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Matthaiou N, Klontzas ME, Kakkos GA, Tsetis K, Maris TG, Ioannou CV, Tsetis D, Kehagias E. Utility of Dual-Energy Computed Tomography in lesion characterization and treatment planning for peripheral Chronic Total Occlusions: A comprehensive analysis of crossing difficulty. Eur J Radiol 2024; 176:111539. [PMID: 38833769 DOI: 10.1016/j.ejrad.2024.111539] [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: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To investigate whether Dual-Energy Computed Tomography (DECT) could be useful in the lesion characterization and endovascular treatment planning of symptomatic patients with peripheral arterial disease (PAD) due to Chronic Total Occlusions (CTO). MATERIALS AND METHODS Between 2018 and 2022, 60 symptomatic patients (52 male, age 71 years) with peripheral arterial CTO underwent DECT angiography before percutaneous endovascular treatment. Patients were classified, according to guidewire crossing difficulty into four categories, which were subsequently correlated with DECT values, including Dual Energy Index (DEI) and Effective Z (Zeff). DECT values were also corelated with crossing time. The crossing difficulty was further correlated with the Trans-Atlantic Inter-Society Consensus Document (TASC II) classification. RESULTS Technical success, defined as perceived antegrade true lumen or subintimal crossing, was achieved in 76.7 %. Among the cases, 20 were deemed easy, 14 moderate, 12 hard and 14 were failed attempts. Statistical analysis revealed a significant correlation between DEI, Zeff values, and the crossing difficulty categories (p < 0.001). Additionally, there was also a correlation between crossing time and DECT values. However, no significant correlation was recorded between difficulty categories and TASC II classification. CONCLUSION Pre-procedural DECT angiography provides valuable information for patient selection and planning of the revascularization strategy. Moreover, it is helpful in the selection of the appropriate PTA materials, based on the lesion characteristics. Further research should be invested in this important field, to determine the optimal treatment approach in patients suffering from PAD due to CTOs.
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Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - Michail E Klontzas
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - George A Kakkos
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Konstantinos Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
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Gao Y, Pan Y, Jia C. Influencing factors and improvement methods of coronary artery plaque evaluation in CT. Front Cardiovasc Med 2024; 11:1395350. [PMID: 38984352 PMCID: PMC11232181 DOI: 10.3389/fcvm.2024.1395350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/14/2024] [Indexed: 07/11/2024] Open
Abstract
Accurate evaluation of the nature and composition of coronary plaque involves clinical follow-up and prognosis. Coronary CT angiography is the most commonly non-invasive method for plaque evaluation, however, the qualitative and quantitative evaluation of plaque based on CT value is inaccurate, due to the influence of luminal attenuation, tube voltage, parameter setting and the subjectivity.
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Affiliation(s)
- Yaqi Gao
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yao Pan
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chongfu Jia
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Kim S, Lee J, Kim J, Kim B, Choi CH, Jung S. Conversion of single-energy CT to parametric maps of dual-energy CT using convolutional neural network. Br J Radiol 2024; 97:1180-1190. [PMID: 38597871 PMCID: PMC11135792 DOI: 10.1093/bjr/tqae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/21/2023] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES We propose a deep learning (DL) multitask learning framework using convolutional neural network for a direct conversion of single-energy CT (SECT) to 3 different parametric maps of dual-energy CT (DECT): virtual-monochromatic image (VMI), effective atomic number (EAN), and relative electron density (RED). METHODS We propose VMI-Net for conversion of SECT to 70, 120, and 200 keV VMIs. In addition, EAN-Net and RED-Net were also developed to convert SECT to EAN and RED. We trained and validated our model using 67 patients collected between 2019 and 2020. Single-layer CT images with 120 kVp acquired by the DECT (IQon spectral CT; Philips Healthcare, Amsterdam, Netherlands) were used as input, while the VMIs, EAN, and RED acquired by the same device were used as target. The performance of the DL framework was evaluated by absolute difference (AD) and relative difference (RD). RESULTS The VMI-Net converted 120 kVp SECT to the VMIs with AD of 9.02 Hounsfield Unit, and RD of 0.41% compared to the ground truth VMIs. The ADs of the converted EAN and RED were 0.29 and 0.96, respectively, while the RDs were 1.99% and 0.50% for the converted EAN and RED, respectively. CONCLUSIONS SECT images were directly converted to the 3 parametric maps of DECT (ie, VMIs, EAN, and RED). By using this model, one can generate the parametric information from SECT images without DECT device. Our model can help investigate the parametric information from SECT retrospectively. ADVANCES IN KNOWLEDGE DL framework enables converting SECT to various high-quality parametric maps of DECT.
