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Yoshida K, Tanabe Y, Hosokawa T, Morikawa T, Fukuyama N, Kobayashi Y, Kouchi T, Kawaguchi N, Matsuda M, Kido T, Kido T. Coronary computed tomography angiography for clinical practice. Jpn J Radiol 2024; 42:555-580. [PMID: 38453814 PMCID: PMC11139719 DOI: 10.1007/s11604-024-01543-1] [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: 07/14/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
Abstract
Coronary artery disease (CAD) is a common condition caused by the accumulation of atherosclerotic plaques. It can be classified into stable CAD or acute coronary syndrome. Coronary computed tomography angiography (CCTA) has a high negative predictive value and is used as the first examination for diagnosing stable CAD, particularly in patients at intermediate-to-high risk. CCTA is also adopted for diagnosing acute coronary syndrome, particularly in patients at low-to-intermediate risk. Myocardial ischemia does not always co-exist with coronary artery stenosis, and the positive predictive value of CCTA for myocardial ischemia is limited. However, CCTA has overcome this limitation with recent technological advancements such as CT perfusion and CT-fractional flow reserve. In addition, CCTA can be used to assess coronary artery plaques. Thus, the indications for CCTA have expanded, leading to an increased demand for radiologists. The CAD reporting and data system (CAD-RADS) 2.0 was recently proposed for standardizing CCTA reporting. This RADS evaluates and categorizes patients based on coronary artery stenosis and the overall amount of coronary artery plaque and links this to patient management. In this review, we aimed to review the major trials and guidelines for CCTA to understand its clinical role. Furthermore, we aimed to introduce the CAD-RADS 2.0 including the assessment of coronary artery stenosis, plaque, and other key findings, and highlight the steps for CCTA reporting. Finally, we aimed to present recent research trends including the perivascular fat attenuation index, artificial intelligence, and the advancements in CT technology.
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Affiliation(s)
- Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Takaaki Hosokawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoro Morikawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Kobayashi
- Department of Radiology, Matsuyama Red Cross Hospital, Bunkyocho, Matsuyama, Ehime, Japan
| | - Takanori Kouchi
- Department of Radiology, Juzen General Hospital, Kitashinmachi, Niihama, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Megumi Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Catapano F, Lisi C, Savini G, Olivieri M, Figliozzi S, Caracciolo A, Monti L, Francone M. Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application. J Comput Assist Tomogr 2024; 48:217-221. [PMID: 37621087 DOI: 10.1097/rct.0000000000001537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The increasing number of coronary computed tomography angiography (CCTA) requests raised concerns about dose exposure. New dose reduction strategies based on artificial intelligence have been proposed to overcome limitations of iterative reconstruction (IR) algorithms. Our prospective study sought to explore the added value of deep-learning image reconstruction (DLIR) in comparison with a hybrid IR algorithm (adaptive statistical iterative reconstruction-veo [ASiR-V]) in CCTA, even in clinical challenging scenarios, as obesity, heavily calcified vessels and coronary stents. METHODS We prospectively included 103 consecutive patients who underwent CCTA. Data sets were reconstructed with ASiR-V and DLIR. For each reconstruction signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was calculated, and qualitative assessment was made with a four-point Likert scale by two independent and blinded radiologists with different expertise. RESULTS Both SNR and CNR were significantly higher in DLIR (SNR-DLIR median value [interquartile range] of 13.89 [11.06-16.35] and SNR-ASiR-V 25.42 [22.46-32.22], P < 0.001; CNR-DLIR 16.84 [9.83-27.08] vs CNR-ASiR-V 10.09 [5.69-13.5], P < 0.001).Median qualitative score was 4 for DLIR images versus 3 for ASiR-V ( P < 0.001), with a good interreader reliability [intraclass correlation coefficient(2,1)e intraclass correlation coefficient(3,1) 0.60 for DLIR and 0.62 and 0.73 for ASiR-V].In the obese and in the "calcifications and stents" groups, DLIR showed significantly higher values of SNR (24.23 vs 11.11, P < 0.001 and 24.55 vs 14.09, P < 0.001, respectively) and CNR (16.08 vs 8.04, P = 0.008 and 17.31 vs 10.14, P = 0.003) and image quality. CONCLUSIONS Deep-learning image reconstruction in CCTA allows better SNR, CNR, and qualitative assessment than ASiR-V, with an added value in the most challenging clinical scenarios.
