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Robb CL, Marquis KM, Steinbrecher KL, Hammer MM, Henry T, Bhalla S, Raptis CA. Evaluation and Utilization of Flow Artifacts at CT. Radiographics 2024; 44:e230134. [PMID: 38662588 DOI: 10.1148/rg.230134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Flow artifacts are commonly encountered at contrast-enhanced CT and can be difficult to discern from true pathologic conditions. Therefore, radiologists must be comfortable distinguishing flow artifacts from true pathologic conditions. This is of particular importance when evaluating the pulmonary arteries and aorta, as a flow artifact may be mistaken for a pulmonary embolism or dissection flap. Understanding the mechanics of flow artifacts and how these artifacts are created can help radiologists in several ways. First, this knowledge can help radiologists appreciate how the imaging characteristics of flow artifacts differ from true pathologic conditions. This information can also help radiologists better recognize the clinical conditions that predispose patients to flow artifacts, such as pneumonia, chronic lung damage, and altered cardiac output. By understanding when flow artifacts may be confounding the interpretation of an examination, radiologists can then know when to pursue other troubleshooting methods to assist with the diagnosis. In these circumstances, the radiologist can consider several troubleshooting methods, including adjusting the imaging protocols, recommending when additional imaging may be helpful, and suggesting which imaging study would be the most beneficial. Finally, flow artifacts can also be used as a diagnostic tool when evaluating the vascular anatomy, examples of which include the characterization of shunts, venous collaterals, intimomedial flaps, and alternative patterns of blood flow, as seen in extracorporeal membrane oxygenation circuits. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Caroline L Robb
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Kaitlin M Marquis
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Kacie L Steinbrecher
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Mark M Hammer
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Travis Henry
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
| | - Constantine A Raptis
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.L.R., K.M.M., K.L.S., S.B., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, Duke University, Durham, NC (T.H.)
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Azour L, Ko JP, Toussie D, Gomez GV, Moore WH. Current imaging of PE and emerging techniques: is there a role for artificial intelligence? Clin Imaging 2022; 88:24-32. [DOI: 10.1016/j.clinimag.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
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Fischer AM, Decker JA, Schoepf J, Varga-Szemes A, Flohr T, Schmidt B, Gutjahr R, Sahbaee P, Giovagnoli DA, Emrich T, Martinez JD, Lari KB, Bayer RR, Martin SS. Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm. Br J Radiol 2022; 95:20201456. [PMID: 35084228 PMCID: PMC10993975 DOI: 10.1259/bjr.20201456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.
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Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- University Department of Geriatric Medicine FELIX PLATTER and
University of Basel, Basel,
Switzerland
| | - Josua A. Decker
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg,
Augsburg, Germany
| | - Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | | | | | | | | | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Medical Center, Mainz,
Germany
- German Center for Cardiovascular Research (DZHK), Partner Site
Rhine Main, Mainz,
Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Kia B Lari
- University of South Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
| | - Robert R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, South
Carolina, USA
| | - Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Frankfurt,
Frankfurt, Germany
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Ropp A, Frazier AA, Gelfand B, Jeudy J. The Dean Effect: An Aortic Arch Flow Artifact Mimicking Dissection. Radiol Cardiothorac Imaging 2022; 4:e210229. [PMID: 35782762 PMCID: PMC8893211 DOI: 10.1148/ryct.210229] [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: 08/12/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 06/15/2023]
Abstract
The unique hemodynamics of the aortic arch create conditions for potential formation of a flow-related artifact that mimics disease on CT angiographic images. The hemodynamic basis for this artifact can be explained by fluid mechanics incorporating a mathematical principle known as the Dean number. Therefore, in this review, the artifact is referred to as the Dean effect. It is important for radiologists and other clinicians to recognize this artifact when encountered. It is also helpful for the interpreting radiologist to have a basic understanding of the relevant hemodynamic principles. This review provides an example of the artifact, reviews the basic underlying hemodynamics, and presents methods of how to prevent this artifact and distinguish it from pathologic mimics in clinical practice. Keywords: CT Angiography, Vascular, Thorax, Aorta, Artifacts, Blood, Dissection, Hemodynamics/Flow Dynamics © RSNA, 2022.