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Affiliation(s)
- Sangwook Kim
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Jimin Lee
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
- Graduate School of Artificial Intelligence, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
| | - Jungye Kim
- Department of Biomedical Engineering, Korea University, Seoul 02841, Republic of Korea
| | - Bitbyeol Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Seongmoon Jung
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Ionizing Radiation Group, Division of Biomedical Metrology, Korea Research Institute of Standards and Science, Daejeon 34114, Republic of Korea
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Steiner J, Richter H, Kaufmann R, Ohlerth S. Characterization of Normal Bone in the Equine Distal Limb with Effective Atomic Number and Electron Density Determined with Single-Source Dual Energy and Detector-Based Spectral Computed Tomography. Animals (Basel) 2024; 14:1064. [PMID: 38612304 PMCID: PMC11010807 DOI: 10.3390/ani14071064] [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: 02/09/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Single-source dual energy (SSDECT) and detector-based spectral computed tomography (DBSCT) are emerging technologies allowing the interrogation of materials that have different attenuation properties at different energies. Both technologies enable the calculation of effective atomic number (EAN), an index to determine tissue composition, and electron density (ED), which is assumed to be associated with cellularity in tissues. In the present prospective observational study, EAN and ED values were determined for 16 zones in normal subchondral and trabecular bone of 37 equine cadaver limbs. Using both technologies, the following findings were obtained: 1. palmar/plantar EAN zone values in the fetlock increased significantly with increasing age of the horse; 2. all EAN and ED values were significantly lower in the trabecular bone than in the subchondral bone of all phalanges; 3. in the distal phalanx and navicular bone, most EAN and ED values were significantly lower compared to the proximal and middle phalanx; and 4. some EAN and ED values were significantly different between front and hind limbs. Several EAN and ED values significantly differed between SSDECT and DBSCT. The reported EAN and ED values in the subchondral and trabecular bone of the equine distal limb may serve as preliminary reference values and aid future evaluation and classification of diseases.
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Affiliation(s)
- Janine Steiner
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (J.S.); (H.R.)
| | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (J.S.); (H.R.)
| | | | - Stefanie Ohlerth
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (J.S.); (H.R.)
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Zhang J, Li S, Wu L, Wang H, Wang C, Zhou Y, Sui B, Zhao X. Application of Dual-Layer Spectral-Detector Computed Tomography Angiography in Identifying Symptomatic Carotid Atherosclerosis: A Prospective Observational Study. J Am Heart Assoc 2024; 13:e032665. [PMID: 38497470 PMCID: PMC11010034 DOI: 10.1161/jaha.123.032665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Dual-layer spectral-detector dual-energy computed tomography angiography (DLCTA) can distinguish components of carotid plaques. Data on identifying symptomatic carotid plaques in patients using DLCTA are not available. METHODS AND RESULTS In this prospective observational study, patients with carotid plaques were enrolled and received DLCTA. The attenuation for both polyenergetic image and virtual monoenergetic images (40, 70, 100, and 140 keV), as well as Z-effective value, were recorded in the noncalcified regions of plaques. Logistic regression models were used to assess the association between attenuations of DLCTA and the presence of symptomatic carotid plaques. In total, 100 participants (mean±SD age, 64.37±8.31 years; 82.0% were men) were included, and 36% of the cases were identified with the symptomatic group. DLCTA parameters were different between 2 groups (symptomatic versus asymptomatic: computed tomography [CT] 40 keV, 152.63 [interquartile range (IQR), 70.22-259.78] versus 256.78 [IQR, 150.34-408.13]; CT 70 keV, 81.28 [IQR, 50.13-119.33] versus 108.87 [IQR, 77.01-165.88]; slope40-140 keV, 0.91 [IQR, 0.35-1.87] versus 1.92 [IQR, 0.96-3.00]; Z-effective value, 7.92 [IQR, 7.53-8.46] versus 8.41 [IQR, 7.94-8.92]), whereas no difference was found in conventional polyenergetic images. The risk of symptomatic plaque was lower in the highest tertiles of attenuations in CT 40 keV (adjusted odds ratio [OR], 0.243 [95% CI, 0.078-0.754]), CT 70 keV (adjusted OR, 0.313 [95% CI, 0.104-0.940]), Z-effective values (adjusted OR, 0.138 [95% CI, 0.039-0.490]), and slope40-140 keV (adjusted OR, 0.157 [95% CI, 0.046-0.539]), with all P values and P trends <0.05. The areas under the curve for CT 40 keV, CT 70 keV, slope 40 to 140 keV, and Z-effective values were 0.64, 0.61, 0.64, and 0.63, respectively. CONCLUSIONS Parameters of DLCTA might help assist in distinguishing symptomatic carotid plaques. Further studies with a larger sample size may address the overlap and improve the diagnostic accuracy.
