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Lu G, Su Y, Jiang Y, Yang L, Wang Y, Shi G, Zhang F, Duan X, Hu H. Improving the visualisation of perforator arteries for anterolateral thigh flaps harvest in CT angiography via sublingual glyceryl trinitrate. Clin Radiol 2023; 78:e791-e797. [PMID: 37574403 DOI: 10.1016/j.crad.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023]
Abstract
AIM To investigate the improvement of image quality and visualisation of the anterolateral thigh (ALT) flap perforators on computed tomography angiography (CTA) after administration of sublingual glyceryl trinitrate (GTN). MATERIALS AND METHODS Sixty patients with oral lesions received thigh CTA examinations were divided randomly into two groups after administration of sublingual GTN (GTN group) or without administration of sublingual GTN (non-GTN group). Two radiologists calculated the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and assessed the image quality of each vessel. Besides, the grade of thigh artery, the lumen diameter of deep femoral artery, lateral circumflex femoral artery (LCFA), the descending branch of LCFA and its proximal and distal perforators, and the number and type of visible perforators were evaluated quantitatively. RESULTS The SNR and CNR were not significantly different between the two groups (p>0.05). The image quality of CTA in the GTN group was significantly better than that in the non-GTN group (p<0.01). The lumen diameters of the deep femoral artery, LCFA, the descending branch of LCFA and its perforators were significantly larger in the GTN group than those in the non-GTN group (p<0.01). Compared with the non-GTN group, the number of visible perforators and the number of visible septocutaneous perforators were significantly more in the GTN group, and the qualitative grade of visible perforators was significantly higher (p<0.001). CONCLUSIONS The administration of sublingual GTN in preoperative thigh CTA can improve the image quality and visualisation of perforator vessels, thus could help surgeons to select the optimum ALT flaps.
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Affiliation(s)
- G Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Su
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Jiang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - L Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - G Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - F Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - X Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - H Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China.
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Yang L, Yan Z, Lu G, Jiang Y, Wang Y, Shi G, Chen L, Hu H, Duan X. Nitroglycerin improves the visibility of fibula-free flap perforators on computed tomography angiography in patients with oral or maxillofacial lesion. Eur J Radiol 2023; 164:110877. [PMID: 37187079 DOI: 10.1016/j.ejrad.2023.110877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To investigate the improvement of image quality and visualization of fibula-free flap (FFF) perforators on computed tomography angiography (CTA) after administration of sublingual nitroglycerin (NTG) tablets. METHODS A total of 60 patients with oral or maxillofacial lesions before CTA of the lower extremity were randomly divided into two groups (NTG group and non-NTG group). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), overall image quality and grading of vessels were evaluated and compared. The lumen diameters of the major arteries and the proximal and distal peroneal perforators were measured. The number of visible perforators in muscular clearance and muscular layer was also counted and compared between the two groups. RESULTS The CNR of posterior tibial artery and overall image quality of CTA images in the NTG group was significantly higher than that in the non-NTG group (p < 0.05), although the SNR and CNR of other arteries did not show significant differences (p > 0.05). The lumen diameters of the peroneal artery and its perforators, anterior tibial artery, and posterior tibial artery were significantly larger in the NTG group (p < 0.001), while no significant difference prevailed in the diameter of the popliteal artery between the two groups (p = 0.298). Compared with the non-NTG group, a significant increase in the number of visible perforators was noted in the NTG group (p < 0.001). CONCLUSIONS The administration of sublingual NTG in CTA of the lower extremity can improve the image quality and visualization of perforators, which aids to surgeons select the optimum FFF.
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Affiliation(s)
- Lingjie Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Zhuoheng Yan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Guoxiong Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Yusong Jiang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Yu Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Guangzi Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lina Chen
- CHN DI CT Collaboration, Siemens Healthcare Ltd, No.399 West Haiyang Road, Shanghai 200126, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Gupta S, Dixit R, Prakash A, Daga MK, Mishra A. Can Sublingual Nitrate Improve Visualization of Lower Limb Arteries on Computed Tomography Angiography? J Comput Assist Tomogr 2023:00004728-990000000-00152. [PMID: 36877793 DOI: 10.1097/rct.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA). METHODS Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done. RESULTS Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group. CONCLUSIONS Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.
