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Tan SK, Ng KH, Yeong CH, Raja Aman RRA, Mohamed Sani F, Abdul Aziz YF, Sun Z. Personalized administration of contrast medium with high delivery rate in low tube voltage coronary computed tomography angiography. Quant Imaging Med Surg 2019; 9:552-564. [PMID: 31143647 DOI: 10.21037/qims.2019.03.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background High delivery rate is an important factor in optimizing contrast medium administration in coronary computed tomography angiography (CCTA). A personalized contrast volume calculation algorithm incorporating high iodine delivery rate (IDR) can reduce total iodine dose (TID) and produce optimal vessel contrast enhancement (VCE) in low tube voltage CCTA. In this study, we developed and validated an algorithm for calculating the volume of contrast medium delivered at a high rate for patients undergoing retrospectively ECG-gated CCTA with low tube voltage protocol. Methods The algorithm for an IDR of 2.22 gI·s-1 was developed based on the relationship between VCE and contrast volume in 141 patients; test bolus parameters and characteristics in 75 patients; and, tube voltage in a phantom study. The algorithm was retrospectively tested in 45 patients who underwent retrospectively ECG-gated CCTA with a 100 kVp protocol. Image quality, TID and radiation dose exposure were compared with those produced using the 120 kVp and routine contrast protocols. Results Age, sex, body surface area (BSA) and peak contrast enhancement (PCE) were significant predictors for VCE (P<0.05). A strong linear correlation was observed between VCE and contrast volume (r=0.97, P<0.05). The 100-to-120 kVp contrast enhancement conversion factor (Ec) was calculated at 0.81. Optimal VCE (250 to 450 HU) and diagnostic image quality were obtained with significant reductions in TID (32.1%) and radiation dose (38.5%) when using 100 kVp and personalized contrast volume calculation algorithm compared with 120 kVp and routine contrast protocols (P<0.05). Conclusions The proposed algorithm could significantly reduce TID and radiation exposure while maintaining optimal VCE and image quality in CCTA with 100 kVp protocol.
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Affiliation(s)
- Sock Keow Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Raja Rizal Azman Raja Aman
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fadhli Mohamed Sani
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, Curtin University, Perth, Australia
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Gang L, Wei-Hua L, Rong A, Jian-Hong Y, Zi-Hua Z, Zhong-Zhi T. Serum Gamma-glutamyltransferase Levels Predict the Progression of Coronary Artery Calcification in Adults With Type 2 Diabetes Mellitus. Angiology 2014; 66:667-74. [PMID: 25163771 DOI: 10.1177/0003319714548566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Progression of coronary artery calcification (CAC) may be more predictive of future coronary heart disease events than a baseline CAC score. We determined whether serum gamma-glutamyltransferase (GGT) activity can independently predict the progression of CAC in adults with type 2 diabetes mellitus (T2DM). Patients (n = 326) without symptomatic cardiovascular (CV) disease were evaluated by CAC imaging. The CAC scores were assessed at baseline and after 20 ± 4 months. Serum GGT activities were significantly higher in progressors compared with nonprogressors (39 ± 16 vs 27 ± 11 U/L, P < .001). Multivariable analyses demonstrated that GGT activity retained a strong association with CAC progression after adjustment for CV risk factors. Additionally, there was a graded association between GGT activity quartile and annualized CAC progression. In asymptomatic patients with T2DM, we prospectively found that serum GGT activity may be an independent predictor of CAC progression but not a predictor of CAC incidence.