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Affiliation(s)
- Jia Zhang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Sijia Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Lei Wu
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Haoyuan Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chuanying Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yinan Zhou
- CT Clinical SpecialistPhilips HealthcareBeijingChina
| | - Binbin Sui
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Tiantan Neuroimaging Center of ExcellenceChina National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xingquan Zhao
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular DiseaseChinese Academy of Medical SciencesBeijingChina
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Chen L, Ji X, Wang Z, Chen Y. Technical note: Error analysis of material-decomposition-based effective atomic number quantification method. Med Phys 2024; 51:419-427. [PMID: 37459046 DOI: 10.1002/mp.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The effective atomic number (Zeff ) is widely applied to the identification of unknown materials. One method to determine the Zeff is material-decomposition-based spectral X-ray imaging. The method relies on certain approximations of the X-ray interaction cross-sections such as empirical model coefficients. The impact of such approximations on the accuracy of Zeff quantification has not been fully investigated. PURPOSE To perform an error analysis of the material-decomposition-based Zeff quantification method and propose a coefficient calibration-in-groups method to improve the modeling accuracy and reduce the Zeff quantification error. METHODS The model of the material-decomposition-based Zeff quantification method relies on the dependence of the interaction cross-sections (σPE ) on the atomic number Z and corresponding coefficient, that is,σ PE ∝ Z m $\sigma _\mathrm{PE}\propto Z^m$ . In this work, all the data is from the National Institute of Standards and Technology (NIST) website. First, the coefficient m is calibrated through a logarithmic fitting method to quickly determine the m values for any certain energy and Zeff ranges. Then materials including elements and common compounds with Zeff ranging from 6-20 are selected as the objects whose effective atomic numbers are to be quantified. Different combinations of basis materials are applied to decompose the object materials and their quantification errors are analyzed. With the help of error analysis, the object materials are divided into high-error and low-error groups based on the decomposition coefficient ratioa m i n / a m a x $a_{min}/a_{max}$ , which is found to have a strong correlation with error, and their coefficients are calibrated in groups. Finally, the average errors of three m selection strategies: (1) using an empirical m value of 3.94, which is also considered a standard method; (2) using a single m value, which is calibrated through the logarithmic fitting method; (3) using different m values calibrated in groups, are calculated to test the effectiveness of our method. RESULTS The approximation of the X-ray interaction cross-section leads to certain errors in Zeff quantification and the error distributions for different basis materials are different. The average errors for most basis material combinations (C(6)/Ca(20), C(6)/Al(13), Al(13)/Ca(20), C(6)/Ne(10), Na(11)/P(15)) are lower than 0.5, maintaining good average accuracy. While the average error for S(16)/Ca(20) is up to 0.8461, leading to more misjudgments on atomic number. Meanwhile, the error distribution regularity can be observed. The Pearson's correlation coefficients of absolute errors and decomposition coefficient ratios are 0.743, 0.8432 and 0.7126 for basis material combinations C(6)/Ca(20), C(6)/Al(13) and Al(13)/Ca(20), indicating a good correlation. The method using either empirical m value of 3.94 or single calibrated m value of 4.619 has relatively high average errors. The proposed method using different m values calibrated in groups has the lowest average errors 0.254, 0.203 and 0.169, which are reduced by 21.6%(0.07), 3.8%(0.008) and 62.9%(0.286) respectively compared with the standard method. CONCLUSIONS The error analysis demonstrates that the approximation of X-ray interaction cross-sections leads to inevitable errors, while also revealing certain error distribution regularity. The coefficient calibrated-in-groups method has better modeling accuracy and has effectively reduced the error compared with the standard method using a single empirical m value of 3.94.
