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Nishihara T, Miyoshi T, Nakashima M, Akagi N, Morimitsu Y, Inoue T, Miki T, Yoshida M, Toda H, Nakamura K, Yuasa S. Diagnostic improvements of calcium-removal image reconstruction algorithm using photon-counting detector CT for calcified coronary lesions. Eur J Radiol 2024; 172:111354. [PMID: 38309215 DOI: 10.1016/j.ejrad.2024.111354] [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: 11/01/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To investigate the diagnostic performance of a calcium-removal image reconstruction algorithm with photon-counting detector-computed tomography (PCD-CT), a technology that hides only the calcified plaque from the spectral data in coronary calcified lesions. METHODS This retrospective study included 17 patients who underwent PCD-coronary CT angiography (CCTA) with at least one significant coronary stenosis (≥50 %) with calcified plaque by CCTA and invasive coronary angiography (ICA) performed within 60 days of CCTA. A total of 162 segments with calcified plaque were evaluated for subjective image quality using a 4-point scale. Their calcium-removal images were reconstructed from conventional images, and both images were compared with ICA images as the reference standard. The contrast-to noise ratios for both images were calculated. RESULTS Conventional and calcium-removal images had a subjective image quality of 2.7 ± 0.5 and 3.2 ± 0.9, respectively (p < 0.001). The percentage of segments with a non-diagnostic image quality was 32.7 % for conventional images and 28.3 % for calcium-removal images (p < 0.001). The segment-based diagnostic accuracy revealed an area under the receiver operating characteristic curve of 0.87 for calcium-removal images and 0.79 for conventional images (p = 0.006). Regarding accuracy, the specificity and positive predictive value of calcium-removal images were significantly improved compared with those of conventional images (80.5 % vs. 69.5 %, p = 0.002 and 64.1 % vs. 52.0 %, p < 0.001, respectively). The objective image quality of the mean contrast-to-noise ratio did not differ between the images (13.9 ± 3.6 vs 13.3 ± 3.4, p = 0.356) CONCLUSIONS: Calcium-removal images with PCD-CT can potentially be used to evaluate diagnostic performance for calcified coronary artery lesions.
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Affiliation(s)
- Takahiro Nishihara
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriaki Akagi
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Morimitsu
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Inoue
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoki Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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2
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Tian X, Chen Y, Pan S, Lan H, Cheng L. Enhanced in-stent luminal visualization and restenosis diagnosis in coronary computed tomography angiography via coronary stent decomposition algorithm from dual-energy image. Comput Biol Med 2024; 171:108128. [PMID: 38342047 DOI: 10.1016/j.compbiomed.2024.108128] [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: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
Stent implantation is a principal therapeutic approach for coronary artery diseases. Nonetheless, the presence of stents significantly interferes with in-stent luminal (ISL) visualization and complicates the diagnosis of in-stent restenosis (ISR), thereby increasing the risk of misdiagnoses and underdiagnoses in coronary computed tomography angiography (CCTA). Dual-energy (DE) CT could calculate the volume fraction for voxels from low- and high-energy images (LHEI) and provide information on specific three basic materials. In this study, the innovative coronary stent decomposition algorithm (CSDA) was developed from the DECT three materials decomposition (TMD), through spectral simulation to determine the scan and attenuation coefficient for the stent, and preliminary execution for an in vitro sophisticated polyether ether ketone (PEEK) 3D-printed right coronary artery (RCA) replica. Furthermore, the whole-coronary-artery replica with multi-stent implantation, the RCA replica with mimetic plaque embedded, and two patients with stent further validated the effectiveness of CSDA. Post-CSDA images manifested no weakened attenuation values, no elevated noise values, and maintained anatomical integrity in the coronary lumen. The stents were effectively removed, allowing for the ISL and ISR to be clearly visualized with a discrepancy in diameters within 10%. We believe that CSDA presents a promising solution for enhancing CCTA diagnostic accuracy post-stent implantation.
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Affiliation(s)
- Xin Tian
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China.
| | - Yunbing Chen
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People's Hospital, Jincheng, 048000, China
| | - Honglin Lan
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Lei Cheng
- The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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3
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Onnis C, Virmani R, Kawai K, Nardi V, Lerman A, Cademartiri F, Scicolone R, Boi A, Congiu T, Faa G, Libby P, Saba L. Coronary Artery Calcification: Current Concepts and Clinical Implications. Circulation 2024; 149:251-266. [PMID: 38227718 PMCID: PMC10794033 DOI: 10.1161/circulationaha.123.065657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.
