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Omaygenc MO, Kadoya Y, Small GR, Chow BJW. Cardiac CT: Competition, complimentary or confounder. J Med Imaging Radiat Sci 2024; 55:S31-S38. [PMID: 38433089 DOI: 10.1016/j.jmir.2024.01.005] [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: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
Coronary CT angiography (CCTA) has been gradually adopted into clinical practice over the last two decades. CCTA has high diagnostic accuracy, prognostic value, and unique features such as assessment of plaque composition. CCTA-derived functional assessment techniques such as fractional flow reserve and CT perfusion are also available and can increase the diagnostic specificity of the modality. These properties propound CCTA as a competitor of functional testing in diagnosis of obstructive CAD, however, utilizing CCTA in a concomitant fashion to potentiate the performance of the latter can lead to better patient care and may provide more accurate prognostic information. Although multiple diagnostic challenges such as evaluation of calcified segments, stents, and small distal vessels still exist, the technologic developments in hardware as well as growing incorporation of artificial intelligence to daily practice are all set to augment the diagnostic and prognostic role of CCTA in cardiovascular disorders.
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Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Yoshito Kadoya
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Gary Robert Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Benjamin Joe Wade Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
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Ren P, He Y, Zhu Y, Zhang T, Cao J, Wang Z, Yang Z. Motion artefact reduction in coronary CT angiography images with a deep learning method. BMC Med Imaging 2022; 22:184. [DOI: 10.1186/s12880-022-00914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to investigate the ability of a pixel-to-pixel generative adversarial network (GAN) to remove motion artefacts in coronary CT angiography (CCTA) images.
Methods
Ninety-seven patients who underwent single-cardiac-cycle multiphase CCTA were retrospectively included in the study, and raw CCTA images and SnapShot Freeze (SSF) CCTA images were acquired. The right coronary artery (RCA) was investigated because its motion artefacts are the most prominent among the artefacts of all coronary arteries. The acquired data were divided into a training dataset of 40 patients, a verification dataset of 30 patients and a test dataset of 27 patients. A pixel-to-pixel GAN was trained to generate improved CCTA images from the raw CCTA imaging data using SSF CCTA images as targets. The GAN’s ability to remove motion artefacts was evaluated by the structural similarity (SSIM), Dice similarity coefficient (DSC) and circularity index. Furthermore, the image quality was visually assessed by two radiologists.
Results
The circularity was significantly higher for the GAN-generated images than for the raw images of the RCA (0.82 ± 0.07 vs. 0.74 ± 0.11, p < 0.001), and there was no significant difference between the GAN-generated images and SSF images (0.82 ± 0.07 vs. 0.82 ± 0.06, p = 0.96). Furthermore, the GAN-generated images achieved the SSIM of 0.87 ± 0.06, significantly better than those of the raw images 0.83 ± 0.08 (p < 0.001). The results for the DSC showed that the overlap between the GAN-generated and SSF images was significantly higher than the overlap between the GAN-generated and raw images (0.84 ± 0.08 vs. 0.78 ± 0.11, p < 0.001). The motion artefact scores of the GAN-generated CCTA images of the pRCA and mRCA were significantly higher than those of the raw CCTA images (3 [4–3] vs 4 [5–4], p = 0.022; 3 [3–2] vs 5[5–4], p < 0.001).
Conclusions
A GAN can significantly reduce the motion artefacts in CCTA images of the middle segment of the RCA and has the potential to act as a new method to remove motion artefacts in coronary CCTA images.
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Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, Leipsic J. Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis. Radiology 2019; 292:597-605. [PMID: 31335283 DOI: 10.1148/radiol.2019182673] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results In the ADVANCE registry, FFRCT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFRCT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P < .001 vs the ADVANCE cohort). The main reason for the inability to perform FFRCT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P < .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P < .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P < .001) cohorts were independent predictors of rejection. Conclusion The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Thinner CT section thickness and lower patient heart rate may increase rates of completion of CT fractional flow reserve analysis. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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Affiliation(s)
- Gianluca Pontone
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jonathan R Weir-McCall
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Andrea Baggiano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Alberico Del Torto
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Laura Fusini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Marco Guglielmo
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Giuseppe Muscogiuri
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Andrea Igoren Guaricci
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Daniele Andreini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Manesh Patel
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Koen Nieman
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Takashi Akasaka
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Campbell Rogers
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Bjarne L Nørgaard
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jeroen Bax
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Gilbert L Raff
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Kavitha Chinnaiyan
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Daniel Berman
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Timothy Fairbairn
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Lynne Hurwitz Koweek
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Jonathon Leipsic
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
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Vardhan M, Gounley J, Chen SJ, Kahn AM, Leopold JA, Randles A. The importance of side branches in modeling 3D hemodynamics from angiograms for patients with coronary artery disease. Sci Rep 2019; 9:8854. [PMID: 31222111 PMCID: PMC6586809 DOI: 10.1038/s41598-019-45342-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022] Open
Abstract
Genesis of atherosclerotic lesions in the human arterial system is critically influenced by the fluid mechanics. Applying computational fluid dynamic tools based on accurate coronary physiology derived from conventional biplane angiogram data may be useful in guiding percutaneous coronary interventions. The primary objective of this study is to build and validate a computational framework for accurate personalized 3-dimensional hemodynamic simulation across the complete coronary arterial tree and demonstrate the influence of side branches on coronary hemodynamics by comparing shear stress between coronary models with and without these included. The proposed novel computational framework based on biplane angiography enables significant arterial circulation analysis. This study shows that models that take into account flow through all side branches are required for precise computation of shear stress and pressure gradient whereas models that have only a subset of side branches are inadequate for biomechanical studies as they may overestimate volumetric outflow and shear stress. This study extends the ongoing computational efforts and demonstrates that models based on accurate coronary physiology can improve overall fidelity of biomechanical studies to compute hemodynamic risk-factors.
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Affiliation(s)
- Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - John Gounley
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - S James Chen
- Department of Medicine/Cardiology, University of Colorado AMC, Aurora, 80045, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, 92103, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Amanda Randles
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA.
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5
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Park JB, Jeong YJ, Lee G, Lee NK, Kim JY, Lee JW. Influence of Heart Rate and Innovative Motion-Correction Algorithm on Coronary Artery Image Quality and Measurement Accuracy Using 256-Detector Row Computed Tomography Scanner: Phantom Study. Korean J Radiol 2019; 20:94-101. [PMID: 30627025 PMCID: PMC6315068 DOI: 10.3348/kjr.2018.0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/03/2018] [Indexed: 12/30/2022] Open
Abstract
Objective To investigate the efficacy of motion-correction algorithm (MCA) in improving coronary artery image quality and measurement accuracy using an anthropomorphic dynamic heart phantom and 256-detector row computed tomography (CT) scanner. Materials and Methods An anthropomorphic dynamic heart phantom was scanned under a static condition and under heart rate (HR) simulation of 50–120 beats per minute (bpm), and the obtained images were reconstructed using conventional algorithm (CA) and MCA. We compared the subjective image quality of coronary arteries using a four-point scale (1, excellent; 2, good; 3, fair; 4, poor) and measurement accuracy using measurement errors of the minimal luminal diameter (MLD) and minimal luminal area (MLA). Results Compared with CA, MCA significantly improved the subjective image quality at HRs of 110 bpm (1.3 ± 0.3 vs. 1.9 ± 0.8, p = 0.003) and 120 bpm (1.7 ± 0.7 vs. 2.3 ± 0.6, p = 0.006). The measurement error of MLD significantly decreased on using MCA at 110 bpm (11.7 ± 5.9% vs. 18.4 ± 9.4%, p = 0.013) and 120 bpm (10.0 ± 7.3% vs. 25.0 ± 16.5%, p = 0.013). The measurement error of the MLA was also reduced using MCA at 110 bpm (19.2 ± 28.1% vs. 26.4 ± 21.6%, p = 0.028) and 120 bpm (17.9 ± 17.7% vs. 34.8 ± 19.6%, p = 0.018). Conclusion Motion-correction algorithm can improve the coronary artery image quality and measurement accuracy at a high HR using an anthropomorphic dynamic heart phantom and 256-detector row CT scanner.
