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Yamamoto Y, Tanabe Y, Kurata A, Yamamoto S, Kido T, Uetani T, Ikeda S, Nakano S, Yamaguchi O, Kido T. Feasibility of four-dimensional similarity filter for radiation dose reduction in dynamic myocardial computed tomography perfusion imaging. FRONTIERS IN RADIOLOGY 2023; 3:1214521. [PMID: 38105799 PMCID: PMC10722229 DOI: 10.3389/fradi.2023.1214521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Rationale and objectives We aimed to evaluate the impact of four-dimensional noise reduction filtering using a four-dimensional similarity filter (4D-SF) on radiation dose reduction in dynamic myocardial computed tomography perfusion (CTP). Materials and methods Forty-three patients who underwent dynamic myocardial CTP using 320-row computed tomography (CT) were included in the study. The original images were reconstructed using iterative reconstruction (IR). Three different CTP datasets with simulated noise, corresponding to 25%, 50%, and 75% reduction of the original dose (300 mA), were reconstructed using a combination of IR and 4D-SF. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were assessed, and CT-derived myocardial blood flow (CT-MBF) was quantified. The results were compared between the original and simulated images with radiation dose reduction. Results The median SNR (first quartile-third quartile) at the original, 25%-, 50%-, and 75%-dose reduced-simulated images with 4D-SF was 8.3 (6.5-10.2), 16.5 (11.9-21.7), 15.6 (11.0-20.1), and 12.8 (8.8-18.1) and that of CNR was 4.4 (3.2-5.8), 6.7 (4.6-10.3), 6.6 (4.3-10.1), and 5.5 (3.5-9.1), respectively. All the dose-reduced-simulated CTPs with 4D-SF had significantly higher image quality scores in SNR and CNR than the original ones (25%-, 50%-, and 75%-dose reduced vs. original images, p < 0.05, in each). The CT-MBF in 75%-dose reduced-simulated CTP was significantly lower than 25%-, 50%- dose-reduced-simulated, and original CTPs (vs. 75%-dose reduced-simulated images, p < 0.05, in each). Conclusion 4D-SF has the potential to reduce the radiation dose associated with dynamic myocardial CTP imaging by half, without impairing the robustness of MBF quantification.
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Affiliation(s)
- Yuta Yamamoto
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Cardiology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shuhei Yamamoto
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shota Nakano
- Canon Medical Systems Corporation, Otawara, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
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Abudureyimu S, Abulaiti P, Li H, Xing Z, Liu S, Li W, Gao Y. Roles of endothelial lipase gene related single nucleotide polymorphisms in patients with coronary artery disease. Gene 2021; 788:145669. [PMID: 33882321 DOI: 10.1016/j.gene.2021.145669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The current work focused on evaluating the roles of endothelial lipase gene (LIPG) related single nucleotide polymorphisms (SNPs) in patients with coronary artery disease (CAD). This study involved 1,883 subjects with 959 CAD patients and 924 healthy controls. Data were harvested to assess the association of LIPG related SNPs including rs3744841, rs3744843, rs3813082 and rs2000813 with the risk of CAD. The CC + AC genotype in rs3813082 played a protective role for CAD [odds ratio (OR) = 0.709, P = 0.039]. Differences existed in apolipoprotein-A1 (Apo-A1) and high-density lipoprotein-cholesterol (HDL-C) levels in rs3744843 variant between control and CAD groups. The rs3744841 variant increased the levels of total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C), Apo-A1 and Lipoprotein a (LPa) in the CAD group and TC, LDL-C, HDL-C, Apo-B, Apo-A1 in the control group. The triglyceride (TG) level was lower in rs2000813 variant in the CAD group and elevated in the control group. The rs2000813 variant decreased the number of vascular stenosis while rs3744843 and rs3744841 variants increased the number of vascular stenosis in CAD patients. This study explored the roles of LIPG related SNPs in CAD, showing that CC + AC genotype in rs3813082 was a protective factor for CAD. The rs3744843, rs3744841 and rs2000813 variants were associated with the levels of lipid parameters in CAD patients. The rs3744843, rs3744841 and rs2000813 variants influenced the number of vascular stenosis in CAD patients. The results of our study might be a promising reference for preventing CAD.
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Affiliation(s)
- Shajidan Abudureyimu
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Palida Abulaiti
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Hui Li
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Zhi Xing
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Shasha Liu
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Wen Li
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China
| | - Ying Gao
- Department of Comprehensive Internal Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011 China.