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Affiliation(s)
- Carlotta Onnis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Alberto Boi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari Italy
| | - Terenzio Congiu
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
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Zerunian M, Pucciarelli F, Caruso D, De Santis D, Polici M, Masci B, Nacci I, Del Gaudio A, Argento G, Redler A, Laghi A. Fast high-quality MRI protocol of the lumbar spine with deep learning-based algorithm: an image quality and scanning time comparison with standard protocol. Skeletal Radiol 2024; 53:151-159. [PMID: 37369725 PMCID: PMC10661795 DOI: 10.1007/s00256-023-04390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The objective of this study is to prospectively compare quantitative and subjective image quality, scanning time, and diagnostic confidence between a new deep learning-based reconstruction(DLR) algorithm and standard MRI protocol of lumbar spine. MATERIALS AND METHODS Eighty healthy volunteers underwent 1.5T MRI examination of lumbar spine from September 2021 to May 2023. Protocol acquisition comprised sagittal T1- and T2-weighted fast spin echo and short-tau inversion recovery images and axial multislices T2-weighted fast spin echo images. All sequences were acquired with both DLR algorithm and standard protocols. Two radiologists, blinded to the reconstruction technique, performed quantitative and qualitative image quality analysis in consensus reading; diagnostic confidence was also assessed. Quantitative image quality analysis was assessed by calculating signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Qualitative image quality analysis and diagnostic confidence were assessed with a five-point Likert scale. Scanning times were also compared. RESULTS DLR SNR was higher in all sequences (all p<0.001). CNR of the DLR was superior to conventional dataset only for axial and sagittal T2-weighted fast spin echo images (p<0.001). Qualitative analysis showed DLR had higher overall quality in all sequences (all p<0.001), with an inter-rater agreement of 0.83 (0.78-0.86). DLR total protocol scanning time was lower compared to standard protocol (6:26 vs 12:59 min, p<0.001). Diagnostic confidence for DLR algorithm was not inferior to standard protocol. CONCLUSION DLR applied to 1.5T MRI is a feasible method for lumbar spine imaging providing morphologic sequences with higher image quality and similar diagnostic confidence compared with standard protocol, enabling a remarkable time saving (up to 50%).
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Affiliation(s)
- Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Francesco Pucciarelli
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Domenico De Santis
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Benedetta Masci
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Ilaria Nacci
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Antonella Del Gaudio
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giuseppe Argento
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Andrea Redler
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, University of Rome "Sapienza" - Sant'Andrea University Hospital, Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, University of Rome "Sapienza" Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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5
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Qiao J, Li S, Yang H, Chen X, Zhu T, Li Q, Wan W, Xu Y, Ge B, Zhao Y, Tang Y, Li F, He Y, Xia L. Subtraction Improves the Accuracy of Coronary CT Angiography in Patients with Severe Calcifications in Identifying Moderate and Severe Stenosis: A Multicenter Study. Acad Radiol 2023; 30:2801-2810. [PMID: 36586762 DOI: 10.1016/j.acra.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the diagnostic accuracy of subtraction coronary computed tomographic angiography (CCTAsub) in identifying ≥ 50% and ≥ 70% coronary stenosis in patients with different degrees of calcification. MATERIALS AND METHODS In this study, 180 patients with coronary calcified plaques who underwent both coronary CT angiography and invasive coronary angiography (ICA) were prospectively enrolled at five centers. Patients were divided into three groups according to the Agatston score: group A (low to moderate, < 400), group B (high, 400-999), and group C (very high, ≥ 1000). Diagnostic accuracies estimated by area under the receiver operating characteristic curve (AUC) were compared between conventional CCTA (CCTAcon) and CCTAsub, with ICA as a reference standard. RESULTS There were 86 patients in group A, 44 in group B, and 50 in group C. In identifying ≥ 70% coronary stenosis, subtraction improved the diagnostic accuracies on a per-segment basis in group B (AUC: 0.80 vs 0.92, p = 0.001) and group C (AUC: 0.75 vs 0.84, p = 0.001) after subtraction. When identifying ≥ 50% coronary stenosis, the per-segment AUC of CCTAsub in group B and C were significantly higher than that in CCTAcon (group B: 0.81 vs 0.92, p < 0.001; group C: 0.77 vs 0.88, p < 0.001). However, no improvement was observed in group A. CONCLUSION Subtraction achieved better diagnostic accuracy in patients with Agatston score ≥ 400, both in identifying ≥ 50% and ≥ 70% coronary stenosis, which was instructive for the application of subtraction in clinical practice.
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Affiliation(s)
- Jinhan Qiao
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Department of Radiology, People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Hongzhi Yang
- Department of Radiology, Xidian Group Hospital, Xi'an, China
| | - Xiaolong Chen
- Image Center Shaanxi Provincial People's Hospital, Xi'an, China
| | - Tingting Zhu
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Li
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Wan
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghao Xu
- Canon Medical Systems (China) CO.,LTD., Building 205, Yard NO.A10, JiuXianQiao North Road, ChaoYang District, 100015, Beijing
| | - Bing Ge
- Canon Medical Systems (China) CO.,LTD., Building 205, Yard NO.A10, JiuXianQiao North Road, ChaoYang District, 100015, Beijing
| | - Yun Zhao
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Tang
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Bejing, China; Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Bejing, China.
