1
|
Jones S, McNeil M, Koczo A. Updates in Cardiovascular Disease Prevention, Diagnosis, and Treatment in Women. Med Clin North Am 2023; 107:285-298. [PMID: 36759098 DOI: 10.1016/j.mcna.2022.10.008] [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] [Indexed: 02/10/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death for American women. CVD is preventable although risk reduction goals are not achieved for women compared with men. Considering a woman's cardiometabolic profile for prevention counseling and prescribing may help. Coronary artery calcium scores provide additional risk assessment and reproductive and menopause histories identify risk enhancers. Diagnosis of CVD is often delayed, and treatment is less optimal for women compared with men. Differences in presentation and underlying CVD etiology (Including spontaneous coronary artery dissection and microvascular disease) may partially account for these disparities. Improvements in CVD imaging to better diagnose these etiologies may benefit women's care.
Collapse
Affiliation(s)
- Sarah Jones
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Montefiore Hospital, 933 West, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Melissa McNeil
- Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Women's Health, VHA Central Office, 64 Caswell Street, Narragansett, RI 02882, USA
| | - Agnes Koczo
- Division of Cardiology, University of Pittsburgh Medical Center, 2350 Terrace Street, Scaife Hall, S-360, Pittsburgh, PA 15213, USA
| |
Collapse
|
2
|
Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
Collapse
Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| |
Collapse
|
3
|
Fusaro M, Caruso D, Tessarin G, de Santis D, Balestriero G, Bortolanza C, Panvini N, Polidori T, Laghi A, Morana G. Comparison of Triple-Rule-Out Prospectively ECG-triggered Systolic and Diastolic Acquisition Protocol in Patients With Acute Chest Pain. J Thorac Imaging 2022; 37:W72-W77. [PMID: 34534998 DOI: 10.1097/rti.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare image quality and coronary interpretability of triple-rule-out systolic and diastolic protocols in patients with acute chest pain. MATERIALS AND METHODS From March 2016 to October 2017 the authors prospectively enrolled patients with undifferentiated acute chest pain, who were at low to intermediate cardiovascular risk. Those with heart rate >75 bpm underwent a systolic prospectively triggered acquisition (systolic triggering [ST]), and in those with ≤75 bpm, end-diastolic triggering (DT) was instead performed. Examinations were evaluated for coronary artery disease, aortic dissection, and pulmonary embolism. Image quality was assessed using a Likert scale. Coronary arteries interpretability was evaluated both on a per-vessel and a per segment basis. The occurrence of major adverse cardiovascular events was investigated. RESULTS The final study population was 189 patients. Fifty-two patients (27.5%) underwent systolic acquisition and 137 (72.5%) underwent diastolic acquisition. No significant differences in overall image quality were observed between DT and ST groups (median score 5 [interquartile ranges 4 to 5] vs. 4 [interquartile ranges 4 to 5], P =0.074). Although both DT and ST protocols showed low percentages of noninterpretable coronary arteries on a per-vessel (1.5% and 6.7%, respectively) and per-segment analysis (1% and 4.7%, respectively), these percentages resulted significantly higher for ST groups ( P <0.001). Obstructive coronary stenosis was observed in 18 patients. Only one case of pulmonary embolism was diagnosed and no cases of aortic dissection were found in our population. No death or major adverse cardiovascular events were observed during follow-up among the 2 groups. CONCLUSIONS Results showed that triple-rule-out computed tomography angiography is a reliable technique in patients with acute chest pain and that an ST acquisition protocol could be considered an alternative acquisition protocol in patients with higher heart rate, reaching a good image quality.