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Society of cardiovascular computed tomography expert consensus document on myocardial computed tomography perfusion imaging. J Cardiovasc Comput Tomogr 2020; 14:87-100. [DOI: 10.1016/j.jcct.2019.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
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Impact of Knowledge-Based Iterative Model Reconstruction on Image Quality and Hemodynamic Parameters in Dynamic Myocardial Computed Tomography Perfusion Using Low-Tube-Voltage Scan: A Feasibility Study. J Comput Assist Tomogr 2019; 43:811-816. [PMID: 31453979 DOI: 10.1097/rct.0000000000000914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge-based iterative model reconstruction (IMR) yields diagnostically acceptable image quality in low-dose static computed tomography (CT). We aimed to evaluate the feasibility of IMR in dynamic myocardial computed tomography perfusion (CTP). METHODS We enrolled 24 patients who underwent stress dynamic CTP using a 256-slice CT. Images were reconstructed using filtered back projection (FBP), hybrid IR, and IMR. Image quality and hemodynamic parameters were compared among three algorithms. RESULTS Qualitative image quality and contrast-to-noise ratio were significantly higher by IMR than by FBP or hybrid IR (visual score: 4.1 vs. 3.0 and 3.5; contrast-to-noise ratio: 12.4 vs. 6.6 and 8.4; P < 0.05). No significant difference was observed among algorithms in CTP-derived myocardial blood flow (1.68 vs. 1.73 and 1.70 mL/g/min). CONCLUSIONS The use of knowledge-based iterative model reconstruction improves image quality without altering hemodynamic parameters in low-dose dynamic CTP, compared with FBP or hybrid IR.
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Impact of the sampling rate of dynamic myocardial computed tomography perfusion on the quantitative assessment of myocardial blood flow. Clin Imaging 2019; 56:93-101. [DOI: 10.1016/j.clinimag.2019.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/23/2019] [Accepted: 03/29/2019] [Indexed: 11/19/2022]
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Patel AR, Maffessanti F, Patel MB, Kebed K, Narang A, Singh A, Medvedofsky D, Zaidi SJ, Mediratta A, Goyal N, Kachenoura N, Lang RM, Mor-Avi V. Hemodynamic impact of coronary stenosis using computed tomography: comparison between noninvasive fractional flow reserve and 3D fusion of coronary angiography with stress myocardial perfusion. Int J Cardiovasc Imaging 2019; 35:1733-1743. [PMID: 31073698 DOI: 10.1007/s10554-019-01618-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Vasodilator-stress CT perfusion imaging in addition to CT coronary angiography (CTCA) may provide a single-test alternative to nuclear stress testing, commonly used to assess hemodynamic significance of stenosis. Another alternative is fractional flow reserve (FFR) calculated from cardiac CT images. We studied the concordance between these two approaches and their relationship to outcomes. We prospectively studied 150 patients with chest pain, who underwent CTCA and regadenoson CT. CTCA images were interpreted for presence and severity of stenosis. Fused 3D displays of subendocardial X-ray attenuation with coronary arteries were created to detect stress perfusion defects (SPD) in each coronary territory. In patients with stenosis > 25%, CT-FFR was quantified. Significant stenosis was determined by: (1) combination of stenosis > 50% with an SPD, (2) CT-FFR ≤ 0.80. Patients were followed-up for 36 ± 25 months for death, myocardial infarction or revascularization. After excluding patients with normal arteries and technical/quality issues, in final analysis of 76 patients, CTCA depicted stenosis > 70% in 13/224 arteries, 50-70% in 24, and < 50% in 187. CT-FFR ≤ 0.80 was found in 41/224 arteries, and combination of SPD with > 50% stenosis in 31/224 arteries. Inter-technique agreement was 89%. Despite high incidence of abnormal CT-FFR (30/76 patients), only 7 patients experienced adverse outcomes; 6/7 also had SPDs. Only 1/9 patients with CT-FFR ≤ 0.80 but normal perfusion had an event. Fusion of CTCA and stress perfusion can help determine the hemodynamic impact of stenosis in one test, in good agreement with CT-FFR. Adding stress CT perfusion analysis may help risk-stratify patients with abnormal CT-FFR.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Francesco Maffessanti
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.,Institute of Computational Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mita B Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Kalie Kebed
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Akhil Narang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Amita Singh
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Diego Medvedofsky
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - S Javed Zaidi
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.,Cardiology Department, Advocate Children's Hospital, Chicago, IL, USA
| | - Anuj Mediratta
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Neha Goyal
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Victor Mor-Avi
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.