| | - Liming Xia
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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6
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Böttcher B, Zsarnoczay E, Varga-Szemes A, Schoepf UJ, Meinel FG, van Assen M, De Cecco CN. Dual-Energy Computed Tomography in Cardiac Imaging. Radiol Clin North Am 2023; 61:995-1009. [PMID: 37758366 DOI: 10.1016/j.rcl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Dual-energy computed tomography (DECT) acquires images using two energy spectra and offers a variation of reconstruction techniques for improved cardiac imaging. Virtual monoenergetic images decrease artifacts improving coronary plaque and stent visualization. Further, contrast attenuation is increased allowing significant reduction of contrast dose. Virtual non-contrast reconstructions enable coronary artery calcium scoring from contrast-enhanced scans. DECT provides advanced plaque imaging with detailed analysis of plaque components, indicating plaque stability. Extracellular volume assessment using DECT offers noninvasive detection of myocardial fibrosis. This review aims to outline the current cardiac applications of DECT, summarize recent literature, and discuss their findings.
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Affiliation(s)
- Benjamin Böttcher
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Uwe Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging and Imaging Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc. 1365 Clifton Road NE, Suite - AT503, Atlanta, GA 30322, USA.
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7
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Rajiah PS, Kambadakone A, Ananthakrishnan L, Sutphin P, Kalva SP. Vascular Applications of Dual-Energy Computed Tomography. Radiol Clin North Am 2023; 61:1011-1029. [PMID: 37758354 DOI: 10.1016/j.rcl.2023.05.005] [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] [Indexed: 10/03/2023]
Abstract
Dual- or multi-energy CT imaging provides several advantages over conventional CT in the context of vascular imaging. Specific advantages include the use of low-energy virtual monoenergetic images (VMIs) to boost iodine attenuation to salvage suboptimal enhanced studies, perform low-contrast material dose studies, and increase conspicuity of small vessels and lesions. Alternatively, high-energy VMIs reduce artifacts caused by some metals, endoprosthesis, calcium blooming, and beam hardening. Virtual non-contrast (VNC) images reduce radiation dose by eliminating the need for a true non-contrast acquisition in multiphasic CT studies. Iodine maps can be used to evaluate perfusion of tissues and lesions.
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Affiliation(s)
- Prabhakar S Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | | | | | - Patrick Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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8
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Grkovski R, Acu L, Ahmadli U, Nakhostin D, Thurner P, Wacht L, Kulcsár Z, Alkadhi H, Winklhofer S. Dual-Energy Computed Tomography in Stroke Imaging : Value of a New Image Acquisition Technique for Ischemia Detection after Mechanical Thrombectomy. Clin Neuroradiol 2023; 33:747-754. [PMID: 36862231 PMCID: PMC10450017 DOI: 10.1007/s00062-023-01270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To assess if a new dual-energy computed tomography (DECT) technique enables an improved visualization of ischemic brain tissue after mechanical thrombectomy in acute stroke patients. MATERIAL AND METHODS The DECT head scans with a new sequential technique (TwinSpiral DECT) were performed in 41 patients with ischemic stroke after endovascular thrombectomy and were retrospectively included. Standard mixed and virtual non-contrast (VNC) images were reconstructed. Infarct visibility and image noise were assessed qualitatively by two readers using a 4-point Likert scale. Quantitative Hounsfield units (HU) were used to assess density differences of ischemic brain tissue versus healthy tissue on the non-affected contralateral hemisphere. RESULTS Infarct visibility was significantly better in VNC compared to mixed images for both readers R1 (VNC: median 1 (range 1-3), mixed: median 2 (range 1-4), p < 0.05) and R2 (VNC: median 2 (range 1-3), mixed: 2 (range 1-4), p < 0.05). Qualitative image noise was significantly higher in VNC compared to mixed images for both readers R1 (VNC: median 3, mixed: 2) and R2 (VNC: median 2, mixed: 1, p < 0.05, each). Mean HU were significantly different between the infarcted tissue and the reference healthy brain tissue on the contralateral hemisphere in VNC (infarct 24 ± 3) and mixed images (infarct 33 ± 5, p < 0.05, each). The mean HU difference between ischemia and reference in VNC images (mean 8 ± 3) was significantly higher (p < 0.05) compared to the mean HU difference in mixed images (mean 5 ± 4). CONCLUSION TwinSpiral DECT allows an improved qualitative and quantitative visualization of ischemic brain tissue in ischemic stroke patients after endovascular treatment.