Collapse
Affiliation(s)
- Michele Fusaro
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| | - Damiano Caruso
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Giovanni Tessarin
- Department of Medicine-DIMED, Institute of Radiology, University of Padova, Padua, Italy
| | - Domenico de Santis
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | | | - Carlo Bortolanza
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| | - Nicola Panvini
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Tiziano Polidori
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Andrea Laghi
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Giovanni Morana
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| |
Collapse
|
4
|
Wang K, Wang X, Zheng S, Li C, Jin L, Li M. Dedicated CCTA Followed by High-Pitch Scanning versus TRO-CT for Contrast Media and Radiation Dose Reduction: A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12112647. [PMID: 36359488 PMCID: PMC9688948 DOI: 10.3390/diagnostics12112647] [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: 09/20/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to compare dedicated coronary computed tomography angiography (CCTA) followed by high-pitch scanning and triple-rule-out computed tomography angiography (TRO-CTA) in terms of radiation dose, contrast media (CM) use, and image quality. Patients with acute chest pain were retrospectively enrolled and assigned to group A (n = 55; scanned with dedicated CCTA followed by high-pitch scanning) or group B (n = 45; with TRO-CTA). Patient characteristics, radiation dose, CM use, and quantitative parameters (CT value, image noise, signal-to-noise ratio, contrast-to-noise ratio, and image quality score) of pulmonary arteries (PAs), thoracic aortae (TAs), and coronary arteries (CAs) were compared. The total effective dose was significantly lower in group A (6.25 ± 2.94 mSv) than B (8.93 ± 4.08 mSv; p < 0.001). CM volume was significantly lower in group A (75.7 ± 8.9 mL) than B (95.0 ± 0 mL; p < 0.001). PA and TA image quality were significantly better in group B, whereas that of CA was significantly better in group A. Qualitative image scores of PA and TA scans rated by radiologists were similar, whereas that of CA scans was significantly higher in group A than B (p < 0.001). Dedicated CCTA followed by high-pitch scanning demonstrated lower radiation doses and CM volume without debasing qualities of PA, TA, and CA scans than did TRO-CTA.
Collapse
Affiliation(s)
- Kun Wang
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Xiaodong Wang
- Shanghai Changfeng Community Health Service Center of Putuo District, Shanghai 200062, China
| | - Shaoqiang Zheng
- Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Cheng Li
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Liang Jin
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-137-6114-8449 (L.J.); +86-138-1662-0371 (M.L.); Fax: +86-021-6248-3180 (L.J. & M.L.)
| | - Ming Li
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-137-6114-8449 (L.J.); +86-138-1662-0371 (M.L.); Fax: +86-021-6248-3180 (L.J. & M.L.)
| |
Collapse
|
5
|
Wilder-Smith AJ, Yang S, Weikert T, Bremerich J, Haaf P, Segeroth M, Ebert LC, Sauter A, Sexauer R. Automated Detection, Segmentation, and Classification of Pericardial Effusions on Chest CT Using a Deep Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12051045. [PMID: 35626201 PMCID: PMC9139725 DOI: 10.3390/diagnostics12051045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 01/15/2023] Open
Abstract
Pericardial effusions (PEFs) are often missed on Computed Tomography (CT), which particularly affects the outcome of patients presenting with hemodynamic compromise. An automatic PEF detection, segmentation, and classification tool would expedite and improve CT based PEF diagnosis; 258 CTs with (206 with simple PEF, 52 with hemopericardium) and without PEF (each 134 with contrast, 124 non-enhanced) were identified using the radiology report (01/2016−01/2021). PEF were manually 3D-segmented. A deep convolutional neural network (nnU-Net) was trained on 316 cases and separately tested on the remaining 200 and 22 external post-mortem CTs. Inter-reader variability was tested on 40 CTs. PEF classification utilized the median Hounsfield unit from each prediction. The sensitivity and specificity for PEF detection was 97% (95% CI 91.48−99.38%) and 100.00% (95% CI 96.38−100.00%) and 89.74% and 83.61% for diagnosing hemopericardium (AUC 0.944, 95% CI 0.904−0.984). Model performance (Dice coefficient: 0.75 ± 0.01) was non-inferior to inter-reader (0.69 ± 0.02) and was unaffected by contrast administration nor alternative chest pathology (p > 0.05). External dataset testing yielded similar results. Our model reliably detects, segments, and classifies PEF on CT in a complex dataset, potentially serving as an alert tool whilst enhancing report quality. The model and corresponding datasets are publicly available.