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Castañer E, Gonzalez A, Andreu M, Lozano C, Gallardo X. Influence of using recommended radiological criteria on MDCT-angiography diagnosis of single isolated subsegmental pulmonary embolism. Eur Radiol 2022; 32:4284-4291. [PMID: 35032211 DOI: 10.1007/s00330-021-08480-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the rate of false-positive diagnoses of MDCT-pulmonary angiography (MDCT-A) in patients with single isolated subsegmental pulmonary embolism (SISSPE). METHODS All patients who underwent MDCT-A between 2006 and 2017 for ruling out acute pulmonary embolism (PE) and received an initial diagnosis of SISSPE were included. The MDCT-A of these patients were reviewed retrospectively by four experienced thoracic radiologists, who applied radiological criteria recommended by the American College of Chest Physicians Antithrombotic Guidelines (ACCP 2016) for the diagnosis of SISSPE. Data extracted from medical records were history of venous thromboembolism (VTE), alternative diagnoses, other diagnostic studies for VTE, anticoagulation, bleeding complications, and VTE over the following 3 months. RESULTS Of 3839 patients undergoing MDCT-A, PE was found in 1021 (26.6%) and SISSPE in 59 (1.5% overall and 5.8% of all patients with PE). An alternative diagnosis to PE was made on the basis of CT in 33 (55.9%) patients. Forty-one (69.5%) patients received anticoagulants, and major life-threatening bleeding complications occurred in 2, with one death. Recurrent PE was not documented in any patient with SISSPE. In the retrospective assessment of the 59 cases of SISSPE, 21 were negative for PE, with a false-positive rate of 35.6% (21/59); so the percentage of SISSPE cases after the revision was 3.7% of all patients with PE; 11 of these 21 patients received anticoagulation. CONCLUSIONS Radiologists should be aware of the high rate of false-positives when making the diagnosis of SISSPE on MDCT-A without using strict diagnostic criteria. Misdiagnosis exposes patients to unnecessary anticoagulation. KEY POINTS • Radiologist should be aware of the high rate of false-positive diagnoses of single isolated subsegmental pulmonary embolism (SISSPE) in MDCT-pulmonary angiography (MDCT-A) performed for ruling out pulmonary embolism. • Misdiagnosis of SISSPE in MDCT-A can be reduced by using strict diagnostic radiological criteria recommended by the American College of Chest Physicians Antithrombotic Guidelines. • Unnecessary anticoagulation therapy with potential severe bleeding complications may result from misdiagnosis of SISSPE.
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Affiliation(s)
- Eva Castañer
- Servei de Diagnòstic per la Imatge, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
| | - Amàlia Gonzalez
- Servei de Diagnòstic per la Imatge, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - Marta Andreu
- Servei de Diagnòstic per la Imatge, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - Carme Lozano
- Servei de Diagnòstic per la Imatge, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - Xavier Gallardo
- Servei de Diagnòstic per la Imatge, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
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Steinbrecher KL, Marquis KM, Bhalla S, Mellnick VM, Ohman JW, Raptis CA. CT of the Difficult Acute Aortic Syndrome. Radiographics 2021; 42:69-86. [PMID: 34951836 DOI: 10.1148/rg.210098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute aortic syndrome (AAS) is classically attributed to three underlying pathologic conditions-aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU). In the majority of cases, the basics of image interpretation are not difficult and have been extensively reviewed in the literature. In this article, the authors extend existing imaging overviews of AAS by highlighting additional factors related to the diagnosis, classification, and characterization of difficult AAS cases. It has been well documented that AAS is caused not only by an AD but by a spectrum of lesions that often have overlap in imaging features and are not clearly distinguishable. Specifically, phase of contrast enhancement, flow artifacts, and flapless AD equivalents can complicate diagnosis and are discussed. While the A/B dichotomy of the Stanford system is still used, the authors subsequently emphasize the Society for Vascular Surgery's new guidelines for the description of acute aortic pathologic conditions given the expanded use of endovascular techniques used in aortic repair. In the final section, atypical aortic rupture and pitfalls are described. As examples of pericardial and shared sheath rupture become more prevalent in the literature, it is important to recognize contrast material third-spacing and mediastinal blood as potential mimics. By understanding these factors related to difficult cases of AAS, the diagnostic radiologist will be able to accurately refine CT interpretation and thus provide information that is best suited to directing management. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - J Westley Ohman
