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McDermott M, Meah MN, Khaing P, Wang KL, Ramsay J, Scott G, Rickman H, Burt T, McGowan I, Fairbairn T, Bucukoglu M, Bull R, Timmis A, van Beek EJR, Roditi G, Adamson PD, Lewis S, Norrie J, McKinstry B, Guthrie B, Ritchie L, Mills NL, Dweck MR, Williams MC, Newby DE. Rationale and Design of SCOT-HEART 2 Trial: CT Angiography for the Prevention of Myocardial Infarction. JACC Cardiovasc Imaging 2024; 17:1101-1112. [PMID: 39001735 DOI: 10.1016/j.jcmg.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 07/15/2024]
Abstract
Coronary artery disease continues to be the leading cause of death globally. Identifying patients who are at risk of coronary artery disease remains a public health priority. At present, the focus of cardiovascular disease prevention relies heavily on probabilistic risk scoring despite no randomized controlled trials demonstrating their efficacy. The concept of using imaging to guide preventative therapy is not new, but has previously focused on indirect measures such as carotid intima-media thickening or coronary artery calcification. In recent trials, patients found to have coronary artery disease on computed tomography (CT) coronary angiography were more likely to be started on preventative therapy and had lower rates of cardiac events. This led to the design of the SCOT-HEART 2 (Scottish Computed Tomography of the Heart 2) trial, which aims to determine whether screening with the use of CT coronary angiography is more clinically effective than cardiovascular risk scoring to guide the use of primary preventative therapies and reduce the risk of myocardial infarction.
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Affiliation(s)
- Michael McDermott
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Phyo Khaing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kang-Ling Wang
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Gillian Scott
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hannah Rickman
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom Burt
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ian McGowan
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Marise Bucukoglu
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Russell Bull
- University Hospital Dorset, Dorset, United Kingdom
| | - Adam Timmis
- The William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Edwin J R van Beek
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Giles Roditi
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Steff Lewis
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Lewis Ritchie
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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2
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Zook S, Tayal B, Kragholm K, Abdelkarim O, Tran D, Cocker M, Ramirez-Giraldo JC, Hallam K, Sexton C, Johnson S, Chang SM. Intraindividual Comparison of Dose Reduction and Coronary Calcium Scoring Accuracy Using Kilovolt-independent and Tin Filtration CT Protocols. Radiol Cardiothorac Imaging 2024; 6:e230246. [PMID: 38934769 PMCID: PMC11211948 DOI: 10.1148/ryct.230246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Purpose To investigate the ability of kilovolt-independent (hereafter, kV-independent) and tin filter spectral shaping to accurately quantify the coronary artery calcium score (CACS) and radiation dose reductions compared with the standard 120-kV CT protocol. Materials and Methods This prospective, blinded reader study included 201 participants (mean age, 60 years ± 9.8 [SD]; 119 female, 82 male) who underwent standard 120-kV CT and additional kV-independent and tin filter research CT scans from October 2020 to July 2021. Scans were reconstructed using a Qr36f kernel for standard scans and an Sa36f kernel for research scans simulating artificial 120-kV images. CACS, risk categorization, and radiation doses were compared by analyzing data with analysis of variance, Kruskal-Wallis test, Mann-Whitney test, Bland-Altman analysis, Pearson correlations, and κ analysis for agreement. Results There was no evidence of differences in CACS across standard 120-kV, kV-independent, and tin filter scans, with median CACS values of 1 (IQR, 0-48), 0.6 (IQR, 0-58), and 0 (IQR, 0-51), respectively (P = .85). Compared with standard 120-kV scans, kV-independent and tin filter scans showed excellent correlation in CACS values (r = 0.993 and r = 0.999, respectively), with high agreement in CACS risk categorization (κ = 0.95 and κ = 0.93, respectively). Standard 120-kV scans had a mean radiation dose of 2.09 mSv ± 0.84, while kV-independent and tin filter scans reduced it to 1.21 mSv ± 0.85 and 0.26 mSv ± 0.11, cutting doses by 42% and 87%, respectively (P < .001). Conclusion The kV-independent and tin filter research CT acquisition techniques showed excellent agreement and high accuracy in CACS estimation compared with standard 120-kV scans, with large reductions in radiation dose. Keywords: CT, Cardiac, Coronary Arteries, Radiation Safety, Coronary Artery Calcium Score, Radiation Dose Reduction, Low-Dose CT Scan, Tin Filter, kV-Independent Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Salma Zook
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Bhupendar Tayal
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Kristian Kragholm
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Ola Abdelkarim
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Diana Tran
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Myra Cocker
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Juan Carlos Ramirez-Giraldo
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Kristina Hallam
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Colleen Sexton
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Stephanie Johnson
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
| | - Su Min Chang
- From the Department of Cardiology, Houston Methodist DeBakey Heart
and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Ste 1801,
Houston, TX 77030 (S.Z., B.T., K.K., O.A., D.T., C.X., S.J., S.M.C.); Department
of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
(O.A.); and CT R&D Collaborations, Siemens Healthineers, Malvern, Pa
(M.C., J.C.R.G., K.H.)