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Affiliation(s)
- Jeong Bin Park
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Joo Jeong
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
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6
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Yu Y, Zhou Z, Sun K, Xi L, Zhang L, Yu L, Wang J, Zheng J, Ding M. Association between coronary artery atherosclerosis and plasma glucose levels assessed by dual-source computed tomography. J Thorac Dis 2018; 10:6050-6059. [PMID: 30622776 DOI: 10.21037/jtd.2018.10.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background To assess the association between coronary artery atherosclerosis (CAA) and plasma glucose parameters in a randomly selected cohort of asymptomatic, community-dwelling, Chinese adults by dual-source computed tomography (DSCT). Methods We randomly selected participants and classified them into three groups based on their plasma glucose levels: normal glucose regulation (NGR), pre-diabetes, and diabetes mellitus (DM). The participants underwent DSCT, and those identified with CAA were divided into four groups according to the severity of their coronary artery stenosis. We analyzed the composition of plaques in all coronary artery segments according to the American Heart Association's (AHA) guidelines. We compared the severity of coronary artery stenosis and the plaque composition with plasma glucose parameters among participants. Results Out of a total of 335 participants, 118 were found to have CAA. The prevalence of CAA was highest (P value for trend =0.031) in the diabetic group (67.7%) followed by the pre-diabetic group (35.1%) then the NGR group (27.7%). Both calcified and mixed plaques were found in the coronary arteries of the diabetic group while mixed and non-calcified plaques predominated in the pre-diabetic and the NGR groups. When data from all subjects with CAA were analyzed, blood glucose parameters, fasting plasma glucose (FPG), 2-hr postprandial plasma glucose (PPG), and hemoglobin A1c (HbA1c), exhibited a positive correlation with the severity of coronary stenosis (P<0.05). Multivariable logistic regression models indicated a significantly higher risk of CAA among the diabetic patients. Triglyceride levels were positively correlated with the blood glucose parameters among the three groups while LDL-C was elevated in the DM group but not in the pre-diabetic group compared to the NGR group. Conclusions The severity of CAA exhibited a direct correlation with the blood glucose parameters, FPG, PPG, and HbA1c. DSCT can accurately detect the presence and distribution of CAA in asymptomatic, community-dwelling subjects. DSCT is a useful screening tool for coronary artery disease (CAD).
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Affiliation(s)
- Yi Yu
- Department of Ultrasound, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Zhiwen Zhou
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Kun Sun
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Lili Xi
- Department of Ultrasound, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Lina Zhang
- Department of Biostatistics, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Lingwei Yu
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jing Wang
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jiayi Zheng
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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Cardiac CT: Technological Advances in Hardware, Software, and Machine Learning Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11. [PMID: 31656551 DOI: 10.1007/s12410-018-9459-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of Review Multidetector row computed tomography (CT) allows noninvasive imaging of the heart and coronary arteries. The purpose of this review is to briefly summarize recent advances in CT hardware and software technology, and machine learning applications for cardiovascular imaging. Recent Findings In the last decades, there have been significant improvements in CT hardware focusing on faster gantry rotation resulting in improved temporal resolution. Concurrent hardware improvements include improved spatial resolution and higher coverage of the patient, enabling faster acquisition. Advances in cardiac CT software include methods for measurement of noninvasive FFR, coronary plaque characterization, and adipose tissue characteristics around the heart. Machine learning approaches using cardiac CT have been shown to improve both risk of prognosis and lesion-specific ischemia. Summary Recent advances in CT hardware and software have expanded the clinical utility of CT for cardiovascular imaging. In the next decades, continued advances can be anticipated in these areas, and in machine learning applications in cardiac CT, as they are incorporated into clinical routine for image acquisition, image analysis, and prediction of patient outcomes.
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Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography. Invest Radiol 2018; 53:264-270. [DOI: 10.1097/rli.0000000000000437] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study. Eur Radiol 2018; 28:2655-2664. [PMID: 29352380 DOI: 10.1007/s00330-017-5223-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to investigate if lesion-specific ischaemia by invasive fractional flow reserve (FFR) can be predicted by an integrated machine learning (ML) ischaemia risk score from quantitative plaque measures from coronary computed tomography angiography (CTA). METHODS In a multicentre trial of 254 patients, CTA and invasive coronary angiography were performed, with FFR in 484 vessels. CTA data sets were analysed by semi-automated software to quantify stenosis and non-calcified (NCP), low-density NCP (LD-NCP, < 30 HU), calcified and total plaque volumes, contrast density difference (CDD, maximum difference in luminal attenuation per unit area) and plaque length. ML integration included automated feature selection and model building from quantitative CTA with a boosted ensemble algorithm, and tenfold stratified cross-validation. RESULTS Eighty patients had ischaemia by FFR (FFR ≤ 0.80) in 100 vessels. Information gain for predicting ischaemia was highest for CDD (0.172), followed by LD-NCP (0.125), NCP (0.097), and total plaque volumes (0.092). ML exhibited higher area-under-the-curve (0.84) than individual CTA measures, including stenosis (0.76), LD-NCP volume (0.77), total plaque volume (0.74) and pre-test likelihood of coronary artery disease (CAD) (0.63); p < 0.006. CONCLUSIONS Integrated ML ischaemia risk score improved the prediction of lesion-specific ischaemia by invasive FFR, over stenosis, plaque measures and pre-test likelihood of CAD. KEY POINTS • Integrated ischaemia risk score improved prediction of ischaemia over quantitative plaque measures • Integrated ischaemia risk score showed higher prediction of ischaemia than standard approach • Contrast density difference had the highest information gain to identify lesion-specific ischaemia.
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Korosoglou G, Marwan M, Giusca S, Schmermund A, Schneider S, Bruder O, Hausleiter J, Schroeder S, Leber A, Limbourg T, Gitsioudis G, Rixe J, Zahn R, Katus HA, Achenbach S, Senges J. Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,339 patients. Data from the German Cardiac Computed Tomography Registry. J Cardiovasc Comput Tomogr 2017; 12:34-41. [PMID: 29195843 DOI: 10.1016/j.jcct.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/22/2017] [Accepted: 11/16/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (coronary CTA) provides non-invasive evaluation of the coronary arteries with high precision for the detection of significant coronary artery disease (CAD). AIM To investigate whether irregular heart rhythm including atrial fibrillation and premature beats during data acquisition influences (i) radiation and contrast media exposure, (ii) number of non-evaluable coronary segments and (iii) diagnostic impact of coronary CTA. METHODS Twelve tertiary care centers with ≥64 slice CT scanners and ≥5 years of experience with cardiovascular imaging participated in this registry. Between 2009 and 2014, 4339 examinations were analysed in patients who underwent clinically indicated coronary CTA for suspected CAD. Clinical and epidemiologic data were gathered from all patients. In addition, clinical presentation, heart rate and rhythm during the scan, Agatston score, radiation and contrast media exposure and the diagnostic impact of coronary CTA were systematically analysed. RESULTS Of 4339 patients in total, 260 (6.0%) had irregular heart rhythm, whereas the remaining 4079 (94.0%) had stable sinus rhythm. Patients with irregular heart rhythm were older (63.2 ± 12.5yrs versus 58.6 ± 11.4yrs. p < 0.001), exhibited a higher rate of pathologic stress tests before CTA (37.1% versus 26.1%, p < 0.01) and higher heart rates during CTA compared to those with sinus rhythm (62.5 ± 11.6bpm versus 58.9 ± 8.5bpm, p < 0.001). Both contrast media exposure and radiation exposure were significantly higher in patients with irregular heart rhythm (90 mL (95%CI = 80-110 mL) versus 80 mL (95%CI = 70-90 mL) and 6.2 mSv (95%CI = 2.5-11.7) versus 3.3 mSv (95%CI = 1.7-6.9), p < 0.001 for both). Coronary CTA excluded significant CAD less frequently in patients with irregular heart rhythm (32.9% versus 44.8%, p < 0.001). This was attributed to the higher rate of examinations with at least one non-diagnostic coronary segment in patients with irregular heart rhythm (10.8% versus 4.6%, p < 0.001). Subsequent invasive angiography could be avoided in 47.2% of patients with irregular heart rhythm compared to 52.9% of patients with sinus rhythm (p = NS), whereas downstream stress testing was recommended in 3.2% of patients with irregular heart rhythm versus 4.0% of patients with sinus rhythm (p = NS). CONCLUSION A significant number of patients scheduled for coronary CTA have irregular heart rhythm in a real-world clinical setting. In such patients, heart rate during coronary CTA is higher, possibly resulting in (i) higher radiation and contrast agent exposure and (ii) more frequent coronary CTA examinations with at least one non-diagnostic coronary artery segment. However, this does not seem to lead to increased downstream stress testing or subsequent invasive procedures.
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Affiliation(s)
- Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany..