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Maffessanti F, Patel AR, Patel MB, Walter JJ, Mediratta A, Medvedofsky D, Kachenoura N, Lang RM, Mor-Avi V. Non-invasive assessment of the haemodynamic significance of coronary stenosis using fusion of cardiac computed tomography and 3D echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:670-680. [PMID: 27461212 DOI: 10.1093/ehjci/jew147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022] Open
Abstract
Aims Abnormal computed tomography coronary angiography (CTCA) often leads to stress testing to determine haemodynamic significance of stenosis. We hypothesized that instead, this could be achieved by fusion imaging of the coronary anatomy with 3D echocardiography (3DE)-derived resting myocardial deformation. Methods and results We developed fusion software that creates combined 3D displays of the coronary arteries with colour maps of longitudinal strain and tested it in 28 patients with chest pain, referred for CTCA (256 Philips scanner) who underwent 3DE (Philips iE33) and regadenoson stress CT. To obtain a reference for stenosis significance, coronaries were also fused with colour maps of stress myocardial perfusion. 3D displays were used to detect stress perfusion defect (SPD) and/or resting strain abnormality (RSA) in each territory. CTCA showed 56 normal arteries, stenosis <50% in 17, and >50% in 8 arteries. Of the 81 coronary territories, SPDs were noted in 20 and RSAs in 29. Of the 59 arteries with no stenosis >50% and no SPDs, considered as normal, 12 (20%) had RSAs. Conversely, with stenosis >50% and SPDs (haemodynamically significant), RSAs were considerably more frequent (5/6 = 83%). Overall, resting strain and stress perfusion findings were concordant in 64/81 arteries (79% agreement). Conclusions Fusion of CTCA and 3DE-derived data allows direct visualization of each coronary artery and strain in its territory. In this feasibility study, resting strain showed good agreement with stress perfusion, indicating that it may be potentially used to assess haemodynamic impact of coronary stenosis, as an alternative to stress testing that entails additional radiation exposure.
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Affiliation(s)
| | - Amit R Patel
- University of Chicago Medical Center, Chicago, IL, USA
| | - Mita B Patel
- University of Chicago Medical Center, Chicago, IL, USA
| | | | | | | | - Nadjia Kachenoura
- University of Chicago Medical Center, Chicago, IL, USA.,Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, UPMC University Paris 06, CNRS 7371, INSERM 1146, F-75013, Paris, France
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Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain. J Am Soc Echocardiogr 2018; 31:664-673. [PMID: 29576220 DOI: 10.1016/j.echo.2018.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Combined evaluation of coronary stenosis and the extent of ischemia is essential in patients with chest pain. Intermediate-grade stenosis on computed tomographic coronary angiography (CTCA) frequently triggers downstream nuclear stress testing. Alternative approaches without stress and/or radiation may have important implications. Myocardial strain measured from echocardiographic images can be used to detect subclinical dysfunction. The authors recently tested the feasibility of fusion of three-dimensional (3D) echocardiography-derived regional resting longitudinal strain with coronary arteries from CTCA to determine the hemodynamic significance of stenosis. The aim of the present study was to validate this approach against accepted reference techniques. METHODS Seventy-eight patients with chest pain referred for CTCA who also underwent 3D echocardiography and regadenoson stress computed tomography were prospectively studied. Left ventricular longitudinal strain data (TomTec) were used to generate fused 3D displays and detect resting strain abnormalities (RSAs) in each coronary territory. Computed tomographic coronary angiographic images were interpreted for the presence and severity of stenosis. Fused 3D displays of subendocardial x-ray attenuation were created to detect stress perfusion defects (SPDs). In patients with stenosis >25% in at least one artery, fractional flow reserve was quantified (HeartFlow). RSA as a marker of significant stenosis was validated against two different combined references: stenosis >50% on CTCA and SPDs seen in the same territory (reference standard A) and fractional flow reserve < 0.80 and SPDs in the same territory (reference standard B). RESULTS Of the 99 arteries with no stenosis >50% and no SPDs, considered as normal, 19 (19%) had RSAs. Conversely, with stenosis >50% and SPDs, RSAs were considerably more frequent (17 of 24 [71%]). The sensitivity, specificity, and accuracy of RSA were 0.71, 0.81, and 0.79, respectively, against reference standard A and 0.83, 0.81, and 0.82 against reference standard B. CONCLUSIONS Fusion of CTCA and 3D echocardiography-derived resting myocardial strain provides combined displays, which may be useful in determination of the hemodynamic or functional impact of coronary abnormalities, without additional ionizing radiation or stress testing.
