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Pepe A, Crimì F, Vernuccio F, Cabrelle G, Lupi A, Zanon C, Gambato S, Perazzolo A, Quaia E. Medical Radiology: Current Progress. Diagnostics (Basel) 2023; 13:2439. [PMID: 37510183 PMCID: PMC10378672 DOI: 10.3390/diagnostics13142439] [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: 06/12/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Recently, medical radiology has undergone significant improvements in patient management due to advancements in image acquisition by the last generation of machines, data processing, and the integration of artificial intelligence. In this way, cardiovascular imaging is one of the fastest-growing radiological subspecialties. In this study, a compressive review was focused on addressing how and why CT and MR have gained a I class indication in most cardiovascular diseases, and the potential impact of tissue and functional characterization by CT photon counting, quantitative MR mapping, and 4-D flow. Regarding rectal imaging, advances in cancer imaging using diffusion-weighted MRI sequences for identifying residual disease after neoadjuvant chemoradiotherapy and [18F] FDG PET/MRI were provided for high-resolution anatomical and functional data in oncological patients. The results present a large overview of the approach to the imaging of diffuse and focal liver diseases by US elastography, contrast-enhanced US, quantitative MRI, and CT for patient risk stratification. Italy is currently riding the wave of these improvements. The development of large networks will be crucial to create high-quality databases for patient-centered precision medicine using artificial intelligence. Dedicated radiologists with specific training and a close relationship with the referring clinicians will be essential human factors.
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Affiliation(s)
- Alessia Pepe
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Filippo Crimì
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Amalia Lupi
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Chiara Zanon
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Sebastiano Gambato
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Anna Perazzolo
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
- Institute of Radiology, Department of Medicine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, University of Udine, 33100 Udine, Italy
| | - Emilio Quaia
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
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2
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Zhang X, Wang Z, Yun X, Li M, Hu J, Wang C, Wei C. Research on accuracy of material identification based on photon counting spectral CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023:XST230054. [PMID: 37334644 DOI: 10.3233/xst-230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Photon counting spectral CT is a significant direction in the development of CT technology and material identification is an important application of spectral CT. However, spectrum estimation in photon counting spectral CT is highly complex and may affect quantification accuracy of material identification. OBJECTIVE To address the problem of energy spectrum estimation in photon-counting spectral CT, this study investigates empirical material decomposition algorithms to achieve accurate quantitative decomposition of the effective atomic number. METHODS The spectrum is first calibrated using the empirical dual-energy calibration (EDEC) method and the effective atomic number is then quantitatively estimated based on the EDEC method. The accuracy of estimating the effective atomic number of materials under different calibration conditions is investigated by designing different calibration phantoms, and accurate quantitation is achieved using suitable calibration settings. Last, the validity of this method is verified through simulations and experimental studies. RESULTS The results demonstrate that the error in estimating the effective atomic number is reduced to within 4% for low and medium Z materials, thereby enabling accurate material identification. CONCLUSION The empirical dual-energy correction method can solve the problem of energy spectrum estimation in photon counting spectral CT. Accurate effective atomic number estimation can be achieved with suitable calibration.
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Affiliation(s)
- Xiaomei Zhang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhe Wang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- Jinan Laboratory of Applied Nuclear Science, Jinan, China
| | - Xiangyu Yun
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Mohan Li
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- Jinan Laboratory of Applied Nuclear Science, Jinan, China
| | - Jinming Hu
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Chengmin Wang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Cunfeng Wei
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
- Jinan Laboratory of Applied Nuclear Science, Jinan, China
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3
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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4
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Boccalini S, Si-Mohamed S, Matzuzzi M, Tillier M, Rotzinger DC, Revel D, Boussel L, Douek P. Effect of contrast material injection protocol on first-pass myocardial perfusion assessed by dual-energy dual-layer computed tomography. Quant Imaging Med Surg 2022; 12:3903-3916. [PMID: 35782242 PMCID: PMC9246727 DOI: 10.21037/qims-21-809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/09/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND Dual-energy dual-layer computed tomography (CT) scanners can provide useful tools, such as iodine maps and virtual monochromatic images (VMI), for the evaluation of myocardial perfusion defects. Data about the influence of acquisition protocols and normal values are still lacking. METHODS Clinically indicated coronary CT-angiographies performed between January-October 2018 in a single university hospital with dual-energy dual-layer CT (DE-DLCT) and different injection protocols were retrospectively evaluated. The two protocols were: 35 mL in patients <80 kg and 0.5 mL/kg in patients >80 kg at 2.5 mL/s (group A) or double contrast dose at 5 mL/s (group B). Patients with coronary stenosis >50% were excluded. Regions of interest were manually drawn on 16 myocardial segments and iodine concentration was measured in mg/mL. Signal-to-noise, contrast-to-noise ratios (CNR) and image noise were measured on conventional images and VMI. RESULTS A total of 30 patients were included for each protocol. With iodine concentrations of 1.38±0.41 mg/mL for protocol A and 2.07±0.73 mg/mL for protocol B, the two groups were significantly different (P<0.001). No significant iodine concentration differences were found between the 16 segments (P=0.47 and P=0.09 for group A and B respectively), between basal, mid and apical segments for group A and B (P=0.28 and P=0.12 for group A and B respectively) and between wall regions for group A (P=0.06 on normalised data). In group B, iodine concentration was significantly different between three wall regions [highest values for the lateral wall, median =2.03 (1.06) mg/mL]. Post-hoc analysis showed highest contrast-to-noise and signal-to-noise in VMI at 40 eV (P<0.05). CONCLUSIONS Iodine concentration in left ventricular myocardium of patients without significant coronary artery stenosis varied depending on the injection protocol and appeared more heterogeneous in different wall regions at faster injection rate and greater iodine load. Signal-to-noise and contrast-to-noise gradually improved when decreasing VMI energy, although at the expenses of higher noise, demonstrating the potential of DE-DLCT to enhance objective image quality.