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Affiliation(s)
- Li Chen
- Laboratory of Image Science and Technology, the School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Xu Ji
- Laboratory of Image Science and Technology, the School of Computer Science and Engineering, Southeast University, Nanjing, China
- Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Southeast University, Nanjing, China
| | - Zhe Wang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- Jinan Laboratory of Applied Nuclear Science, Jinan, China
| | - Yang Chen
- Laboratory of Image Science and Technology, the School of Computer Science and Engineering, Southeast University, Nanjing, China
- Jiangsu Provincial Joint International Research Laboratory of Medical Information Processing, Southeast University, Nanjing, China
- Key Laboratory of New Generation Artificial Intelligence Technology and Its Interdisciplinary Applications (Southeast University), Ministry of Education, China
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Böttcher B, Zsarnoczay E, Varga-Szemes A, Schoepf UJ, Meinel FG, van Assen M, De Cecco CN. Dual-Energy Computed Tomography in Cardiac Imaging. Radiol Clin North Am 2023; 61:995-1009. [PMID: 37758366 DOI: 10.1016/j.rcl.2023.05.004] [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] [Indexed: 10/03/2023]
Abstract
Dual-energy computed tomography (DECT) acquires images using two energy spectra and offers a variation of reconstruction techniques for improved cardiac imaging. Virtual monoenergetic images decrease artifacts improving coronary plaque and stent visualization. Further, contrast attenuation is increased allowing significant reduction of contrast dose. Virtual non-contrast reconstructions enable coronary artery calcium scoring from contrast-enhanced scans. DECT provides advanced plaque imaging with detailed analysis of plaque components, indicating plaque stability. Extracellular volume assessment using DECT offers noninvasive detection of myocardial fibrosis. This review aims to outline the current cardiac applications of DECT, summarize recent literature, and discuss their findings.
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Affiliation(s)
- Benjamin Böttcher
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Uwe Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging and Imaging Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc. 1365 Clifton Road NE, Suite - AT503, Atlanta, GA 30322, USA.
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Liu LP, Shapira N, Sahbaee P, Gang GJ, Knollman FD, Chen MY, Litt HI, Noël PB. Consistency of spectral results in cardiac dual-source photon-counting CT. Sci Rep 2023; 13:14895. [PMID: 37689744 PMCID: PMC10492823 DOI: 10.1038/s41598-023-41969-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open
Abstract
We evaluate stability of spectral results at different heart rates, acquisition modes, and cardiac phases in first-generation clinical dual-source photon-counting CT (PCCT). A cardiac motion simulator with a coronary stenosis mimicking a 50% eccentric calcium plaque was scanned at five different heart rates (0, 60-100 bpm) with the three available cardiac scan modes (high pitch prospectively ECG-triggered spiral, prospectively ECG-triggered axial, retrospectively ECG-gated spiral). Subsequently, full width half max (FWHM) of the stenosis, Dice score (DSC) for the stenosed region, and eccentricity of the non-stenosed region were calculated for virtual monoenergetic images (VMI) at 50, 70, and 150 keV and iodine density maps at both diastole and systole. FWHM averaged differences of - 0.20, - 0.28, and - 0.15 mm relative to static FWHM at VMI 150 keV across acquisition parameters for high pitch prospectively ECG-triggered spiral, prospectively ECG-triggered axial, and retrospectively ECG-gated spiral scans, respectively. Additionally, there was no effect of heart rate and acquisition mode on FWHM at diastole (p-values < 0.001). DSC demonstrated similarity among parameters with standard deviations of 0.08, 0.09, 0.11, and 0.08 for VMI 50, 70, and 150 keV, and iodine density maps, respectively, with insignificant differences at diastole (p-values < 0.01). Similarly, eccentricity illustrated small differences across heart rate and acquisition mode for each spectral result. Consistency of spectral results at different heart rates and acquisition modes for different cardiac phase demonstrates the added benefit of spectral results from PCCT to dual-source CT to further increase confidence in quantification and advance cardiovascular diagnostics.
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Affiliation(s)
- Leening P Liu
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
| | - Nadav Shapira
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Grace J Gang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Harold I Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter B Noël
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
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Wang LJ, Zhai PQ, Xue LL, Shi CY, Zhang Q, Zhang H. Machine learning-based identification of symptomatic carotid atherosclerotic plaques with dual-energy computed tomography angiography. J Stroke Cerebrovasc Dis 2023; 32:107209. [PMID: 37290153 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107209] [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: 01/28/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE This study aimed to develop and validate a machine learning model incorporating both dual-energy computed tomography (DECT) angiography quantitative parameters and clinically relevant risk factors for the identification of symptomatic carotid plaques to prevent acute cerebrovascular events. METHODS The data of 180 patients with carotid atherosclerosis plaques were analysed from January 2017 to December 2021; 110 patients (64.03±9.58 years old, 20 women, 90 men) were allocated to the symptomatic group, and 70 patients (64.70±9.89 years old, 50 women, 20 men) were allocated to the asymptomatic group. Overall, five machine learning models using the XGBoost algorithm, based on different CT and clinical features, were developed in the training cohort. The performances of all five models were assessed in the testing cohort using receiver operating characteristic curves, accuracy, recall rate, and F1 score. RESULTS The shapley additive explanation (SHAP) value ranking showed fat fraction (FF) as the highest among all CT and clinical features and normalised iodine density (NID) as the 10th. The model based on the top 10 features from the SHAP measurement showed optimal performance (area under the curve [AUC] .885, accuracy .833, recall rate .933, F1 score .861), compared with the other four models based on conventional CT features (AUC .588, accuracy .593, recall rate .767, F1 score .676), DECT features (AUC .685, accuracy .648, recall rate .667, F1 score .678), conventional CT and DECT features (AUC .819, accuracy .740, recall rate .867, F1 score .788), and all CT and clinical features (AUC .878, accuracy .833, recall rate .867, F1 score .852). CONCLUSION FF and NID can serve as useful imaging markers of symptomatic carotid plaques. This tree-based machine learning model incorporating both DECT and clinical features could potentially comprise a non-invasive method for identification of symptomatic carotid plaques to guide clinical treatment strategies.