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Affiliation(s)
- Risto Grkovski
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
- Department of Radiology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Leyla Acu
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Uzeyir Ahmadli
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Nakhostin
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Lorenz Wacht
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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9
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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10
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Li F, He Q, Xu L, Zhou Y, Sun Y, Wang Z, Xu Y, Yang Z, He Y. Diagnostic Accuracy of Subtraction Coronary CT Angiography in Severely Calcified Segments: Comparison Between Readers With Different Levels of Experience. Front Cardiovasc Med 2022; 9:828751. [PMID: 35387432 PMCID: PMC8977640 DOI: 10.3389/fcvm.2022.828751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSubtraction coronary CT angiography (CCTA) may reduce blooming and beam-hardening artifacts. This study aimed to assess its value in improving the diagnostic accuracy of readers with different experience levels.MethodWe prospectively enrolled patients with target segment who underwent CCTA and invasive coronary angiography (ICA). Target segment images were independently evaluated by three groups of radiologists with different experience levels with CCTA using ICA as the standard reference. Diagnostic accuracy was measured by the area under the curve (AUC), using ≥50% stenosis as the cut-off value.ResultsIn total, 134 target segments with severe calcification from 47 patients were analyzed. The mean specificity of conventional CCTA for each group ranged from 22.4 to 42.2%, which significantly improved with subtraction CCTA, ranging from 81.3 to 85.7% (all p < 0.001). The mean sensitivity of conventional CCTA for each group ranged from 83.3 to 88.0%. Following calcification subtraction, the mean sensitivity decreased for the novice (p < 0.001) and junior (p = 0.017) radiologists but was unchanged for the senior radiologists (p = 0.690). With subtraction CCTA, the mean AUCs of CCTA significantly increased: values ranged from 0.53, 0.54, and 0.61 to 0.70, 0.74, and 0.85 for the novice, junior, and senior groups (all p < 0.001).ConclusionSubtraction CCTA could improve the diagnostic accuracy of radiologists at all experience levels of CCTA interpretation.
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Affiliation(s)
- Fang Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qing He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lixue Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Zhou
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yufei Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yinghao Xu
- Canon Medical Systems (China) Co. Ltd., Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Zhenghan Yang
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yi He
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11
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Zerdoumi S, Hashem IAT, Jhanjhi NZ. A new spatial spherical pattern model into interactive cartography pattern: multi-dimensional data via geostrategic cluster. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 81:22903-22952. [PMID: 35125925 PMCID: PMC8800558 DOI: 10.1007/s11042-021-11339-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 06/14/2023]
Abstract
A growing amount of research conducted in digital, cooperative with advances in Artificial Intelligence, Computer Vision including Machine learning, has managed to the advance of progressive techniques that aim to detect and process affective information contained in multi-modal evidences. This research intends to bring together for theoreticians and practitioners from academic fields, professionals and industries and extends to be visualizing cries such epidemic, votes, social Phenomena in spherical representation interactive model working in the broad range of topics relevant to multi - modal data processing and forensics tools developing. Furthermore, progress has been made in this research besides that in this research conducted progression of mapping claims in present epoch necessitate the capacities of virtual guide of any understandable Geo-Visualization of spatial features that talented to convert the quantities of spatial pattern into cartography. The enlargement of a novel approaches fit for visualization of spatial pattern constituencies Starting exclusive Input Set of object O, set associated with feature F for regenerating Output the set C , interested region I special target C Even so, as indicated by the construction of the prototype as listed earlier in this thread, does it have the incentive for improvements: Representation could be used by Google Earth can Using Project enhancement representation whereby provides a 3D or 4D interaction with life measures with a view to cartography. In addition, the initiative suggests that a tool not accessible for disseminating information to the public can be addressed by the use of online mapping, which fuses with trends visualization for political circles and electors. But as mentioned above the framework is developed and it's also possible in the current example, for improvements: The project's representation 3D or 4D interacting Earth can use measures of life Earth From the map viewpoint. That's what that says. That means that. Which just means. Developers have concerns that. So it. Designers concern about that. This study supports the new, multi - demission and deployed countries in conjunction with another data is processed. Comprehensive, well-interpreted source data for the Data like Malaysia Jabatan Pendaftaran (JPN).
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Affiliation(s)
- Saber Zerdoumi
- School of Computer Science & Engineering, Taylor’s University, Subang Jaya, 47500 Malaysia
| | - Ibrahim Abaker Targio Hashem
- College of Computing and Informatics, Department of Computer Science, University of Sharijah, Sharjah, 27272 UAE
| | - Noor Zaman Jhanjhi
- School of Computer Science & Engineering, Taylor’s University, Subang Jaya, 47500 Malaysia
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12
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Chen J, Niu Z, Zhan K, Tao X, Tian F, Ding J, Jin Z, Hu X. Evaluation of Modified Calcium Removal Algorithm in dual energy CT of Internal Carotid Artery. Eur J Radiol 2021; 145:109927. [PMID: 34773829 DOI: 10.1016/j.ejrad.2021.109927] [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: 04/12/2021] [Revised: 06/23/2021] [Accepted: 08/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the performance of a dual-energy (DE) calcium removal software based on a modified three-material decomposition algorithm in assessing the stenosis of the internal carotid artery (ICA) in comparison with mixed images using digital subtraction angiography (DSA) as the reference standard. METHODS Forty-six patients (38 men; 67±8 years old), including 154 calcified ICA segments C1-C2 (59), C3-C5 (63), C6 (24), and C7 (8), were recruited in this retrospective study. Mixed images and virtual non-calcium (VNCa) images using the modified dual-energy computed tomography (DECT) algorithm were reconstructed. The differences between VNCa and DSA images vs. mixed and DSA images of degree of stenosis were compared. The intraclass correlation coefficient (ICC) was used for assessing the agreement between VNCa, mixed images, and DSA. RESULTS The degree of stenosis differed significantly between mixed and DSA images in the C3-C5 (30%±17.9% vs. 23.0%±16.9%, p = 0.026) and C6 (38.3%±15.4% vs. 28.5%±13.3%, p = 0.023) segments. The stenosis of VNCa images showed no significant difference with DSA images in all segments (all p > 0.05). The ICCs between VNCa and DSA images (0.86-0.97) were higher than those between the mixed and DSA images (0.68-0.96) in all segments. CONCLUSION The performance of a modified three-material decomposition DECT algorithm for calcium removal in ICA stenosis evaluation, particularly for the C3-C5 and C6 ICA segments, was promising.