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Scholtz JE, Ghoshhajra B. Advances in cardiac CT contrast injection and acquisition protocols. Cardiovasc Diagn Ther 2017; 7:439-451. [PMID: 29255688 PMCID: PMC5716940 DOI: 10.21037/cdt.2017.06.07] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/25/2017] [Indexed: 01/27/2023]
Abstract
Cardiac computed tomography (CT) imaging has become an important part of modern cardiovascular care. Coronary CT angiography (CTA) is the first choice imaging modality for non-invasive visualization of coronary artery stenosis. In addition, cardiac CT does not only provide anatomical evaluation, but also functional and valvular assessment, and myocardial perfusion evaluation. In this article we outline the factors which influence contrast enhancement, give an overview of current contrast injection and acquisition protocols, with focus on current emerging topics such as pre-transcatheter aortic valve replacement (TAVR) planning, cardiac CT for congenital heart disease (CHD) patients, and myocardial CT perfusion (CTP). Further, we point out areas where we see potential for future improvements in cardiac CT imaging based on a closer interaction between CT scanner settings and contrast injection protocols to tailor injections to patient- and exam-specific factors.
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Affiliation(s)
- Jan-Erik Scholtz
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Shen Y, Hu X, Zou X, Zhu D, Li Z, Hu D. Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of "double low" for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. Int J Clin Pract 2016; 70 Suppl 9B:B5-B15. [PMID: 27577514 DOI: 10.1111/ijcp.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 06/15/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Imaging communities have already reached a consensus that the radiation dose of computed tomography (CT) should be reduced as much as reasonably achievable to lower population risks. Increasing attention is being paid to iodinated contrast media (CM) induced nephrotoxicity (CIN); a decrease in the intake of iodinated CM is required by increasingly more radiologists. Theoretically, the radiation dose varies with the tube current time and square of the tube voltage, with higher iodine contrast at low photon energies (Huda et al. [2000] Radiology, 21 7, 430-435).The use of low tube voltage is a promising strategy to reduce both the radiation dose and CM burden. The term 'double low' has been coined to describe scanning protocols that reduce radiation dose and iodine intake synchronously. These protocols are becoming increasingly popular in the clinical setting. PURPOSE The aim of this review was to describe all original studies using the 'double low' strategy in the last 5 years. METHODS We searched an online electronic database (PubMed) from January 2011 to December 2015 for original studies published on the relationship of low tube voltage with low radiation dose and low iodine contrast media burden in patients undergoing CT scans. Studies that failed to reduce radiation dose or iodine CM burden were excluded in this study. RESULTS Thirty-seven studies aimed at reducing radiation dose using low tube voltage combined with iodine CM reduced protocols were included in this study. Most studies evaluated conditions associated with arteries. Four were cerebral and neck computed tomography angiography (CTA) studies, 15 were pulmonary CTA (pCTA) and coronary CTA (cCTA) studies, one concerned myocardial perfusion, five studies focused on the thoracic and abdominal aorta, and one investigated renal arteries. Three studies consisted of CT venography (CTV) of the pelvis and lower extremities. Six publications examined the liver, and two focused on the kidney. CONCLUSION Overall, this review demonstrates that the low tube voltage CT protocol is a powerful tool to reduce the radiation dose in CTA, especially with pCTA and cCTA.