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Affiliation(s)
- Sara Boccalini
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- Univerisity Claude Bernard Lyon 1, Lyon, France
| | - Salim Si-Mohamed
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Maxime Matzuzzi
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - Manon Tillier
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - David C. Rotzinger
- Department of Radiology, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Didier Revel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Loic Boussel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Philippe Douek
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
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Tarkowski P, Czekajska-Chehab E. Dual-Energy Heart CT: Beyond Better Angiography-Review. J Clin Med 2021; 10:jcm10215193. [PMID: 34768713 PMCID: PMC8584316 DOI: 10.3390/jcm10215193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/30/2022] Open
Abstract
Heart CT has undergone substantial development from the use of calcium scores performed on electron beam CT to modern 256+-row CT scanners. The latest big step in its evolution was the invention of dual-energy scanners with much greater capabilities than just performing better ECG-gated angio-CT. In this review, we present the unique features of dual-energy CT in heart diagnostics.
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6
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Zhang L, Li L, Feng G, Fan T, Jiang H, Wang Z. Advances in CT Techniques in Vascular Calcification. Front Cardiovasc Med 2021; 8:716822. [PMID: 34660718 PMCID: PMC8511450 DOI: 10.3389/fcvm.2021.716822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular calcification, a common pathological phenomenon in atherosclerosis, diabetes, hypertension, and other diseases, increases the incidence and mortality of cardiovascular diseases. Therefore, the prevention and detection of vascular calcification play an important role. At present, various techniques have been applied to the analysis of vascular calcification, but clinical examination mainly depends on non-invasive and invasive imaging methods to detect and quantify. Computed tomography (CT), as a commonly used clinical examination method, can analyze vascular calcification. In recent years, with the development of technology, in addition to traditional CT, some emerging types of CT, such as dual-energy CT and micro CT, have emerged for vascular imaging and providing anatomical information for calcification. This review focuses on the latest application of various CT techniques in vascular calcification.
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Affiliation(s)
- Lijie Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Tingpan Fan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Han Jiang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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7
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Ruiz-Muñoz A, Valente F, Dux-Santoy L, Guala A, Teixidó-Turà G, Galián-Gay L, Gutiérrez L, Fernández-Galera R, Casas G, González-Alujas T, Ferreira-González I, Evangelista A, Rodríguez-Palomares J. Diagnostic value of quantitative parameters for myocardial perfusion assessment in patients with suspected coronary artery disease by single- and dual-energy computed tomography myocardial perfusion imaging. IJC HEART & VASCULATURE 2021; 32:100721. [PMID: 33604450 PMCID: PMC7873634 DOI: 10.1016/j.ijcha.2021.100721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 12/01/2022]
Abstract
Purpose To compare performance of visual and quantitative analyses for detecting myocardial ischaemia from single- and dual-energy computed tomography (CT) in patients with suspected coronary artery disease (CAD). Methods Eighty-four patients with suspected CAD were scheduled for dual-energy cardiac CT at rest (CTA) and pharmacological stress (CTP). Myocardial CT perfusion was analysed visually and using three parameters: mean attenuation density (MA), transmural perfusion ratio (TPR) and myocardial perfusion reserve index (MPRI), on both single-energy CT and CT-based iodine images. Significant CAD was defined in AHA-segments by concomitant myocardial hypoperfusion identified visually or quantitatively (parameter < threshold) and coronary stenosis detected by CTA. Single-photon emission CT and invasive coronary angiography were used as reference. Perfusion-parameter cut-off values were calculated in a randomly-selected subgroup of 30 patients. Results The best-performing thresholds for TPR, MPRI and MA were 0.96, 23 and 0.5 for single-energy CT and 0.97, 47 and 0.3 for iodine imaging. For both CT-imaging modalities, TPR yielded the highest area under receiver operating characteristic curve (AUC) (0.99 and 0.97 for single-energy CT and iodine imaging, respectively, in vessel-based analysis) compared to visual analysis, MA and MPRI. Visual interpretation on iodine imaging resulted in higher AUC compared to that on single-energy CT in per-vessel (AUC: 0.93 vs 0.86, respectively) and per-patient (0.94 vs 0.93) analyses. Conclusion Transmural perfusion ratio on both CT-imaging modalities is the best-performing parameter for detecting myocardial ischaemia compared to visual method and other perfusion parameters. Visual analysis on CT-based iodine imaging outperforms that on single-energy CT.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Filipa Valente
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lydia Dux-Santoy
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Galián-Gay
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Gutiérrez
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rubén Fernández-Galera
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Guillem Casas
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa González-Alujas
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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8
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Kay FU. Dual-energy CT and coronary imaging. Cardiovasc Diagn Ther 2020; 10:1090-1107. [PMID: 32968662 PMCID: PMC7487394 DOI: 10.21037/cdt.2020.04.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy computed tomography has been proposed for enhancing the evaluation of coronary artery disease in many fronts. However, the clinical translation of such applications has followed a slower pace of clinical translation. This paper will review the evidence supporting the use of dual-energy computed tomography in coronary artery disease (CAD) and provide some practical illustrations, while underscoring the challenges and gaps in knowledge that have contributed to this phenomenon.