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Affiliation(s)
- Sanchita Gupta
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Anjali Prakash
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Mradul Kumar Daga
- Department of Internal Medicine and Infectious disease, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Dhanalakshmi B, Shijith KP, Sharma P. A prospective interventional study to assess the advantage of premedication with sublingual nitroglycerin in evaluation of peripheral vascular disease with computed tomography peripheral angiography. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_527_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Impact of Sublingual Nitroglycerin on the Assessment of Computed Tomography–derived Fractional Flow Reserve. J Comput Assist Tomogr 2021; 46:23-28. [DOI: 10.1097/rct.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography. Eur Radiol 2020; 31:515-524. [PMID: 32785771 DOI: 10.1007/s00330-020-07104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the coronary vasodilation effects of spray with those induced by tablet administration in coronary CT angiography (CCTA). METHODS A total of 2024 patients who underwent CCTA were identified for this retrospective study, including 828 patients with spray (spray group) and 1169 with tablets (tablet group). Of these, 93 patients underwent CCTA at least twice using both spray and tablets. The number of measurable segments and diameters of all 18 segments was measured. The number of measurable segments was compared between groups. RESULTS No statistically significant differences were evident between these two groups in terms of clinical characteristics. All coronary segments except the ramus intermedius (RI) and left posterior descending artery (L-PDA) were significantly larger in the spray group than in the tablet group (all p < 0.001). In peripheral and branch vessels, as well as in central and main coronary arteries, the diameters were significantly larger in the spray group than in the tablet group (all p < 0.001). Although not always statistically significant, all coronary segments tended to be more measurable on CCTA with spray than with tablet. In the subgroup that underwent CCTA twice using both spray and tablets, all coronary segments except the RI, obtuse marginal artery 2 (OM2), and L-PDA were significantly larger in the spray group than in the tablet group (all p < 0.05). CONCLUSION Lingual isosorbide dinitrate (ISDN) spray was more efficacious than sublingual nitroglycerin (NTG) tablets in coronary vasodilation for CCTA. Therefore, lingual ISDN spray should be preferred over sublingual NTG tablets for CCTA. KEY POINTS • Lingual ISDN spray was more efficacious than sublingual NTG tablet for coronary vasodilation in coronary CT angiography, even in elderly patients. • The diameters of all coronary segments except RI and L-PDA were significantly larger, and there were significantly more coronary segments greater than 1.5 mm, except RI and L-PDA, in the spray group than in the tablet group in the whole study group. • Even in peripheral and branch vessels, the diameters of coronary arteries were significantly larger in the spray group than in the tablet group, and they were also larger in elderly patients.
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Kutaiba N, Lukies M, Galea M, Begbie M, Smith G, Kearney L, Spelman T, Lim RP. The effects of sublingual nitroglycerin administration in coronary computed tomography angiography. Clin Imaging 2020; 60:194-199. [DOI: 10.1016/j.clinimag.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
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Impact of sublingual nitroglycerin dosage on FFRCT assessment and coronary luminal volume–to–myocardial mass ratio. Eur Radiol 2019; 29:6829-6836. [DOI: 10.1007/s00330-019-06293-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
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Hoshika M, Yasui K, Niguma T, Kojima T, Nishiyama N, Suzuki D, Togami I. Novel contrast-injection protocol for high-resolution abdominal CT-angiography: vascular visualization improvement with vasodilator. Abdom Radiol (NY) 2017; 42:2571-2578. [PMID: 28488179 DOI: 10.1007/s00261-017-1163-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the usefulness of a novel contrast-injection protocol for high-resolution abdominal computed tomography angiography (CTA) using nitroglycerin (NTG). METHODS Abdominal CTA was performed in 80 patients using two 64-detector-row CT scanners. Forty patients were examined after administration of sublingual NTG (NTG group), while 40 were examined without NTG administration (non-NTG group). Arterial phase images were acquired with maximum intensity projection and volume rendering. Reduction rates: vessel cross-sectional areas ratio of 10 cm distal to origin at the superior mesenteric artery, contrast enhancements, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed. Three reviewers evaluated degree of depiction of the peripancreatic vasculature using a four-point scale (1 = poor, 4 = excellent). RESULTS Reduction rates were significantly lower in the NTG group (P < 0.001), while there were no significant differences in contrast enhancements, SNR, or CNR between groups. Visual evaluation results of the NTG group were significantly better than those of the non-NTG group (P < 0.01). CONCLUSION Abdominal CTA using NTG improved visualization of the abdominal peripheral vessels. This improved arterial view may be beneficial for preoperative evaluation of the arterial anatomy.