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Affiliation(s)
- Jiao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Zhongfeng Niu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Kun Zhan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Xinwei Tao
- Siemens Healthineers China, No.399, West Haiyang Road, Shanghai, China
| | - Fengjuan Tian
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Jing Ding
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Zhexia Jin
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Xiuhua Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China.
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Zhang L, Li L, Feng G, Fan T, Jiang H, Wang Z. Advances in CT Techniques in Vascular Calcification. Front Cardiovasc Med 2021; 8:716822. [PMID: 34660718 PMCID: PMC8511450 DOI: 10.3389/fcvm.2021.716822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular calcification, a common pathological phenomenon in atherosclerosis, diabetes, hypertension, and other diseases, increases the incidence and mortality of cardiovascular diseases. Therefore, the prevention and detection of vascular calcification play an important role. At present, various techniques have been applied to the analysis of vascular calcification, but clinical examination mainly depends on non-invasive and invasive imaging methods to detect and quantify. Computed tomography (CT), as a commonly used clinical examination method, can analyze vascular calcification. In recent years, with the development of technology, in addition to traditional CT, some emerging types of CT, such as dual-energy CT and micro CT, have emerged for vascular imaging and providing anatomical information for calcification. This review focuses on the latest application of various CT techniques in vascular calcification.
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Affiliation(s)
- Lijie Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Tingpan Fan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Han Jiang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Sartoretti T, Eberhard M, Nowak T, Gutjahr R, Jost G, Pietsch H, Schmidt B, Flohr T, Alkadhi H, Euler A. Photon-Counting Multienergy Computed Tomography With Spectrally Optimized Contrast Media for Plaque Removal and Stenosis Assessment. Invest Radiol 2021; 56:563-570. [PMID: 33660630 DOI: 10.1097/rli.0000000000000773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to systematically evaluate the potential to combine investigational contrast media with spectrally optimized energy-thresholding of photon-counting detector computed tomography (PCCT) for subtraction of calcified plaques in a coronary artery stenosis phantom. METHODS A small vessel phantom containing 3 fillable tubes (diameter, 3 mm each) with calcified plaques was placed into an anthropomorphic chest phantom. The plaques had incremental thicknesses ranging from 0.3 to 2.7 mm, simulating vessel stenoses ranging from 10% to 90% of the lumen diameter. The phantom was filled with 5 different investigational contrast media (iodine, bismuth, hafnium, holmium, and tungsten) at equal mass concentrations (15 mg/mL) and was imaged on a prototype PCCT at 140 kVp using optimized, contrast media-dependent energy thresholds. Contrast maps (CMs) were reconstructed for each contrast medium by applying a linear 2-material decomposition algorithm. Image noise magnitude and noise texture of CM were compared among the contrast media using the noise power spectrum. Two blinded readers independently rated the vessel lumen visualization on short-axis and the overall subjective image quality on long-axis CM relative to iodine as the reference standard. Four readers determined the highest degree of stenosis that could be assessed with high diagnostic confidence on long-axis CM. RESULTS Average image noise on CM was lower for tungsten (49 HU) and hafnium (62 HU) and higher for bismuth (81 HU) and holmium (165 HU) compared with iodine (78 HU). Noise texture of CM was similar among the contrast media. Interreader agreement for vessel lumen visualization on short-axis CM ranged from moderate to excellent (k = 0.567-0.814). Compared with iodine, lumen visualization of each reader was improved using tungsten (P < 0.001 for both readers), similar to improved using hafnium (P = 0.008, P = 0.29), similar using bismuth (P = 0.38, P = 0.69), and decreased using holmium (both, P < 0.001). Overall subjective image quality was similar for holmium and superior for tungsten, hafnium, and bismuth as compared with iodine. Higher-degree stenoses were evaluable with high confidence using tungsten (mean, 70%; interquartile range, 70%-70%), bismuth (70%; 60%-70%), and hafnium (75%; 70%-80%) compared with iodine (50%; 50%-60%) and holmium (50%; 50%-60%). CONCLUSIONS Spectral optimization in PCCT combined with investigational contrast media can improve calcium subtraction and stenosis assessment in small vessels. Contrast maps of tungsten and, to a lesser extent, hafnium as contrast media yielded superior image noise properties and improved vessel lumen visualization, along with a higher subjective image quality compared with the reference standard iodine.