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Axel Schmermund
- Cardiovascular Center Bethanien (CCB), Frankfurt Am Main, Germany
| | | | | | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilian's University, Munich, Germany
| | - Stephen Schroeder
- Department of Cardiology and Pneumology, Alb Fils Clinics, Geislingen, Germany
| | | | - Tobias Limbourg
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Gitsios Gitsioudis
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Johannes Rixe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Ralf Zahn
- Department of Cardiology, Ludwigshafen, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Andreini D, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M, Volpato V, Annoni A, Baggiano A, Formenti A, Mancini ME, Beltrama V, Ditali V, Campari A, Fiorentini C, Bartorelli AL, Pepi M. Atrial Fibrillation: Diagnostic Accuracy of Coronary CT Angiography Performed with a Whole-Heart 230-µm Spatial Resolution CT Scanner. Radiology 2017; 284:676-684. [PMID: 28445682 DOI: 10.1148/radiol.2017161779] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To assess image quality, interpretability, diagnostic accuracy, and radiation exposure of a computed tomography (CT) scanner with 16-cm coverage and 230-µm spatial resolution at coronary artery evaluation in patients with atrial fibrillation (AF) by using invasive coronary angiography (ICA) as the reference method and to compare the results with those obtained in patients with sinus rhythm (SR). Materials and Methods Written informed consent and institutional ethics committee approval were obtained. Between March 2015 and February 2016, 166 consecutive patients were prospectively enrolled (83 with AF, 83 with SR). They underwent ICA and coronary CT angiography performed with a whole-heart CT scanner. Image quality, coronary segment interpretability, effective dose (ED), and diagnostic accuracy were assessed at CT angiography and were compared with those attained with ICA. Diagnostic performance of the groups was compared with the pairwise McNemar test. Results Mean heart rate during scanning was 83 beats per minute ± 21 (standard deviation) in the AF group and 63 beats per minute ± 14 in the SR group (P < .01). Coronary interpretability was 98.5% in the AF group and 98.4% in the SR group (P = .96). In a segment-based analysis, sensitivity and specificity in the detection of coronary stenosis of more than 50% compared with detection of ICA were 96.4% and 98.7%, respectively, in the chronic AF group (P = .98) and 95.6% and 98.1%, respectively, in the SR group (P = .32). In a patient-based analysis, sensitivity and specificity were 95.2% and 97.6%, respectively, in the chronic AF group (P = .95) and 97.8% and 94.7%, respectively, in the SR group (P = .93). Conclusion Whole-heart CT enables evaluation of coronary arteries with high image quality, low radiation exposure, and high diagnostic accuracy in patients with chronic AF, with a diagnostic performance similar to that in patients with SR. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Daniele Andreini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Gianluca Pontone
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Saima Mushtaq
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Edoardo Conte
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Perchinunno
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Guglielmo
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Volpato
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Annoni
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Baggiano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alberto Formenti
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Maria Elisabetta Mancini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Virginia Beltrama
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Ditali
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alessandro Campari
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Cesare Fiorentini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Antonio L Bartorelli
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Mauro Pepi
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
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Abstract
Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide. Although invasive coronary angiography has previously been the gold standard in establishing the diagnosis of CAD, there is a growing shift to more appropriately use the cardiac catheterization laboratory to perform interventional procedures once a diagnosis of CAD has been established by noninvasive imaging modalities rather than using it primarily as a diagnostic facility to confirm or refute CAD. With ongoing technological advancements, noninvasive imaging plays a pre-eminent role in not only diagnosing CAD but also informing the choice of appropriate therapies, establishing prognosis, all while containing costs and providing value-based care. Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging. These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. This review will discuss their advantages and limitations and their usage in the diagnostic pathway for patients with CAD. We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia. Recognizing that clinicians have a multitude of tests to choose from, we provide an underpinning of the principles of ischemia detection by these various modalities, focusing on anatomy vs physiology, the database justifying their use, their prognostic capabilities and lastly, their appropriate and judicious use in this era of patient-centered, cost-effective imaging.
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Cui Y, Zeng W, Yu J, Lu J, Hu Y, Diao N, Liang B, Han P, Shi H. Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT. PLoS One 2017; 12:e0174352. [PMID: 28346530 PMCID: PMC5367806 DOI: 10.1371/journal.pone.0174352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis < 50%, and significantly wider in the non-calcified plaque group than calcified. Multivariable analyses showed the bifurcation angle of LAD-LCx was an independent predictor for significant left coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction.
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Affiliation(s)
- Yue Cui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjuan Zeng
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Lu
- Department of Nuclear Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yuannan Hu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Diao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Slomka PJ, Dey D, Sitek A, Motwani M, Berman DS, Germano G. Cardiac imaging: working towards fully-automated machine analysis & interpretation. Expert Rev Med Devices 2017; 14:197-212. [PMID: 28277804 DOI: 10.1080/17434440.2017.1300057] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Non-invasive imaging plays a critical role in managing patients with cardiovascular disease. Although subjective visual interpretation remains the clinical mainstay, quantitative analysis facilitates objective, evidence-based management, and advances in clinical research. This has driven developments in computing and software tools aimed at achieving fully automated image processing and quantitative analysis. In parallel, machine learning techniques have been used to rapidly integrate large amounts of clinical and quantitative imaging data to provide highly personalized individual patient-based conclusions. Areas covered: This review summarizes recent advances in automated quantitative imaging in cardiology and describes the latest techniques which incorporate machine learning principles. The review focuses on the cardiac imaging techniques which are in wide clinical use. It also discusses key issues and obstacles for these tools to become utilized in mainstream clinical practice. Expert commentary: Fully-automated processing and high-level computer interpretation of cardiac imaging are becoming a reality. Application of machine learning to the vast amounts of quantitative data generated per scan and integration with clinical data also facilitates a move to more patient-specific interpretation. These developments are unlikely to replace interpreting physicians but will provide them with highly accurate tools to detect disease, risk-stratify, and optimize patient-specific treatment. However, with each technological advance, we move further from human dependence and closer to fully-automated machine interpretation.
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Affiliation(s)
- Piotr J Slomka
- a Department of Imaging (Division of Nuclear Medicine) and Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Damini Dey
- b Biomedical Imaging Research Institute , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | | | - Manish Motwani
- d Cardiovascular Imaging , Manchester Heart Centre, Manchester Royal Infirmary , Manchester , UK
| | - Daniel S Berman
- a Department of Imaging (Division of Nuclear Medicine) and Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Guido Germano
- a Department of Imaging (Division of Nuclear Medicine) and Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
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Lee DH, Youn HJ, Jung HO, Chang K, Choi YS, Jung JI. The cardiovascular risk factors associated with the plaque pattern on coronary computed tomographic angiography in subjects for health check-up. Clin Hypertens 2017; 23:6. [PMID: 28265463 PMCID: PMC5333424 DOI: 10.1186/s40885-017-0062-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although it is known that coronary computed tomographic angiography (CCTA) offers highly negative predictive value to exclude obstructive coronary lesions, the plaque pattern on CCTA has not been fully understood. The purpose of this study was to explore the difference of the plaque patterns on CCTA and to assess the cardiovascular risks in healthy subjects. METHODS A total of 3914 subjects (mean age: 55 ± 10 years, M : F = 2649 : 1265) who underwent CCTA for health check-up between January 2009 and December 2012 were enrolled. According to coronary artery calcium score (CACS) and plaque pattern on CCTA, subjects were categorized into four groups (group 1: normal; group 2: "non-calcified" plaque; group 3: "calcified" plaque; group 4: mixed plaque). We analyzed cardiovascular risks and Framingham risk score (FRS) among the groups. RESULTS The incidence of each group was group 1 in 55.0% (2152/3914), group 2 in 5.1% (200/3914), group 3 in 8.2% (319/3914), and group 4 in 7.2% (280/3914), respectively. There was no difference of FRS among the groups (6.4 ± 6.4%; 6.5 ± 4.6%; 8.2 ± 5.8%; 7.7 ± 5.7% p = 0.086). In multivariate analysis, HbA1c (OR = 2.285; 95%CI = 1.029 - 5.071; p = 0.042) in group 2; age (OR = 1.115; 95%CI = 1.034 - 1.202; p = 0.005) and smoking status (OR = 3.386; 95%CI = 1.124 - 10.202; p = 0.030) in group 3; and age (OR = 1.054; 95%CI = 1.011 - 1.099; p = 0.014) and hypertension (OR = 3.087; 95%CI = 1.536 - 6.202; p = 0.001) in group 4 were independent factors. CONCLUSIONS Our data suggest that more individualized therapy for reduction of cardiovascular risks associated with plaque pattern on CCTA could be considered in healthy subjects.