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Affiliation(s)
- Ling-Jie Wang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Pei-Qing Zhai
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Li-Li Xue
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Cai-Yun Shi
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Qian Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Hua Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
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Matthaiou N, Galanakis N, Papadakis AE, Kehagias E, Kontopodis N, Charalambous S, Perisinakis K, Maris TG, Ioannou CV, Tsetis D. Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study. J Vasc Interv Radiol 2022; 33:1531-1535. [PMID: 36100065 DOI: 10.1016/j.jvir.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/07/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022] Open
Abstract
This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes-dual-energy index (DEI) and effective Z (Zeff)-were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Zeff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Zeff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.
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Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece
| | - Antonios E Papadakis
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Konstantinos Perisinakis
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece.
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Li W, Liu M, Yu F, Zhu W, Yu X, Guo X, Yang Q. Detection of left atrial appendage thrombus by dual-energy computed tomography-derived imaging biomarkers in patients with atrial fibrillation. Front Cardiovasc Med 2022; 9:809688. [PMID: 35935656 PMCID: PMC9354661 DOI: 10.3389/fcvm.2022.809688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Aims This study aimed to assess the diagnostic performances of dual-energy computed tomography (CT)-derived iodine concentration and effective atomic number (Zeff) in early-phase cardiac CT in detecting left atrial appendage (LAA) thrombus and differentiating thrombus from spontaneous echo contrast (SEC) in patients with atrial fibrillation using transesophageal echocardiography (TEE) as the reference standard. Methods and results A total of 389 patients with atrial fibrillation were prospectively recruited. All patients underwent a single-phase cardiac dual-energy CT scan using a third-generation dual-source CT. The iodine concentration, Zeff, and conventional Hounsfield units (HU) in the LAA were measured and normalized to the ascending aorta (AA) of the same slice to calculate the LAA/AA ratio. Of the 389 patients, TEE showed thrombus in 15 (3.9%), SEC in 33 (8.5%), and no abnormality in 341 (87.7%) patients. Using TEE findings as the reference standard, the respective sensitivity, specificity, positive predictive value, and negative predictive value of the LAA/AA HU ratio for detecting LAA thrombus were 100.0, 96.8, 55.6, and 100.0%; those of the LAA/AA iodine concentration ratio were 100.0, 99.2, 83.3, and 100.0%; and those of the LAA/AA Zeff ratio were 100.0, 98.9, 79.0, and 100.0%. The areas under the receiver operator characteristic curve (AUC) of the LAA/AA iodine concentration ratio (0.978; 95% CI 0.945–1.000) and Zeff ratio (0.962; 95% CI 0.913–1.000) were significantly larger than that of the LAA/AA HU ratio (0.828; 95% CI 0.714–0.942) in differentiating the thrombus from the SEC (both P < 0.05). Although the AUC of the LAA/AA iodine concentration ratio was larger than that of the LAA/AA Zeff ratio, no significant difference was found between them (P = 0.259). Conclusion The dual-energy CT-derived iodine concentration and the Zeff showed better diagnostic performance than the conventional HU in early-phase cardiac CT in detecting LAA thrombus and differentiating the thrombus from the circulatory stasis. However, these results need to be validated in large-cohort studies with late-phase images.