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Emoto T, Kidoh M, Oda S, Sakabe D, Morita K, Hatemura M, Nakaura T, Nagayama Y, Inoue T, Funama Y, Takashio S, Tsujita K, Hirai T. Diagnostic performance of unenhanced electrocardiogram-gated cardiac CT for detecting myocardial edema. Medicine (Baltimore) 2024; 103:e38295. [PMID: 38758838 PMCID: PMC11098205 DOI: 10.1097/md.0000000000038295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
To assess the diagnostic performance of unenhanced electrocardiogram (ECG)-gated cardiac computed tomography (CT) for detecting myocardial edema, using MRI T2 mapping as the reference standard. This retrospective study protocol was approved by our institutional review board, which waived the requirement for written informed consent. Between December 2017 to February 2019, consecutive patients who had undergone T2 mapping for myocardial tissue characterization were identified. We excluded patients who did not undergo unenhanced ECG-gated cardiac CT within 3 months from MRI T2 mapping or who had poor CT image quality. All patients underwent unenhanced ECG-gated cardiac CT with an axial scan using a third-generation, 320 × 0.5 mm detector-row CT unit. Two radiologists together drew regions of interest (ROIs) in the interventricular septum on the unenhanced ECG-gated cardiac CT images. Using T2 mapping as the reference standard, the diagnostic performance of unenhanced cardiac CT for detecting myocardial edema was evaluated by using the area under the receiver operating characteristic curve with sensitivity and specificity. Youden index was used to find an optimal sensitivity-specificity cutoff point. A cardiovascular radiologist independently performed the measurements, and interobserver reliability was assessed using intraclass correlation coefficients for CT value measurements. A P value of <.05 was considered statistically significant. We included 257 patients who had undergone MRI T2 mapping. Of the 257 patients, 35 patients underwent unenhanced ECG-gated cardiac CT. One patient was excluded from the study because of poor CT image quality. Finally, 34 patients (23 men; age 64.7 ± 14.6 years) comprised our study group. Using T2 mapping, we identified myocardial edema in 19 patients. Mean CT and T2 values for 34 patients were 46.3 ± 2.7 Hounsfield unit and 49.0 ± 4.9 ms, respectively. Mean CT values moderately correlated with mean T2 values (Rho = -0.41; P < .05). Mean CT values provided a sensitivity of 63.2% and a specificity of 93.3% for detecting myocardial edema, with a cutoff value of ≤45.0 Hounsfield unit (area under the receiver operating characteristic curve = 0.77; P < .01). Inter-observer reproducibility in measuring mean CT values was excellent (intraclass correlation coefficient = 0.93; [95% confidence interval: 0.86, 0.96]). Myocardial edema could be detected by CT value of myocardium in unenhanced ECG-gated cardiac CT.
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Affiliation(s)
- Takafumi Emoto
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Daisuke Sakabe
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Kosuke Morita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Masahiro Hatemura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Taihei Inoue
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Chuo-ku, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
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Xiao H, Wang X, Yang P, Wang L, Xu J. Coronary artery calcium scoring assessment in ultra-low-dose chest computed tomography. Clin Imaging 2024; 106:110045. [PMID: 38056107 DOI: 10.1016/j.clinimag.2023.110045] [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: 09/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To investigate the effect of non-electrocardiogram (ECG) -triggered ultra-low-dose CT (ULD-CT) with different reconstruction protocols on coronary artery calcium (CAC) scoring assessment, compared with ECG-triggered CAC CT (CAC-CT). METHODS This prospective study included 115 patients who underwent CAC-CT and ULD-CT scans under the same topogram images. CAC-CT adopted a prospective ECG-triggered sequential acquisition with a tube potential of 120 kV, and the reconstruction protocol was standard Qr36 + slice 3 mm (CACQr-3mm group). ULD-CT adopted a non-ECG-triggered high-pitch acquisition with a tube potential of Sn100 kV, and four groups of images (named ULDQr-3mm, ULDSa-3mm, ULDQr-1.5mm, and ULDSa-1.5mm) were reconstructed using different reconstruction algorithms (standard Qr36, kV-independent Sa36) and slice thicknesses (3 mm, 1.5 mm). The accuracy of CAC detection by ULD-CT was calculated. The agreement of the CAC score between ULD-CT and CAC-CT scans was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plot, and the agreement of risk categorization was assessed using weighted kappa. RESULTS The sensitivity and specificity of the ULDSa-1.5mm group for detecting positive CAC were 100% and 97.4%, respectively (k = 0.980). The CAC score for the ULDSa-3mm and ULDSa-1.5mm groups demonstrated excellent agreement with the CACQr-3mm group (ICC = 0.992, 0.990, respectively), with a mean difference of -12.3 and - 12.4. The agreement of risk categorization based on absolute and percentile CAC score between the ULDSa-1.5mm and CACQr-3mm groups was excellent (weighted k = 0.954, 0.983, respectively), and risk reclassification rates were low (3.5%, 2.8%, respectively). The effective dose was reduced by approximately 77.2% for the ULD-CT compared to the CAC-CT (0.18 mSv vs. 0.79 mSv, p < 0.001). CONCLUSION Reconstruction with a 1.5-mm slice thickness and kV-independent iterative algorithmic protocol in ULD-CT yielded excellent agreement in CAC score quantification and risk categorization compared with ECG-triggered CAC-CT.