Collapse
Affiliation(s)
- Adrian Jonathan Wilder-Smith
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Shan Yang
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Thomas Weikert
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Martin Segeroth
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Lars C. Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zürich, 8057 Zürich, Switzerland;
| | - Alexander Sauter
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Raphael Sexauer
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-613-286-584
| |
Collapse
|
6
|
He X, Guo BJ, Lei Y, Wang T, Fu Y, Curran WJ, Zhang LJ, Liu T, Yang X. Automatic segmentation and quantification of epicardial adipose tissue from coronary computed tomography angiography. Phys Med Biol 2020; 65:095012. [PMID: 32182595 DOI: 10.1088/1361-6560/ab8077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epicardial adipose tissue (EAT) is a visceral fat deposit, that's known for its association with factors, such as obesity, diabetes mellitus, age, and hypertension. Segmentation of the EAT in a fast and reproducible way is important for the interpretation of its role as an independent risk marker intricate. However, EAT has a variable distribution, and various diseases may affect the volume of the EAT, which can increase the complexity of the already time-consuming manual segmentation work. We propose a 3D deep attention U-Net method to automatically segment the EAT from coronary computed tomography angiography (CCTA). Five-fold cross-validation and hold-out experiments were used to evaluate the proposed method through a retrospective investigation of 200 patients. The automatically segmented EAT volume was compared with physician-approved clinical contours. Quantitative metrics used were the Dice similarity coefficient (DSC), sensitivity, specificity, Jaccard index (JAC), Hausdorff distance (HD), mean surface distance (MSD), residual mean square distance (RMSD), and the center of mass distance (CMD). For cross-validation, the median DSC, sensitivity, and specificity were 92.7%, 91.1%, and 95.1%, respectively, with JAC, HD, CMD, MSD, and RMSD are 82.9% ± 8.8%, 3.77 ± 1.86 mm, 1.98 ± 1.50 mm, 0.37 ± 0.24 mm, and 0.65 ± 0.37 mm, respectively. For the hold-out test, the accuracy of the proposed method remained high. We developed a novel deep learning-based approach for the automated segmentation of the EAT on CCTA images. We demonstrated the high accuracy of the proposed learning-based segmentation method through comparison with ground truth contour of 200 clinical patient cases using 8 quantitative metrics, Pearson correlation, and Bland-Altman analysis. Our automatic EAT segmentation results show the potential of the proposed method to be used in computer-aided diagnosis of coronary artery diseases (CADs) in clinical settings.
Collapse
Affiliation(s)
- Xiuxiu He
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America. Co-first author
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
In-Hospital Cost Comparison of Triple-Rule-Out Computed Tomography Angiography Versus Standard of Care in Patients With Acute Chest Pain. J Thorac Imaging 2020; 35:198-203. [PMID: 32032251 DOI: 10.1097/rti.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the utilization of invasive and noninvasive tests and compare cost in patients presenting with chest pain to the emergency department (ED) who underwent either triple-rule-out computed tomography angiography (TRO-CTA) or standard of care. MATERIALS AND METHODS We performed a retrospective single-center analysis of 2156 ED patients who presented with acute chest pain with a negative initial troponin and electrocardiogram for myocardial injury. Patient cohorts matched by patient characteristics who had undergone TRO-CTA as a primary imaging test (n=1139) or standard of care without initial CTA imaging (n=1017) were included in the study. ED visits, utilization of tests, and costs during the initial episode of hospital care were compared. RESULTS No significant differences in the diagnosis of coronary artery disease, pulmonary embolism, or aortic dissection were observed. Median ED waiting time (4.5 vs. 7.0 h, P<0.001), median total length of hospital stay (5.0 vs. 32.0 h, P<0.001), hospital admission rate (12.6% vs. 54.2%, P<0.001), and ED return rate to our hospital within 30 days (3.5% vs. 14.6%, P<0.001) were significantly lower in the TRO-CTA group. Moreover, reduced rates of additional testing and invasive coronary angiography (4.9% vs. 22.7%, P<0.001), and ultimately lower total cost per patient (11,783$ vs. 19,073$, P<0.001) were observed in the TRO-CTA group. CONCLUSIONS TRO-CTA as an initial imaging test in ED patients presenting with acute chest pain was associated with shorter ED and hospital length of stay, fewer return visits within 30 days, and ultimately lower ED and hospitalization costs.
Collapse
|
8
|
Monica MP, Merkely B, Szilveszter B, Drobni ZD, Maurovich-Horvat P. Computed Tomographic Angiography for Risk Stratification in Patients with Acute Chest Pain - The Triple Rule-out Concept in the Emergency Department. Curr Med Imaging 2020; 16:98-110. [PMID: 32003310 DOI: 10.2174/1573405614666180604095120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/20/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute chest pain is one of the most common reasons for Emergency Department (ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening condition, urgent identification of the etiology of chest pain is of utmost importance in emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes (AAS). DISCUSSION The concept of Triple Rule-out Computed Tomographic Angiography (TRO-CTA) for patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic angiography as a single imaging technique, able to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical evaluation and outcomes of these patients. CONCLUSION This review aims to summarize the main indications and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest pain.
