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Huang Z, Ding Y, Yang Y, Zhao S, Zhang S, Xiao J, Ding C, Guo N, Li Z, Zhou S, Cao G, Wang X. Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates. Acta Radiol 2024; 65:123-132. [PMID: 36847335 DOI: 10.1177/02841851231158730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Limited studies have investigated the accuracy of therapeutic decision-making using machine learning-based coronary computed tomography angiography (ML-CCTA) compared with CCTA. PURPOSE To investigate the performance of ML-CCTA for therapeutic decision compared with CCTA. MATERIAL AND METHODS The study population consisted of 322 consecutive patients with stable coronary artery disease. The SYNTAX score was calculated with an online calculator based on ML-CCTA results. Therapeutic decision-making was determined by ML-CCTA results and the ML-CCTA-based SYNTAX score. The therapeutic strategy and the appropriate revascularization procedure were selected using ML-CCTA, CCTA, and invasive coronary angiography (ICA) independently. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of ML-CCTA and CCTA for selecting revascularization candidates were 87.01%, 96.43%, 95.71%, 89.01%, 91.93%, and 85.71%, 87.50%, 86.27%, 86.98%, 86.65%, respectively, using ICA as the standard reference. The area under the receiver operating characteristic curve (AUC) of ML-CCTA for selecting revascularization candidates was significantly higher than CCTA (0.917 vs. 0.866, P = 0.016). Subgroup analysis showed the AUC of ML-CCTA for selecting percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) candidates was significantly higher than CCTA (0.883 vs. 0.777, P < 0.001, 0.912 vs. 0.826, P = 0.003, respectively). CONCLUSION ML-CCTA could distinguish between patients who need revascularization and those who do not. In addition, ML-CCTA showed a slightly superior to CCTA in making an appropriate decision for patients and selecting a suitable revascularization strategy.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ding
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengchao Zhao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Ding
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiguang Zhou
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guijuan Cao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ngo HG, Nair GB, Al-Katib S. Impact of a structured reporting template on the quality of HRCT radiology reports for interstitial lung disease. Clin Imaging 2023; 97:78-83. [PMID: 36921449 DOI: 10.1016/j.clinimag.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This QI study compared the completeness of HRCT radiology reports before and after the implementation of a disease-specific structured reporting template for suspected cases of interstitial lung disease (ILD). MATERIALS AND METHODS A pre-post study of radiology reports for HRCT of the thorax at a multicenter health system was performed. Data was collected in 6-month period intervals before (June 2019-November 2019) and after (January 2021-June 2021) the implementation of a disease-specific template. The use of the template was voluntary. The primary outcome measure was the completeness of HRCT reports graded based on the documentation of ten descriptors. The secondary outcome measure assessed which descriptor(s) improved after the intervention. RESULTS 521 HRCT reports before and 557 HRCT reports after the intervention were reviewed. Of the 557 reports, 118 reports (21%) were created using the structured reporting template. The mean completeness score of the pre-intervention group was 9.20 (SD = 1.08) and the post-intervention group was 9.36 (SD = 1.03) with a difference of -0.155, 95% CI [-0.2822, -0.0285, p < 0.0001]. Within the post-intervention group, the mean completeness score of the unstructured reports was 9.25 (SD = 1.07) and the template reports was 9.93 (SD = 0.25) with a difference of -0.677, 95% CI [-0.7871, -0.5671, p < 0.0001]. After the intervention, the use of two descriptors improved significantly: presence of honeycombing from 78.3% to 85.1% (p < 0.0039) and technique from 90% to 96.6% (p < 0.0001). DISCUSSION Shifting to disease-specific structured reporting for HRCT exams of suspected ILD is beneficial, as it improves the completeness of radiology reports. Further research on how to improve the voluntary uptake of a disease-specific template is needed to help increase the acceptance of structured reporting among radiologists.
