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Takumi K, Nagano H, Ueda K, Umehara T, Tokunaga T, Kamimura G, Sato M, Nakanosono R, Yoshiura T. Left atrial CT volume and CHA 2DS 2-VASc score predict early pulmonary vein stump thrombus after left upper lobectomy. Sci Rep 2023; 13:4965. [PMID: 36973354 PMCID: PMC10042883 DOI: 10.1038/s41598-023-32240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
The purpose of this study is to clarify the feasibility of left atrial (LA) volume measurement and CHA2DS2-VASc score for predicting the development of pulmonary vein (PV) stump thrombus after left upper lobectomy (LUL). The study population comprised 50 patients who underwent LUL for pulmonary lesions. All patients were evaluated for the development of PV stump thrombus at 7 days after LUL. LA volume was measured using preoperative CT and the CHA2DS2-VASc score was evaluated. LA volume and CHA2DS2-VASc score were compared between patients with and without the development of PV stump thrombus using the Mann-Whitney U test. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the accuracy of prediction of PV stump thrombus development. PV stump thrombus was detected in 17 (33.4%) of the 50 patients. LA volume was significantly greater in patients who developed PV stump thrombus than in those without thrombus (79.7 ± 19.4 vs. 66.6 ± 17.0 mL, p = 0.040). CHA2DS2-VASc score was significantly higher in patients with PV stump thrombosis than in those without thrombus (3.4 ± 1.5 vs. 2.5 ± 1.5, p = 0.039). Area under the ROC curve values for predicting PV stump thrombus were 0.679, 0.676, and 0.714 for LA volume, CHA2DS2-VASc score, and their combination, respectively. In conclusion, LA volume measured using preoperative CT and CHA2DS2-VASc score may help predict the development of PV stump thrombus after LUL.
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Affiliation(s)
- Koji Takumi
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan.
| | - Hiroaki Nagano
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Kazuhiro Ueda
- Departments of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Tadashi Umehara
- Departments of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Takuya Tokunaga
- Departments of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Go Kamimura
- Departments of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Masami Sato
- Departments of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Ryota Nakanosono
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Takashi Yoshiura
- Departments of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
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Asif A, Charters PFP, Thompson CAS, Komber HMEI, Hudson BJ, Rodrigues JCL. Artificial intelligence can detect left ventricular dilatation on contrast-enhanced thoracic computer tomography relative to cardiac magnetic resonance imaging. Br J Radiol 2022; 95:20210852. [PMID: 35286140 PMCID: PMC9815728 DOI: 10.1259/bjr.20210852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of an automated algorithm to detect left ventricular (LV) dilatation on non-ECG gated CT, using cardiac magnetic resonance (CMR) as reference standard. METHODS Consecutive patients with contrast-enhanced CT thorax and CMR within 31 days (2016-2020) were analysed (n = 84). LV dilatation was defined against age-, sex- and body surface area-specific values for CMR. CTs underwent automated artificial intelligence(AI)-derived analysis that segmented ventricular chambers, presenting maximal LV diameter and volume. Area under the receiver operator curve (AUC-ROC) analysis identified CT thresholds with ≥90% sensitivity and highest specificity and ≥90% specificity with highest sensitivity. Youden's Index was used to identify thresholds with optimised sensitivity and specificity. RESULTS Automated diameter analysis was feasible in 92% of cases (77/84; 45 men, age 61 ± 14 years, mean CT to CMR interval 10 ± 8 days). Relative to CMR as a reference standard, 45% had LV dilatation. In males, an automated LV diameter measurement of ≥55.5 mm was ≥90% specific for CMR-defined LV dilatation (positive predictive value (PPV) 85.7%, negative predictive value (NPV) 61.2%, accuracy 68.9%). In females, an LV diameter of ≥49.7 mm was ≥90% specific for CMR-defined LV dilatation (PPV 66.7%, NPV 73.1%, accuracy 71.9%). AI CT volumetry data did not significantly improve AUC performance. CONCLUSION Fully automated AI-derived analysis LV dilatation on routine unselected non-gated contrast-enhanced CT thorax studies is feasible. We have defined thresholds for the detection of LV dilatation on CT relative to CMR, which could be used to routinely screen for dilated cardiomyopathy at the time of CT. ADVANCES IN KNOWLEDGE We show, for the first time, that a fully-automated AI-derived analysis of maximal LV chamber axial diameter on non-ECG-gated thoracic CT is feasible in unselected real-world cases and that the derived measures can predict LV dilatation relative to cardiac magnetic resonance imaging, the non-invasive reference standard for determining cardiac chamber size. We have derived sex-specific cut-off values to screen for LV dilatation on routine contrast-enhanced thoracic CT. Future work should validate these thresholds and determine if technology can alter clinical outcomes in a cost-effective manner.