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Affiliation(s)
- Thomas Sartoretti
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Subtraction improves the accuracy of coronary CT angiography for detecting obstructive disease in severely calcified segments. Eur Radiol 2021; 31:6211-6219. [PMID: 34142220 DOI: 10.1007/s00330-021-08092-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the accuracy, diagnostic confidence, and interobserver agreement of subtraction coronary CT angiography (CCTA) versus invasive coronary angiography on 320-row CT in coronary segments with severe or non-severe calcification. MATERIALS/METHODS Sixty-four patients (33 men, 66.6 ± 8.2 years) with suspected coronary artery disease (CAD) were prospectively enrolled from October 2019 to June 2020. The cross-sectional circumferential extent of calcification was used to classify calcified segments as non-severely ( < 180°) or severely calcified ( ≥ 180°). Three independent, blinded radiologists evaluated the severity of coronary stenosis. Interobserver agreement was evaluated using Fleiss' kappa (κ). A multiple-reader multiple-case receiver operating characteristic (ROC) method was conducted, and diagnostic accuracy was measured using the mean areas under the ROC curves (AUCs), with ≥ 50% stenosis as a cut-off. Diagnostic confidence, diagnostic accuracy, and interobserver agreement were compared between CCTA with or without subtraction information in severely and non-severely calcified segments. RESULTS In cases with severe calcification (51 patients, 146 segments), CCTA with subtraction information achieved better diagnostic accuracy (per-patient AUC: 0.73 vs 0.57, p = 0.03; per-segment AUC: 0.85 vs 0.62, p = 0.01), diagnostic confidence (3.7 vs 2.6, p < 0.001), and interobserver agreement (κ: 0.59 vs 0.30). Diagnostic accuracy (per-patient AUC: 0.81 vs 0.93, p = 0.30; per-patient AUC: 0.79 vs 0.82, p = 0.54) was not increased in cases with non-severe calcification (13 patients, 190 segments). CONCLUSIONS CCTA with subtraction information achieved better diagnostic accuracy in cases of severe calcification (circumferential extent ≥ 180°). However, for non-severe calcification (circumferential extent < 180°), the effect of calcium subtraction was unclear, as it did not improve diagnostic accuracy. KEY POINTS • Subtraction coronary CT angiography achieves better diagnostic accuracy, higher diagnostic confidence, and increased interobserver agreement for severe calcification (circumferential extent ≥ 180°). • Calcium subtraction does not improve the diagnostic accuracy of coronary CT angiography for calcification with a circumferential extent of < 180°.
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Rajiah P, Parakh A, Kay F, Baruah D, Kambadakone AR, Leng S. Update on Multienergy CT: Physics, Principles, and Applications. Radiographics 2020; 40:1284-1308. [DOI: 10.1148/rg.2020200038] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Anushri Parakh
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Fernando Kay
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Dhiraj Baruah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (P.R., S.L.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P., A.R.K.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (F.K.); and Department of Radiology, Medical University of South Carolina, Charleston, SC (D.B.)
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Kay FU. Dual-energy CT and coronary imaging. Cardiovasc Diagn Ther 2020; 10:1090-1107. [PMID: 32968662 PMCID: PMC7487394 DOI: 10.21037/cdt.2020.04.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Dual-energy computed tomography has been proposed for enhancing the evaluation of coronary artery disease in many fronts. However, the clinical translation of such applications has followed a slower pace of clinical translation. This paper will review the evidence supporting the use of dual-energy computed tomography in coronary artery disease (CAD) and provide some practical illustrations, while underscoring the challenges and gaps in knowledge that have contributed to this phenomenon.
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Affiliation(s)
- Fernando Uliana Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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18
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Agostini A, Borgheresi A, Mari A, Floridi C, Bruno F, Carotti M, Schicchi N, Barile A, Maggi S, Giovagnoni A. Dual-energy CT: theoretical principles and clinical applications. Radiol Med 2019; 124:1281-1295. [PMID: 31792703 DOI: 10.1007/s11547-019-01107-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023]
Abstract
The physical principles of dual-energy computed tomography (DECT) are as old as computed tomography (CT) itself. To understand the strengths and the limits of this technology, a brief overview of theoretical basis of DECT will be provided. Specific attention will be focused on the interaction of X-rays with matter, on the principles of attenuation of X-rays in CT toward the intrinsic limits of conventional CT, on the material decomposition algorithms (two- and three-basis-material decomposition algorithms) and on effective Rho-Z methods. The progresses in material decomposition algorithms, in computational power of computers and in CT hardware, lead to the development of different technological solutions for DECT in clinical practice. The clinical applications of DECT are briefly reviewed in relation to the specific algorithms.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy.