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Affiliation(s)
- Fernando Uliana Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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9
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Han D, Shah S, Lee JH, Elmore K, Gransar H, Danad I, Kumar V, Raman S, Hartaigh BÓ, Dunham S, Lin FY, Min JK. An approach to evaluate myocardial perfusion defect assessment for projection-based DECT: A phantom study. Clin Imaging 2020; 63:10-15. [DOI: 10.1016/j.clinimag.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
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10
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McCollough CH, Boedeker K, Cody D, Duan X, Flohr T, Halliburton SS, Hsieh J, Layman RR, Pelc NJ. Principles and applications of multienergy CT: Report of AAPM Task Group 291. Med Phys 2020; 47:e881-e912. [DOI: 10.1002/mp.14157] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Kirsten Boedeker
- Canon (formerly Toshiba) Medical Systems Corporation 1440 Warnall Ave Los Angeles CA 90024 USA
| | - Dianna Cody
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Xinhui Duan
- Southwestern Medical Center University of Texas 5323 Harry Hines Blvd Dallas TX 75390‐9071 USA
| | - Thomas Flohr
- Siemens Healthcare GmbH Siemensstr. 3 Forchheim BY 91031 Germany
| | | | - Jiang Hsieh
- GE Healthcare Technologies 3000 N. Grandview Blvd. W-1190 Waukesha WI 53188 USA
| | - Rick R. Layman
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Norbert J. Pelc
- Stanford University 443 Via Ortega, Room 203 Stanford CA 94305‐4125 USA
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11
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Singh A, Mor-Avi V, Patel AR. The role of computed tomography myocardial perfusion imaging in clinical practice. J Cardiovasc Comput Tomogr 2020; 14:185-194. [DOI: 10.1016/j.jcct.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
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12
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Taron J, Foldyna B, Eslami P, Hoffmann U, Nikolaou K, Bamberg F. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. ROFO-FORTSCHR RONTG 2019; 191:817-826. [PMID: 31250415 PMCID: PMC6839890 DOI: 10.1055/a-0924-5883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rapid improvement of scanner and postprocessing technology as well as the introduction of minimally invasive procedures requiring preoperative imaging have led to the broad utilization of cardiac computed tomography (CT) beyond coronary CT angiography (CTA). METHOD This review article presents an overview of recent literature on cardiac CT. The goal is to summarize the current guidelines on performing cardiac CT and to list established as well as emerging techniques with a special focus on extracoronary applications. RESULTS AND CONCLUSION Most recent guidelines for the appropriate use of cardiac CT include the evaluation of coronary artery disease, cardiac morphology, intra- and extracardiac structures, and functional and structural assessment of the myocardium under certain conditions. Besides coronary CTA, novel applications such as the calculation of a CT-derived fractional flow reserve (CT-FFR), assessment of myocardial function and perfusion imaging, as well as pre-interventional planning in valvular heart disease or prior pulmonary vein ablation in atrial fibrillation are becoming increasingly important. Especially these extracoronary applications are of growing interest in the field of cardiac CT and are expected to be gradually implemented in the daily clinical routine. KEY POINTS · Coronary artery imaging remains the main indication for cardiac CT. · Novel computational fluid dynamics allow the calculation of a CT-derived fractional flow reserve in patients with known or suspected coronary artery disease. · Cardiac CT delivers information on left ventricular volume as well as myocardial function and perfusion. · CT is the cardinal element for pre-interventional planning in transcatheter valve implantation and pulmonary vein isolation. CITATION FORMAT · Taron J, Foldyna B, Eslami P et al. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. Fortschr Röntgenstr 2019; 191: 817 - 826.
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Affiliation(s)
- Jana Taron
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Borek Foldyna
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Parastou Eslami
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Scholtz JE, Hedgire S, Ghoshhajra BB. Technical Aspects, Interpretation, and Body of Evidence for Coronary Computed Tomography Angiography. Radiol Clin North Am 2019; 57:13-23. [DOI: 10.1016/j.rcl.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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So A, Wisenberg G, Teefy P, Yadegari A, Bagur R, Hadway J, Morrison L, MacDonald A, Gaskin D, Butler J, Biernaski H, Skanes S, Park SD, Islam A, Hsieh J, Lee TY. Functional CT assessment of extravascular contrast distribution volume and myocardial perfusion in acute myocardial infarction. Int J Cardiol 2018; 266:15-23. [DOI: 10.1016/j.ijcard.2018.02.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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15
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Danad I, Cho I, Elmore K, Schulman-Marcus J, ó Hartaigh B, Stuijfzand WJ, Carrascosa P, Min JK. Comparative diagnostic accuracy of dual-energy CT myocardial perfusion imaging by monochromatic energy versus material decomposition methods. Clin Imaging 2018; 50:1-4. [DOI: 10.1016/j.clinimag.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/12/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022]
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Ramsey BC, Fentanes E, Choi AD, Branch KR, Thomas DM. Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11:16. [PMID: 29963220 PMCID: PMC5984644 DOI: 10.1007/s12410-018-9456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states. RECENT FINDINGS CCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics. SUMMARY CTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.