Collapse
Affiliation(s)
- Marton-Popovici Monica
- Department of Internal Medicine and Critical Care, Swedish Medical Center, Edmonds, Washington, United States
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dora Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
9
|
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique. AJR Am J Roentgenol 2017; 209:370-379. [DOI: 10.2214/ajr.17.17850] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Fung GSK, Ciuffo L, Ashikaga H, Taguchi K. Motion estimation for cardiac functional analysis using two x-ray computed tomography scans. Med Phys 2017. [PMID: 28639400 DOI: 10.1002/mp.12425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This work concerns computed tomography (CT)-based cardiac functional analysis (CFA) with a reduced radiation dose. As CT-CFA requires images over the entire heartbeat, the scans are often performed at 10-20% of the tube current settings that are typically used for coronary CT angiography. A large image noise then degrades the accuracy of motion estimation. Moreover, even if the scan was performed during the sinus rhythm, the cardiac motion observed in CT images may not be cyclic with patients with atrial fibrillation. In this study, we propose to use two CT scan data, one for CT angiography at a quiescent phase at a standard dose and the other for CFA over the entire heart beat at a lower dose. METHODS We have made the following four modifications to an image-based cardiac motion estimation method we have previously developed for a full-dose retrospectively gated coronary CT angiography: (a) a full-dose prospectively gated coronary CT angiography image acquired at the least motion phase was used as the reference image; (b) a three-dimensional median filter was applied to lower-dose retrospectively gated cardiac images acquired at 20 phases over one heartbeat in order to reduce image noise; (c) the strength of the temporal regularization term was made adaptive; and (d) a one-dimensional temporal filter was applied to the estimated motion vector field in order to decrease jaggy motion patterns. We describe the conventional method iME1 and the proposed method iME2 in this article. Five observers assessed the accuracy of the estimated motion vector field of iME2 and iME1 using a 4-point scale. The observers repeated the assessment with data presented in a new random order 1 week after the first assessment session. RESULTS The study confirmed that the proposed iME2 was robust against the mismatch of noise levels, contrast enhancement levels, and shapes of the chambers. There was a statistically significant difference between iME2 and iME1 (accuracy score, 2.08 ± 0.81 versus 2.77 ± 0.98, P < 0.01) and the improvement by the score of + 0.69 seemed clinically relevant. Inter-observer concordance was good: The inter-class correlation coefficient was 0.63 and Kendall's rank correlation coefficients were in the range of 0.41-0.67 (P < 0.01), respectively. Intra-observer reproducibility between sessions was good with the inter-class correlation coefficient of 0.76. CONCLUSION We have proposed iME2 method for CT-CFA with two CT scans. The observer study verified the robustness and accuracy of iME2 method and its improved performance over iME1 method.
Collapse
Affiliation(s)
- George S K Fung
- Division of Medical Imaging Physics, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Luisa Ciuffo
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Hiroshi Ashikaga
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Katsuyuki Taguchi
- Division of Medical Imaging Physics, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| |
Collapse
|
11
|
Dobra M, Bordi L, Nyulas T, Stănescu A, Morariu M, Condrea S, Benedek T. Clinical update. Computed Tomography — an Emerging Tool for Triple Rule-Out in the Emergency Department. A Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
New imaging tools have been developed in recent years to rapidly and accurately diagnose life-threatening diseases associated with high mortality rates, such as acute coronary syndromes, acute aortic dissection, or pulmonary embolism. The concept of using computed tomographic (CT) assessment in emergency settings is based on the possibility of excluding multiple acute pathologies within one scan. It can be used for patients complaining of acute chest pain of unclear etiology with the possible association of acute coronary dissection or pulmonary embolism, but only a low to moderate risk of developing an acute coronary syndrome. One of the benefits of this protocol is the possibility of decreasing the number of patients who are hospitalized for further investigations. The technique also allows the rapid triage of patients and the safe discharge of those who show negative results. The aim of this review is to summarize the current medical literature regarding the potential use of CT for the triple rule-out (TRO) of coronary etiologies.