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Affiliation(s)
- Huawei Xiao
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Xiangquan Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Panfeng Yang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Ling Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Jian Xu
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
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Zsarnóczay E, Varga-Szemes A, Emrich T, Szilveszter B, van der Werf NR, Mastrodicasa D, Maurovich-Horvat P, Willemink MJ. Characterizing the Heart and the Myocardium With Photon-Counting CT. Invest Radiol 2023; 58:505-514. [PMID: 36822653 DOI: 10.1097/rli.0000000000000956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Noninvasive cardiac imaging has rapidly evolved during the last decade owing to improvements in computed tomography (CT)-based technologies, among which we highlight the recent introduction of the first clinical photon-counting detector CT (PCD-CT) system. Multiple advantages of PCD-CT have been demonstrated, including increased spatial resolution, decreased electronic noise, and reduced radiation exposure, which may further improve diagnostics and may potentially impact existing management pathways. The benefits that can be obtained from the initial experiences with PCD-CT are promising. The implementation of this technology in cardiovascular imaging allows for the quantification of coronary calcium, myocardial extracellular volume, myocardial radiomics features, epicardial and pericoronary adipose tissue, and the qualitative assessment of coronary plaques and stents. This review aims to discuss these major applications of PCD-CT with a focus on cardiac and myocardial characterization.
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Affiliation(s)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
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Andre F, Seitz S, Fortner P, Allmendinger T, Sommer A, Brado M, Sokiranski R, Fink J, Kauczor HU, Heussel CP, Herth F, Frey N, Görich J, Buss SJ. Simultaneous assessment of heart and lungs with gated high-pitch ultra-low dose chest CT using artificial intelligence-based calcium scoring. Eur J Radiol Open 2023; 10:100481. [PMID: 36852255 PMCID: PMC9958356 DOI: 10.1016/j.ejro.2023.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose The combined testing for coronary artery and pulmonary diseases is of clinical interest as risk factors are shared. In this study, a novel ECG-gated tin-filtered ultra-low dose chest CT protocol (GCCT) for integrated heart and lung acquisition and the applicability of artificial intelligence (AI)-based coronary artery calcium scoring were assessed. Methods In a clinical registry of 10481 patients undergoing heart and lung CT, GCCT was applied in 44 patients on a dual-source CT. Coronary calcium scans (CCS) with 120 kVp, 100 kVp, and tin-filtered 100 kVp (Sn100) of controls, matched with regard to age, sex, and body-mass index, were retrieved from the registry (ntotal=176, 66.5 (59.4-74.0) years, 52 men). Automatic tube current modulation was used in all scans. In 20 patients undergoing GCCT and Sn100 CCS, Agatston scores were measured both semi-automatically by experts and by AI, and classified into six groups (0, <10, <100, <400, <1000, ≥1000). Results Effective dose decreased significantly from 120 kVp CCS (0.50 (0.41-0.61) mSv) to 100 kVp CCS (0.34 (0.26-0.37) mSv) to Sn100 CCS (0.14 (0.11-0.17) mSv). GCCT showed higher values (0.28 (0.21-0.32) mSv) than Sn100 CCS but lower than 120 kVp and 100 kVp CCS (all p < 0.05) despite greater scan length. Agatston scores correlated strongly between GCCT and Sn100 CCS in semi-automatic and AI-based measurements (both ρ = 0.98, p < 0.001) resulting in high agreement in Agatston score classification (κ = 0.97, 95% CI 0.92-1.00; κ = 0.89, 95% CI 0.79-0.99). Regarding chest findings, further diagnostic steps were recommended in 28 patients. Conclusions GCCT allows for reliable coronary artery disease and lung cancer screening with ultra-low radiation exposure. GCCT-derived Agatston score shows excellent agreement with standard CCS, resulting in equivalent risk stratification.