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Affiliation(s)
- Bryan C. Ramsey
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
| | - Emilio Fentanes
- Cardiology Division, Department of Medicine, Tripler Army Medical Center, Honolulu, HI USA
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC USA
| | | | - Dustin M. Thomas
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
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Albrecht MH, De Cecco CN, Schoepf UJ, Spandorfer A, Eid M, De Santis D, Varga-Szemes A, van Assen M, von Knebel-Doeberitz PL, Tesche C, Puntmann VO, Nagel E, Vogl TJ, Nance JW. Dual-energy CT of the heart current and future status. Eur J Radiol 2018; 105:110-118. [PMID: 30017266 DOI: 10.1016/j.ejrad.2018.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
Several applications utilizing dual-energy cardiac CT (DECT) have recently transitioned from the realm of research into clinical workflows. DECT acquisition techniques and subsequent post-processing can provide improved qualitative analysis, allow quantitative imaging, and have the potential to decrease requisite radiation and contrast material doses. Additionally, several experimental DECT techniques are pending further investigation and may improve the diagnostic accuracy of cardiac CT and/or provide evaluation of emerging imaging biomarkers in the future. This review article will summarize the major applications utilizing DECT in diagnosis of cardiovascular disease, including both the clinically used and investigational techniques examined to date.
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Affiliation(s)
- Moritz H Albrecht
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany.
| | - Carlo N De Cecco
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - U Joseph Schoepf
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Adam Spandorfer
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Marwen Eid
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Domenico De Santis
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University of Rome "Sapienza", Department of Radiological Sciences, Oncological and Pathological Sciences, Latina, Italy.
| | - Akos Varga-Szemes
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Marly van Assen
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University Medical Center Groningen, Center for Medical Imaging, Department of Radiology, Groningen, The Netherlands.
| | - Philipp L von Knebel-Doeberitz
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Christian Tesche
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich, Germany.
| | - Valentina O Puntmann
- University Hospital Frankfurt, Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.
| | - Eike Nagel
- University Hospital Frankfurt, Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.
| | - Thomas J Vogl
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany.
| | - John W Nance
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
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Zhao XM, Wang M, Wu RZ, Dharaiya E, Feng F, Li ML, You H, Wang Y, Wang YN, Jin ZY. Dual-layer spectral detector CT monoenergetic reconstruction improves image quality of non-contrast cerebral CT as compared with conventional single energy CT. Eur J Radiol 2018; 103:131-138. [PMID: 29803379 DOI: 10.1016/j.ejrad.2018.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate and compare image quality of monoenergetic reconstructions from spectral NCCT to conventional 120 kVp images acquired at a similar dose. MATERIALS AND METHODS Patients undergoing NCCT on a dual-layer spectral detector CT (n = 30) and a conventional CT (n = 30) were enrolled in the study. The spectral detector CT data was reconstructed at monoenergetic images from 40 to 140 keV in 5-keV increments and 65-70 keV in 1-keV increments (Group A1) and using single energy CT equivalent reconstruction (Group A2). The reference conventional 120kVp images (Group B) were acquired using a standard-of-care protocol with the same radiation dose. We evaluated the image quality of monoenergetic images and determined the optimal keV level using HU attenuation, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), artifact evaluation in posterior fossa by placing region-of-interest (ROI) and subjective image score by 2 radiologists independently using a 4-point scale (1-excellent, 4-undiagnostic). RESULTS The SNR and subjective image score were optimal at 66-70keV, while monoenergetic 68 keV images with a higher SNR (18.48 ± 1.94, 15.55 ± 1.56 and 14.33 ± 1.38 for Group 68keV, A2 and B respectively, p < 0.001), CNR (4.09 ± 0.65, 3.43 ± 0.56 and 3.52 ± 0.55 for Group 68keV, A2 and B respectively, p < 0.001) and a lower noise (1.80 ± 0.19, 2.11 ± 0.19 and 2.25 ± 0.25 for Group 68keV, A2 and B respectively, p < 0.001). CONCLUSION Spectral NCCT monoenergetic reconstructions at 68 keV improve image quality and reduce artifact compared to conventional single energy CT without radiation dose penalty.
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Affiliation(s)
- Xue-Mei Zhao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Man Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Run-Ze Wu
- Clinical Science, Philips Healthcare, China
| | | | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Ozguner O, Dhanantwari A, Halliburton S, Wen G, Utrup S, Jordan D. Objective image characterization of a spectral CT scanner with dual-layer detector. Phys Med Biol 2018; 63:025027. [PMID: 29185436 DOI: 10.1088/1361-6560/aa9e1b] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This work evaluated the performance of a detector-based spectral CT system by obtaining objective reference data, evaluating attenuation response of iodine and accuracy of iodine quantification, and comparing conventional CT and virtual monoenergetic images in three common phantoms. Scanning was performed using the hospital's clinical adult body protocol. Modulation transfer function (MTF) was calculated for a tungsten wire and visual line pair targets were evaluated. Image noise power spectrum (NPS) and pixel standard deviation were calculated. MTF for monoenergetic images agreed with conventional images within 0.05 lp cm-1. NPS curves indicated that noise texture of 70 keV monoenergetic images is similar to conventional images. Standard deviation measurements showed monoenergetic images have lower noise except at 40 keV. Mean CT number and CNR agreed with conventional images at 75 keV. Measured iodine concentration agreed with true concentration within 6% for inserts at the center of the phantom. Performance of monoenergetic images at detector based spectral CT is the same as, or better than, that of conventional images. Spectral acquisition and reconstruction with a detector based platform represents the physical behaviour of iodine as expected and accurately quantifies the material concentration.