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Affiliation(s)
- Yaqi Shen
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xianlun Zou
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Di Zhu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhen Li
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Daoyu Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Mor-Avi V, Kachenoura N, Maffessanti F, Bhave NM, Port S, Lodato JA, Chandra S, Freed BH, Lang RM, Patel AR. Three-dimensional quantification of myocardial perfusion during regadenoson stress computed tomography. Eur J Radiol 2016; 85:885-92. [PMID: 27130047 DOI: 10.1016/j.ejrad.2016.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/15/2016] [Accepted: 02/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is no accepted methodology for CT-based vasodilator stress myocardial perfusion imaging and analysis. We developed a technique for quantitative 3D analysis of CT images, which provides several indices of myocardial perfusion. We sought to determine the ability of these indices during vasodilator stress to identify segments supplied by coronary arteries with obstructive disease and to test the accuracy of the detection of perfusion abnormalities against SPECT. METHODS We studied 93 patients referred for CT coronary angiography (CTCA) who underwent regadenoson stress. 3D analysis of stress CT images yielded segmental perfusion indices: mean X-ray attenuation, severity of defect and relative defect volume. Each index was averaged for myocardial segments, grouped by severity of stenosis: 0%, <50%, 50-70%, and >70%. Objective detection of perfusion abnormalities was optimized in 47 patients and then independently tested in the remaining 46 patients. RESULTS CTCA depicted normal coronary arteries or non-obstructive disease in 62 patients and stenosis of >50% in 31. With increasing stenosis, segmental attenuation showed a 7% decrease, defect severity increased 11%, but relative defect volume was 7-fold higher in segments with obstructive disease (p<0.001). In the test group, detection of perfusion abnormalities associated with stenosis >50% showed sensitivity 0.78, specificity 0.54, accuracy 0.59. When compared to SPECT in a subset of 21 patients (14 with abnormal SPECT), stress CT perfusion analysis showed sensitivity 0.79, specificity 0.71, accuracy 0.76. CONCLUSIONS 3D analysis of vasodilator stress CT images provides quantitative indices of myocardial perfusion, of which relative defect volume was most robust in identifying segments supplied by arteries with obstructive disease. This study may have implications on how CT stress perfusion imaging is performed and analyzed.
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Affiliation(s)
- Victor Mor-Avi
- University of Chicago Medical Center, Chicago, IL, United States.
| | - Nadjia Kachenoura
- University of Chicago Medical Center, Chicago, IL, United States; Sorbonne Universités, UPMC University Paris 06, CNRS 7371, INSERM 1146, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | | | - Nicole M Bhave
- University of Chicago Medical Center, Chicago, IL, United States
| | - Steven Port
- Aurora Health Care, Milwaukee, WI, United States
| | - Joseph A Lodato
- University of Chicago Medical Center, Chicago, IL, United States
| | - Sonal Chandra
- University of Chicago Medical Center, Chicago, IL, United States
| | - Benjamin H Freed
- University of Chicago Medical Center, Chicago, IL, United States
| | - Roberto M Lang
- University of Chicago Medical Center, Chicago, IL, United States
| | - Amit R Patel
- University of Chicago Medical Center, Chicago, IL, United States
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Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning. Phys Med 2015; 31:702-7. [DOI: 10.1016/j.ejmp.2015.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/07/2015] [Accepted: 05/30/2015] [Indexed: 11/20/2022] Open
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Regadenoson-Stress Dynamic Myocardial Perfusion Improves Diagnostic Performance of CT Angiography in Assessment of Intermediate Coronary Artery Stenosis in Asymptomatic Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:105629. [PMID: 26236712 PMCID: PMC4506745 DOI: 10.1155/2015/105629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
The prospective study included 54 asymptomatic high-risk patients who underwent coronary CT angiography (CTA) and regadenoson-induced stress CT perfusion (rsCTP). Diagnostic accuracy of significant stenosis (≥50%) determination was evaluated for CTA alone and CTA + rsCTP in 27 patients referred to ICA due to the positive rsCTP findings. Combined evaluation of CTA + rsCTP had higher diagnostic accuracy over CTA alone (per-segment: specificity 96 versus 68%, p = 0.002; per-vessel: specificity 95 versus 75%, p = 0.012) and high overruling rate of rsCTP was proved in intermediate stenosis (40–70%). Results demonstrate a significant additional value of rsCTP in the assessment of intermediate coronary artery stenosis found with CTA.
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Abstract
OBJECTIVE. The purpose of this study was to comprehensively study estimated radiation doses for subjects included in the main analysis of the Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography (CORE320) study ( ClinicalTrials.gov identifier NCT00934037), a clinical trial comparing combined CT angiography (CTA) and perfusion CT with the reference standard catheter angiography plus myocardial perfusion SPECT. SUBJECTS AND METHODS. Prospectively acquired data on 381 CORE320 subjects were analyzed in four groups of testing related to radiation exposure. Radiation dose estimates were compared between modalities for combined CTA and perfusion CT with respect to covariates known to influence radiation exposure and for the main clinical outcomes defined by the trial. The final analysis assessed variations in radiation dose with respect to several factors inherent to the trial. RESULTS. The mean radiation dose estimate for the combined CTA and perfusion CT protocol (8.63 mSv) was significantly (p < 0.0001 for both) less than the average dose delivered from SPECT (10.48 mSv) and the average dose from diagnostic catheter angiography (11.63 mSv). There was no significant difference in estimated CTA-perfusion CT radiation dose for subjects who had false-positive or false-negative results in the CORE320 main analyses in a comparison with subjects for whom the CTA-perfusion CT findings were in accordance with the reference standard SPECT plus catheter angiographic findings. CONCLUSION. Radiation dose estimates from CORE320 support clinical implementation of a combined CT protocol for assessing coronary anatomy and myocardial perfusion.