Collapse
Affiliation(s)
- Mihaela Dobra
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Tiberiu Nyulas
- University of Medicine and Pharmacy, Tîrgu Mureș , Romania
| | - Alexandra Stănescu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Mirabela Morariu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Sebastian Condrea
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
- University of Medicine and Pharmacy, Tîrgu Mureș , Romania
| |
Collapse
|
12
|
Saraswat A, Narasimhan S. Lex parsimoniae. J Cardiol Cases 2017; 15:187-189. [PMID: 30279776 DOI: 10.1016/j.jccase.2017.02.001] [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: 10/21/2016] [Revised: 01/10/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022] Open
Abstract
We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From computed tomography coronary angiography, a left anterior descending artery lesion was identified and successfully revascularized with a drug-eluting stent. Due to persistent chest pain, further investigation revealed a descending aortic dissection, which was conservatively managed. This case highlights the potential challenges of diagnosis in dual pathologies and emphasizes initiating appropriate investigations. <Learning objectives: It is important to consider all differential diagnoses in atypical presentations of possible acute coronary syndrome. As clinical presentations and risk factors may be similar, initiating appropriate diagnostic and management pathways are crucial to avoid misdiagnosis.>.
Collapse
Affiliation(s)
| | - Seshasayee Narasimhan
- Gold Coast University Hospital, Southport, QLD, Australia.,University of Newcastle, Callaghan, NSW, Australia.,University of New England, Armidale, NSW, Australia
| |
Collapse
|
13
|
Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain. Eur J Radiol 2016; 86:163-168. [PMID: 28027742 DOI: 10.1016/j.ejrad.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/18/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. MATERIALS AND METHODS This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. RESULTS 225 subjects (age, 56.2±11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01-1.13permm) and LV mass (HR:1.05, 95%CI:1.00-1.10perg) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. CONCLUSION CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and obstructive coronary artery disease.
Collapse
|
14
|
Mírka H, Ferda J, Baxa J. Assessment of myocardial enhancement during coronary CT angiography in critically ill patients. Eur J Radiol 2016; 85:1909-1913. [PMID: 27435494 DOI: 10.1016/j.ejrad.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
Abstract
There are still challenges and unmet needs for the imaging techniques, such as conditions of uncertain origin in patients with clinically serious, life-threatening conditions with unknown cause that are not associated with dominant chest pain, ECG changes or other symptoms indicating a possible primarily cardiac or coronary cause. The contribution of the myocardial enhancement evaluation of urgent cardiac CTA scans significantly improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. When incorporating the myocardial enhancement assessment into the imaging algorithm of an emergency department, emphasis is placed on a uniform imaging procedure and a uniform evaluation approach. The color coded images of the myocardial enhancement in emergency situations helps identify the most serious pathologies and shorten the time to adequate targeted therapy in patients.
Collapse
Affiliation(s)
- Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic; Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Alej Svobody 76, 304 60 Plzeň, Czech Republic.
| | - Jiří Ferda
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic.
| | - Jan Baxa
- Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň, Czech Republic.
| |
Collapse
|
15
|
Smulders MW, Kietselaer BL, Schalla S, Bucerius J, Jaarsma C, van Dieijen-Visser MP, Mingels AM, Rocca HPBL, Post M, Das M, Crijns HJ, Wildberger JE, Bekkers SC. Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging? Am Heart J 2016; 177:102-11. [PMID: 27297855 DOI: 10.1016/j.ahj.2016.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
Collapse
|
16
|
Triple rule-out computed tomography for risk stratification of patients with acute chest pain. J Cardiovasc Comput Tomogr 2016; 10:291-300. [PMID: 27375202 DOI: 10.1016/j.jcct.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 12/22/2022]
Abstract
AIMS Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain. METHODS We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive" if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome. The clinical endpoint was occurrence of a major adverse cardiovascular event (MACE) within 30 days, defined by a composite of all cause death, myocardial infarction, revascularization, major cardiovascular surgery, or thrombolytic therapy. Clinical risk scores for acute chest pain including TIMI, GRACE, Diamond-Forrester, and HEART were determined and compared to the TRO-CT findings. RESULTS TRO-CT revealed clinically significant cardiovascular disease in 239 patients (23.3%). MACE occurred in 119 patients (49.8%) with positive TRO-CT and in 7 patients (0.9%) with negative TRO-CT (p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of TRO-CT was 95%, 88%, 54%, and 99%, respectively. TRO-CT was a better discriminator between patients with vs. without events as compared to clinical risk scores (c-statistics = 0.91 versus 0.64 to 0.71; integrated discrimination improvement = 0.31 to 0.37; p < 0.001 for all comparisons). Patients with a negative TRO-CT showed shorter ED stay times and admission rates compared to patients with positive TRO-CT, irrespective of clinical risk scores (p < 0.001 for all comparisons). CONCLUSION Triple rule-out CT has high predictive performance for 30-day MACE and permits rapid triage and low admission rates irrespective of clinical risk scores.