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Affiliation(s)
- Han G Ngo
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America.
| | - Girish B Nair
- Department of Pulmonary and Critical Care Medicine, Corewell Health William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
| | - Sayf Al-Katib
- Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States of America
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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Seyedhasani SN, Dorri S, Pournik O, Alamdaran SA, Eslami S. Improving data adequacy of ultrasonography reports for non-alcoholic fatty liver disease (NAFLD) through a national structured template. Acta Radiol 2023; 64:473-478. [PMID: 35538852 DOI: 10.1177/02841851221093141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a prevalent disorder that increases due to lifestyle, the rising rate of obesity, and population ages worldwide. Diagnostic ways, including sonography, do not have an explicit reporting structure. PURPOSE To create a structure template for NAFLD reporting, investigate its completeness, and assess the specialist opinions of using it in clinical practice. MATERIAL AND METHODS A structured reporting template (SRT) was designed and implemented in four stages. At first, important features were extracted from a comprehensive literature review and were evaluated by 10 radiologists and gastroenterologists using the Likert scale. Finally, the usefulness of the SRT in comparison with the conventional reporting template (CRT) was judged by 10 gastroenterologists completing the questionnaire. RESULTS Demographic information and sonography of the liver, gallbladder, and spleen organs were the most critical features. The completeness scores of SRT reports were higher than CRT scores for almost all the factors studied. The difference in the scores was significant for most of the parameters. Moreover, the total completeness score increased from 42% in CRT to 92% in SRT. A comparison of the report adequacy of two reports was seen in all items. The SRT obtained more rates from specialists. CONCLUSION Introduction of the SRT for NAFLD significantly enhanced the completeness of reporting to reduce variability in the interpretation of the related reports by clinicians. Nevertheless, more studies are needed to generalize the results in real scales for patients with NAFLD.
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Affiliation(s)
- Seyedeh Nahid Seyedhasani
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Health Sciences Research Center, 435810Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Sara Dorri
- Health Information Technology Research Center, 48455Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Pournik
- Department of Community Medicine, School of Medicine, 440827Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
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Ippolito D, Talei Franzesi C, Cangiotti C, Riva L, De Vito A, Gandola D, Maino C, Marra P, Muscogiuri G, Sironi S. Inter-observer agreement and image quality of model-based algorithm applied to the Coronary Artery Disease-Reporting and Data System score. Insights Imaging 2022; 13:176. [DOI: 10.1186/s13244-022-01286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
To evaluate the inter-observer agreement of the CAD-RADS reporting system and compare image quality between model-based iterative reconstruction algorithm (MBIR) and standard iterative reconstruction algorithm (IR) of low-dose cardiac computed tomography angiography (CCTA).
Methods
One-hundred-sixty patients undergone a 256-slice MDCT scanner using low-dose CCTA combined with prospective ECG-gated techniques were enrolled. CCTA protocols were reconstructed with both MBIR and IR. Each study was evaluated by two readers using the CAD-RADS lexicon. Vessels enhancement, image noise, signal-to-noise (SNR), and contrast-to-noise (CNR) were computed in the axial native images, and inter-observer agreement was assessed. Radiation dose exposure as dose–length product (DLP) and effective dose were finally reported.
Results
The reliability analysis between the two readers was almost perfect for all CAD-RADS standard categories. Moreover, a significantly higher value of subjective qualitative analysis, SNR, and CNR in MBIR images compared to IR were found, due to a lower noise level (all p < 0.05). The mean DLP measured was 63.9 mGy*cm, and the mean effective dose was 0.9 mSv.
Conclusion
Inter-observer agreement of CAD-RADS was excellent confirming the importance, the feasibility, and the reproducibility of the CAD-RADS scoring system for CCTA. Moreover, lower noise and higher image quality with MBIR compared to IR were found.
Implications for practice
MBIR, by reducing noise and improving image quality, can help a better assessment of CAD-RADS, in comparison with standard IR algorithm.