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Affiliation(s)
- Florian Andre
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
- MVZ-DRZ Heidelberg, Heidelberg, Germany
- Correspondence to: University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
| | | | | | | | | | | | | | | | - Hans-Ulrich Kauczor
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg
| | - Claus P. Heussel
- University of Heidelberg, Thoraxklinik, Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- University of Heidelberg, Thoraxklinik, Department of Pneumology and Critical Care Medicine, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Norbert Frey
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
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van der Werf NR, Rodesch PA, Si-Mohamed S, van Hamersvelt RW, Greuter MJW, Leiner T, Boussel L, Willemink MJ, Douek P. Improved coronary calcium detection and quantification with low-dose full field-of-view photon-counting CT: a phantom study. Eur Radiol 2022; 32:3447-3457. [PMID: 34997284 DOI: 10.1007/s00330-021-08421-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the current study was to systematically assess coronary artery calcium (CAC) detection and quantification for spectral photon-counting CT (SPCCT) in comparison to conventional CT and, in addition, to evaluate the possibility of radiation dose reduction. METHODS Routine clinical CAC CT protocols were used for data acquisition and reconstruction of two CAC containing cylindrical inserts which were positioned within an anthropomorphic thorax phantom. In addition, data was acquired at 50% lower radiation dose by reducing tube current, and slice thickness was decreased. Calcifications were considered detectable when three adjacent voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). Quantification of CAC (as volume and mass score) was assessed by comparison with known physical quantities. RESULTS In comparison with CT, SPCCT detected 33% and 7% more calcifications for the small and large phantoms, respectively. At reduced radiation dose and reduced slice thickness, small phantom CAC detection increased by 108% and 150% for CT and SPCCT, respectively. For the large phantom size, noise levels interfered with CAC detection. Although comparable between CT and SPCCT, routine protocols CAC quantification showed large deviations (up to 134%) from physical CAC volume. At reduced radiation dose and slice thickness, physical volume overestimations decreased to 96% and 72% for CT and SPCCT, respectively. In comparison with volume scores, mass score deviations from physical quantities were smaller. CONCLUSION CAC detection on SPCCT is superior to CT, and was even preserved at a reduced radiation dose. Furthermore, SPCCT allows for improved physical volume estimation. KEY POINTS • In comparison with conventional CT, increased coronary artery calcium detection (up to 156%) for spectral photon-counting CT was found, even at 50% radiation dose reduction. • Spectral photon-counting CT can more accurately measure physical volumes than conventional CT, especially at reduced slice thickness and for high-density coronary artery calcium. • For both conventional and spectral photon-counting CT, reduced slice thickness reconstructions result in more accurate physical mass approximation.
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Affiliation(s)
- N R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - P A Rodesch
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - S Si-Mohamed
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - R W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boussel
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - M J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - P Douek
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
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8
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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9
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van der Werf NR, Greuter MJW, Booij R, van der Lugt A, Budde RPJ, van Straten M. Coronary calcium scores on dual-source photon-counting computed tomography: an adapted Agatston methodology aimed at radiation dose reduction. Eur Radiol 2022; 32:5201-5209. [PMID: 35230517 PMCID: PMC9279264 DOI: 10.1007/s00330-022-08642-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/25/2022]
Abstract
Objectives The aim of this study was to determine mono-energetic (monoE) level–specific photon-counting CT (PCCT) Agatston thresholds, to yield monoE level independent Agatston scores validated with a dynamic cardiac phantom. Also, we examined the potential of dose reduction for PCCT coronary artery calcium (CAC) studies, when reconstructed at low monoE levels. Methods Theoretical CAC monoE thresholds were calculated with data from the National Institute of Standards and Technology (NIST) database. Artificial CAC with three densities were moved in an anthropomorphic thorax phantom at 0 and 60–75 bpm, and scanned at full and 50% dose on a first-generation dual-source PCCT. For all densities, Agatston scores and maximum CT numbers were determined. Agatston scores were compared with the reference at full dose and 70 keV monoE level; deviations (95% confidence interval) < 10% were deemed to be clinically not-relevant. Results Averaged over all monoE levels, measured CT numbers deviated from theoretical CT numbers by 6%, 13%, and − 4% for low-, medium-, and high-density CAC, respectively. At 50% reduced dose and 60–75 bpm, Agatston score deviations were non-relevant for 60 to 100 keV and 60 to 120 keV for medium- and high-density CAC, respectively. Conclusion MonoE level–specific Agatston score thresholds resulted in similar scores as in standard reconstructions at 70 keV. PCCT allows for a potential dose reduction of 50% for CAC scoring using low monoE reconstructions for medium- and high-density CAC. Key Points • Mono-energy level–specific Agatston thresholds allow for reproducible coronary artery calcium quantification on mono-energetic images. • Increased calcium contrast-to-noise ratio at reduced mono-energy levels allows for coronary artery calcium quantification at 50% reduced radiation dose for medium- and high-density calcifications. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08642-5.