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Affiliation(s)
- Orhan Ozguner
- Computer Science, Case Western Reserve University, Cleveland, OH 44106, United States of America. Philips Healthcare, Cleveland, OH 44143, United States of America
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Cardiac Dual-Energy CT Applications and Clinical Impact. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Patrick JC, Terry Thompson R, So A, Butler J, Faul D, Stodilka RZ, Yartsev S, Prato FS, Gaede S. Technical Note: Comparison of megavoltage, dual-energy, and single-energy CT-based μ-maps for a four-channel breast coil in PET/MRI. Med Phys 2017. [PMID: 28622420 DOI: 10.1002/mp.12407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The purpose of this study was to describe and evaluate methods for calculating a megavoltage computed tomography (MVCT)-derived MR hardware attenuation map (μ-map) and dual-energy CT (DECT) for 511 keV photons. METHODS Phantom measurements were acquired on a whole-body hybrid PET/MRI system, using a four-channel receive-only MR radiofrequency (RF) breast coil. Two acquisitions were performed: with the phantoms positioned in the four-channel RF breast coil, and without the breast coil. PET attenuation from the breast coil was corrected using three different CT-derived hardware μ-maps: (a) Single-energy CT (SECT), (b) DECT, and (c) MVCT. Each attenuation-corrected (AC) PET volume was evaluated and compared with the acquisition performed without the breast coil. RESULTS The breast coil attenuated PET photons by 10% overall. Threshold values were applied to the SECT μ-map to reduce the effects of metal artifacts, but overcorrection occurred in more highly attenuated regions. The DECT-derived virtual monochromatic image reduced beam-hardening artifacts, but other metal artifacts remained. Despite the remaining metal artifacts in the DECT image, it led to an improvement in the more attenuated regions. The MVCT images appear to be free from metal artifacts leading to an artifact-free μ-map and a further improvement AC-PET images. CONCLUSIONS Our MVCT-based approach for creating μ-maps for MR RF coils greatly reduces artifacts produced by metal in a SECT approach. This eliminates the need for other artifact reduction methods, including the application of a threshold of narrow beam attenuation coefficients, or disassembling hardware to remove high-Z components before imaging with a kilovoltage source.
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Affiliation(s)
- John C Patrick
- London Regional Cancer Program, Physics and Engineering Dept., London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - R Terry Thompson
- Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Aaron So
- Lawson Health Research Institute, London, ON, Canada.,Imaging Laboratories, Robarts Research Institute, London, ON, Canada
| | - John Butler
- Lawson Health Research Institute, London, ON, Canada
| | | | - Robert Z Stodilka
- Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Slav Yartsev
- London Regional Cancer Program, Physics and Engineering Dept., London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Frank S Prato
- Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Stewart Gaede
- London Regional Cancer Program, Physics and Engineering Dept., London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
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22
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So A, Imai Y, Nett B, Jackson J, Nett L, Hsieh J, Wisenberg G, Teefy P, Yadegari A, Islam A, Lee TY. Technical Note: Evaluation of a 160-mm/256-row CT scanner for whole-heart quantitative myocardial perfusion imaging. Med Phys 2017; 43:4821. [PMID: 27487900 DOI: 10.1118/1.4957389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The authors investigated the performance of a recently introduced 160-mm/256-row CT system for low dose quantitative myocardial perfusion (MP) imaging of the whole heart. This platform is equipped with a gantry capable of rotating at 280 ms per full cycle, a second generation of adaptive statistical iterative reconstruction (ASiR-V) to correct for image noise arising from low tube voltage potential/tube current dynamic scanning, and image reconstruction algorithms to tackle beam-hardening, cone-beam, and partial-scan effects. METHODS Phantom studies were performed to investigate the effectiveness of image noise and artifact reduction with a GE Healthcare Revolution CT system for three acquisition protocols used in quantitative CT MP imaging: 100, 120, and 140 kVp/25 mAs. The heart chambers of an anthropomorphic chest phantom were filled with iodinated contrast solution at different concentrations (contrast levels) to simulate the circulation of contrast through the heart in quantitative CT MP imaging. To evaluate beam-hardening correction, the phantom was scanned at each contrast level to measure the changes in CT number (in Hounsfield unit or HU) in the water-filled region surrounding the heart chambers with respect to baseline. To evaluate cone-beam artifact correction, differences in mean water HU between the central and peripheral slices were compared. Partial-scan artifact correction was evaluated from the fluctuation of mean water HU in successive partial scans. To evaluate image noise reduction, a small hollow region adjacent to the heart chambers was filled with diluted contrast, and contrast-to-noise ratio in the region before and after noise correction with ASiR-V was compared. The quality of MP maps acquired with the CT system was also evaluated in porcine CT MP studies. Myocardial infarct was induced in a farm pig from a transient occlusion of the distal left anterior descending (LAD) artery with a catheter-based interventional procedure. MP maps were generated from the dynamic contrast-enhanced (DCE) heart images taken at baseline and three weeks after the ischemic insult. RESULTS Their results showed that the phantom and animal images acquired with the CT platform were minimally affected by image noise and artifacts. For the beam-hardening phantom study, changes in water HU in the wall surrounding the heart chambers greatly reduced from >±30 to ≤ ± 5 HU at all kVp settings except one region at 100 kVp (7 HU). For the cone-beam phantom study, differences in mean water HU from the central slice were less than 5 HU at two peripheral slices with each 4 cm away from the central slice. These findings were reproducible in the pig DCE images at two peripheral slices that were 6 cm away from the central slice. For the partial-scan phantom study, standard deviations of the mean water HU in 10 successive partial scans were less than 5 HU at the central slice. Similar observations were made in the pig DCE images at two peripheral slices with each 6 cm away from the central slice. For the image noise phantom study, CNRs in the ASiR-V images were statistically higher (p < 0.05) than the non-ASiR-V images at all kVp settings. MP maps generated from the porcine DCE images were in excellent quality, with the ischemia in the LAD territory clearly seen in the three orthogonal views. CONCLUSIONS The study demonstrates that this CT system can provide accurate and reproducible CT numbers during cardiac gated acquisitions across a wide axial field of view. This CT number fidelity will enable this imaging tool to assess contrast enhancement, potentially providing valuable added information beyond anatomic evaluation of coronary stenoses. Furthermore, their results collectively suggested that the 100 kVp/25 mAs protocol run on this CT system provides sufficient image accuracy at a low radiation dose (<3 mSv) for whole-heart quantitative CT MP imaging.