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Affiliation(s)
- Ashar Asif
- Medical School, University of Bristol, Bristol, UK
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Butt W, Dhillon PS, Lenthall R, Malik L, Izzath W, Krishnan K, George B, Pointon K. Left Atrial Enlargement on Non-Gated CT Is Associated with Large Vessel Occlusion in Acute Ischaemic Stroke. Cerebrovasc Dis Extra 2021; 11:87-91. [PMID: 34551410 PMCID: PMC8543283 DOI: 10.1159/000519121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Recent reports have suggested that atrial fibrillation (AF) is more prevalent in the large vessel occlusion (LVO) subgroup of acute ischaemic stroke patients. Given the association between left atrial enlargement (LAE) and AF, we sought to evaluate the feasibility of assessing LAE on non-gated CT and its association with LVO in the hyperacute stroke setting. Methods We analysed our prospectively collected database that included all stroke patients referred for consideration of endovascular treatment between April 14, 2020, and May 21, 2020. During this period, a CT chest was included in our regional stroke protocol to aid triage of patients suspected for COVID-19 from which cardiac measurements were obtained. Patients were dichotomized into LVO and no-LVO groups, and LA measurements were trichotomized into normal, borderline, and enlarged. Univariate analyses were performed between groups. Results Of the included 38 patients, 21 were categorized as LVO and 17 as no LVO. There was a statistically significant association between LAE and LVO (p = 0.028). No significant difference was demonstrated between groups for the baseline AF and other clinical characteristics, except for baseline NIHSS (p = 0.0005). There was excellent inter- and intra-rater reliability (ICC = 0.969) for LA measurements. Conclusion Our study provides preliminary data to suggest LAE is more prevalent in the LVO stroke subgroup at presentation and can be reliably assessed on non-gated CT in the hyperacute setting. These findings have potential implications for stratifying secondary management and may prompt a more rigorous pursuit of occult AF or other cardiac causes of stroke.
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Affiliation(s)
- Waleed Butt
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Permesh Singh Dhillon
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Robert Lenthall
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Luqman Malik
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Wazim Izzath
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Kailash Krishnan
- Stroke Medicine, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Bindu George
- Cardiothoracic Radiology Department, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Kate Pointon
- Cardiothoracic Radiology Department, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Guglielmi V, Planken RN, Mihl C, Niesen S, Staals J, Coutinho JM, Postma AA. Non-gated cardiac CT angiography for detection of cardio-aortic sources of embolism in the acute phase of ischaemic stroke. J Neurol Neurosurg Psychiatry 2020; 91:442-443. [PMID: 31974129 DOI: 10.1136/jnnp-2019-321923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Valeria Guglielmi
- Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robrecht Nils Planken
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Casper Mihl
- Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sandra Niesen
- Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Staals
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonathan M Coutinho
- Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alida A Postma
- Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands .,School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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Nuffer Z, Baran TM, Krishnamoorthy V, Kaproth-Joslin K, Chaturvedi A. Accuracy of Non-Electrocardiographically Gated Thoracic CT Angiography for Right Atrial and Right Ventricular Enlargement. Radiol Cardiothorac Imaging 2019; 1:e190008. [PMID: 33778516 PMCID: PMC7977741 DOI: 10.1148/ryct.2019190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/30/2019] [Accepted: 07/11/2019] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the role of long-axis (LA) and short-axis (SA) measurements of the right atrium (RA) and right ventricle (RV) at non-electrocardiographically (ECG) gated thoracic CT angiography for identification of RA enlargement and RV enlargement. MATERIALS AND METHODS This study was a retrospective case review of 138 patients who underwent both non-ECG-gated CT angiography and ECG-gated CT angiography concurrently from November 2016 through November 2018. The SA and LA of the RA and RV were measured by two observers blinded to the ECG-gated CT angiography data. ECG-gated CT angiography-derived RA end-systolic and RV end-diastolic volumes were used as standard of reference to derive cutoff values for diagnosis of RA and RV enlargement. RESULTS In this study, 138 patients were evaluated (70 men, 68 women; mean age, 70.0 years ± 18.4 [standard deviation]; mean body mass index, 29.3 kg/m2 ± 8.1). Of these patients, ECG-gated CT angiography revealed 36.2% had RA enhancement and 19.0% had RV enhancement. The best predictor of RA enhancement was the product of atrial LA and SA measurements, for which a threshold value of 3210 mm2 yielded a 94% sensitivity and 81.8% specificity (area under the curve [AUC], 0.92). A threshold of 55.5 mm for LA diameter had 86% sensitivity and 78.4% specificity in identifying RA enlargement. RV enlargement could be predicted if the SA diameter was greater than 48.5 mm (76.9% sensitivity and 64.9% specificity) and with a body surface area indexed value of 27.0 mm/m2 (92.3% sensitivity and 74.8% specificity [AUC, 0.87]). CONCLUSION RA and RV enlargement can be accurately diagnosed by using non-ECG-gated CT angiography.© RSNA, 2019Supplemental material is available for this article.