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Affiliation(s)
- Niels R van der Werf
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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van Praagh GD, Wang J, van der Werf NR, Greuter MJW, Mastrodicasa D, Nieman K, van Hamersvelt RW, Oostveen LJ, de Lange F, Slart RHJA, Leiner T, Fleischmann D, Willemink MJ. Coronary Artery Calcium Scoring: Toward a New Standard. Invest Radiol 2022; 57:13-22. [PMID: 34261083 PMCID: PMC10072789 DOI: 10.1097/rli.0000000000000808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although the Agatston score is a commonly used quantification method, rescan reproducibility is suboptimal, and different CT scanners result in different scores. In 2007, McCollough et al (Radiology 2007;243:527-538) proposed a standard for coronary artery calcium quantification. Advancements in CT technology over the last decade, however, allow for improved acquisition and reconstruction methods. This study aims to investigate the feasibility of a reproducible reduced dose alternative of the standardized approach for coronary artery calcium quantification on state-of-the-art CT systems from 4 major vendors. MATERIALS AND METHODS An anthropomorphic phantom containing 9 calcifications and 2 extension rings were used. Images were acquired with 4 state-of-the-art CT systems using routine protocols and a variety of tube voltages (80-120 kV), tube currents (100% to 25% dose levels), slice thicknesses (3/2.5 and 1/1.25 mm), and reconstruction techniques (filtered back projection and iterative reconstruction). Every protocol was scanned 5 times after repositioning the phantom to assess reproducibility. Calcifications were quantified as Agatston scores. RESULTS Reducing tube voltage to 100 kV, dose to 75%, and slice thickness to 1 or 1.25 mm combined with higher iterative reconstruction levels resulted in an on average 36% lower intrascanner variability (interquartile range) compared with the standard 120 kV protocol. Interscanner variability per phantom size decreased by 34% on average. With the standard protocol, on average, 6.2 ± 0.4 calcifications were detected, whereas 7.0 ± 0.4 were detected with the proposed protocol. Pairwise comparisons of Agatston scores between scanners within the same phantom size demonstrated 3 significantly different comparisons at the standard protocol (P < 0.05), whereas no significantly different comparisons arose at the proposed protocol (P > 0.05). CONCLUSIONS On state-of-the-art CT systems of 4 different vendors, a 25% reduced dose, thin-slice calcium scoring protocol led to improved intrascanner and interscanner reproducibility and increased detectability of small and low-density calcifications in this phantom. The protocol should be extensively validated before clinical use, but it could potentially improve clinical interscanner/interinstitutional reproducibility and enable more consistent risk assessment and treatment strategies.
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Affiliation(s)
| | - Jia Wang
- Department of Environmental Health and Safety, Stanford University, Stanford CA
| | | | | | | | | | | | - Luuk J Oostveen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | - Frank de Lange
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | | | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | | | - Martin J Willemink
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
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11
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van der Werf NR, van Gent M, Booij R, Bos D, van der Lugt A, Budde RPJ, Greuter MJW, van Straten M. Dose Reduction in Coronary Artery Calcium Scoring Using Mono-Energetic Images from Reduced Tube Voltage Dual-Source Photon-Counting CT Data: A Dynamic Phantom Study. Diagnostics (Basel) 2021; 11:2192. [PMID: 34943428 PMCID: PMC8699960 DOI: 10.3390/diagnostics11122192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/23/2022] Open
Abstract
In order to assess coronary artery calcium (CAC) quantification reproducibility for photon-counting computed tomography (PCCT) at reduced tube potential, an anthropomorphic thorax phantom with low-, medium-, and high-density CAC inserts was scanned with PCCT (NAEOTOM Alpha, Siemens Healthineers) at two heart rates: 0 and 60-75 beats per minute (bpm). Five imaging protocols were used: 120 kVp standard dose (IQ level 16, reference), 90 kVp at standard (IQ level 16), 75% and 45% dose and tin-filtered 100 kVp at standard dose (IQ level 16). Each scan was repeated five times. Images were reconstructed using monoE reconstruction at 70 keV. For each heart rate, CAC values, quantified as Agatston scores, were compared with the reference, whereby deviations >10% were deemed clinically relevant. Reference protocol radiation dose (as volumetric CT dose index) was 4.06 mGy. Radiation dose was reduced by 27%, 44%, 67%, and 46% for the 90 kVp standard dose, 90 kVp 75% dose, 90 kVp 45% dose, and Sn100 standard dose protocol, respectively. For the low-density CAC, all reduced tube current protocols resulted in clinically relevant differences with the reference. For the medium- and high-density CAC, the implemented 90 kVp protocols and heart rates revealed no clinically relevant differences in Agatston score based on 95% confidence intervals. In conclusion, PCCT allows for reproducible Agatston scores at a reduced tube voltage of 90 kVp with radiation dose reductions up to 67% for medium- and high-density CAC.
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Affiliation(s)
- Niels R. van der Werf
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
| | - Margo van Gent
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.v.G.); (M.J.W.G.)