Collapse
|
17
|
Abstract
OBJECTIVE The objective of the present study is to quantify the diagnostic yield of triple-rule-out (TRO) CT for the evaluation of acute chest pain in emergency department patients. MATERIALS AND METHODS All TRO CT studies performed at our institution from 2006 to 2015 were reviewed. Scans were performed on a 256-MDCT scanner, with the use of ECG gating and a biphasic contrast injection. Radiology reports were reviewed to identify diagnoses that could explain chest pain, including coronary and noncoronary diagnoses, and significant incidental findings that did not account for the patient's presentation. The total numbers of coronary and noncoronary diagnoses and incidental findings were calculated. RESULTS Four of 1196 total cases that were identified were excluded from the study because of inadequate image quality. A total of 970 patients (81.4%) had a negative study result without a significant coronary or noncoronary diagnosis. A total of 139 patients (11.7%) had significant coronary artery disease (50% stenosis or greater). One hundred six patients (8.9%) had a noncoronary diagnosis that could explain chest pain (p < 0.02), most commonly pulmonary embolism (28 patients [2.3%]), aortic aneurysm (24 patients [2.0%]), or pneumonia (20 patients [1.7%]). Thirty cases (27.3%) of pulmonary embolism and aortic pathologic findings would not have been detected with coronary CT angiography because of unopacified right-side circulation or limited z-axis coverage. A total of 528 incidental findings not considered to explain chest pain were noted in 418 patients (35.1%). CONCLUSION In 8.9% of patients, TRO CT detected a significant noncoronary diagnosis that could explain acute chest pain, including pathologic findings that would not be identified on dedicated coronary CT angiography.
Collapse
|
18
|
Ilia R, Shimony A, Shalev A, Cafri C, Weinstein JM. The incremental value of coronary computerized tomography angiography following invasive coronary angiography with an emphasis on equivocal left main stenosis. Int J Cardiol 2015; 201:119-20. [PMID: 26296049 DOI: 10.1016/j.ijcard.2015.07.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Reuben Ilia
- Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheva, Israel.
| | - Avi Shimony
- Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Arieh Shalev
- Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Carlos Cafri
- Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Jean Marc Weinstein
- Cardiology Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheva, Israel
| |
Collapse
|
19
|
Den Harder AM, Willemink MJ, De Ruiter QMB, De Jong PA, Schilham AMR, Krestin GP, Leiner T, Budde RPJ. Dose reduction with iterative reconstruction for coronary CT angiography: a systematic review and meta-analysis. Br J Radiol 2015; 89:20150068. [PMID: 26562096 DOI: 10.1259/bjr.20150068] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the achievable radiation dose reduction for coronary CT angiography (CCTA) with iterative reconstruction (IR) in adults and the effects on image quality. METHODS PubMed and EMBASE were searched, and original articles concerning IR for CCTA in adults using prospective electrocardiogram triggering were included. Primary outcome was the effective dose using filtered back projection (FBP) and IR. Secondary outcome was the effect of IR on objective and subjective image quality. RESULTS The search yielded 1616 unique articles, of which 10 studies (1042 patients) were included. The pooled routine effective dose with FBP was 4.2 mSv [95% confidence interval (CI) 3.5-5.0]. A dose reduction of 48% to a pooled effective dose of 2.2 mSv (95% CI 1.3-3.1) using IR was reported. Noise, contrast-to-noise ratio and subjective image quality were equal or improved in all but one study, whereas signal-to-noise ratio was decreased in two studies with IR at reduced dose. CONCLUSION IR allows for CCTA acquisition with an effective dose of 2.2 mSv with preserved objective and subjective image quality.