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Affiliation(s)
- Dong-Hyeon Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Hae-Ok Jung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
| | - Jung Im Jung
- Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 137-701 Korea
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Long B, Koyfman A. Best Clinical Practice: Current Controversies in Evaluation of Low-Risk Chest Pain-Part 1. J Emerg Med 2016; 51:668-676. [PMID: 27693075 DOI: 10.1016/j.jemermed.2016.07.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chest pain is a common presentation to the emergency department (ED), though the majority of patients are not diagnosed with acute coronary syndrome (ACS). Many patients are admitted to the hospital due to fear of ACS. OBJECTIVE Our aim was to investigate controversies in low-risk chest pain evaluation, including risk of missed ACS, stress test, and coronary computed tomography angiography (CCTA). DISCUSSION Chest pain accounts for 10 million ED visits in the United States annually. Many patients are at low risk for a major cardiac adverse event (MACE). With negative troponin and nonischemic electrocardiogram (ECG), the risk of MACE and myocardial infarction (MI) is < 1%. The American Heart Association recommends further evaluation in low- to intermediate-risk patients within 72 h. These modalities add little to further risk stratification. These evaluations do not appropriately risk stratify patients who are already at low risk, nor do they diagnose acute MI. CCTA is an anatomic evaluation of the coronary vasculature with literature support to decrease ED length of stay, though it is associated with downstream testing. Literature is controversial concerning further risk stratification in already low-risk patients. CONCLUSIONS With nonischemic ECG and negative cardiac biomarker, the risk of ACS approaches < 1%. Use of stress test and CCTA for risk stratification of low-risk chest pain patients is controversial. These tests may allow prognostication but do not predict ACS risk beyond ECG and troponin. CCTA may be useful for intermediate-risk patients, though further studies are required.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
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Selçuk T, Otçu H, Yüceler Z, Bilgili Ç, Bulakçı M, Savaş Y, Çelik Ö. Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality. Balkan Med J 2016; 33:283-93. [PMID: 27308072 DOI: 10.5152/balkanmedj.2016.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/01/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN Retrospective cross-sectional study. METHODS Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.
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Affiliation(s)
- Tuba Selçuk
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey; Department of Medical Imaging Techniques, İstanbul Gelişim University Vocational School of Health Services
| | - Hafize Otçu
- Department of Radiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zeyneb Yüceler
- Department of Radiology, Şereflikoçhisar Government Hospital, Ankara, Turkey
| | - Çiğdem Bilgili
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mesut Bulakçı
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yıldıray Savaş
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Dey D, Diaz Zamudio M, Schuhbaeck A, Juarez Orozco LE, Otaki Y, Gransar H, Li D, Germano G, Achenbach S, Berman DS, Meave A, Alexanderson E, Slomka PJ. Relationship Between Quantitative Adverse Plaque Features From Coronary Computed Tomography Angiography and Downstream Impaired Myocardial Flow Reserve by 13N-Ammonia Positron Emission Tomography: A Pilot Study. Circ Cardiovasc Imaging 2016; 8:e003255. [PMID: 26467104 DOI: 10.1161/circimaging.115.003255] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND We investigated the relationship of quantitative plaque features from coronary computed tomography (CT) angiography and coronary vascular dysfunction by impaired myocardial flow reserve (MFR) by (13)N-Ammonia positron emission tomography (PET). METHODS AND RESULTS Fifty-one patients (32 men, 62.4±9.5 years) underwent combined rest-stress (13)N-ammonia PET and CT angiography scans by hybrid PET/CT. Regional MFR was measured from PET. From CT angiography, 153 arteries were evaluated by semiautomated software, computing arterial noncalcified plaque (NCP), low-density NCP (NCP<30 HU), calcified and total plaque volumes, and corresponding plaque burden (plaque volumex100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum difference in luminal attenuation per unit area in the lesion), and plaque length. Quantitative stenosis, plaque burden, and myocardial mass were combined by boosted ensemble machine-learning algorithm into a composite risk score to predict impaired MFR (MFR≤2.0) by PET in each artery. Nineteen patients had impaired regional MFR in at least 1 territory (41/153 vessels). Patients with impaired regional MFR had higher arterial NCP (32.4% versus 17.2%), low-density NCP (7% versus 4%), and total plaque burden (37% versus 19.3%, P<0.02). In multivariable analysis with 10-fold cross-validation, NCP burden was the most significant predictor of impaired MFR (odds ratio, 1.35; P=0.021 for all). For prediction of impaired MFR with 10-fold cross-validation, receiver operating characteristics area under the curve for the composite score was 0.83 (95% confidence interval, 0.79-0.91) greater than for quantitative stenosis (0.66, 95% confidence interval, 0.57-0.76, P=0.005). CONCLUSIONS Compared with stenosis, arterial NCP burden and a composite score combining quantitative stenosis and plaque burden from CT angiography significantly improves identification of downstream regional vascular dysfunction.
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Affiliation(s)
- Damini Dey
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.).
| | - Mariana Diaz Zamudio
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Annika Schuhbaeck
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Luis Eduardo Juarez Orozco
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Yuka Otaki
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Heidi Gransar
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Debiao Li
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Guido Germano
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Stephan Achenbach
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Daniel S Berman
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Aloha Meave
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Erick Alexanderson
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
| | - Piotr J Slomka
- From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.)
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Machida H, Tanaka I, Fukui R, Shen Y, Ishikawa T, Tate E, Ueno E. Current and Novel Imaging Techniques in Coronary CT. Radiographics 2015; 35:991-1010. [PMID: 26046942 DOI: 10.1148/rg.2015140181] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multidetector coronary computed tomography (CT), which is widely performed to assess coronary artery disease noninvasively and accurately, provides excellent image quality. Use of electrocardiography (ECG)-controlled tube current modulation and low tube voltage can reduce patient exposure to nephrotoxic contrast media and carcinogenic radiation when using standard coronary CT with a retrospective ECG-gated helical scan. Various imaging techniques are expected to overcome the limitations of standard coronary CT, which also include insufficient spatial and temporal resolution, beam-hardening artifacts, limited coronary plaque characterization, and an inability to allow functional assessment of coronary stenosis. Use of a step-and-shoot scan, iterative reconstruction, and a high-pitch dual-source helical scan can further reduce radiation dose. Dual-energy CT can improve contrast medium enhancement and reasonably reduce the contrast dose when combined with noise reduction with the use of iterative reconstruction. High-definition CT can improve spatial resolution and diagnostic evaluation of small or peripheral coronary vessels and coronary stents. Dual-source CT and a motion correction algorithm can improve temporal resolution and reduce coronary motion artifacts. Whole-heart coverage with 320-detector CT and an intelligent boundary registration algorithm can eliminate stair-step artifacts. By decreasing beam hardening and enabling material decomposition, dual-energy CT is expected to remove or reduce the depiction of coronary calcification to improve intraluminal evaluation of calcified vessels and to provide detailed analysis of coronary plaque components and accurate qualitative and quantitative assessment of myocardial perfusion. Fractional flow reserve derived from coronary CT is a state-of-the-art noninvasive technique for accurately identifying myocardial ischemia beyond coronary CT. Understanding these techniques is important to enhance the value of coronary CT for assessment of coronary artery disease.
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Affiliation(s)
- Haruhiko Machida
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Isao Tanaka
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Rika Fukui
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Yun Shen
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Takuya Ishikawa
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Etsuko Tate
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
| | - Eiko Ueno
- From the Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan (H.M., I.T., R.F., Y.S., T.I., E.T., E.U.); and GE Healthcare, Tokyo, Japan (Y.S.)
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Impact of an intra-cycle motion correction algorithm on overall evaluability and diagnostic accuracy of computed tomography coronary angiography. Eur Radiol 2015; 26:147-56. [PMID: 25953001 DOI: 10.1007/s00330-015-3793-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/15/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a novel intra-cycle motion correction algorithm (MCA) on overall evaluability and diagnostic accuracy of cardiac computed tomography coronary angiography (CCT). METHODS From a cohort of 900 consecutive patients referred for CCT for suspected coronary artery disease (CAD), we enrolled 160 (18 %) patients (mean age 65.3 ± 11.7 years, 101 male) with at least one coronary segment classified as non-evaluable for motion artefacts. The CCT data sets were evaluated using a standard reconstruction algorithm (SRA) and MCA and compared in terms of subjective image quality, evaluability and diagnostic accuracy. RESULTS The mean heart rate during the examination was 68.3 ± 9.4 bpm. The MCA showed a higher Likert score (3.1 ± 0.9 vs. 2.5 ± 1.1, p < 0.001) and evaluability (94%vs.79 %, p < 0.001) than the SRA. In a 45-patient subgroup studied by clinically indicated invasive coronary angiography, specificity, positive predictive value and accuracy were higher in MCA vs. SRA in segment-based and vessel-based models, respectively (87%vs.73 %, 50%vs.34 %, 85%vs.73 %, p < 0.001 and 62%vs.28 %, 66%vs.51 % and 75%vs.57 %, p < 0.001). In a patient-based model, MCA showed higher accuracy vs. SCA (93%vs.76 %, p < 0.05). CONCLUSIONS MCA can significantly improve subjective image quality, overall evaluability and diagnostic accuracy of CCT. KEY POINTS Cardiac computed tomographic coronary angiography (CCT) allows non-invasive evaluation of coronary arteries. Intra-cycle motion correction algorithm (MCA) allows for compensation of coronary motion. An MCA improves image quality, CCT evaluability and diagnostic accuracy.