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Affiliation(s)
- Minori Hoshika
- Department of Radiology (Services), Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-Shi, Okayama, 700-8511, Japan.
| | - Kotaro Yasui
- Department of Radiology, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Takefumi Niguma
- Department of Surgery, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Toru Kojima
- Department of Surgery, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Norimi Nishiyama
- Department of Radiology (Services), Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-Shi, Okayama, 700-8511, Japan
| | - Daisuke Suzuki
- Department of Radiology (Services), Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-Shi, Okayama, 700-8511, Japan
| | - Izumi Togami
- Department of Radiology, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
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Ghekiere O, Nchimi A, Djekic J, El Hachemi M, Mancini I, Hansen D, Vanhoenacker P, de Roos A, Dendale P. Coronary Computed Tomography Angiography: Patient-related factors determining image quality using a second-generation 320-slice CT scanner. Int J Cardiol 2016; 221:970-6. [PMID: 27441477 DOI: 10.1016/j.ijcard.2016.07.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the diagnostic confidence of Coronary Computed Tomography Angiography (CCTA) and the effect of patient-related factors on CCTA image quality using a second-generation 320-slice scanner. METHODS AND RESULTS 200 consecutive patients (mean age 60±12years; 109 men) prospectively underwent CCTA. The mean body mass index (BMI) was 27.1±4.9kg/m(2); the median heart rate (HR) was 60.0 (interquartile range (IQR), 53.9-66.1) beats per minute (bpm). The median segment's diameter was 2.8 (IQR, 2.2-3.4) mm. For each coronary segment ≥1.5mm in diameter, two readers scored: diameter narrowing as < or ≥50%, overall diagnostic confidence and motion-related image quality, with interobserver agreement kappa-values of 0.89, 0.91 and 0.61 respectively. Seventy-nine of the 2505 evaluated segments (3.2%) had non-diagnostic image quality because of coronary calcifications (66/79; 83.5%), stent- (6/79; 7.5%), pacemaker- (2/79; 2.5%) or motion-related artifacts (5/79; 6.5%). The effect of patient-related factors on motion-related image quality was investigated by multinomial logistic regression in 181 patients with calcium score (IQR, 0-446.5). Increasing coronary diameter was the most improving image quality factor (odds ratio (OR), 1.8637; p<0.001), marginally followed by lower HR (OR, 0.9547; p<0.001) and calcium score (OR, 0.9997; p=0.04). Gender (p=0.70), age (p=0.24) and BMI (p=0.45) did not affect image quality. CONCLUSION Using a second-generation 320-slice scanner, CCTA diagnostic confidence is predominantly affected by coronary calcifications, whereas motion-related image quality is non-diagnostic only in exceptional cases and mainly influenced by the coronary diameter. For future developments, our study findings therefore suggest greater requirements concerning spatial resolution and calcium-related artifact removal than concerning temporal resolution, especially to improve diagnostic confidence in patient groups with smaller coronary diameters.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium; Department of Radiology, Jessa Hospital, Stadsomvaart 11, B-3500 Hasselt, Belgium; Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium.
| | - Alain Nchimi
- Liège University (ULg), GIGA Cardiovascular Sciences, Domaine Universitaire du Sart Tilman, Rue de l'hôpital, 1, B-4000 Liège, Belgium
| | - Julien Djekic
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium
| | - Mounia El Hachemi
- Liège University (ULg), GIGA Cardiovascular Sciences, Domaine Universitaire du Sart Tilman, Rue de l'hôpital, 1, B-4000 Liège, Belgium
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, B-4000 Liège, Belgium
| | - Dominique Hansen
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium
| | - Piet Vanhoenacker
- Department of Radiology, OLV Hospital Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Albinusdreef, 2, NL-2333 ZA Leiden, The Netherlands
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, B-3500 Hasselt, Belgium; Heart Center Hasselt, Jessa Hospital, Stadsomvaart, 11, B-3500 Hasselt, Belgium
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Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review. Eur Radiol 2015; 25:3536-42. [PMID: 25994194 PMCID: PMC4636517 DOI: 10.1007/s00330-015-3791-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate and blood pressure, and diagnostic accuracy of coronary computed tomography (CT) angiography. METHODS A systematic search was performed in PubMed, EMBASE and Web of Science. The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied. RESULTS Of the 217 studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy. Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention. CONCLUSION Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes. KEY POINTS • Sublingual nitroglycerin administration results in significant coronary artery dilatation. • Nitroglycerin increases the number of evaluable coronary branches. • Image quality is improved the most in smaller coronary branches. • Nitroglycerin increases the diagnostic accuracy of coronary CT angiography. • Most side effects are mild and do not require medical intervention.