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Noninvasive physiologic assessment of coronary stenoses using cardiac CT. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435737. [PMID: 25685790 PMCID: PMC4320886 DOI: 10.1155/2015/435737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022]
Abstract
Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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17
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Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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18
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Analysis of myocardial perfusion from vasodilator stress computed tomography: Does improvement in image quality by iterative reconstruction lead to improved diagnostic accuracy? J Cardiovasc Comput Tomogr 2014; 8:238-45. [DOI: 10.1016/j.jcct.2014.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/18/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
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Funama Y, Taguchi K, Utsunomiya D, Oda S, Katahira K, Tokuyasu S, Yamashita Y. Image quality assessment of an iterative reconstruction algorithm applied to abdominal CT imaging. Phys Med 2014; 30:527-34. [PMID: 24662097 DOI: 10.1016/j.ejmp.2014.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 02/19/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare the noise and accuracy on images of the whole porcine liver acquired with iterative reconstruction (IMR, Philips Healthcare, Cleveland, OH, USA) and filtered back projection (FBP) methods. MATERIALS AND METHODS We used non-enhanced porcine liver to simulate the human liver and acquired it 100 times to obtain the average FBP value as the ground-truth. The mean and the standard deviation ("inter-scan SD") of the pixel values on the 100 image acquisitions were calculated for FBP and for three levels of IMR (L1, L2, and L3). We also calculated the noise power spectrum (NPS) and the normalized NPS for the 100 image acquisitions. RESULTS The spatial SD for the porcine liver parenchyma on these slices was 9.92, 4.37, 3.63, and 2.30 Hounsfield units with FBP, IMR-L1, IMR-L2, and IMR-L3, respectively. The detectability of small faint features was better on single IMR than single FBP images. The inter-scan SD value for IMR-L3 images was 53% larger at the liver edges than at the liver parenchyma; it was only 10% larger on FBP images. Assessment of the normalized NPS showed that the noise on IMR images was comprised primarily of low-frequency components. CONCLUSION IMR images yield the same structure informations as FBP images and image accuracy is maintained. On level 3 IMR images the image noise is more strongly suppressed than on IMR images of the other levels and on FBP images.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto 862-0976, Japan.
| | - Katsuyuki Taguchi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
| | | | | | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
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Patel AR, Bhave NM, Mor-Avi V. Myocardial perfusion imaging with cardiac computed tomography: state of the art. J Cardiovasc Transl Res 2013; 6:695-707. [PMID: 23963959 DOI: 10.1007/s12265-013-9499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
Cardiac computed tomography (CCT) has become an important tool for the anatomic assessment of patients with suspected coronary disease. Its diagnostic accuracy for detecting the presence of underlying coronary artery disease and ability to risk stratify patients are well documented. However, the role of CCT for the physiologic assessment of myocardial perfusion during resting and stress conditions is only now emerging. With the addition of myocardial perfusion imaging to coronary imaging, CCT has the potential to assess both coronary anatomy and its functional significance with a single non-invasive test. In this review, we discuss the current state of CCT myocardial perfusion imaging for the detection of myocardial ischemia and myocardial infarction and examine its complementary role to CCT coronary imaging.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, Cardiac Imaging Center, University of Chicago, Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA,
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Resting cardiac 64-MDCT does not reliably detect myocardial ischemia identified by radionuclide imaging. AJR Am J Roentgenol 2013; 200:337-42. [PMID: 23345355 DOI: 10.2214/ajr.11.8171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI). MATERIALS AND METHODS We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed. RESULTS Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods. CONCLUSION Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.