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Stefanini GG, Windecker S. Can coronary computed tomography angiography replace invasive angiography? Coronary computed tomography angiography cannot replace invasive angiography. Circulation 2015; 131:418-25; discussion 426. [PMID: 25623124 DOI: 10.1161/circulationaha.114.008148] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Andreini D, Pontone G, Mushtaq S, Bertella E, Conte E, Segurini C, Baggiano A, Bartorelli AL, Annoni A, Formenti A, Petullà M, Beltrama V, Fiorentini C, Pepi M. Low-dose CT coronary angiography with a novel IntraCycle motion-correction algorithm in patients with high heart rate or heart rate variability. Eur Heart J Cardiovasc Imaging 2015; 16:1093-100. [PMID: 25762564 DOI: 10.1093/ehjci/jev033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 01/10/2023] Open
Abstract
AIMS Motion artefacts due to high or irregular heart rate (HR) are common limitations of coronary computed tomography (CT) angiography (CCTA). The aim of the study was to evaluate the impact of a new motion-correction (MC) algorithm used in conjunction with low-dose prospective ECG-triggering CCTA on motion artefacts, image quality, and coronary assessability. METHODS AND RESULTS Among 380 patients undergoing CCTA for suspected CAD, we selected 120 patients with pre-scanning HR >70 bpm or HR variability (HRv) >10 bpm during scanning irrespective of pre-scanning HR or both conditions. In patients with pre-scanning HR <65 or ≥65 bpm, prospective ECG triggering with padding of 80 ms (58 cases) or padding of 200 ms (62 cases) was used, respectively. Mean pre-scanning HR and HRv were 70 ± 7 and 10.9 ± 4 bpm, respectively. Overall, the mean effective dose was 3.4 ± 1.3 mSv, while a lower dose (2.4 ± 0.9 mSv) was measured for padding of 80 ms. In a segment-based analysis, coronary assessability was significantly higher (P < 0.0001) with MC (97%) when compared with standard (STD) reconstruction (81%) due to a significant reduction (P < 0.0001) in severe artefacts (54 vs. 356 cases, respectively). An artefact sub-analysis showed significantly lower number of motion artefacts and artefacts related to chest movement with MC (16 and 4 cases) than with STD reconstruction (286 and 24 cases, P < 0.0001 and P < 0.05, respectively). The number of coronary segments ranked among those of excellent image quality was significantly higher with MC (P < 0.001). CONCLUSIONS The MC algorithm improves CCTA image quality and coronary assessability in patients with high HR and HRv, despite low radiation dose.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via C. Parea 4, Milan 20138, Italy
| | | | | | | | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via C. Parea 4, Milan 20138, Italy
| | | | | | | | | | - Cesare Fiorentini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via C. Parea 4, Milan 20138, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Kang D, Dey D, Slomka PJ, Arsanjani R, Nakazato R, Ko H, Berman DS, Li D, Kuo CCJ. Structured learning algorithm for detection of nonobstructive and obstructive coronary plaque lesions from computed tomography angiography. J Med Imaging (Bellingham) 2015; 2:014003. [PMID: 26158081 DOI: 10.1117/1.jmi.2.1.014003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/11/2015] [Indexed: 12/28/2022] Open
Abstract
Visual identification of coronary arterial lesion from three-dimensional coronary computed tomography angiography (CTA) remains challenging. We aimed to develop a robust automated algorithm for computer detection of coronary artery lesions by machine learning techniques. A structured learning technique is proposed to detect all coronary arterial lesions with stenosis [Formula: see text]. Our algorithm consists of two stages: (1) two independent base decisions indicating the existence of lesions in each arterial segment and (b) the final decision made by combining the base decisions. One of the base decisions is the support vector machine (SVM) based learning algorithm, which divides each artery into small volume patches and integrates several quantitative geometric and shape features for arterial lesions in each small volume patch by SVM algorithm. The other base decision is the formula-based analytic method. The final decision in the first stage applies SVM-based decision fusion to combine the two base decisions in the second stage. The proposed algorithm was applied to 42 CTA patient datasets, acquired with dual-source CT, where 21 datasets had 45 lesions with stenosis [Formula: see text]. Visual identification of lesions with stenosis [Formula: see text] by three expert readers, using consensus reading, was considered as a reference standard. Our method performed with high sensitivity (93%), specificity (95%), and accuracy (94%), with receiver operator characteristic area under the curve of 0.94. The proposed algorithm shows promising results in the automated detection of obstructive and nonobstructive lesions from CTA.
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Affiliation(s)
- Dongwoo Kang
- University of Southern California , Department of Electrical Engineering, Los Angeles, California 90089, United States
| | - Damini Dey
- Cedars-Sinai Medical Center , Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, California 90048, United States
| | - Piotr J Slomka
- Cedars-Sinai Medical Center , Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Los Angeles, California 90048, United States
| | - Reza Arsanjani
- Cedars-Sinai Medical Center , Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Los Angeles, California 90048, United States
| | - Ryo Nakazato
- Cedars-Sinai Medical Center , Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Los Angeles, California 90048, United States
| | - Hyunsuk Ko
- University of Southern California , Department of Electrical Engineering, Los Angeles, California 90089, United States
| | - Daniel S Berman
- Cedars-Sinai Medical Center , Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Los Angeles, California 90048, United States
| | - Debiao Li
- Cedars-Sinai Medical Center , Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, California 90048, United States
| | - C-C Jay Kuo
- University of Southern California , Department of Electrical Engineering, Los Angeles, California 90089, United States
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Functional relevance of coronary artery disease by cardiac magnetic resonance and cardiac computed tomography: myocardial perfusion and fractional flow reserve. BIOMED RESEARCH INTERNATIONAL 2015; 2015:297696. [PMID: 25692133 PMCID: PMC4323071 DOI: 10.1155/2015/297696] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/31/2014] [Indexed: 01/17/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.
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Diagnostic quality of dual-source coronary CT examinations performed without heart rate control: importance of obesity and heart rate on image quality. J Comput Assist Tomogr 2015; 38:949-55. [PMID: 25032805 DOI: 10.1097/rct.0000000000000135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For dual-source cardiac computed tomography (CT) scans without heart rate (HR) control, the influence of body habitus on quality is uncertain. We evaluated study quality across a range of HRs and body size. METHODS One hundred sixty subjects were randomly selected for 4 HR groups (<70, 70-79, 80-89, ≥90 beats per minute) from 703 subjects who underwent cardiac CT without premedication. Coronary visualization quality was scored on a 3-point scale (1, nondiagnostic; 2, diagnostic; 3, excellent). RESULTS Ninety-nine percent of coronaries were diagnostic quality. Six vessels were nondiagnostic, mostly due to motion. Nondiagnostic or diagnostic scores (<3) were greatest in the group with HR of more than or equal to 90 beats per minute. All normal weight subjects had excellent quality, but 6% of vessels in overweight and 17% in obese subjects had diagnostic scores less than 3. The mean effective dose was 11.4 mSv and correlated with body size. CONCLUSIONS Diagnostic quality cardiac CT examinations can be obtained without premedication regardless of body size.
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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Correlation between low tube voltage in dual source CT coronary artery imaging with image quality and radiation dose. ACTA ACUST UNITED AC 2014; 34:616-620. [PMID: 25135738 DOI: 10.1007/s11596-014-1326-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/16/2014] [Indexed: 01/12/2023]
Abstract
The influence of low tube voltage in dual source CT (DSCT) coronary artery imaging on image quality and radiation dose and its application value in clinical practice were investigated. Totally, 300 cases of chest pain with low body mass index (BMI <18.5 kg/m(2)) subjected to DSCT coronary artery imaging were prospectively enrolled. The heart rate in all patients were greater than 65/min. The retrospective ECG gated scanning mode and simple random sampling method were used to assign the patients into groups A, B and C (n=100 each). The patients in groups A, B and C experienced 120-, 100-, and 80-kV tube voltage imaging respectively, and the image quality was evaluated. The CT volume dose index (CTDIvol) and dose length product (DLP) were recorded, and the effective dose (ED) was calculated in each group. The image quality scores and radiation doses in groups were compared, and the influence of tube voltage on image quality and radiation dose was analyzed. The results showed that the excellent rate of image quality in groups A, B and C was 95.69%, 94.72% and 96.33% respectively with the difference being not statistically significant among the three groups (P>0.05). The CTDIvol values in groups A, B and C were 51.35±12.21, 21.28±7.13 and 6.34±3.34 mGy, respectively, with the difference being statistically significant (P<0.05). The ED values in groups A, B and C were 9.27±1.63, 4.56±2.29 and 2.29±1.69 mSv, respectively, with the difference being statistically significant (P<0.05). It was suggested that for the patients with low BMI, the application of DSCT coronary artery imaging with low tube voltage can obtain satisfactory image quality, and simultaneously, significantly reduce the radiation dose.