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
| | - Ricardo P. J. Budde
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
| | - Marcel J. W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.v.G.); (M.J.W.G.)
- Department of Robotics and Mechatronics, University of Twente, 7522 NB Enschede, The Netherlands
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (R.B.); (D.B.); (A.v.d.L.); (R.P.J.B.); (M.v.S.)
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12
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Pan YK, Sun MH, Wang JJ, Chen XB, Kan XJ, Ge YH, Guo ZP. Effect of different reconstruction algorithms on coronary artery calcium scores using the reduced radiation dose protocol: a clinical and phantom study. Quant Imaging Med Surg 2021; 11:1504-1517. [PMID: 33816187 DOI: 10.21037/qims-20-437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background This study aimed to evaluate the effects of different iterative reconstruction (IR) algorithms on coronary artery calcium (CAC) score quantification using the reduced radiation dose (RRD) protocol in an anthropomorphic phantom and in patients. Methods A thorax phantom, containing 9 calcification inserts with varying hydroxyapatite (HA) densities, was scanned with the reference protocol [120 kv, 80 mAs, filtered back projection (FBP)] and RRD protocol (120 kV, 20-80 mAs, 5 mAs interval) using a 256-slice computed tomography (CT) scanner. Raw data were reconstructed with different reconstruction algorithms [iDose4 levels 1-7 and iterative model reconstruction (IMR) levels 1-3]. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and Agatston score (AS) were calculated for each image series. The correction factor was derived from linear regression analysis between the reference image series and other image series with different parameters. Additionally, 40 patients were scanned with the RRD protocol (50 mAs) and reconstructed with FBP, iDose4 level 4, and IMR level 2. AS was calculated for the 3-group image series, and was corrected by applying a correction factor for the IMR group. The agreement of risk stratification with different reconstruction algorithms was also analyzed. Results For the phantom study, the iDose4 and IMR groups had significantly higher SNR and CNR than the FBP group (all P<0.05). There were no significant differences in the total AS after comparing image series reconstructed with iDose4 (level 1-7) and FBP (all P>0.05), while AS from the IMR (level 1-3) image series were lower than the FBP group (all P<0.05). The tube current of 50 mAs was determined for the clinical study, and the correction factor was 1.14. For the clinical study, the median AS from the iDose4 and IMR groups were both significantly lower compared to the FBP image series [(112.89 (63.01, 314.09), 113.22 (64.78, 364.95) vs. 118.59 (65.05, 374.48), both P<0.05]. After applying the correction factor, the adjusted AS from the IMR group was not significantly different from that of the FBP group [126.48 (69.62, 355.85) vs. 118.59 (65.05, 374.48), P=0.145]. Moreover, the agreement in risk stratification between FBP and IMR improved from 0.81 to 0.85. Conclusions The RRD CAC scoring scan using the IMR reconstruction algorithm is clinically feasible, and a correction factor can help reduce the AS underestimation effect.
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Affiliation(s)
- Yu-Kun Pan
- Department of Radiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming-Hua Sun
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Jia Wang
- Department of Radiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Xiao-Jing Kan
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Hui Ge
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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13
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Jin L, Gao Y, Jiang A, Li Z, Wang P, Li M. Can the Coronary Artery Calcium Score Scan Reduce the Radiation Dose in Coronary Computed Tomography Angiography? Acad Radiol 2021; 28:364-369. [PMID: 32209277 DOI: 10.1016/j.acra.2020.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES Radiation exposure from coronary computed tomography angiography (CCTA) remains a cause for concern. The objective of this study was to investigate whether using the coronary artery calcium score scan (CACS) would reduce the radiation dose for CCTA scanning and the overall radiation exposure (ORE). MATERIALS AND METHODS In total, 256 patients were examined with a third-generation dual-source CT (n = 200) or 256-row CT (n = 56), among whom 105 (Group A) and 28 patients (Group B), respectively, underwent CCTA with CACS for field of view planning. The remaining patients, with the scout view for field of view planning, constituted Group A1 and B1. The scanning parameter settings were standardized between groups. RESULTS Shorter scan lengths were observed in Group A (9.98 ± 0.79 cm) compared to Group A1 (13.64 ± 1.79 cm; p < 0.001), which also resulted in a lower dose-length product (DLP) in Group A (115.04 ± 64.13) relative to Group A1 (138.67 ± 68.87; p < 0.05). Similarly, shorter scan lengths were found in Group B (14.92 ± 1.17 cm) compared to Group B1 (15.79 ± 0.63 cm; p = 0.001); this resulted in a lower DLP (322.07 ± 45.39) compared to Group B1 (354.34 ± 65.27; p = 0.036). The CACS resulted in an increase in ORE in both groups. CONCLUSION CACS may have a critical role in the reduction of radiation dose in CCTA scanning, but the potential effectiveness of CACS in reducing ORE is weak.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Zhenlin Li
- Radiology Department, West China Hospital, Affiliated to SiChuan University, Chengdu, China
| | - Peijun Wang
- Radiology Department, Tongji Hospital, Affiliated to Tongji University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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14
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Vonder M, van der Aalst CM, de Koning HJ. Coronary artery calcium scoring in individuals at risk for coronary artery disease: current status and future perspectives. Br J Radiol 2020; 93:20190880. [PMID: 31999209 PMCID: PMC7465842 DOI: 10.1259/bjr.20190880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/27/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of this review is to provide clinicians with an overview of the role of coronary artery calcium (CAC) scoring across the spectrum ranging from asymptomatic individuals to chronic chest pain patients. We will briefly introduce the technical background of CAC scoring, summarize the major guidelines per type of patient at risk and discuss latest research with respect to CAC. Finally, the reader should be able to determine when CAC scoring is indicated or may be of added value.