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy.
| | - Alessandra Borgheresi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Alberto Mari
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Chiara Floridi
- Department of Health Sciences, Diagnostic and Interventional Radiology, Hospital "San Paolo", University of Milan, Milan, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Marina Carotti
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Nicolò Schicchi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Stefania Maggi
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
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Arendt CT, Czwikla R, Lenga L, Wichmann JL, Albrecht MH, Booz C, Martin SS, Leithner D, Tischendorf P, Blandino A, Vogl TJ, D'Angelo T. Improved coronary artery contrast enhancement using noise-optimised virtual monoenergetic imaging from dual-source dual-energy computed tomography. Eur J Radiol 2019; 122:108666. [PMID: 31786506 DOI: 10.1016/j.ejrad.2019.108666] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE To define optimal kiloelectron volt (keV) settings for virtual monoenergetic imaging (VMI) reconstruction at dual-energy coronary computed tomography angiography (DE-CCTA). METHOD Fifty-one DE-CCTA data sets (33 men; mean age, 63.9 ± 13.2 years) were reconstructed as standard linearly-blended images (F_0.6; 60% of 90 kVp, 40% of 150 kVpSn), and with traditional (VMI) and noise-optimised (VMI+) algorithms from 40 to 100 keV in 10-keV intervals. Objective image quality was assessed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. Three observers subjectively evaluated vascular contrast, image sharpness, noise and delineation of coronary plaques. RESULTS Median values for objective image analysis were highest in VMI + series at 40 keV (SNR, 44.5; CNR: 33.5), significantly superior (allp < 0.001) to the best VMI series at 70 keV (SNR, 28.1; CNR, 18.4) and standard F_0.6 images (SNR, 23.2; CNR, 15.6). Overall subjective metrics achieved higher scores at 40-keV VMI+ series in comparison to 70-keV VMI series and F_0.6 images (all p < 0.001), with optimal vascular contrast (5; ICC, 0.90), good image sharpness (4; 0.88), low noise (4; 0.82), and optimal plaque delineation (5; 0.89). CONCLUSIONS DE-CCTA image reconstruction with 40-keV VMI + allows for significant improvement of both objective and subjective image quality.
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Affiliation(s)
- Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rouben Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alfredo Blandino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tommaso D'Angelo
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany; Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina, Messina, Italy
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Weir-McCall JR, Wang R, Halankar J, Hsieh J, Hague CJ, Rosenblatt S, Fan Z, Sellers SL, Murphy DT, Blanke P, Xu L, Leipsic JA. Effect of a calcium deblooming algorithm on accuracy of coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2019; 14:131-136. [PMID: 31378687 DOI: 10.1016/j.jcct.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Coronary artery calcification is a significant contributor to reduced accuracy of coronary computed tomographic angiography (CTA) in the assessment of coronary artery disease severity. The aim of the current study is to assess the impact of a prototype calcium deblooming algorithm on the diagnostic accuracy of CTA. METHODS 40 patients referred for invasive catheter angiography underwent CTA and invasive catheter angiography. The CTA were reconstructed using a standard soft tissue kernel (CTASTAND) and a deblooming algorithm (CTADEBLOOM). CTA studies were read with and without the deblooming algorithm blinded to the invasive coronary angiogram findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for the detection of stenosis ≥50% or ≥70% were evaluated using quantitative coronary angiography as the reference standard. Image quality was assessed using a 5-point scale, and the presence of image artifact recorded. RESULTS All studies were diagnostic with 548 segments available for evaluation. Image score was 3.64 ± 0.72 with CTADEBLOOM, versus 3.56 ± 0.72 with CTASTAND (p = 0.38). CTADEBLOOM had significantly less calcium blooming artifact than CTASTAND (12.5% vs. 47.5%, p = 0.001). Based on a 50% stenosis threshold for defining significant disease, the Sensitivity/Specificity/PPV/NPV/Accuracy were 65.9/84.9/27.6/96.6/83.4 for CTADEBLOOM and 75.0/81.9/26.6/97.4/81.4 for CTASTAND using a ≥50% threshold. CTADEBLOOM specificity was significantly higher than CTASTAND (84.9% vs. 81.5%, p = 0.03), with no difference between the algorithms in sensitivity (p = 0.22), or accuracy (p = 0.15). These results remained unchanged when a stenosis threshold of ≥70% was used. Interobserver agreement was fair with both techniques (CTADEBLOOM k = 0.38, CTASTAND k = 0.37). CONCLUSION In this proof of concept study, coronary calcification deblooming using a prototype post-processing algorithm is feasible and reduces calcium blooming with an improvement of the specificity of the CTA exam.