Collapse
Affiliation(s)
| | - Martin J Willemink
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Quirina M B De Ruiter
- 2 Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim A De Jong
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arnold M R Schilham
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gabriel P Krestin
- 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ricardo P J Budde
- 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands
| |
Collapse
|
20
|
High pitch CT in triple rule-out studies: Radiation dose and image quality compared to multidetector CT. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rxeng.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Fernández del Valle A, Delgado Sánchez-Gracián C, Oca Pernas R, Grande Astorquiza A, Bustos Fiore A, Trinidad López C, Tardáguila de la Fuente G. Tomografía computarizada de pitch alto en estudios de triple descarte: dosis de radiación y calidad de la imagen comparada con la de la tomografía computarizada multidetector. RADIOLOGIA 2015; 57:412-8. [DOI: 10.1016/j.rx.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
|
22
|
Hollander JE, Chang AM. Triple Rule Out CTA Scans or the Right Test for the Right Patient. JACC Cardiovasc Imaging 2015; 8:826-7. [PMID: 26183554 DOI: 10.1016/j.jcmg.2015.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Judd E Hollander
- Department of Emergency Medicine & the National Academic Center for Telehealth, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Anna Marie Chang
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
23
|
Updates on Coronary CTA in the Emergency Department. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
|
25
|
Garrett KG, De Cecco CN, Schoepf UJ, Silverman JR, Krazinski AW, Geyer LL, Lewis AJ, Headden GF, Ravenel JG, Suranyi P, Meinel FG. Residents' performance in the interpretation of on-call "triple-rule-out" CT studies in patients with acute chest pain. Acad Radiol 2014; 21:938-44. [PMID: 24928163 DOI: 10.1016/j.acra.2014.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of radiology residents in the interpretation of on-call, emergency "triple-rule-out" (TRO) computed tomographic (CT) studies in patients with acute chest pain. MATERIALS AND METHODS The study was institutional review board-approved and Health Insurance Portability and Accountability Act compliant. Data from 617 on-call TRO studies were analyzed. Dedicated software enables subspecialty attendings to grade discrepancies in interpretation between preliminary trainee reports and their final interpretation as "unlikely to be significant" (minor discrepancies) or "likely to be significant" for patient management (major discrepancies). The frequency of minor, major and all discrepancies in resident's TRO interpretations was compared to 609 emergent non-electrocardiography (ECG)-synchronized chest CT studies using Pearson χ(2) test. RESULTS Minor discrepancies occurred more often in the TRO group (9.1% vs. 3.9%, P < .001), but there was no difference in the frequency of major discrepancies (2.1% vs. 2.8%, P = .55). Minor discrepancies in the TRO group most commonly resulted from missed extrathoracic findings with missed liver lesions being the most frequent. Major discrepancies mostly encompassed cardiac and extracardiac vascular findings but did not result in unnecessary interventions, significant immediate changes in management, or adverse patient outcomes. CONCLUSIONS On-call resident interpretation of TRO CT studies in patients with acute chest pain is congruent with final subspecialty attending interpretation in the overwhelming majority of cases. The rate of discrepancies likely to affect patient management in this domain is not different from emergent non-ECG-synchronized chest CT.
Collapse
|
26
|
|
27
|
Keenan NG, Pugliese F, Davies LC. The role of computed tomography in cardiovascular imaging: from X-ray department to emergency room. Expert Rev Cardiovasc Ther 2014; 12:57-69. [DOI: 10.1586/14779072.2014.870034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Automated quantification of epicardial adipose tissue using CT angiography: evaluation of a prototype software. Eur Radiol 2013; 24:519-26. [PMID: 24192980 DOI: 10.1007/s00330-013-3052-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study evaluated the performance of a novel automated software tool for epicardial fat volume (EFV) quantification compared to a standard manual technique at coronary CT angiography (cCTA). METHODS cCTA data sets of 70 patients (58.6 ± 12.9 years, 33 men) were retrospectively analysed using two different post-processing software applications. Observer 1 performed a manual single-plane pericardial border definition and EFVM segmentation (manual approach). Two observers used a software program with fully automated 3D pericardial border definition and EFVA calculation (automated approach). EFV and time required for measuring EFV (including software processing time and manual optimization time) for each method were recorded. Intraobserver and interobserver reliability was assessed on the prototype software measurements. T test, Spearman's rho, and Bland-Altman plots were used for statistical analysis. RESULTS The final EFVA (with manual border optimization) was strongly correlated with the manual axial segmentation measurement (60.9 ± 33.2 mL vs. 65.8 ± 37.0 mL, rho = 0.970, P < 0.001). A mean of 3.9 ± 1.9 manual border edits were performed to optimize the automated process. The software prototype required significantly less time to perform the measurements (135.6 ± 24.6 s vs. 314.3 ± 76.3 s, P < 0.001) and showed high reliability (ICC > 0.9). CONCLUSIONS Automated EFVA quantification is an accurate and time-saving method for quantification of EFV compared to established manual axial segmentation methods. KEY POINTS • Manual epicardial fat volume quantification correlates with risk factors but is time-consuming. • The novel software prototype automates measurement of epicardial fat volume with good accuracy. • This novel approach is less time-consuming and could be incorporated into clinical workflow.