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Huang Z, Xiao J, Wang X, Li Z, Guo N, Hu Y, Li X, Wang X. Clinical Evaluation of the Automatic Coronary Artery Disease Reporting and Data System (CAD-RADS) in Coronary Computed Tomography Angiography Using Convolutional Neural Networks. Acad Radiol 2022; 30:698-706. [PMID: 35753936 DOI: 10.1016/j.acra.2022.05.015] [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: 01/06/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES The coronary artery disease reporting and data system (CAD-RADS™) was recently introduced to standardise reporting. We aimed to evaluate the utility of an automatic postprocessing and reporting system based on CAD-RADS™ in suspected coronary artery disease (CAD) patients. MATERIALS AND METHODS Clinical evaluation was performed in 346 patients who underwent coronary computed tomography angiography (CCTA). We compared deep learning (DL)-based CCTA with human readers for evaluation of CAD-RADS™ with commercially-available automated segmentation and manual postprocessing in a retrospective validation cohort. RESULTS Compared with invasive coronary angiography, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the DL model for diagnosis of CAD were 79.02%, 86.52%, 89.50%, 73.94%, and 82.08%, respectively. There was no significant difference between the DL-based and the reader-based CAD-RADS™ grading of CCTA results. Consistency testing showed that the Kappa value between the model and the readers was 0.775 (95% confidence interval [CI]: 0.728-0.823, p < 0.001), 0.802 (95% CI: 0.756-0.847, p < 0.001), and 0.796 (95% CI: 0.750-0.843, p < 0.001), respectively. This system reduces the time taken from 14.97 ± 1.80 min to 5.02 ± 0.8 min (p < 0.001). CONCLUSION The standardised reporting of DL-based CAD-RADS™ in CCTA can accurately and rapidly evaluate suspected CAD patients, and has good consistency with grading by radiologists.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Jinhui Building, Qiyang Road, 100102 Beijing, China
| | - Yun Hu
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Huang Z, Zhang S, Jin N, Hu Y, Xiao J, Li Z, Yang Y, Sun R, Wang Z, Li X, Xie Y, Wang X. Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD. BMC Cardiovasc Disord 2021; 21:476. [PMID: 34602055 PMCID: PMC8487531 DOI: 10.1186/s12872-021-02286-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD. METHODS 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using time dependent receiver-operating characteristic (ROC) curves and The Hosmer-Lemeshow goodness-of-fit test was employed to evaluate calibration. RESULTS A total of 540 patients died from all causes with a median follow-up of 4.3 ± 2.1 years. Kaplan-Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI 0.420-1.764) for CAD-RADS 1 to HR 2.761 (95% CI 1.961-3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HRs for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The area under the time dependent ROC curve for prediction of all-cause death was 0.7917, 0.7805, 0.7991for CAD-RADS in 1 year, 3 year, 5 year, respectively, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index. CONCLUSIONS The CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes in prognostic value of all-cause mortality. Traditional and simplest CAD classification should be preferable, given the more number of groups and complexity of CAD-RADS and Duke prognostic index, without using more time consuming classification.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Nan Jin
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun Hu
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Ruihong Sun
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Zheng Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Xiang Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Yuanliang Xie
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
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Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-1203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [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: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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Papp S, Bárczi G, Karády J, Kolossváry M, Drobni ZD, Simon J, Boussoussou M, Vattay B, Szilveszter B, Jermendy G, Merkely B, Maurovich-Horvat P. Coronary plaque burden of the left anterior descending artery in patients with or without myocardial bridge: A case-control study based on coronary CT-angiography. Int J Cardiol 2020; 327:231-235. [PMID: 33276021 DOI: 10.1016/j.ijcard.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical significance of myocardial bridging (MB) on the left anterior descending artery (LAD) is debated. We aimed to assess the association between MB and LAD plaque volumes/compositions in a case-control set up. METHODS In our retrospective analysis we investigated 50 cases with incidentally recognized LAD MB and 50 matched controls without LAD MB on coronary computed tomography angiography. We quantified plaque volumes proximal to the MB and beneath it in patients with MB and in the corresponding coronary segments in patients without MB. RESULTS In total, we have included 100 patients (mean age 60.6 ± 10.8 years, males: 80%). Plaque volume was similar in the LAD segments proximal to the MB in cases vs. controls (150.0 mm3 [IQR: 90.7-194.5 mm3] vs. 132.8 mm3 [IQR: 94.2-184.3 mm3], respectively; p = 0.95) while the plaque volume was smaller beneath LAD MB vs. control segment (16.2 mm3 [IQR: 12.6-25.8 mm3] vs. 21.1 mm3 [IQR: 14.0-42.4 mm3], respectively; p = 0.002). No significant differences were found regarding different plaque components in segments proximal to the MB while fatty plaque and necrotic core volumes were smaller or negligible in coronary segment beneath MB than in controls (0.07 mm3 [IQR: 0.005-0.27 mm3] vs. 12.7 mm3 [IQR: 7.4-24.4 mm3] and 0.00 mm3 [IQR: 0.00-0.04 mm3] vs. 0.06 mm3 [IQR: 0.03-2.8 mm3], respectively (p < 0.001). CONCLUSION Comparing patients with MB vs. matched controls without it, MB was not associated with increased plaque volumes in LAD segment proximal to MB and plaque quantity was smaller in the MB segment. Our data are supportive of benign nature of incidentally recognized LAD MB.