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Affiliation(s)
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Jiang Hsieh
- GE Healthcare Technologies, Waukesha, WI, USA
| | | | | | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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De Santis D, De Cecco CN, Schoepf UJ, Nance JW, Yamada RT, Thomas BA, Otani K, Jacobs BE, Turner DA, Wichmann JL, Eid M, Varga-Szemes A, Caruso D, Grant KL, Schmidt B, Vogl TJ, Laghi A, Albrecht MH. Modified calcium subtraction in dual-energy CT angiography of the lower extremity runoff: impact on diagnostic accuracy for stenosis detection. Eur Radiol 2019; 29:4783-4793. [PMID: 30805703 DOI: 10.1007/s00330-019-06032-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the diagnostic accuracy of a modified three-material decomposition calcium subtraction (CS) algorithm for the detection of arterial stenosis in dual-energy CT angiography (DE-CTA) of the lower extremity runoff compared to standard image reconstruction, using digital subtraction angiography (DSA) as the reference standard. METHODS Eighty-eight patients (53 males; mean age, 65.9 ± 11 years) with suspected peripheral arterial disease (PAD) who had undergone a DE-CTA examination of the lower extremity runoff between May 2014 and May 2015 were included in this IRB-approved, HIPAA-compliant retrospective study. Standard linearly blended and CS images were reconstructed and vascular contrast-to-noise ratios (CNR) were calculated. Two independent observers assessed subjective image quality using a 5-point Likert scale. Diagnostic accuracy for ≥ 50% stenosis detection was analyzed in a subgroup of 45 patients who had undergone additional DSA. Diagnostic accuracy parameters were estimated with a random-effects logistic regression analysis and compared using generalized estimating equations. RESULTS CS datasets showed higher CNR (15.3 ± 7.3) compared to standard reconstructions (13.5 ± 6.5, p < 0.001). Both reconstructions showed comparable qualitative image quality scores (CS, 4.64; standard, 4.57; p = 0.220). Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) for CS reconstructions was 96.5% (97.5%, 95.6%, 90.9%, 98.1) and 93.1% (98.8%, 90.4%, 82.3%, 99.1%) for standard images. CONCLUSIONS A modified three-material decomposition CS algorithm provides increased vascular CNR, equivalent qualitative image quality, and greater diagnostic accuracy for the detection of significant arterial stenosis of the lower extremity runoff on DE-CTA compared with standard image reconstruction. KEY POINTS • Calcified plaques may lead to overestimation of stenosis severity and false positive results, requiring additional invasive digital subtraction angiography (DSA). • A modified three-material decomposition algorithm for calcium subtraction provides greater diagnostic accuracy for the detection of significant arterial stenosis of the lower extremity runoff compared with standard image reconstruction. • The application of this algorithm in patients with heavily calcified vessels may be helpful to potentially reduce inconclusive CT angiography examinations and the need for subsequent invasive DSA.
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Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Radiological Sciences, Oncology and Pathology, Sant'Andrea University Hospital, "Sapienza" - University of Rome, Rome, Italy
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - John W Nance
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Ricardo T Yamada
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Brooke A Thomas
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Katharina Otani
- Imaging and Therapy Systems Division, Healthcare Sector, Siemens Japan K.K., Tokyo, Japan
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - D Alan Turner
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Julian L Wichmann
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marwen Eid
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, Sant'Andrea University Hospital, "Sapienza" - University of Rome, Rome, Italy
| | | | - Bernhard Schmidt
- Division of Computed Tomography, Siemens Healthineers, Forchheim, Germany
| | - Thomas J Vogl
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, Sant'Andrea University Hospital, "Sapienza" - University of Rome, Rome, Italy
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Scholtz JE, Hedgire S, Ghoshhajra BB. Technical Aspects, Interpretation, and Body of Evidence for Coronary Computed Tomography Angiography. Radiol Clin North Am 2019; 57:13-23. [DOI: 10.1016/j.rcl.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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De Santis D, Eid M, De Cecco CN, Jacobs BE, Albrecht MH, Varga-Szemes A, Tesche C, Caruso D, Laghi A, Schoepf UJ. Dual-Energy Computed Tomography in Cardiothoracic Vascular Imaging. Radiol Clin North Am 2018; 56:521-534. [PMID: 29936945 DOI: 10.1016/j.rcl.2018.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual energy computed tomography is becoming increasingly widespread in clinical practice. It can expand on the traditional density-based data achievable with single energy computed tomography by adding novel applications to help reach a more accurate diagnosis. The implementation of this technology in cardiothoracic vascular imaging allows for improved image contrast, metal artifact reduction, generation of virtual unenhanced images, virtual calcium subtraction techniques, cardiac and pulmonary perfusion evaluation, and plaque characterization. The improved diagnostic performance afforded by dual energy computed tomography is not associated with an increased radiation dose. This review provides an overview of dual energy computed tomography cardiothoracic vascular applications.
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Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Marwen Eid
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Lazarettstraße 36, Munich 80636, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
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