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Affiliation(s)
- Aaron So
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
| | - Yasuhiro Imai
- CT Engineering, GE Healthcare, Waukesha, Wisconsin 53188
| | - Brian Nett
- CT Engineering, GE Healthcare, Waukesha, Wisconsin 53188
| | - John Jackson
- CT Engineering, GE Healthcare, Waukesha, Wisconsin 53188
| | - Liz Nett
- CT Engineering, GE Healthcare, Waukesha, Wisconsin 53188
| | - Jiang Hsieh
- CT Engineering, GE Healthcare, Waukesha, Wisconsin 53188
| | - Gerald Wisenberg
- Cardiology, University Hospital, London Health Sciences Centre, London, Ontario N6A 5A5, Canada
| | - Patrick Teefy
- Cardiology, University Hospital, London Health Sciences Centre, London, Ontario N6A 5A5, Canada
| | - Andrew Yadegari
- Cardiology, University Hospital, London Health Sciences Centre, London, Ontario N6A 5A5, Canada
| | - Ali Islam
- Radiology, St. Joseph's Hospital London, Ontario N6A 4V2, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada and Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8, Canada
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Accuracy of iodine quantification using dual energy CT in latest generation dual source and dual layer CT. Eur Radiol 2017; 27:3904-3912. [PMID: 28168368 PMCID: PMC5544802 DOI: 10.1007/s00330-017-4752-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/18/2016] [Accepted: 01/17/2017] [Indexed: 01/22/2023]
Abstract
Objective To determine the accuracy of iodine quantification with dual energy computed tomography (DECT) in two high-end CT systems with different spectral imaging techniques. Methods Five tubes with different iodine concentrations (0, 5, 10, 15, 20 mg/ml) were analysed in an anthropomorphic thoracic phantom. Adding two phantom rings simulated increased patient size. For third-generation dual source CT (DSCT), tube voltage combinations of 150Sn and 70, 80, 90, 100 kVp were analysed. For dual layer CT (DLCT), 120 and 140 kVp were used. Scans were repeated three times. Median normalized values and interquartile ranges (IQRs) were calculated for all kVp settings and phantom sizes. Results Correlation between measured and known iodine concentrations was excellent for both systems (R = 0.999–1.000, p < 0.0001). For DSCT, median measurement errors ranged from −0.5% (IQR −2.0, 2.0%) at 150Sn/70 kVp and −2.3% (IQR −4.0, −0.1%) at 150Sn/80 kVp to −4.0% (IQR −6.0, −2.8%) at 150Sn/90 kVp. For DLCT, median measurement errors ranged from −3.3% (IQR −4.9, −1.5%) at 140 kVp to −4.6% (IQR −6.0, −3.6%) at 120 kVp. Larger phantom sizes increased variability of iodine measurements (p < 0.05). Conclusion Iodine concentration can be accurately quantified with state-of-the-art DECT systems from two vendors. The lowest absolute errors were found for DSCT using the 150Sn/70 kVp or 150Sn/80 kVp combinations, which was slightly more accurate than 140 kVp in DLCT. Key Points • High-end CT scanners allow accurate iodine quantification using different DECT techniques. • Lowest measurement error was found in scans with largest photon energy separation. • Dual-source CT quantified iodine slightly more accurately than dual layer CT.
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van Hamersvelt RW, Willemink MJ, de Jong PA, Milles J, Vlassenbroek A, Schilham AMR, Leiner T. Feasibility and accuracy of dual-layer spectral detector computed tomography for quantification of gadolinium: a phantom study. Eur Radiol 2017; 27:3677-3686. [PMID: 28124106 PMCID: PMC5544796 DOI: 10.1007/s00330-017-4737-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/24/2023]
Abstract
Objectives The aim of this study was to evaluate the feasibility and accuracy of dual-layer spectral detector CT (SDCT) for the quantification of clinically encountered gadolinium concentrations. Methods The cardiac chamber of an anthropomorphic thoracic phantom was equipped with 14 tubular inserts containing different gadolinium concentrations, ranging from 0 to 26.3 mg/mL (0.0, 0.1, 0.2, 0.4, 0.5, 1.0, 2.0, 3.0, 4.0, 5.1, 10.6, 15.7, 20.7 and 26.3 mg/mL). Images were acquired using a novel 64-detector row SDCT system at 120 and 140 kVp. Acquisitions were repeated five times to assess reproducibility. Regions of interest (ROIs) were drawn on three slices per insert. A spectral plot was extracted for every ROI and mean attenuation profiles were fitted to known attenuation profiles of water and pure gadolinium using in-house-developed software to calculate gadolinium concentrations. Results At both 120 and 140 kVp, excellent correlations between scan repetitions and true and measured gadolinium concentrations were found (R > 0.99, P < 0.001; ICCs > 0.99, CI 0.99–1.00). Relative mean measurement errors stayed below 10% down to 2.0 mg/mL true gadolinium concentration at 120 kVp and below 5% down to 1.0 mg/mL true gadolinium concentration at 140 kVp. Conclusion SDCT allows for accurate quantification of gadolinium at both 120 and 140 kVp. Lowest measurement errors were found for 140 kVp acquisitions. Key Points • Gadolinium quantification may be useful in patients with contraindication to iodine. • Dual-layer spectral detector CT allows for overall accurate quantification of gadolinium. • Interscan variability of gadolinium quantification using SDCT material decomposition is excellent.
