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Liguori C, Frauenfelder G, Massaroni C, Saccomandi P, Giurazza F, Pitocco F, Marano R, Schena E. Emerging clinical applications of computed tomography. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:265-78. [PMID: 26089707 PMCID: PMC4467659 DOI: 10.2147/mder.s70630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
X-ray computed tomography (CT) has recently been experiencing remarkable growth as a result of technological advances and new clinical applications. This paper reviews the essential physics of X-ray CT and its major components. Also reviewed are recent promising applications of CT, ie, CT-guided procedures, CT-based thermometry, photon-counting technology, hybrid PET-CT, use of ultrafast-high pitch scanners, and potential use of dual-energy CT for material differentiations. These promising solutions and a better knowledge of their potentialities should allow CT to be used in a safe and effective manner in several clinical applications.
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Affiliation(s)
| | | | - Carlo Massaroni
- Measurement and Biomedical Instrumentation Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paola Saccomandi
- Measurement and Biomedical Instrumentation Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Riccardo Marano
- Department of Radiological Sciences, Institute of Radiology, Catholic University of Rome, A Gemelli University Hospital, Rome, Italy
| | - Emiliano Schena
- Measurement and Biomedical Instrumentation Unit, Università Campus Bio-Medico di Roma, Rome, Italy
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Measuring myocardial perfusion: the role of PET, MRI and CT. Clin Radiol 2015; 70:576-84. [DOI: 10.1016/j.crad.2014.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
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Secchi F, De Cecco CN, Spearman JV, Silverman JR, Ebersberger U, Sardanelli F, Schoepf UJ. Monoenergetic extrapolation of cardiac dual energy CT for artifact reduction. Acta Radiol 2015; 56:413-8. [PMID: 24615417 DOI: 10.1177/0284185114527867] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Monoenergetic extrapolation of cardiac dual-energy computed tomography (DECT) could be useful in artifact reduction in clinical practice. PURPOSE To evaluate the potential of monoenergetic extrapolation of cardiac DECT data for reducing artifacts from metal and high iodine contrast concentration. MATERIAL AND METHODS With IRB approval and in HIPAA compliance, 35 patients (22 men, 61 ± 12 years) underwent cardiac DECT with dual-source CT (100 kVp and 140 kVp). Contrast material injection protocols were adapted to the patient's weight using non-ionic low-osmolar 370 mgI/mL iopromide. Datasets were transferred to a stand-alone workstation and dedicated monoenergetic analysis software was used for postprocessing. Reconstructions with the following five photon energies were generated: 40 keV, 60 keV, 80 keV, 100 keV, and 120 keV. Artifact severity was graded on a 5-point Likert scale (0, massive artifact; 5, absence of artifact). The size of artifact and image noise (expressed as HU) in anatomic structures adjacent to the artifact were measured. Quantitative and subjective image quality was compared using Friedman and Wilcoxon tests. RESULTS We observed artifacts arising from densely concentrated contrast material in the superior vena cava (SVC) in 18 patients, from sternal wires in 14, from bypass clips in eight, and from coronary artery stents in seven. Artifact size in monoenergetic reconstructions from 40 to 120 keV decreased from 21.3 to 19 mm for the SVC (P < 0.001), from 8.4 to 2.6 mm for sternal wires (P < 0.001), from 6.4 to 2.2 mm for bypass clips (P < 0.001), and from 5.9 to 2.7 mm for stents (P < 0.001), respectively. The quality score changed from 0.2 to 3.8 for the SVC (P < 0.001), from 0.1 to 4 for sternal wires (P < 0.001), from 0 to 3.9 for bypass clips (P < 0.001), and from 0 to 3.9 for stents (P < 0.001). Lowest noise in adjacent structures was found at 80 keV for the SVC (39.1 HU), for sternal wires (33.3), for bypass clips (26.9), and for stents (33.9). CONCLUSION A significant reduction of high-attenuation artifacts can be achieved by use of higher monoenergetic energy levels with cardiac DECT. However, image noise in anatomic structures affected by artifacts is lowest at 80 keV, which suggests an evaluation approach that makes use of multiple energy levels for a complete diagnosis.
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Affiliation(s)
- Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese, Italy
| | - Carlo Nicola De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza” – Polo Pontino, Latina, Italy
| | - James Vance Spearman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Robert Silverman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Ullrich Ebersberger
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Francesco Sardanelli
- IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese, Italy
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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