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Affiliation(s)
- Wenhuan Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mingxi Liu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fangfang Yu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Capital Medical University, Beijing, China
| | - Xianbo Yu
- CT Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Xiaojuan Guo,
| | - Qi Yang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qi Yang,
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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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Dual-energy CT plaque characteristics of post mortem thin-cap fibroatheroma in comparison to infarct-related culprit lesions. Heart Vessels 2021; 37:400-410. [PMID: 34608510 DOI: 10.1007/s00380-021-01942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Improvement of non-invasive identification of high-risk plaque may increase the preventive options of acute coronary syndrome. To describe the characteristics of thin-cap fibroatheroma (TCFA) in a post mortem model in comparison to characteristics of culprit lesions in patients with non-ST-elevation-myocardial-infarction (NSTEMI) using the dual energy computed tomography (DECT). Three post mortem hearts were prepared with iodine-contrast, inserted in a Kyoto phantom and scanned by DECT. Six TCFA were identified using histopathological analysis (cap thickness < 65 μm and necrotic core > 10% of the plaque area). In the NSTEMI group, 29 patients were scheduled to DECT prior to coronary angiography and invasive treatment. Culprit lesions were identified blinded for the patient history by two independent invasive cardiologists using the coronary angiography. The DECT analysis of TCFA and culprit lesions was performed retrospectively with determination of effective atomic number (Effective-Z), Hounsfield Unit (HU), plaque type (non-calcified, predominantly non-calcified, predominantly calcified or calcified), spotty calcification,, plaque length, plaque volume and plaque burden and the remodeling index. The Effective-Z, HU and plaqueburden were significantly different between TCFA and culprit lesions (P < 0.05).The TCFA plaques were more calcified in comparison to culprit lesions (P < 0.05). No significant difference in the other plaque characteristics was observed. The use of DECT demonstrated different Effective-Z values and different characteristics of post mortem TCFA in comparison to in vivo culprit lesions. This finding may highlight, that not all TCFA should be considered as vulnerable.
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Utility of Dual-Layer Spectral-Detector CTA to Characterize Carotid Atherosclerotic Plaque Components: An Imaging-Histopathology Comparison in Patients Undergoing Endarterectomy. AJR Am J Roentgenol 2021; 218:517-525. [PMID: 34549604 DOI: 10.2214/ajr.21.26540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The composition of non-calcified portions of carotid atherosclerotic plaque represents an important marker of plaque vulnerability and ischemia risk. Objective: To assess the utility of dual-layer spectral-detector CTA (DLCTA) parameters for carotid plaque component characterization, using histologic results from carotid endarterectomy (CEA) as reference. Methods: Seven patients (5 male, 2 female; 61.6±8.5 years old) with carotid plaque awaiting CEA were prospectively enrolled and underwent preoperative supra-aortic DLCTA. A neuroradiologist and pathologist performed joint slice-by-slice review of histologic slices of resected plaques and CTA images. ROIs were placed on non-calcified components [lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous tissue, loose matrix (LM)] on CTA images in comparison with corresponding histologic slices using anatomic landmarks. For each ROI, attenuation was recorded for polyenergetic images (CTPI) and virtual monoenergetic images with keV ranging from 40-140 (CT40-140keV); attenuation spectrum curve slope was calculated; and Z-effective value (representing effective atomic number) was recorded. DLCTA parameters were compared among plaque components. Results: Seven plaques with a total of 65 slices and 364 ROIs (159 fibrous tissue, 96 LRNC, 86 loose matrix, 23 IPH) were analyzed. All parameters (CTPI, CT40-140keV, slope from 40 to 140 keV, Z-effective value) showed significant differences between LRNC and the other components (all p<.001). For example, mean CTPI was 37.1±15.1 HU for LRNC, 58.4±21.6 HU for IPH, 69.7±20.5 HU for fibrous tissue, and 69.6±19.6 HU for loose matrix; mean CT40keV was 28.1±36.7 HU for LRNC, 87.5±48.9 HU for IPH, 106.3±47.5 HU for fibrous tissue, and 102.6±48.0 HU for loose matrix. AUC for differentiating LRNC from other components was highest (0.945) for CT40kev and decreased with higher keV; AUC for CTPI was 0.908. CT40kev also had highest accuracy (90.4%); at cutoff of 55.7 HU, CT40kev had 88.5% sensitivity and 90.9% specificity. For differentiating IPH from fibrous tissue and loose matrix, AUC was highest at 0.652 for CTPI and 0.645 for CT40kev. Conclusion: DLCTA showed strong performance in differentiating LRNC from other non-calcified plaque components; CT40kev had highest accuracy, outperforming conventional polyenergetic images. Clinical Impact: DLCTA parameters may help characterize carotid plaque composition as a marker of vulnerable plaque and ischemia risk.