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Affiliation(s)
- Li Gang
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Lu Wei-Hua
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Ai Rong
- College of Foreign Language, Huazhong Agriculture University, Wuhan, China
| | - Yang Jian-Hong
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
| | - Zhou Zi-Hua
- Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Tang Zhong-Zhi
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
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Komatsu S, Kamata T, Imai A, Ohara T, Miyaji K, Kobayashi Y, Kodama K. Quantitative analysis of coronary vessels with optimized intracoronary CT number. PLoS One 2014; 9:e85312. [PMID: 24409326 PMCID: PMC3883697 DOI: 10.1371/journal.pone.0085312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background Variability in intracoronary computed tomography (CT) number may influence vessel quantification. We confirmed the feasibility of a novel method for measuring vessel diameter and area using coronary CT angiography (CCTA) with an optimized intracoronary CT number, 350 HU. Methods We performed intravascular ultrasound (IVUS) imaging in 52 patients with significant stenosis detected by coronary CT angiography targeting 350 HU using a CT number-controlling system. We measured 0-to-0 HU distances in the cross-sectional coronary images of 32 patients. We analyzed the ratio of 0-to-0 HU distances in CT images to media-to-media distances in IVUS images (C:I ratio). The area of ≥0 HU for 103 representative points in the remaining 20 patients was compared to the area of the traced external elastic membrane (EEM) in IVUS images. Results There was a strong correlation between 0-to-0 HU distance in CT images and media-to-media diameter in IVUS images (r = 0.97, p<0.001). The C:I ratio was 1.1. EEM area was estimated by dividing the area of ≥0 HU by the square of C:I. There was also a strong correlation between the estimated EEM area and the EEM area in IVUS images (r = 0.95, p<0.001). Conclusions Media-to-media diameter and EEM area can be estimated by CCTA targeting the optimized intracoronary CT number when blood vessel borders are defined at 0 HU.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan
- * E-mail:
| | - Teruaki Kamata
- Department of Diagnostic Imaging, Amagasaki Central Hospital, Hyogo, Japan
| | - Atsuko Imai
- Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan
- Department of Cardiology, Osaka University School of Medicine, Osaka, Japan
| | - Tomoki Ohara
- Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan
| | - Kazuaki Miyaji
- Department of Diagnostic Imaging, Amagasaki Central Hospital, Hyogo, Japan
| | | | - Kazuhisa Kodama
- Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan
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Diagnostic value of parasternal pulmonary artery short-axis view for the anomalous origin of the left coronary artery from the pulmonary artery. J Cardiol 2013; 63:444-8. [PMID: 24289898 DOI: 10.1016/j.jjcc.2013.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/17/2013] [Accepted: 10/18/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of parasternal pulmonary artery (PA) short-axis view for the anomalous origin of left coronary artery (LCA) from the pulmonary artery by echocardiography. METHODS A total of 13 patients (3 boys) aged from 2 months to 12 years were enrolled. Transthoracic echocardiography, including cross-sectional imaging and color Doppler flow imaging, were performed, and their diagnoses were confirmed by operation. RESULTS Among the 13 patients, 7 had LCA originated from the left posterior wall of PA, 2 from the posterior wall, and 4 from the right posterior wall. The PA short-axis view could visualize the anomalous origin of the LCA from left posterior or posterior wall of PA clearly. The LCA and aortic wall were overlapping at 3-4 o'clock at PA short-axis view in the patients with LCA originating from the right posterior wall of PA. It was similar with the image of the LCA originating from the aorta. But the blood flow was opposite to that of LCA with normal origin. CONCLUSIONS The parasternal PA short-axis view is a good view to visualize the anomalous origin of the LCA.
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Komatsu S, Imai A, Kamata T, Ohara T, Takewa M, Minamiguchi H, Ohe R, Nishiuchi K, Kobayashi Y, Miyaji K, Yoshida J, Kodama K. CT number-controlling system for reproducibility of intracoronary CT number on follow-up coronary CT angiography. J Cardiol 2013; 62:82-6. [PMID: 23764248 DOI: 10.1016/j.jjcc.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/23/2013] [Accepted: 03/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) may be useful for noninvasive follow-up; however, evaluation of coronary stenosis and CT number of plaque may be inaccurate under different vessel enhancement of contrast media. We examined the reproducibility of the CT number of repeat CCTA using our original CT number-controlling system (CTN-CS), which selects contrast level by a multiple regression equation using body surface area and peak CT number and peak time on timing bolus and during CCTA. METHODS AND RESULTS One hundred seventy-two patients who underwent serial CCTA were prospectively and randomly assigned to 3 groups. In the first group, Group A, the amount of contrast for the second CCTA was determined by CTN-CS to match the intracoronary CT number of the first CCTA. In Group B, each patient received the same amount of intravenous contrast in both CCTA examinations. In Group C, 0.7 mL/mg body weight (BW) of contrast medium (350 mgI/mL) was used for baseline and follow-up CCTAs. The regression of repeated CCTAs was the best in Group A (r=0.85, p<0.001) vs. Group B (r=0.52, p<0.001), and Group C (r=0.61, p<0.001). The absolute difference between intracoronary CT numbers of the second and first CCTA was the lowest in Group A (24.8 ± 21.8HU), followed by Group B (37.6 ± 26.2 HU; p<0.05) and Group C (46.5 ± 34.4HU; p<0.001). CONCLUSIONS Using CTN-CS, the difference of intracoronary CT numbers of the second and first CCTA was the smallest when compared to CCTAs using the same contrast volumes or constant volumes per body weight.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan.
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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: 30] [Impact Index Per Article: 2.7] [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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