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Abstract
Functional imaging in patients with suspected or known coronary artery disease (CAD) is crucial for the identification of patients who could benefit from coronary revascularization. Several studies demonstrated the high diagnostic accuracy of Single-photon-emission computed tomography myocardial perfusion imaging, stress perfusion magnetic resonance imaging, and of invasive FFR measurements for the detection of hemodynamic relevant stenosis. Cardiac computed tomography (CT) used to be limited to coronary angiography (CTA); current guidelines recommend CTA only for the exclusion of CAD. Technological advances now offer the possibility to assess myocardial perfusion by computed tomography (CT-MPI). Though different acquisition protocols and post-processing algorithms still have to be evaluated, initial clinical studies could already show a diagnostic accuracy comparable to the established imaging modalities. Thus, cardiac CT may offer a combined approach of anatomical and functional imaging. Beside the need for further studies, especially on the prognostic value of CT-MPI to stratify future cardiovascular events, the comparatively high radiation exposure and additional administration of contrast agent has to be taken in account.
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Affiliation(s)
- Alexander Becker
- Department of Cardiology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
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Rief M, Stenzel F, Kranz A, Schlattmann P, Dewey M. Time efficiency and diagnostic accuracy of new automated myocardial perfusion analysis software in 320-row CT cardiac imaging. Korean J Radiol 2012; 14:21-9. [PMID: 23323027 PMCID: PMC3542299 DOI: 10.3348/kjr.2013.14.1.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/02/2012] [Indexed: 01/29/2023] Open
Abstract
Objective We aimed to evaluate the time efficiency and diagnostic accuracy of automated myocardial computed tomography perfusion (CTP) image analysis software. Materials and Methods 320-row CTP was performed in 30 patients, and analyses were conducted independently by three different blinded readers by the use of two recent software releases (version 4.6 and novel version 4.71GR001, Toshiba, Tokyo, Japan). Analysis times were compared, and automated epi- and endocardial contour detection was subjectively rated in five categories (excellent, good, fair, poor and very poor). As semi-quantitative perfusion parameters, myocardial attenuation and transmural perfusion ratio (TPR) were calculated for each myocardial segment and agreement was tested by using the intraclass correlation coefficient (ICC). Conventional coronary angiography served as reference standard. Results The analysis time was significantly reduced with the novel automated software version as compared with the former release (Reader 1: 43:08 ± 11:39 min vs. 09:47 ± 04:51 min, Reader 2: 42:07 ± 06:44 min vs. 09:42 ± 02:50 min and Reader 3: 21:38 ± 3:44 min vs. 07:34 ± 02:12 min; p < 0.001 for all). Epi- and endocardial contour detection for the novel software was rated to be significantly better (p < 0.001) than with the former software. ICCs demonstrated strong agreement (≥ 0.75) for myocardial attenuation in 93% and for TPR in 82%. Diagnostic accuracy for the two software versions was not significantly different (p = 0.169) as compared with conventional coronary angiography. Conclusion The novel automated CTP analysis software offers enhanced time efficiency with an improvement by a factor of about four, while maintaining diagnostic accuracy.
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Affiliation(s)
- Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
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Imaging of Myocardial Perfusion and Late Enhancement. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quantitative three-dimensional evaluation of myocardial perfusion during regadenoson stress using multidetector computed tomography. J Comput Assist Tomogr 2012; 36:443-9. [PMID: 22805675 DOI: 10.1097/rct.0b013e31825833a3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The ability of multidetector computed tomography (MDCT) to detect stress-induced myocardial perfusion abnormalities is of great clinical interest as a potential tool for the combined evaluation of coronary stenosis and its hemodynamic significance. We tested the hypothesis that quantitative 3-dimensional (3D) analysis of myocardial perfusion from MDCT images obtained during regadenoson stress would more accurately detect the presence of significant coronary artery disease (CAD) than identical analysis when performed on resting MDCT images. METHODS We prospectively studied 50 consecutive patients referred for CT coronary angiography (CTCA) who agreed to undergo additional imaging with regadenoson (0.4 mg; Astellas). Images were acquired using prospective gating (256-channel; Philips). Custom analysis software was used to define 3D myocardial segments, and calculate for each segment an index of severity and extent of perfusion abnormality, Qh, which was compared with perfusion defects predicted by the presence and severity of coronary stenosis on CTCA. RESULTS Three patients were excluded because of image artifacts. In the remaining 47 patients, CTCA depicted stenosis more than 50% in 23 patients in 37 of 141 coronary arteries. In segments supplied by the obstructed arteries, myocardial attenuation was slightly reduced compared with normally perfused segments at rest (mean [SD], 91 [21] vs 93 [26] Hounsfield units, not significant) and, to a larger extent, at peak stress (102 [21] vs 112 [20] Hounsfield units, P < 0.05). In contrast, index Qh was significantly increased at rest (0.40 [0.48] vs 0.26 [0.41], P < 0.05) and reached a nearly 3-fold difference at peak stress (0.66 [0.74] vs 0.28 [0.51], P < 0.05). The addition of regadenoson improved the diagnosis of CAD, as reflected by an increase in sensitivity (from 0.57 to 0.91) and improvement in accuracy (from 0.65 to 0.77). CONCLUSIONS Quantitative 3D analysis of MDCT images allows objective detection of CAD, the accuracy of which is improved by regadenoson stress.