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Affiliation(s)
- Sára Papp
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Bárczi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia D Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Jermendy
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
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The correlation of deep learning-based CAD-RADS evaluated by coronary computed tomography angiography with breast arterial calcification on mammography. Sci Rep 2020; 10:11532. [PMID: 32661231 PMCID: PMC7359346 DOI: 10.1038/s41598-020-68378-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/18/2020] [Indexed: 12/16/2022] Open
Abstract
This study sought to evaluate the association of breast arterial calcification (BAC) on breast screening mammography with the Coronary Artery Disease-Reporting and Data System (CAD-RADS) based on Deep Learning-coronary computed tomography angiography (CCTA). This prospective single institution study included asymptomatic women over 40 who underwent CCTA and breast cancer screening mammography between July 2018 and April 2019. CAD-RADS was scored based on Deep Learning (DL). Mammograms were assessed visually for the presence of BAC. A total of 213 patients were included in the analysis. In comparison to the low CAD-RADS (CAD-RADS < 3) group, the high CAD-RADS (CAD-RADS ≥ 3) group, more often had a history of hypertension (P = 0.036), diabetes (P = 0.017), and chronic kidney disease (P = 0.006). They also had a significantly higher level of LDL-C (P = 0.024), while HDL-C was lower than in the low CAD-RADS group (P = 0.003). BAC was also significantly higher in the high CAD-RADS group (P = 0.002). In multivariate analysis, the presence of BAC [odd ratio (OR) 10.22, 95% CI 2.86–36.49, P < 0.001] maintained a significant associations with CAD-RADS after adjustment by meaningful variable. The same tendency was also found after adjustment by all covariates. There was a significant correlation between the severities of CAD detected by DL based CCTA and BAC in women undergoing breast screening mammography. BAC may be used as an additional diagnostic tool to predict the severity of CAD in this population.
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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12
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Popa LE, Petresc B, Cătană C, Moldovanu CG, Feier DS, Lebovici A, Schiau C, Rancea RA, Molnar A, Buruian MM. Association between cardiovascular risk factors and coronary artery disease assessed using CAD-RADS classification: a cross-sectional study in Romanian population. BMJ Open 2020; 10:e031799. [PMID: 31915161 PMCID: PMC6955553 DOI: 10.1136/bmjopen-2019-031799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between cardiovascular risk factors and Coronary Artery Disease-Reporting and Data System (CAD-RADS) score in the Romanian population. CAD-RADS is a new, standardised method to assess coronary artery disease (CAD) using coronary CT angiography (CCTA). DESIGN A cross-sectional observational, patient-based study. SETTING Referred imaging centre for CAD in Transylvania, Romania. PARTICIPANTS We retrospectively reviewed 674 patients who underwent CCTA between January 2017 and August 2018. The exclusion criteria included: previously known CAD, defined as prior myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery (n=91), cardiac CT for other than evaluation of possible CAD (n=85), significant arrhythmias compromising imaging quality (n=23). Finally, 475 patients fulfilled the inclusion criteria. METHODS Demographical, clinical and CCTA characteristics of the patients were obtained. CAD was evaluated using CAD-RADS score. Obstructive CAD was defined as ≥50% stenosis of ≥1 coronary segment on CCTA. RESULTS We evaluated the association between risk factors and CAD-RADS score in univariate and multivariable analysis. We divided the patients into two groups according to the CAD-RADS system: group 1: CAD-RADS score between 0 and 2 (stenosis <50%) and group 2: CAD-RADS score ≥3 (stenosis ≥50%). On univariate analysis, male gender, age, hypertension, dyslipidaemia, smoking and diabetes mellitus were positively associated with a CAD-RADS score ≥3. The multivariate analysis showed that male sex, age, dyslipidaemia, hypertension and smoking were independently associated with obstructive CAD. CONCLUSION This study demonstrated a significant association between multiple cardiovascular risk factors and a higher coronary atherosclerotic burden assessed using CAD-RADS system in the Romanian population.