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15
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Xu C, Yi Y, Han Y, Xie H, Lu X, Vembar M, Leiner T, Jin Z, Wang Y. Incremental improvement of diagnostic performance of coronary CT angiography for the assessment of coronary stenosis in the presence of calcium using a dual-layer spectral detector CT: validation by invasive coronary angiography. Int J Cardiovasc Imaging 2021; 37:2561-2572. [PMID: 34176031 DOI: 10.1007/s10554-021-02205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
To investigate value of spectral reconstructions for the quantification of coronary stenosis in the presence of calcified or partially calcified plaques using a dual-layer spectral detector CT (SDCT). Seventy-two consecutive patients were retrospectively enrolled. Conventional 120 kVp images, eight virtual monoenergetic images (VMI) (70 to 140 keV), the effective atomic number (Z effective) and iodine no water images were reconstructed. Invasive coronary angiography was used as the reference standard. Parallel and serial testing were used to assess the incremental diagnostic value of Z effective and iodine no water images to the best VMI series. 122 coronary lesions of 72 patients (49 men and 23 women; 63.7 ± 10.2 years) were enrolled in analysis. Reconstruction at 100 keV yielded optimal diagnostic performance, the sensitivity, specificity, PPV, NPV and diagnostic accuracy to identify stenosis ≥ 50% or ≥ 70% were 84%, 70%, 80%, 76%, 79% and 78%, 98%, 93%, 91%, 92%, respectively. A serial combination (100 keV VMI followed by Z effective images) resulted in an improved specificity (from 70 to 80%) with a moderate loss of sensitivity (81% from 84%) in identifying ≥ 50% stenosis (P = 0.021). For patients with high Agatston score, this combination could further reduce false positive cases and improve diagnostic accuracy. 100 keV VMI provide optimal diagnostic performance for the detection of coronary stenosis in the presence of calcified or partially calcified plaques using a dual-layer SDCT, with further improvements obtained with the combined use of Z effective images.
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Affiliation(s)
- Cheng Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yan Yi
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yechen Han
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhi Xie
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaomei Lu
- Clinical Science, Philips Healthcare, Beijing, China
| | - Mani Vembar
- CT Clinical Science, Philips Healthcare, Cleveland, OH, USA
| | - Tim Leiner
- Department of Radiology, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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16
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Pascart T, Carpentier P, Choi HK, Norberciak L, Ducoulombier V, Luraschi H, Houvenagel E, Legrand J, Verclytte S, Becce F, Budzik JF. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: The VASCURATE study. Semin Arthritis Rheum 2021; 51:895-902. [PMID: 34198148 DOI: 10.1016/j.semarthrit.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden. METHODS Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi. RESULTS We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p<0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p<0.001). CONCLUSION Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
| | - Paul Carpentier
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA
| | - Laurène Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Julie Legrand
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Sébastien Verclytte
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
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Watanabe T, Furuse Y, Akasaka T, Sasaki N, Mukai-Yatagai N, Yamamoto K. Feasibility of effective atomic number assessment in coronary intervention for chronic total occlusion. J Cardiovasc Med (Hagerstown) 2021; 22:146-148. [PMID: 33351535 DOI: 10.2459/jcm.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Characteristics of culprit lesion in patients with non-ST-elevation myocardial infarction and improvement of diagnostic utility using dual energy cardiac CT. Int J Cardiovasc Imaging 2021; 37:1781-1788. [PMID: 33502653 DOI: 10.1007/s10554-020-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
AIMS The aim of the study was to identify the characteristics of the culprit lesions compared to non-culprit lesions in patients with non-ST-elevation-myocardial infarction using dual energy computed tomography (DECT). METHODS AND RESULTS In 29 patients, we identified 29 culprit lesions and 227 non-culprit lesions. Quantitative values such as the effective atomic number (effective-Z) and Hounsfield Units (HU) values were measured. Furthermore, all the lesions were characterised using characteristics such as composition (non-calcified, predominantly-non-calcified, predominantly-calcified, or calcified), presence of spotty calcification, remodelling index, and napkin ring sign. The mean effective-Z and HU values were significantly lower in culprit lesions than in non-culprit lesions (8.99 ± 1.21 vs 9.79 ± 1.52; p = 0.0066 and 87.41 ± 84.97 vs. 154.45 ± 176.13; p = 0.0447). The culprit lesions had a higher frequency of non-calcified plaques and predominantly non-calcified plaques, and were with a greater presence of napkin ring signs in comparison with non-culprit lesions. There were no differences in the presence of spotty calcification or remodelling index. By adding effective-Z to plaque characteristics such as non-calcified, positive remodelling, spotty calcification, and napkin rings we observed a significant increased sensitivity of detecting culprit lesions (65.5% vs.44.8%), but no significant changes in area under curve (AUC). CONCLUSION The use of DECT adds new information of the plaque composition expressed by the effective-Z, which differs significantly in culprit lesions in comparison with non-culprit lesions. The use of the effective-Z improves the diagnostic sensitivity in detection of culprit lesions.