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Lee H, Kim JA, Lee JS, Suh J, Paik SH, Park JS. Impact of a vendor-specific motion-correction algorithm on image quality, interpretability, and diagnostic performance of daily routine coronary CT angiography: influence of heart rate on the effect of motion-correction. Int J Cardiovasc Imaging 2014; 30:1603-12. [DOI: 10.1007/s10554-014-0499-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
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Jiang B, Wang J, Lv X, Cai W. Dual-source CT versus single-source 64-section CT angiography for coronary artery disease: A meta-analysis. Clin Radiol 2014; 69:861-9. [PMID: 24854029 DOI: 10.1016/j.crad.2014.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 01/14/2023]
Abstract
AIM To perform a meta-analysis to compare the diagnostic performance of single-source 64-section computed tomography (CT) versus dual-source CT angiography for diagnosis of coronary artery disease (CAD). MATERIALS AND METHODS The Cochrane Library, MEDLINE, and EMBASE were searched for relevant original papers. Inclusion criteria were (1) significant CAD defined as ≥50% reduction in luminal diameter by invasive coronary angiography as reference standard; (2) single-source 64-section CT or dual-source CT was used; (3) results were reported in absolute numbers of true-positive, false-positive, true-negative, and false-negative results or sufficiently detailed data for deriving these numbers were presented. A random-effects model was used for the meta-analysis. RESULTS Fifty-one papers including 3966 patients who underwent single-source 64-section CT and 2047 patients who underwent dual-source CT at a per-patient level were pooled. The diagnostic values of single-source 64-section CT versus dual-source CT were 97% versus 97% for sensitivity (p = 0.386), 78% versus 86% for specificity (p < 0.001), 90% versus 85% for positive predictive value (PPV; p < 0.001), 93% versus 97% for negative predictive value (NPV; p = 0.001), 6.8 versus 6.5 for positive likelihood ratio (p = 0.018), 0.04 versus 0.04 for negative likelihood ratio (p = 0.625), and 191.59 versus 207.37 for diagnostic odds ratio (p = 0.043), respectively. CONCLUSION Dual-source CT and single-source 64-section CT have similar negative likelihood ratios and, therefore, there was no significant difference in their utility to rule out CAD in intermediate-risk patients. However, compared to single-source 64-section CT, dual-source CT has significantly higher specificity, so that CT-based decisions for subsequent coronary catheter angiography are more accurate.
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Affiliation(s)
- B Jiang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - J Wang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
| | - X Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - W Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
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Deriving coronary artery calcium scores from CT coronary angiography: a proposed algorithm for evaluating stable chest pain. Int J Cardiovasc Imaging 2014; 30:1135-43. [DOI: 10.1007/s10554-014-0439-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/28/2014] [Indexed: 02/05/2023]
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Multicenter Evaluation Of Coronary Dual-Source CT angiography in patients with intermediate Risk of Coronary Artery Stenoses (MEDIC): study design and rationale. J Cardiovasc Comput Tomogr 2014; 8:183-8. [PMID: 24939066 DOI: 10.1016/j.jcct.2014.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The diagnostic performance of multidetector row CT to detect coronary artery stenosis has been evaluated in numerous single-center studies, with only limited data from large cohorts with low-to-intermediate likelihood of coronary disease and in multicenter trials. The Multicenter Evaluation of Coronary Dual-Source CT Angiography in Patients with Intermediate Risk of Coronary Artery Stenoses (MEDIC) trial determines the accuracy of dual-source CT (DSCT) to identify persons with at least 1 coronary artery stenosis among patients with low-to-intermediate pretest likelihood of disease. METHODS The MEDIC trial was designed as a prospective, multicenter, international trial to evaluate the diagnostic performance of DSCT for the detection of coronary artery stenosis compared with invasive coronary angiography. The study includes 8 sites in Germany, India, Mexico, the United States, and Denmark. The study population comprises patients referred for a diagnostic coronary angiogram because of suspected coronary artery disease with an intermediate pretest likelihood as determined by sex, age, and symptoms. All evaluations are performed by blinded core laboratory readers. RESULTS The primary outcome of the MEDIC trial is the accuracy of DSCT to identify the presence of coronary artery stenoses with a luminal diameter narrowing of 50% or more on a per-vessel basis. Secondary outcome parameters include per-patient and per-segment diagnostic accuracy for 50% stenoses and accuracy to identify stenoses of 70% or more. Furthermore, secondary outcome parameters include the influence of heart rate, Agatston score, body weight, body mass index, image quality, and diagnostic confidence on the accuracy to detect coronary artery stenoses >50% on a per-vessel basis. CONCLUSION The results of the MEDIC trial will assess the clinical utility of coronary CT angiography in the evaluation of patients with intermediate pretest likelihood of coronary artery disease.
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Li M, Du XM, Jin ZT, Peng ZH, Ding J, Li L. The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis. PLoS One 2014; 9:e84937. [PMID: 24465453 PMCID: PMC3897406 DOI: 10.1371/journal.pone.0084937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/20/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. MATERIALS AND METHODS PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. RESULTS 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%. CONCLUSION The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
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Affiliation(s)
- Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Xiang-min Du
- Department of Medical Engineering, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Zhi-tao Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - Zhao-hui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Juan Ding
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Li Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
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Effect of kVp on image quality and accuracy in coronary CT angiography according to patient body size: a phantom study. Int J Cardiovasc Imaging 2013; 29 Suppl 2:83-91. [DOI: 10.1007/s10554-013-0298-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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Li M, Zhang GM, Zhao JS, Jiang ZW, Peng ZH, Jin ZT, Sun G. Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. Clin Radiol 2013; 69:163-71. [PMID: 24268513 DOI: 10.1016/j.crad.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography with and without the application of a β-blocker. MATERIALS AND METHODS An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize diagnostic test data. RESULTS The pooled sensitivity at the patient level was 0.98 [95% confidence intervals (CI): 0.97-0.99], and specificity 0.88 (95% CI: 0.84-0.91). The results showed that without heart rate control, the sensitivity and specificity at the patient level did not decrease (p = 0.27 and 0.56, respectively). At the artery level, no significant differences in sensitivity and specificity for studies with and without heart rate control were detected (p = 0.04 and 0.05, respectively). At the segment level, the specificity decreased without heart rate control (p = 0.03), whereas the sensitivity was not influenced (p = 0.63). The median radiation exposure was 2.6 mSv, with 1.6 mSv and 8 mSv for heart rate-controlled studies and uncontrolled studies, respectively. CONCLUSIONS DSCT coronary angiography without heart rate control has a similar excellent diagnostic performance at the patient level as that of heart rate control groups. However, controlling for heart rate to decrease radiation and to provide effective information for selecting the therapeutic strategy and risk stratification is recommended.
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Affiliation(s)
- M Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - G-M Zhang
- Department of Medical Cardiology, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - J-S Zhao
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, China
| | - Z-W Jiang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Z-H Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Z-T Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - G Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
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Lymperopoulos A, Negussie S, Walklett K. β1- and α2C-adrenergic receptor polymorphisms and the antiarrhythmic effect of bucindolol in heart failure with reduced ejection fraction. Pharmacogenomics 2013; 14:1545-9. [PMID: 24088125 DOI: 10.2217/pgs.13.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Anastasios Lymperopoulos
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences, Nova Southeastern University College of Pharmacy, HPD (Terry) Building/Room 1338, Fort Lauderdale, FL 33328-2018, USA
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Kang D, Slomka PJ, Nakazato R, Arsanjani R, Cheng VY, Min JK, Li D, Berman DS, Kuo CCJ, Dey D. Automated knowledge-based detection of nonobstructive and obstructive arterial lesions from coronary CT angiography. Med Phys 2013; 40:041912. [PMID: 23556906 DOI: 10.1118/1.4794480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Visual analysis of three-dimensional (3D) coronary computed tomography angiography (CCTA) remains challenging due to large number of image slices and tortuous character of the vessels. The authors aimed to develop a robust, automated algorithm for unsupervised computer detection of coronary artery lesions. METHODS The authors' knowledge-based algorithm consists of centerline extraction, vessel classification, vessel linearization, lumen segmentation with scan-specific lumen attenuation ranges, and lesion location detection. Presence and location of lesions are identified using a multi-pass algorithm which considers expected or "normal" vessel tapering and luminal stenosis from the segmented vessel. Expected luminal diameter is derived from the scan by automated piecewise least squares line fitting over proximal and mid segments (67%) of the coronary artery considering the locations of the small branches attached to the main coronary arteries. RESULTS The authors applied this algorithm to 42 CCTA patient datasets, acquired with dual-source CT, where 21 datasets had 45 lesions with stenosis ≥ 25%. The reference standard was provided by visual and quantitative identification of lesions with any stenosis ≥ 25% by three expert readers using consensus reading. The authors algorithm identified 42 lesions (93%) confirmed by the expert readers. There were 46 additional lesions detected; 23 out of 39 (59%) of these were less-stenosed lesions. When the artery was divided into 15 coronary segments according to standard cardiology reporting guidelines, per-segment basis, sensitivity was 93% and per-segment specificity was 81% using 10-fold cross-validation. CONCLUSIONS The authors' algorithm shows promising results in the detection of both obstructive and nonobstructive CCTA lesions.