Collapse
|
29
|
Ayaram D, Bellolio MF, Murad MH, Laack TA, Sadosty AT, Erwin PJ, Hollander JE, Montori VM, Stiell IG, Hess EP. Triple rule-out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis. Acad Emerg Med 2013; 20:861-71. [PMID: 24050793 DOI: 10.1111/acem.12210] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/14/2013] [Accepted: 03/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of "triple rule-out" (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing). METHODS Four electronic databases were searched, along with reference lists and contacted content experts, for relevant studies from inception until October 2012. Eligible studies enrolled patients with nontraumatic chest pain, shortness of breath, suspected acute coronary syndrome (ACS), PE, or aortic dissection; used at least 64-slice CT technology; and compared TRO CT to another diagnostic modality. RESULTS Eleven studies enrolling 3,539 patients (791 TRO and 2,748 non-TRO) were included (one randomized controlled trial and 10 observational). There was no significant difference in image quality between TRO and dedicated CT scans. TRO CT had the following pooled diagnostic accuracy estimates for coronary artery disease: sensitivity of 94.3% (95% confidence interval [CI] = 89.1% to 97.5%), specificity of 97.4% (95% CI = 96.1% to 98.4%), positive likelihood ratio (LR+) of 17.71 (95% CI = 3.92 to 79.96), and negative likelihood ratio (LR-) of 0.08 (95% CI = 0.02 to 0.27). There were insufficient numbers of patients with PE or aortic dissection to generate diagnostic accuracy estimates for these conditions. Use of TRO CT involved greater radiation exposure (mean difference [MD] = 4.84 mSv, 95% CI = 1.65 to 8.04 mSv) and contrast exposure (MD = 38.0 mL, 95% CI = 28.1 to 48.0 mL) compared to non-TRO CT patients. CONCLUSIONS Triple rule-out CT is highly accurate for detecting coronary artery disease. Given the low (<1%) prevalence of PE and aortic dissection in the included studies, and the increased radiation and contrast exposure, there are insufficient data to recommend use of TRO CT in the diagnosis of these conditions.
Collapse
Affiliation(s)
- David Ayaram
- Department of Emergency Medicine; Division of Emergency Medicine Research; Mayo Clinic; Rochester MN
| | - M. Fernanda Bellolio
- Department of Emergency Medicine; Division of Emergency Medicine Research; Mayo Clinic; Rochester MN
| | - M. Hassan Murad
- The Knowledge and Evaluation Research Unit; Mayo Clinic; Rochester MN
- The Department of Internal Medicine; Division of Preventive Medicine; Mayo Clinic; Rochester MN
| | - Torrey A. Laack
- Department of Emergency Medicine; Division of Emergency Medicine Research; Mayo Clinic; Rochester MN
| | - Annie T. Sadosty
- Department of Emergency Medicine; Division of Emergency Medicine Research; Mayo Clinic; Rochester MN
| | - Patricia J. Erwin
- The Mayo Medical Libraries; Mayo Clinic College of Medicine; Rochester MN
| | - Judd E. Hollander
- The Department of Emergency Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Victor M. Montori
- The Knowledge and Evaluation Research Unit; Mayo Clinic; Rochester MN
- The Department of Internal Medicine; Division of Endocrinology and Metabolism; Mayo Clinic; Rochester MN
| | - Ian G. Stiell
- The Department of Emergency Medicine and Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Erik P. Hess
- Department of Emergency Medicine; Division of Emergency Medicine Research; Mayo Clinic; Rochester MN
- The Knowledge and Evaluation Research Unit; Mayo Clinic; Rochester MN
| |
Collapse
|
30
|
Maroules CD, Blaha MJ, El-Haddad MA, Ferencik M, Cury RC. Establishing a successful coronary CT angiography program in the emergency department: Official writing of the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (FiRST). J Cardiovasc Comput Tomogr 2013; 7:150-6. [DOI: 10.1016/j.jcct.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/08/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
|