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Coronary artery bypass grafting and perioperative stroke: imaging of atherosclerotic plaques in the ascending aorta with ungated high-pitch CT-angiography. Sci Rep 2020; 10:13909. [PMID: 32807858 PMCID: PMC7431556 DOI: 10.1038/s41598-020-70830-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Abstract
Perioperative stroke is a devastating complication after coronary artery bypass graft (CABG) surgery, with atherosclerosis of the ascending aorta as important risk factor. During surgical manipulation, detachment of plaques can lead to consecutive embolization into brain-supplying arteries. High-pitch computed tomography angiography (HP-CTA) represents a non-invasive imaging modality, which provides the opportunity for comprehensive imaging of the ascending aorta, including plaque detection and advanced characterization. In our present retrospective study on 719 individuals, who had undergone HP-CTA within 6 months prior to CABG, atherosclerotic disease of the ascending aorta was evaluated with respect to perioperative stroke rates. For image analysis, the ascending aorta was divided into a proximal and distal part, consisting of four segments, and evaluated for presence and distribution of calcified and mixed plaques. All patients with perioperative stroke presented with atherosclerotic disease of the ascending aorta. The stroke rate was significantly associated with the presence and extent of atherosclerotic disease. Patients burdened with mixed plaques presented with significantly higher perioperative stroke rates. This study demonstrates that HP-CTA allows accurate evaluation of plaque extent and composition in the ascending aorta, and therefore may improve risk stratification of stroke prior to CABG.
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20
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Yi Y, Zhao XM, Wu RZ, Wang Y, Vembar M, Jin ZY, Wang YN. Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT. Int Heart J 2019; 60:608-617. [PMID: 31105142 DOI: 10.1536/ihj.18-340] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to investigate the performance of low keV mono-energetic reconstructions in spectral coronary computed tomography angiography (CCTA) using spectral detector CT (SDCT) with reduced contrast media and radiation dose.Sixty patients were randomly assigned to Groups A and B (both n = 30) to undergo CCTA on a dual-layer SDCT with tube voltage 120 kVp and 100 kVp (average tube current: 108.5 and 73.8 mAs, respectively), with contrast media volume of 36 mL used in both groups. The mono-energetic 40-80 keV and conventional 120 kVp images in Group A and conventional 100 kVp images in Group B were reconstructed. Quantitative and qualitative image quality (IQ) were evaluated in the aortic root and distal segments of the coronary arteries.The patient characteristics were not significantly different between the two groups (all P≥ 0.47), nor was the effective radiation dose (1.5 ± 0.3 and 1.4 ± 0.3 mSv, P = 0.20). The quantitative IQ in aorta and coronary arteries of mono-energetic 40-60 keV was superior to conventional 120 kVp and 100 kVp images (all P < 0.05). The noise in spectral images was lower compared to conventional images (all P < 0.01). The subjective IQ score of 40-50 keV images was not significantly different from that of 100 kVp images (P > 0.8).The mono-energetic 40-50 keV reconstructions from spectral CCTA using SDCT provide improved IQ compared to conventional techniques while facilitating reduced radiation dose and contrast media.
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Affiliation(s)
- Yan Yi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xue-Mei Zhao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Run-Ze Wu
- CT Clinical Science, Philips Healthcare, Cleveland
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Mani Vembar
- CT Clinical Science, Philips Healthcare, Cleveland
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Giannopoulos AA, Benz DC, Gräni C, Buechel RR. Imaging the event-prone coronary artery plaque. J Nucl Cardiol 2019; 26:141-153. [PMID: 28685252 DOI: 10.1007/s12350-017-0982-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/19/2017] [Indexed: 12/18/2022]
Abstract
Acute coronary events, the dreaded manifestation of coronary atherosclerosis, remain one of the main contributors to mortality and disability in the developed world. The majority of those events are associated with atherosclerotic plaques-related thrombus formation following an acute disruption, that being rupture or erosion, of an event-prone lesion. These historically termed vulnerable plaques have been the target of numerous benchtop and clinical research endeavors, yet to date without solid results that would allow for early identification and potential treatment. Technological leaps in cardiovascular imaging have provided novel insights into the formation and role of the event-prone plaques. From intracoronary optical coherence tomography that has enhanced our understanding of the pathophysiological mechanisms of plaque disruption, over coronary computed tomography angiography that enables non-invasive serial plaque imaging, and positron emission tomography poised to be rapidly implemented into clinical practice to the budding field of plaque imaging with cardiac magnetic resonance, we summarize the invasive and non-invasive imaging modalities currently available in our armamentarium. Finally, the current status and potential future imaging directions are critically appraised.
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Affiliation(s)
- Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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22
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Shah NR, Cheezum MK, Motoyama S, Chatzizisis YS. Do we really need another individual coronary plaque characterization measurement? Atherosclerosis 2017; 261:160-162. [PMID: 28438319 DOI: 10.1016/j.atherosclerosis.2017.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Michael K Cheezum
- Department of Medicine (Cardiology Service), Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, Aichi, Japan
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