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Affiliation(s)
- Dongwoo Kang
- Department of Electrical Engineering, University of Southern California, Los Angeles, California 90089, USA
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Fujimura T, Miura T, Nao T, Yoshimura M, Nakashima Y, Okada M, Okamura T, Yamada J, Ohshita C, Wada Y, Matsunaga N, Matsuzaki M, Yano M. Dual-source computed tomography coronary angiography in patients with high heart rate. Heart Vessels 2013; 29:443-8. [PMID: 23812582 DOI: 10.1007/s00380-013-0383-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
Although single-source 64-multislice computed tomography coronary angiography (SSCTA) needs to reduce heart rate (HR), dual-source computed tomography coronary angiography (DSCTA) can acquire images even in tachycardia. The accuracy of DSCTA during tachycardia is compared to the accuracy of SSCTA at reduced HR. Patients who received invasive coronary angiography and either SSCTA or DSCTA were included. In the SSCTA group, HR was reduced to <65 beats per minute (bpm) with β-blocker (n = 27), while in the DSCTA group patients whose HR was >65 bpm were selected (n = 27). The diagnostic accuracy for significant coronary stenosis was calculated by comparing the invasive coronary angiography. Using dual-Doppler echocardiography, isovolumic relaxation time (IRT) and diastasis time (DT) were evaluated in these patients. In SSCTA, sensitivity was 89 %, specificity 99 %, the positive predictive value (PPV) 94 %, and the negative predictive value (NPV) was 98 %. In DSCTA, sensitivity was 96 %, the specificity was 99 %, PPV was 91 %, and NPV was 99 % (all NS compared to SSCTA). When HR was >75 bpm, DT was markedly shortened (<83 ms), however IRT was maintained >85 ms. Thus, the image reconstruction at the phase of IRT is feasible in DSCTA because of its temporal resolution of 83 ms. High temporal resolution of DSCTA shows equivalent accuracy of coronary stenosis detection to SSCTA, without reducing heart rate, because of its image reconstruction at IRT.
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Affiliation(s)
- Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan
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A randomized, double-blind, placebo-controlled, phase II dose-finding study of the short acting β1-blocker, landiolol hydrochloride, in patients with suspected ischemic cardiac disease. Int J Cardiovasc Imaging 2013; 29 Suppl 1:7-20. [PMID: 23784548 PMCID: PMC3722440 DOI: 10.1007/s10554-013-0253-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/31/2013] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to compare the safety and efficacy of the short-acting β1-receptor blocker, landiolol hydrochloride (0.06 and 0.125-mg/kg), to placebo during coronary computed tomography angiography (CTA) in a phase 2 dose-finding study. A total of 183 patients suspected of having ischemic cardiac disease and scheduled to undergo an invasive coronary angiography were randomized to groups treated with landiolol hydrochloride (0.06 or 0.125-mg/kg) or placebo. The heart rate, safety, and the performance of coronary diagnosis using landiolol hydrochloride were evaluated in a multicenter, double-blind, randomized, parallel study. The patients’ heart rates during the coronary CTA were 67.6 ± 8.7 and 62.6 ± 7.8 beats/min in the 0.06 and 0.125-mg/kg landiolol hydrochloride groups, respectively, both of which were significantly lower than the heat rate of 73.7 ± 11.8 beats/min in the placebo group (P = 0.003 and P < 0.001, respectively). No adverse events or reactions occurred at an incidence of 5 % or greater, confirming the safety of landiolol hydrochloride. The proportion of correctly classified patients was significantly higher in the 0.125-mg/kg landiolol hydrochloride group than in the placebo group (73.6 vs. 50.0 %). Landiolol hydrochloride at doses of 0.06 and 0.125-mg/kg significantly decreased the heart rate compared with a placebo. The present findings suggest that landiolol hydrochloride is safe and useful at a dose of 0.125-mg/kg to improve coronary diagnostic performance during coronary CTA.
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Xu Y, Bi Y, Li M, Wang T, Sun K, Xu M, Lu J, Yu Y, Li X, Lai S, Wang W, Ning G. Significant coronary stenosis in asymptomatic Chinese with different glycemic status. Diabetes Care 2013; 36:1687-94. [PMID: 23462666 PMCID: PMC3661849 DOI: 10.2337/dc12-0977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate coronary artery stenosis in early diabetes or prediabetes asymptomatic of myocardial ischemia in community-dwelling Chinese adults. RESEARCH DESIGN AND METHODS Age- and sex-matched participants with normal glucose regulation (NGR), prediabetes, or diabetes diagnosed within 5 years, asymptomatic of coronary artery disease (CAD), were randomly selected from a community-dwelling Chinese population aged 40-60 years. Dual-source computed tomography coronary angiography was used to evaluate the existence and extent of coronary stenosis, which was considered significant if >50% narrowing of vessel lumen was detected. RESULTS After excluding uninterpretable segments attributable to motion artifacts, a total of 135 participants with NGR, 132 with prediabetes, and 134 with diabetes participated in data analysis. Significant coronary stenosis was detected in 10 (7.4%), 10 (7.6%), and 22 (16.4%) individuals with NGR, prediabetes, and diabetes, respectively (P for trend = 0.029). Diabetes, rather than prediabetes, was associated with a significant 2.34-fold elevated risk [odds ratio (OR) 2.34 (95% CI 1.01-5.43); P = 0.047] of significant coronary stenosis as compared with that associated with NGR. Levels of glucose evaluation were independently and significantly associated with risks of significant coronary stenosis in diabetes. Each 1-SD increase in fasting plasma glucose, 2-h postload plasma glucose, and HbA1c conveyed 2.11-fold, 1.73-fold, and 1.81-fold higher risks of significant coronary stenosis, respectively, after adjustment for other conventional cardiovascular risk factors. CONCLUSIONS Using a noninvasive CAD diagnostic modality such as dual-source computed tomography coronary angiography, we detected a markedly elevated risk of significant coronary stenosis with early diabetes in asymptomatic Chinese adults.