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Affiliation(s)
- Loredana Elisabeta Popa
- Department of Radiology, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania
- Department of Radiology, Hiperdia-Affidea Imaging Center, Cluj-Napoca, Romania
| | - Bianca Petresc
- Department of Radiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | - Cristina Cătană
- Department of Radiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | | | - Diana Sorina Feier
- Department of Radiology, Hiperdia-Affidea Imaging Center, Cluj-Napoca, Romania
- Department of Radiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
- Department of Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Lebovici
- Department of Radiology, Hiperdia-Affidea Imaging Center, Cluj-Napoca, Romania
- Department of Radiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
- Department of Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Călin Schiau
- Department of Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Alina Rancea
- Department of Cardiology, Heart Institute "Niculae Stăncioiu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery, Heart Institute "Niculae Stăncioiu" Cluj-Napoca, Cluj-Napoca, Romania
- Cardiovascular and Thoracic Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mircea Marian Buruian
- Department of Radiology, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania
- Department of Radiology, Emergency County Hospital Târgu Mureş, Târgu Mureş, Romania
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Evidence of the benefits, advantages and potentialities of the structured radiological report: An integrative review. Artif Intell Med 2019; 102:101770. [PMID: 31980107 DOI: 10.1016/j.artmed.2019.101770] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 12/27/2022]
Abstract
The structured report is a new trend for the preparation and manipulation of radiological examination reports. The structuring of the radiological report data can bring many benefits and advantages over other existing methodologies. Research and studies about the structured radiological report are highly relevant in clinical and academic subjects, improving medical practice, reducing unobserved problems by radiologists, improving reporting practices and medical diagnoses. Exposing the benefits, advantages and potential of the structured radiological report is important in encouraging the acceptance and implementation of this method by radiology professionals who are still somewhat resistant. The present review highlights the factors that contribute to the consolidation of adopting the structured radiology report methodology, addressing a variety of studies focused on the structuring of the radiological report. This integrative review of the literature is proposed by searching publications and journals databases (CAPES - Coordination of Improvement of Higher-Level Personnel, SciELO - Scientific Electronic Library Online, and PubMed - Publisher Medline) to develop a complete and unified understanding of the subject, so that it becomes a major part of evidence-based initiatives.
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Ramanathan S, Al Heidous M, Alkuwari M. Coronary Artery Disease-Reporting and Data System (CAD-RADS): strengths and limitations. Clin Radiol 2019; 74:411-417. [PMID: 30765109 DOI: 10.1016/j.crad.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 11/01/2018] [Accepted: 01/16/2019] [Indexed: 01/24/2023]
Abstract
A new standardised reporting system was introduced recently for coronary computed tomography (CT) angiography interpretation called CAD-RADS (Coronary Artery Disease-Reporting and Data System). Like any other new reporting platform, CAD-RADS has both advantages and disadvantages. Consistency in reporting, better clarity of communication, and more streamlined clinical recommendations are the major strengths of CAD-RADS. It has many limitations such as misinterpretation of CT angiography findings inherent to any CT angiography examination and unique disadvantages like misclassification of abnormalities, potential to misguide the referring physicians by suggesting management based on a single score. In addition, CAD-RADS does not include the details on location and extent of disease in the coronary arteries, coronary anomalies and other cardiac and extra cardiac findings.
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Affiliation(s)
- S Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - M Al Heidous
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar
| | - M Alkuwari
- Department of Radiology, Heart Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar
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