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Image quality with single-heartbeat 320-multidetector computed tomographic coronary angiography. J Comput Assist Tomogr 2014; 38:444-50. [PMID: 24651741 DOI: 10.1097/rct.0000000000000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to establish the feasibility of single-heartbeat 320-multidetector computed tomographic coronary angiography (CTCA) and assess variables affecting image quality. METHODS Consecutive patients (n = 249, 38% male) underwent CTCA. Two observers assessed image quality using a 4-point scale (1, excellent; 4, poor). RESULTS Mean heart rate was 60 beats per minute (95% confidence interval, 59-62); body mass index, 29 kg/m (28-30); and dose-length product, 283 mGy·cm (266-301). During scanning, 133 (51%) received sublingual glyceryl trinitrate (GTN), 9 (4%) had ectopics, and 12 (5%) had atrial fibrillation. Diagnostic image quality was obtained in 99% with mean image quality of 1.4 (1.3, 1.5). Age, sex, atrial fibrillation, ectopics, diabetes mellitus (12%), and obstructive disease were not related to image quality. A lower heart rate and GTN were associated with improved image quality (P ≤ 0.001). CONCLUSIONS Optimal image quality in single-heartbeat 320-multidetector CTCA is achievable in 99% of unselected patients. Image quality is improved by lower heart rate and GTN.
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Wallis A, Manghat N, Hamilton M. The role of coronary CT in the assessment and diagnosis of patients with chest pain. Clin Med (Lond) 2012; 12:222-9. [PMID: 22783772 PMCID: PMC4953483 DOI: 10.7861/clinmedicine.12-3-222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The role of cardiac computed tomography (CT) in the assessment and management of patients with suspected cardiac chest pain has been formally recognised in NICE guidance 95. When the technique and patient selection are appropriate, cardiac CT is a valuable diagnostic tool, particularly for patients with a low to intermediate pre-test probability of coronary artery disease. The physician must be aware of the implications of the recent guidelines; hence, we present an illustrated synopsis on the current technique and the indications for the use of calcium scoring and cardiac CT in the assessment and management of patients with suspected cardiac chest pain.
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Torres FS, Crean AM, Nguyen ET, Paul N. Strategies for radiation-dose reduction and image-quality optimization in multidetector computed tomographic coronary angiography. Can Assoc Radiol J 2010; 61:271-9. [PMID: 20605399 DOI: 10.1016/j.carj.2009.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/17/2022] Open
Abstract
The technological evolution of computed tomography (CT) in the last decade has placed CT coronary angiography (CTCA) in the spotlight of imaging modalities available to evaluate patients with coronary artery disease. Widespread utilisation of CTCA has generated concern from the medical community regarding potential health issues related to the significant radiation exposure associated with this method, and several modifications of the CTCA technique have been proposed to reduce the radiation exposure without affecting the diagnostic image quality. This review will discuss a practical approach to performing CTCA to ensure that the radiation dose is minimized while maintaining diagnostic image quality.
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Affiliation(s)
- Felipe S Torres
- Department of Medical Imaging, University of Toronto and University Health Network, Toronto, Ontario, Canada.
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Boardman H, Sugihara C. An introduction to non-invasive cardiac imaging. Br J Hosp Med (Lond) 2010; 71:M74-7. [DOI: 10.12968/hmed.2010.71.sup5.47933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
According to the World Health Organization (2009), an estimated 17.1 million people died from cardiovascular disease in 2005 (29% of global deaths), 7.2 million from coronary heart disease. It is the number one killer globally and with new and more complex ways of investigating the heart non-invasively, it is important to understand what is available and when to use each modality. This article explains how the different forms of non-invasive cardiac imaging work, their advantages and disadvantages (Table 1), when to use each one and finally what developments are likely in the future. Some may not be available in all hospitals, but access and availability to cardiac imaging is likely to change significantly in the future.
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