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Sharma A, Arbab-Zadeh A. Assessment of coronary heart disease by CT angiography: current and evolving applications. J Nucl Cardiol 2012; 19:796-806. [PMID: 22527798 DOI: 10.1007/s12350-012-9556-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Computed tomography angiography (CTA) of the heart is a rapidly evolving application for comprehensive assessment of coronary arterial anatomy, myocardial function, perfusion, and myocardial viability. Thus, cardiac CTA is capable of retrieving the most critical information for guiding the management of patients with suspected coronary heart disease (CHD). Ongoing technologic advancements have allowed acquiring such information within minutes, at radiation doses that are lower than those from conventional computed tomography imaging or common nuclear imaging techniques. Cardiac CTA has positioned itself as an imaging modality that may be well suited to fulfill central needs of cardiovascular medicine. This article reviews the evidence for the clinical utility of cardiac CTA in patients with suspected CHD.
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Affiliation(s)
- Abhishek Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Hulten EA, Bittencourt MS, Ghoshhajra B, Blankstein R. Stress CT perfusion: coupling coronary anatomy with physiology. J Nucl Cardiol 2012; 19:588-600. [PMID: 22456969 DOI: 10.1007/s12350-012-9546-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
While multiple different imaging tests can be used to evaluate patients with known or suspected coronary artery disease (CAD), each of them is designed to evaluate either coronary anatomy or physiology. Recently, it has been recognized that cardiac CT can be used to evaluate stress and rest myocardial perfusion in addition to its capabilities to image the coronary arteries, thus allowing for the simultaneous evaluation of the anatomical burden and physiological significance of CAD in a single exam. In this review, the strengths and the limitations of imaging coronary anatomy and myocardial perfusion will be discussed. Next, key technical aspects of how to perform and interpret CT perfusion imaging will be summarized while providing an update of the most recent data in this emerging field. Finally, future directions and opportunities for further research will be discussed.
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Affiliation(s)
- Edward A Hulten
- Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA
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Mehra VC, Valdiviezo C, Arbab-Zadeh A, Ko BS, Seneviratne SK, Cerci R, Lima JAC, George RT. A stepwise approach to the visual interpretation of CT-based myocardial perfusion. J Cardiovasc Comput Tomogr 2011; 5:357-69. [PMID: 22146495 DOI: 10.1016/j.jcct.2011.10.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/15/2022]
Abstract
Cardiovascular anatomic and functional testing have been longstanding and key components of cardiac risk assessment. As part of that strategy, CT-based imaging has made steady progress, with coronary computed tomography angiography (CTA) now established as the most sensitive noninvasive strategy for assessment of significant coronary artery disease. Myocardial CT perfusion imaging (CTP), as the functional equivalent of coronary CTA, is being tested in currently ongoing multicenter trials and is proposed to enhance the accuracy of coronary CTA alone. However, unlike coronary CTA that has published guidelines for interpretation and is rapidly gaining applicability in the noninvasive risk assessment paradigms, myocardial CTP is rapidly evolving, and guidance on a standard approach to its interpretation is lacking. In this article we describe a practical stepwise approach for interpretation of myocardial CTP that should add to the clinical applicability of this modality. These steps include (1) coronary CTA interpretation for potentially obstructive atherosclerosis, (2) reconstruction and preprocessing of myocardial CTP images, (3) image quality assessment and the identification of potentially confounding artifacts, (4) rest and stress image interpretation for enhancement patterns and areas of hypoattenuation, and (5) correlation of coronary anatomy and myocardial perfusion deficits. This systematic review uses already published methods from multiple clinical studies and is intended for general usage, independent of the platform used for image acquisition.
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