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Affiliation(s)
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giovanni Savini
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marzia Olivieri
- Department of neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Figliozzi
- From the Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Caracciolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Shu G, Zhao L, Li F, Jiang Y, Zhang X, Yu C, Pan J, Sun SK. Metallic artifacts-free spectral computed tomography angiography based on renal clearable bismuth chelate. Biomaterials 2024; 305:122422. [PMID: 38128318 DOI: 10.1016/j.biomaterials.2023.122422] [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: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Computed tomography angiography (CTA) is one of the most important diagnosis techniques for various vascular diseases in clinic. However, metallic artifacts caused by metal implants and calcified plaques in more and more patients severely hinder its wide applications. Herein, we propose an improved metallic artifacts-free spectral CTA technique based on renal clearable bismuth chelate (Bi-DTPA dimeglumine) for the first time. Bi-DTPA dimeglumine owns the merits of ultra-simple synthetic process, approximately 100% of yield, large-scale production capability, good biocompatibility, and favorable renal clearable ability. More importantly, Bi-DTPA dimeglumine shows superior contrast-enhanced effect in CTA compared with clinical iohexol at a wide range of X-ray energies especially in higher X-ray energy. In rabbits' model with metallic transplants, Bi-DTPA dimeglumine assisted-spectral CTA can not only effectively mitigate metallic artifacts by reducing beam hardening effect under high X-ray energy, but also enables accurate delineation of vascular structure. Our proposed strategy opens a revolutionary way to solve the bottleneck problem of metallic artifacts in CTA examinations.
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Affiliation(s)
- Gang Shu
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300203, China; Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Lu Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fengtan Li
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300203, China.
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Wolf EV, Halfmann MC, Varga-Szemes A, Fink N, Kloeckner R, Bockius S, Allmendinger T, Hagenauer J, Koehler T, Kreitner KF, Schoepf UJ, Münzel T, Düber C, Gori T, Yang Y, Hell MM, Emrich T. Photon-Counting Detector CT Virtual Monoenergetic Images for Coronary Artery Stenosis Quantification: Phantom and In Vivo Evaluation. AJR Am J Roentgenol 2024; 222:e2330481. [PMID: 38197760 DOI: 10.2214/ajr.23.30481] [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: 01/11/2024]
Abstract
BACKGROUND. Calcium blooming causes stenosis overestimation on coronary CTA. OBJECTIVE. The purpose of this article was to evaluate the impact of virtual monoenergetic imaging (VMI) reconstruction level on coronary artery stenosis quantification using photon-counting detector (PCD) CT. METHODS. A phantom containing two custom-made vessels (representing 25% and 50% stenosis) underwent PCD CT acquisitions without and with simulated cardiac motion. A retrospective analysis was performed of 33 patients (seven women, 26 men; mean age, 71.3 ± 9.0 [SD] years; 64 coronary artery stenoses) who underwent coronary CTA by PCD CT followed by invasive coronary angiography (ICA). Scans were reconstructed at nine VMI energy levels (40-140 keV). Percentage diameter stenosis (PDS) was measured, and bias was determined from the ground-truth stenosis percentage in the phantom and ICA-derived quantitative coronary angiography measurements in patients. Extent of blooming artifact was measured in the phantom and in calcified and mixed plaques in patients. RESULTS. In the phantom, PDS decreased for 25% stenosis from 59.9% (40 keV) to 13.4% (140 keV) and for 50% stenosis from 81.6% (40 keV) to 42.3% (140 keV). PDS showed lowest bias for 25% stenosis at 90 keV (bias, 1.4%) and for 50% stenosis at 100 keV (bias, -0.4%). Blooming artifacts decreased for 25% stenosis from 61.5% (40 keV) to 35.4% (140 keV) and for 50% stenosis from 82.7% (40 keV) to 52.1% (140 keV). In patients, PDS for calcified plaque decreased from 70.8% (40 keV) to 57.3% (140 keV), for mixed plaque decreased from 69.8% (40 keV) to 56.3% (140 keV), and for noncalcified plaque was 46.6% at 40 keV and 54.6% at 140 keV. PDS showed lowest bias for calcified plaque at 100 keV (bias, 17.2%), for mixed plaque at 140 keV (bias, 5.0%), and for noncalcified plaque at 40 keV (bias, -0.5%). Blooming artifacts decreased for calcified plaque from 78.4% (40 keV) to 48.6% (140 keV) and for mixed plaque from 73.1% (40 keV) to 44.7% (140 keV). CONCLUSION. For calcified and mixed plaque, stenosis severity measurements and blooming artifacts decreased at increasing VMI reconstruction levels. CLINICAL IMPACT. PCD CT with VMI reconstruction helps overcome current limitations in stenosis quantification on coronary CTA.