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Affiliation(s)
- Yu Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
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Performance of dual source versus 256-slice multi-slice CT in the evaluation of 16 coronary artery stents. Eur J Radiol 2013; 82:601-7. [DOI: 10.1016/j.ejrad.2012.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 04/13/2012] [Accepted: 04/19/2012] [Indexed: 11/21/2022]
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Cotarlan V, Brofferio A, Gerhard GS, Chu X, Shirani J. Impact of β(1)- and β(2)-adrenergic receptor gene single nucleotide polymorphisms on heart rate response to metoprolol prior to coronary computed tomographic angiography. Am J Cardiol 2013; 111:661-6. [PMID: 23261005 DOI: 10.1016/j.amjcard.2012.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022]
Abstract
A slow, steady heart rate (HR) is necessary for optimal image quality during coronary computed tomographic angiography. Beta blockers are often used, but the goal HR is not achieved in some patients. The aim of this study was to examine the influence of single-nucleotide polymorphisms (SNPs) of the β(1) (codons 49 and 389) and β(2) (codons 16, 27, and 164) adrenergic receptor (AR) genes on HR response to metoprolol in 200 adults (mean age 56 ± 11 years) referred for coronary computed tomographic angiography (using a 64-slice scanner). Oral and intravenous (IV) metoprolol was given to achieve a goal HR of <60 beats/min. Overall, 37 patients (18.5%) did not reach the goal HR despite the administration of oral (181 ± 116 mg) and IV (4.2 ± 9.4 mg) metoprolol. Patients with the β(1)-AR Ser49Gly or Gly49Gly genotype (n = 49) more often failed to reach an optimal HR compared to those with the Ser49Ser genotype (n = 151) (29% vs 15%, p = 0.04), despite receiving higher doses of oral (210 ± 115 vs 172 ± 115 mg, p = 0.048) and IV (7 ± 13 vs 3 ± 8 mg, p = 0.02) metoprolol. Similarly, patients with the β(1)-AR Gly389Gly genotype (n = 11) more often failed to reach an optimal HR compared to those with the Arg389Arg and Arg389Gly genotypes (n = 189) (45% vs 17%, p = 0.02), despite receiving higher doses of IV (13 ± 15 vs 4 ± 9 mg, p = 0.002) but not oral (162 ± 105 vs 182 ± 117 mg, p = 0.50) metoprolol. Multivariate analysis identified β(1)-AR SNPs at codons 49 and 389 and β(2)-AR SNP at codon 27 as independent predictors of suboptimal HR response. In conclusion, these data indicate that the selected SNPs of β(1)-AR and β(2)-AR genes influence HR response to metoprolol in patients who undergo coronary computed tomographic angiography.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Adult
- Aged
- Aged, 80 and over
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/genetics
- DNA/genetics
- Female
- Genotype
- Heart Rate/genetics
- Humans
- Male
- Metoprolol/administration & dosage
- Middle Aged
- Polymorphism, Single Nucleotide
- Prospective Studies
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Vlad Cotarlan
- Department of Cardiology, Geisinger Medical Center, Danville, PA, USA
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Komatsu S, Kamata T, Imai A, Ohara T, Takewa M, Ohe R, Miyaji K, Yoshida J, Kodama K. Coronary computed tomography angiography using ultra-low-dose contrast media: radiation dose and image quality. Int J Cardiovasc Imaging 2013; 29:1335-40. [PMID: 23440348 DOI: 10.1007/s10554-013-0201-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/21/2013] [Indexed: 01/15/2023]
Abstract
To analyze the invasiveness and image quality of coronary CT angiography (CCTA) with 80 kV. We enrolled 181 patients with low body weight and low calcium level. Of these, 154 patients were randomly assigned to 1 of 3 groups: 280 HU/80 kV (n = 51); 350 HU/80 kV (n = 51); or 350 HU/120 kV (n = 52). The amount of contrast media (CM) was decided with a CT number-controlling system. Twenty-seven patients were excluded because of an invalid time density curve by timing bolus. The predicted amount of CM, volume CT dose index, dose-length product, effective dose, image noise, and 5-point image quality were measured. The amounts of CM for the 80 kV/280 HU, 80 kV/350 HU, and 120 kV/350 HU groups were 10 ± 4 mL, 15 ± 7 mL, and 30 ± 6 mL, respectively. Although image noise was greater at 80 than 120 kV, there was no significant difference in image quality between 80 kV/350 HU and 120 kV/350 HU (p = 0.390). There was no significant difference in image quality between 80 kV/280 HU and 80 kV/350 HU (4.4 ± 0.7 vs. 4.7 ± 0.4, p = 0.056). The amount of CM and effective dose was lower for 80 kV CCTA than for 120 kV CCTA. CCTA at 80 kV/280 HU may decrease the amount of CM and radiation dose necessary while maintaining image quality.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital, 1-12-1, Shio-e, Amagasaki, Hyogo, 661-0976, Japan.
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Enhanced temporal resolution at cardiac CT with a novel CT image reconstruction algorithm: Initial patient experience. Eur J Radiol 2013; 82:270-4. [DOI: 10.1016/j.ejrad.2012.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 10/01/2012] [Accepted: 10/03/2012] [Indexed: 11/19/2022]
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Weijs B, Pisters R, Haest RJ, Kragten JA, Joosen IA, Versteylen M, Timmermans CC, Pison L, Blaauw Y, Hofstra L, Nieuwlaat R, Wildberger J, Crijns HJ. Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls. Heart Rhythm 2012; 9:1923-9. [DOI: 10.1016/j.hrthm.2012.08.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Indexed: 12/16/2022]
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Controlling intracoronary CT number for coronary CT angiography. J Cardiol 2012; 61:155-61. [PMID: 23159208 DOI: 10.1016/j.jjcc.2012.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/29/2012] [Accepted: 09/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Controlling intracoronary computed tomography (CT) number for coronary CT angiography (CCTA) has been difficult. OBJECTIVE The study assessed whether intracoronary CT number of CCTA could be estimated. METHODS One hundred twenty six patients were randomly assigned to either CCTA with 30 mL of contrast media (CM) following 5 mL of CM at timing bolus or CCTA with 50 mL of CM following 10 mL of CM at timing bolus. The relationships between intracoronary CT number and patients' characteristics and peak time and peak CT number at timing bolus in patients who showed valid time-density curve were analyzed in both groups. Then, the multiple regression equation best described was made. The prediction system was validated by 112 patients randomly targeted between 250 HU and 430 HU of CT number. RESULTS In group 5/30, intracoronary CT number was positively correlated with peak CT number at timing bolus (correlation coefficient, 1.42, p<0.001), negatively correlated with body surface area (-109.19, p<0.001) and peak time (-6.93, p<0.001). Whereas, intracoronary CT number was positively correlated with only peak CT number at timing bolus (1.33, p<0.001) in group 10/50. Then, CT number-controlling system using the simple equation best described CT number was established for CCTA following 5 mL of CM at timing bolus. Of 112 patients, there was good correlation between target CT number and measured CT number (r=0.85, p<0.0001) in 96 patients (85.7%), having valid time-density curve at timing bolus. CONCLUSIONS Controlling CT number may be enabled by CT number-controlling system following 5 mL of CM at timing bolus.
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Jensen JK, Medina HM, Nørgaard BL, Øvrehus KA, Jensen JM, Nielsen LH, Maurovich-Horvat P, Engel LC, Januzzi JL, Hoffmann U, Truong QA. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. Int J Cardiol 2012; 160:171-4. [DOI: 10.1016/j.ijcard.2011.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/11/2011] [Accepted: 04/14/2011] [Indexed: 11/25/2022]
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Bhagalia R, Pack JD, Miller JV, Iatrou M. Nonrigid registration-based coronary artery motion correction for cardiac computed tomography. Med Phys 2012; 39:4245-54. [PMID: 22830758 DOI: 10.1118/1.4725712] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE X-ray computed tomography angiography (CTA) is the modality of choice to noninvasively monitor and diagnose heart disease with coronary artery health and stenosis detection being of particular interest. Reliable, clinically relevant coronary artery imaging mandates high spatiotemporal resolution. However, advances in intrinsic scanner spatial resolution (CT scanners are available which combine nearly 900 detector columns with focal spot oversampling) can be tempered by motion blurring, particularly in patients with unstable heartbeats. As a result, recently numerous methods have been devised to improve coronary CTA imaging. Solutions involving hardware, multisector algorithms, or β-blockers are limited by cost, oversimplifying assumptions about cardiac motion, and populations showing contraindications to drugs, respectively. This work introduces an inexpensive algorithmic solution that retrospectively improves the temporal resolution of coronary CTA without significantly affecting spatial resolution. METHODS Given the goal of ruling out coronary stenosis, the method focuses on "deblurring" the coronary arteries. The approach makes no assumptions about cardiac motion, can be used on exams acquired at high heart rates (even over 75 beats/min), and draws on a fast and accurate three-dimensional (3D) nonrigid bidirectional labeled point matching approach to estimate the trajectories of the coronary arteries during image acquisition. Motion compensation is achieved by employing a 3D warping of a series of partial reconstructions based on the estimated motion fields. Each of these partial reconstructions is created from data acquired over a short time interval. For brevity, the algorithm "Subphasic Warp and Add" (SWA) reconstruction. RESULTS The performance of the new motion estimation-compensation approach was evaluated by a systematic observer study conducted using nine human cardiac CTA exams acquired over a range of average heart rates between 68 and 86 beats/min. Algorithm performance was based-lined against exams reconstructed using standard filtered-backprojection (FBP). The study was performed by three experienced reviewers using the American Heart Association's 15-segment model. All vessel segments were evaluated to quantify their viability to allow a clinical diagnosis before and after motion estimation-compensation using SWA. To the best of the authors' knowledge this is the first such observer study to show that an image processing-based software approach can improve the clinical diagnostic value of CTA for coronary artery evaluation. CONCLUSIONS Results from the observer study show that the SWA method described here can dramatically reduce coronary artery motion and preserve real pathology, without affecting spatial resolution. In particular, the method successfully mitigated motion artifacts in 75% of all initially nondiagnostic coronary artery segments, and in over 45% of the cases this improvement was enough to make a previously nondiagnostic vessel segment clinically diagnostic.
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