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Hota P, Simpson S. Going beyond Cardiomegaly: Evaluation of Cardiac Chamber Enlargement at Non-Electrocardiographically Gated Multidetector CT: Current Techniques, Limitations, and Clinical Implications. Radiol Cardiothorac Imaging 2019; 1:e180024. [PMID: 33778499 DOI: 10.1148/ryct.2019180024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 01/13/2023]
Abstract
Cardiac chamber enlargement is important in the prediction of morbidity and mortality for a multitude of cardiovascular processes. Although non-electrocardiographically (ECG) gated multidetector CT is a commonly used cross-sectional imaging modality to evaluate a litany of cardiothoracic processes, a standardized method for evaluating and reporting cardiac chamber size does not exist. This has led to heterogeneity in the reporting of cardiac enlargement at routine multidetector CT with most readers often using gestalt assessment and the term cardiomegaly, which does not implicate the chamber or chambers that are enlarged. The purpose of this review article is to highlight advantages and limitations of several techniques used to assess cardiac chamber size at non-ECG-gated multidetector CT and to provide readers with reproducible and rapid measurements to determine if cardiac chamber size is present. The long-term aim would be to promote discussions between radiologists and institutions that would result in improved accuracy and decreased variability when commenting on cardiac chamber size. © RSNA, 2019.
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Affiliation(s)
- Partha Hota
- Department of Radiology, Division of Thoracic Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (P.H.) and Department of Radiology, Division of Cardiothoracic Imaging, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Scott Simpson
- Department of Radiology, Division of Thoracic Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (P.H.) and Department of Radiology, Division of Cardiothoracic Imaging, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S.)
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7
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Krueger M, Cronin P, Sayyouh M, Kelly AM. Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Insights Imaging 2019; 10:10. [PMID: 30725202 PMCID: PMC6365314 DOI: 10.1186/s13244-019-0693-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT. Conclusion This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.
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Affiliation(s)
- Maren Krueger
- Fulford Radiology, Base Hospital, Private Bag 2016, New Plymouth, Taranaki, 4342, New Zealand
| | - Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mohamed Sayyouh
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aine Marie Kelly
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Diagnostic Accuracy of Sex-Specific Chest CT Measurements Compared With Cardiac MRI Findings in the Assessment of Cardiac Chamber Enlargement. AJR Am J Roentgenol 2018; 211:993-999. [DOI: 10.2214/ajr.18.19805] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Measuring Left Ventricular Size in Non–Electrocardiographic-gated Chest Computed Tomography. J Thorac Imaging 2018. [DOI: 10.1097/rti.0000000000000275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography. Eur Radiol 2017; 28:1310-1317. [PMID: 28956130 DOI: 10.1007/s00330-017-5041-3] [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: 03/03/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. METHODS Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m2 was chosen for maximal normal LA volume. RESULTS 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). CONCLUSION A left atrium area superior to three times the vertebral area indicates LAE with high specificity. KEY POINTS • Left atrial enlargement is a frequent condition associated with poor cardiac outcome. • Left atrial enlargement is highly time-consuming to diagnose on CT. • The left atrio-vertebral ratio quickly assesses left atrial enlargement. • A left atrial area > three times vertebral area is highly specific.