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Affiliation(s)
- Marleen Vonder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Best practice for the nuclear medicine technologist in CT-based attenuation correction and calcium score for nuclear cardiology. Eur J Hybrid Imaging 2020; 4:11. [PMID: 34191150 PMCID: PMC8218053 DOI: 10.1186/s41824-020-00080-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
The use of hybrid systems is increasingly growing in Europe and this is progressively important for the final result of diagnostic tests. As an integral part of the hybrid imaging system, computed tomography (CT) plays a crucial role in myocardial perfusion imaging diagnostics. Throughout Europe, a variety of equipment is available and also different university curricula of the nuclear medicine technologist are observed. Hence, the Technologist Committee of the European Association of Nuclear Medicine proposes to identify, through a bibliographic review, the recommendations for best practice in computed tomography applied to attenuation correction and calcium score in myocardial perfusion imaging, which courses in the set of knowledge, skills, and competencies for nuclear medicine technologists. This document aims at providing recommendations for CT acquisition protocols and CT image optimization in nuclear cardiology.
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16
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Vingiani V, Abadia AF, Schoepf UJ, Fischer AM, Varga-Szemes A, Sahbaee P, Allmendinger T, Giovagnoli DA, Hudson HT, Marano R, Tinnefeld FC, Martin SS. Individualized coronary calcium scoring at any tube voltage using a kV-independent reconstruction algorithm. Eur Radiol 2020; 30:5834-5840. [PMID: 32468107 DOI: 10.1007/s00330-020-06951-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE We prospectively investigate the feasibility of a patient specific automated tube voltage selection (ATVS)-based coronary artery calcium scoring (CACS) protocol, using a kV-independent reconstruction algorithm, to achieve significant dose reductions while maintaining the overall cardiac risk classification. METHODS Forty-three patients (mean age, 61.8 ± 9.0 years; 40% male) underwent a clinically indicated CACS scan at 120kVp, as well as an additional CACS acquisition using an individualized tube voltage between 70 and 130kVp based on the ATVS selection (CARE-kV). Datasets of the additional CACS scans were reconstructed using a kV-independent algorithm that allows for calcium scoring without changing the weighting threshold of 130HU, regardless of the tube voltage chosen for image acquisition. Agatston scores and radiation dose derived from the different ATVS-based CACS studies were compared to the standard acquisition at 120kVp. RESULTS Thirteen patients displayed a score of 0 and were correctly identified with the ATVS protocol. Agatston scores derived from the standard 120kVp (median, 33.4; IQR, 0-289.7) and the patient-tailored kV-independent protocol (median, 47.5; IQR, 0-287.5) showed no significant differences (p = 0.094). The intra-class correlation for Agatston scores derived from the two different protocols was excellent (ICC = 0.99). The mean dose-length-product was 29.8 ± 11.9 mGy × cm using the ATVS protocol and 31.7 ± 11.4 mGy × cm using the standard 120kVp protocol (p < 0.001). Additionally, 95% of patients were classified into the same risk category (0, 1-10, 11-100, 101-400, or > 400) using the patient-tailored protocol. CONCLUSIONS ATVS-based CACS, using a kV-independent algorithm, allows for high accuracy compared to the standard 120kVp scanning, while significantly reducing radiation dose parameters. KEY POINTS • ATVS allows for CT scanning with reduced radiation dose values. • KV-independent CACS is feasible at any tube voltage between 70 and 130 kVp. • ATVS applied to kV-independent CACS can significantly reduce the radiation dose.