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Affiliation(s)
- Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Martin J Willemink
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Julien Milles
- CT Clinical Science, Philips HealthCare, Best, The Netherlands
| | | | - Arnold M R Schilham
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury. J Comput Assist Tomogr 2017; 41:354-359. [DOI: 10.1097/rct.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Computed tomography (CT) coronary angiography is a well-validated non-invasive technique for accurate and expedient diagnosis of coronary artery disease (CAD). However, a limitation of coronary CT angiography (CCTA) is its limited capability to identify physiologically significant stenoses, which may eventuate the need for further functional testing. Stress CT myocardial perfusion imaging (CT-MPI) is an emerging technique that has the ability to identify flow-limiting stenoses. RECENT FINDINGS The combination of CCTA coronary and CT-MPI has transformed the modality from a tool to assess anatomy and morphology to a modality capable of simultaneous assessment of coronary stenoses and their physiologic significance. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CT-MPI in comparison to a number of reference standard modalities for CAD diagnosis, including single-photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve testing. SUMMARY While there is still a need for consensus regarding acquisition techniques as well as analysis and interpretation of CT-MPI, with further validation, it is likely to become a powerful adjunctive tool to CCTA in the management of patients with suspected coronary disease.
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Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
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Fahmi R, Eck BL, Levi J, Fares A, Dhanantwari A, Vembar M, Bezerra HG, Wilson DL. Quantitative myocardial perfusion imaging in a porcine ischemia model using a prototype spectral detector CT system. Phys Med Biol 2016; 61:2407-31. [PMID: 26943749 PMCID: PMC6953388 DOI: 10.1088/0031-9155/61/6/2407] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We optimized and evaluated dynamic myocardial CT perfusion (CTP) imaging on a prototype spectral detector CT (SDCT) scanner. Simultaneous acquisition of energy sensitive projections on the SDCT system enabled projection-based material decomposition, which typically performs better than image-based decomposition required by some other system designs. In addition to virtual monoenergetic, or keV images, the SDCT provided conventional (kVp) images, allowing us to compare and contrast results. Physical phantom measurements demonstrated linearity of keV images, a requirement for quantitative perfusion. Comparisons of kVp to keV images demonstrated very significant reductions in tell-tale beam hardening (BH) artifacts in both phantom and pig images. In phantom images, consideration of iodine contrast to noise ratio and small residual BH artifacts suggested optimum processing at 70 keV. The processing pipeline for dynamic CTP measurements included 4D image registration, spatio-temporal noise filtering, and model-independent singular value decomposition deconvolution, automatically regularized using the L-curve criterion. In normal pig CTP, 70 keV perfusion estimates were homogeneous throughout the myocardium. At 120 kVp, flow was reduced by more than 20% on the BH-hypo-enhanced myocardium, a range that might falsely indicate actionable ischemia, considering the 0.8 threshold for actionable FFR. With partial occlusion of the left anterior descending (LAD) artery (FFR < 0.8), perfusion defects at 70 keV were correctly identified in the LAD territory. At 120 kVp, BH affected the size and flow in the ischemic area; e.g. with FFR ≈ 0.65, the anterior-to-lateral flow ratio was 0.29 ± 0.01, over-estimating stenosis severity as compared to 0.42 ± 0.01 (p < 0.05) at 70 keV. On the non-ischemic inferior wall (not a LAD territory), the flow ratio was 0.50 ± 0.04 falsely indicating an actionable ischemic condition in a healthy territory. This ratio was 1.00 ± 0.08 at 70 keV. Results suggest that projection-based keV imaging with the SDCT system and proper processing could enable useful myocardial CTP, much improved over conventional CT.
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Affiliation(s)
- Rachid Fahmi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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Danad I, Fayad ZA, Willemink MJ, Min JK. New Applications of Cardiac Computed Tomography: Dual-Energy, Spectral, and Molecular CT Imaging. JACC Cardiovasc Imaging 2016; 8:710-23. [PMID: 26068288 DOI: 10.1016/j.jcmg.2015.03.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 01/16/2023]
Abstract
Computed tomography (CT) has evolved into a powerful diagnostic tool, and it is impossible to imagine current clinical practice without CT imaging. Because of its widespread availability, ease of clinical application, superb sensitivity for the detection of coronary artery disease, and noninvasive nature, CT has become a valuable tool within the armamentarium of cardiologists. In the past few years, numerous technological advances in CT have occurred, including dual-energy CT, spectral CT, and CT-based molecular imaging. By harnessing the advances in technology, cardiac CT has advanced beyond the mere evaluation of coronary stenosis to an imaging tool that permits accurate plaque characterization, assessment of myocardial perfusion, and even probing of molecular processes that are involved in coronary atherosclerosis. Novel innovations in CT contrast agents and pre-clinical spectral CT devices have paved the way for CT-based molecular imaging.
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Affiliation(s)
- Ibrahim Danad
- Department of Radiology, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin J Willemink
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - James K Min
- Department of Radiology, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York.