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Yen A, Feneis J, Castellanos LR. Detection of concentric left ventricular wall hypertrophy by contrast-enhanced non-electrocardiogram-gated chest computed tomography. J Cardiovasc Comput Tomogr 2017; 11:482-488. [PMID: 29031436 DOI: 10.1016/j.jcct.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND No established measure of concentric left ventricular wall hypertrophy (cLVH) on routine computed tomography (CT) of the adult chest currently exists. The objective of this study was to identify and test linear measures for the detection of cLVH using transthoracic echocardiography (TTE) as the reference standard. METHODS Contrast-enhanced non-electrocardiogram-gated chest CTs acquired within two weeks of TTE were retrospectively evaluated. Two radiologists independently made trans-axial measurements in the proximal half of the left ventricle at its approximate widest internal diameter: maximum septal thickness (sept), maximum lateral wall thickness (lat), and inner (Id) and outer (Od) wall-wall diameters at the level of greatest combined myocardial thickness. The sum of sept and lat, hereafter Thmax, and modified cross-sectional area (Amod = Od2 - Id2) were calculated. Sept, lat, Thmax, and Amod were evaluated by receiver operating characteristic (ROC) curves using TTE as the reference standard. Thresholds were optimized for specificity and applied to a validation cohort. Inter-rater agreement was assessed by a simple unweighted Kappa statistic (κ). RESULTS Sept and Amod were selected based on areas under the ROC curves of 0.75 and 0.71, respectively, using 100 CTs. Thresholds of 1.6 cm and 30 cm2, respectively, showed similar specificities of 98% with sensitivities of 27% and 30%, respectively. Applied to a validation cohort of 100 CTs, sept had higher combined positive predictive value (75%), inter-rater agreement (κ = 0.58), specificity (91%), and sensitivity (24%). CONCLUSION Linear measures demonstrate utility in the diagnosis of cLVH on routine contrast-enhanced chest CT.
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Affiliation(s)
- Andrew Yen
- UC San Diego Health, Department of Radiology, 200 West Arbor Drive, MC 8756, San Diego, CA 92103, United States.
| | - Jennifer Feneis
- UC San Diego Health, Department of Radiology, 200 West Arbor Drive, MC 8756, San Diego, CA 92103, United States.
| | - Luis R Castellanos
- UC San Diego Health, Department of Medicine, Division of Cardiovascular Medicine, 9452 Medical Center Drive, MC 7411, La Jolla, CA 92037, United States.
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Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation. Eur J Radiol 2016; 85:255-260. [PMID: 26724674 DOI: 10.1016/j.ejrad.2015.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before. OBJECTIVES Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations. METHOD Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema. MEASUREMENTS AND MAIN RESULTS The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema. CONCLUSIONS LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation. The results were significantly different between the two populations of patients (no heart condition versus cardiogenic pulmonary oedema) suggesting a high potential for clinical application.
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Laborda-Vidal P, Maddox TW, Navarro-Cubas X, Dukes-McEwan J, McConnell JF. Comparison between echocardiographic and non-ECG-gated CT measurements in dogs. Vet Rec 2015; 176:335. [DOI: 10.1136/vr.102724] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- P. Laborda-Vidal
- Small Animal Teaching Hospital, School of Veterinary Science, Leahurst Campus, University of Liverpool; Neston Wirral UK
| | - T. W. Maddox
- Small Animal Teaching Hospital, School of Veterinary Science, Leahurst Campus, University of Liverpool; Neston Wirral UK
| | - X. Navarro-Cubas
- Small Animal Teaching Hospital, School of Veterinary Science, Leahurst Campus, University of Liverpool; Neston Wirral UK
| | - J. Dukes-McEwan
- Small Animal Teaching Hospital, School of Veterinary Science, Leahurst Campus, University of Liverpool; Neston Wirral UK
| | - J. F. McConnell
- Small Animal Teaching Hospital, School of Veterinary Science, Leahurst Campus, University of Liverpool; Neston Wirral UK
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Minkowitz S, Haramati LB, Zalta B, Spindola-Franco HF, Christos PJ, Levsky JM. Can left ventricular function be assessed on non-ECG-gated CT? Clin Imaging 2014; 38:669-74. [PMID: 24794203 DOI: 10.1016/j.clinimag.2014.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/25/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
To evaluate whether non-gated computed tomography (CT) can assess left ventricular (LV) function, 101 patients with both CT and echocardiography were selected, with ejection fraction <50% on echocardiography used as a reference standard. CTs were blindly reevaluated, and qualitative assessment of LV dysfunction on CT correlated with echocardiographic dysfunction, odds ratio of 21.0 (95% confidence interval=6.55-71.0), specificity of 86% (56/65). Systolic and diastolic images were identified on CT, and the ratio of systolic to diastolic LV internal diameters and ratio of LV to RV internal diameter were determined, both showing correlation with LV dysfunction on echocardiography (P<.0001). Non-gated CT can be used to predict LV dysfunction.
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Affiliation(s)
- Shlomo Minkowitz
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Linda B Haramati
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Benjamin Zalta
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Hugo F Spindola-Franco
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Paul J Christos
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Jeffrey M Levsky
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
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