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Affiliation(s)
- Vincenzo Vingiani
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andres F Abadia
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Andreas M Fischer
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Pooyan Sahbaee
- Computed Tomography - Research & Development, Siemens Healthcare GmbH, Forchheim, Germany.,Siemens Medical Solutions USA, Malvern, PA, USA
| | - Thomas Allmendinger
- Computed Tomography - Research & Development, Siemens Healthcare GmbH, Forchheim, Germany
| | - Dante A Giovagnoli
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - H Todd Hudson
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Riccardo Marano
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fiona C Tinnefeld
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Simon S Martin
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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17
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High-pitch dual-source CT for coronary artery calcium scoring: A head-to-head comparison of non-triggered chest versus triggered cardiac acquisition. J Cardiovasc Comput Tomogr 2020; 15:65-72. [PMID: 32505593 DOI: 10.1016/j.jcct.2020.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification, compared to ECG-triggered cardiac CT. METHODS We selected 1,000 participants from the ImaLife study, 50% with coronary calcification on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest CT using third-generation dual-source technology. Reconstruction settings were equal for both acquisitions. CAC scores were determined by Agatston's method, and divided dichotomously (0, >0), and into risk categories (0, 1-99, 100-399, ≥400). We investigated the influence of heart rate and body mass index (BMI) on risk reclassification. RESULTS Positive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac CT, chest CT had sensitivity of 0.96 (95%CI 0.94-0.98) and specificity of 0.99 (95%CI 0.97-0.99) for CAC detection (κ = 0.95). In participants with coronary calcification on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus 40, p˂0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95). Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five (84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13% for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart rate. CONCLUSION Low-dose, high-pitch chest CT, using third-generation dual-source technology shows almost perfect agreement with cardiac CT in CAC detection and risk stratification. However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac CT, and results in inaccurate risk categorization in BMI ≥30.
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Vingiani V, Abadia AF, Schoepf UJ, Fischer AM, Varga-Szemes A, Sahbaee P, Allmendinger T, Tesche C, Griffith LP, Marano R, Martin SS. Low-kV coronary artery calcium scoring with tin filtration using a kV-independent reconstruction algorithm. J Cardiovasc Comput Tomogr 2020; 14:246-250. [DOI: 10.1016/j.jcct.2019.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/16/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
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Hinzpeter R, Weber L, Euler A, Kasel AM, Tanner FC, Alkadhi H, Eberhard M. Aortic valve calcification scoring with computed tomography: impact of iterative reconstruction techniques. Int J Cardiovasc Imaging 2020; 36:1575-1581. [PMID: 32335821 DOI: 10.1007/s10554-020-01862-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/22/2020] [Indexed: 12/01/2022]
Abstract
To investigate whether image reconstruction with iterative reconstruction (IR) affects aortic valve calcification (AVC) scoring and likelihood categorization of severe aortic stenosis (AS). In this IRB-approved retrospective study, we included 100 consecutive patients with AS (40 females; mean age 77 ± 10 years; age range: 36-99 years) undergoing CT prior to transcatheter aortic valve replacement. Non-enhanced, electrocardiography-gated CT of the heart was reconstructed with filtered back projection (FBP) and with advanced modeled IR at strength levels 1-5. AVC Agatston scores were calculated and gender-specific cut-off values for AS likelihood categorization were applied according to current European Society of Cardiology recommendations (from unlikely to very likely). Friedman test with post-hoc Bonferroni correction was applied to analyze interval- and ordinal-scaled data. Compared to FBP, each IR strength level produced significantly different AVC Agatston scores (p < 0.001-0.002). Median AVC Agatston score for image reconstruction with FBP was 2527 (IQR: 1711-3663) and decreased with increasing IR strength levels up to 2281 (IQR: 1471-3357) at strength level 5. Likelihood categorization of severe AS was significantly different among image reconstruction algorithms (p < 0.001). Image reconstruction with IR strength level 5 led to a downward shift of likelihood categorization in 28 patients (28%) compared to images reconstructed with FBP. IR significantly impacts AVC scoring with significantly decreasing AVC scores with increasing IR strength levels. This leads to relevant changes in likelihood categorization of patients with severe AS., leading to underestimation of severe AS.
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Affiliation(s)
- Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland
| | - Lucas Weber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland
| | - Andre Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland
| | - Albert M Kasel
- Department of Cardiology, University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland.
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Coronary artery calcium: A modern rubric for an established approach. J Cardiovasc Comput Tomogr 2020; 14:18-19. [DOI: 10.1016/j.jcct.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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Coronary artery calcium: A technical argument for a new scoring method. J Cardiovasc Comput Tomogr 2019; 13:347-352. [DOI: 10.1016/j.jcct.2018.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/24/2023]
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Al’Aref SJ, Mrsic Z, Feuchtner G, Min JK, Villines TC. The Journal of Cardiovascular Computed Tomography year in review - 2018. J Cardiovasc Comput Tomogr 2018; 12:529-538. [DOI: 10.1016/j.jcct.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/24/2022]
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Einstein AJ. Optimizing coronary artery calcium scanning to meet the challenges of population screening. J Cardiovasc Comput Tomogr 2018; 13:303-304. [PMID: 30337275 DOI: 10.1016/j.jcct.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew J Einstein
- Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, United States.
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