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Halliburton SS, Rajiah P. Cardiac CT Scanner Technology: What Is New and What Is Next? CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9370-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 2. J Comput Assist Tomogr 2016; 40:846-850. [DOI: 10.1097/rct.0000000000000539] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Danad I, Ó Hartaigh B, Min JK. Dual-energy computed tomography for detection of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:1345-56. [PMID: 26549789 DOI: 10.1586/14779072.2015.1102055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent technological advances in computed tomography (CT) technology have fulfilled the prerequisites for the cardiac application of dual-energy CT (DECT) imaging. By exploiting the unique characteristics of materials when exposed to two different x-ray energies, DECT holds great promise for the diagnosis and management of coronary artery disease. It allows for the assessment of myocardial perfusion to discern the hemodynamic significance of coronary disease and possesses high accuracy for the detection and characterization of coronary plaques, while facilitating reductions in radiation dose. As such, DECT enabled cardiac CT to advance beyond the mere detection of coronary stenosis expanding its role in the evaluation and management of coronary atherosclerosis.
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Affiliation(s)
- Ibrahim Danad
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
| | - Bríain Ó Hartaigh
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
| | - James K Min
- a Department of Radiology, Weill Cornell Medical College , Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital , New York , NY , USA
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Coronary computed tomography angiography for the assessment of chest pain: current status and future directions. Int J Cardiovasc Imaging 2015; 31 Suppl 2:125-43. [DOI: 10.1007/s10554-015-0698-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 02/02/2023]
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Carrascosa PM, Deviggiano A, Capunay C, Campisi R, de Munain ML, Vallejos J, Tajer C, Rodriguez-Granillo GA. Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease. Eur J Radiol 2015; 84:637-42. [DOI: 10.1016/j.ejrad.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/04/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
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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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Rajiah P, Halliburton SS. Dual Energy Imaging in Cardiovascular CT: Current Status and Impact on Radiation, Contrast and Accuracy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9289-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress Myocardial Perfusion: Imaging with Multidetector CT. Radiology 2014; 270:25-46. [DOI: 10.1148/radiol.13112739] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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39
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Abstract
Coronary artery disease (CAD) remains the leading cause of death and morbidity worldwide. To date, diagnostic evaluation of patients with suspected CAD has relied upon the use of physiologic non-invasive testing by stress electrocardiography, echocardiography, myocardial perfusion imaging (MPI) and magnetic resonance imaging. Indeed, the importance of physiologic evaluation of CAD has been highlighted by large-scale randomized trials that demonstrate the propitious benefit of an integrated anatomic-physiologic evaluation method by performing lesion-specific ischemia assessment by fractional flow reserve (FFR)-widely considered the "gold" standard for ischemia assessment-at the time of invasive angiography. Coronary CT angiography (CCTA) has emerged as an attractive non-invasive test for anatomic illustration of the coronary arteries and atherosclerotic plaque. In a series of prospective multicenter trials, CCTA has been proven as having high diagnostic performance for stenosis detection as compared to invasive angiography. Nevertheless, CCTA evaluation of obstructive stenoses is prone to overestimation of severity and further, detection of stenoses by CCTA does not reliably determine the hemodynamic significance of the visualized lesions. Recently, a series of technological innovations have advanced the possibility of CCTA to enable physiologic evaluation of CAD, thereby creating the potential of this test to provide an integrated anatomic-physiologic assessment of CAD. These advances include rest-stress MPI by CCTA as well as the use of computational fluid dynamics to non-invasively calculate FFR from a typically acquired CCTA. The purpose of this review is to summarize the most recent data addressing these 2 physiologic methods of CAD evaluation by CCTA.
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Affiliation(s)
- Minisha Kochar
- Division of Cardiology, Kaiser Permanente, Panorama City, CA, USA
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A randomized, double-blind, placebo-controlled, phase II dose-finding study of the short acting β1-blocker, landiolol hydrochloride, in patients with suspected ischemic cardiac disease. Int J Cardiovasc Imaging 2013; 29 Suppl 1:7-20. [PMID: 23784548 PMCID: PMC3722440 DOI: 10.1007/s10554-013-0253-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/31/2013] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to compare the safety and efficacy of the short-acting β1-receptor blocker, landiolol hydrochloride (0.06 and 0.125-mg/kg), to placebo during coronary computed tomography angiography (CTA) in a phase 2 dose-finding study. A total of 183 patients suspected of having ischemic cardiac disease and scheduled to undergo an invasive coronary angiography were randomized to groups treated with landiolol hydrochloride (0.06 or 0.125-mg/kg) or placebo. The heart rate, safety, and the performance of coronary diagnosis using landiolol hydrochloride were evaluated in a multicenter, double-blind, randomized, parallel study. The patients’ heart rates during the coronary CTA were 67.6 ± 8.7 and 62.6 ± 7.8 beats/min in the 0.06 and 0.125-mg/kg landiolol hydrochloride groups, respectively, both of which were significantly lower than the heat rate of 73.7 ± 11.8 beats/min in the placebo group (P = 0.003 and P < 0.001, respectively). No adverse events or reactions occurred at an incidence of 5 % or greater, confirming the safety of landiolol hydrochloride. The proportion of correctly classified patients was significantly higher in the 0.125-mg/kg landiolol hydrochloride group than in the placebo group (73.6 vs. 50.0 %). Landiolol hydrochloride at doses of 0.06 and 0.125-mg/kg significantly decreased the heart rate compared with a placebo. The present findings suggest that landiolol hydrochloride is safe and useful at a dose of 0.125-mg/kg to improve coronary diagnostic performance during coronary CTA.
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