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., V.M.M., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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Ko JP, Goldstein JM, Latson LA, Azour L, Gozansky EK, Moore W, Patel S, Hutchinson B. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. Radiographics 2021; 41:399-424. [PMID: 33646903 DOI: 10.1148/rg.2021200055] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest CT angiography (CTA) is essential in the diagnosis of acute aortic syndromes. Chest CTA quality can be optimized with attention to technical parameters pertaining to noncontrast imaging, timing of contrast-enhanced imaging, contrast material volume, kilovolt potential, tube-current modulation, and decisions regarding electrocardiographic-gating and ultra-fast imaging, which may affect the accurate diagnosis of acute aortic syndromes. An understanding of methods to apply to address suboptimal image quality is useful, as the accurate identification of acute aortic syndromes is essential for appropriate patient management. Acute aortic syndromes have high morbidity and mortality, particularly when involving the ascending aorta, and include classic aortic dissection, penetrating atherosclerotic ulcer, and acute intramural hematoma. An understanding of the pathogenesis and distinguishing imaging features of acute aortic syndromes and aortic rupture and some less common manifestations is helpful when interpreting imaging examinations. Related entities, such as ulcerated plaque, ulcerlike projections, and intramural blood pools, and mimics, such as vasculitis and aortic thrombus, are important to recognize; knowledge of these is important to avoid interpretive pitfalls. In addition, an awareness of postsurgical aortic changes can be useful when interpreting CTA examinations when patient history is incomplete. The authors review technical considerations when performing CTA, discuss acute aortic syndromes, and highlight diagnostic challenges encountered when interpreting aortic CTA examinations. ©RSNA, 2021.
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Affiliation(s)
- Jane P Ko
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Jonathan M Goldstein
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Larry A Latson
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Lea Azour
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Elliott K Gozansky
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - William Moore
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Smita Patel
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Barry Hutchinson
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
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Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography. J Thorac Imaging 2020; 35:W107-W118. [PMID: 32235186 DOI: 10.1097/rti.0000000000000504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Left atrial appendage (LAA) mechanical exclusion is being investigated for nonpharmacologic stroke risk reduction in selected patients with atrial fibrillation. There are multiple potential approaches in various stages of development and clinical application, each of which depends on specific cardiothoracic anatomic characteristics for optimal performance. Multiple imaging modalities can be utilized for application of this technology, with transesophageal echocardiography used for intraprocedural guidance. Cardiovascular computed tomographic angiography can act as a virtual patient avatar, allowing for the assessment of cardiac structures in the context of surrounding cardiac, coronary vascular, thoracic vascular, and visceral and skeletal anatomy, aiding preprocedural decision-making, planning, and follow-up. Although transesophageal echocardiography is used for intraprocedural guidance, computed tomographic angiography may be a useful adjunct for preprocedure assessment of LAA sizing and anatomic obstacles or contraindications to deployment, aiding in the assessment of optimal approaches. Potential approaches to LAA exclusion include endovascular occlusion, epicardial ligation, primary minimally invasive intercostal thoracotomy with thoracoscopic LAA ligation or appendectomy, and minimally invasive or open closure as part of cardiothoracic surgery for other indications. The goals of these procedures are complete isolation or exclusion of the entire appendage without leaving a residual appendage stump or residual flow with avoidance of acute or chronic damage to surrounding cardiovascular structures. The cardiovascular imager plays an important role in the preprocedural and postprocedural assessment of the patient undergoing LAA exclusion.
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Stefanidis K, Green J, Konstantelou E, Robbie H. Flow artefact mimicking pulmonary embolism in pulmonary hypertension. BMJ Case Rep 2020; 13:13/2/e234652. [PMID: 32107262 DOI: 10.1136/bcr-2020-234652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Jordan Green
- Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Elissavet Konstantelou
- 1st Department of Respiratory Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hasti Robbie
- Radiology, King's College Hospital NHS Foundation Trust, London, UK
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Approach to Abnormal Chest Computed Tomography Contrast Enhancement in the Hospitalized Patient. Radiol Clin North Am 2020; 58:93-103. [DOI: 10.1016/j.rcl.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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