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Affiliation(s)
- Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Nicola Fink
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany
| | - Stefanie Bockius
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | | | | | | | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Thomas Münzel
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Tommaso Gori
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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Sun Z, Silberstein J, Vaccarezza M. Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment. J Cardiovasc Dev Dis 2024; 11:22. [PMID: 38248892 PMCID: PMC10816599 DOI: 10.3390/jcdd11010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring images with high spatial and temporal resolution. The recent emergence of photon-counting CT has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor-patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease. With the widespread use of artificial intelligence, machine learning, and deep learning in cardiovascular disease, the diagnostic performance of cardiovascular CT has significantly improved, with promising results being presented in terms of both disease diagnosis and prediction. This review article provides an overview of the applications of cardiovascular CT, covering its performance from the perspective of its diagnostic value based on traditional lumen assessment to the identification of vulnerable lesions for the prediction of disease outcomes with the use of these advanced technologies. The limitations and future prospects of these technologies are also discussed.
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Affiliation(s)
- Zhonghua Sun
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
| | - Jenna Silberstein
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
| | - Mauro Vaccarezza
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; (J.S.); (M.V.)
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA 6102, Australia
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Abstract
ABSTRACT Noninvasive vascular imaging with computed tomography (CT) has become the clinical mainstay for many indications and body regions. The recent introduction of photon-counting detector (PCD)-CT into clinical routine has further broadened the spectrum of vascular applications. Technical improvements of PCD-CT, such as the decreased noise levels, improved contrast-to-noise ratio, and full spectral multienergy data information from every acquisition, have the potential to further impact on clinical decision making and ultimately on outcome of vascular patients. Early experience with the new PCD-CT technology demonstrates these improvements in various aspects. This review summarizes the main advantages of PCD-CT for vascular imaging a discussion of the PureLumen and PureCalcium algorithms.
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Affiliation(s)
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pack JD, Xu M, Wang G, Baskaran L, Min J, De Man B. Cardiac CT blooming artifacts: clinical significance, root causes and potential solutions. Vis Comput Ind Biomed Art 2022; 5:29. [PMID: 36484886 PMCID: PMC9733770 DOI: 10.1186/s42492-022-00125-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
This review paper aims to summarize cardiac CT blooming artifacts, how they present clinically and what their root causes and potential solutions are. A literature survey was performed covering any publications with a specific interest in calcium blooming and stent blooming in cardiac CT. The claims from literature are compared and interpreted, aiming at narrowing down the root causes and most promising solutions for blooming artifacts. More than 30 journal publications were identified with specific relevance to blooming artifacts. The main reported causes of blooming artifacts are the partial volume effect, motion artifacts and beam hardening. The proposed solutions are classified as high-resolution CT hardware, high-resolution CT reconstruction, subtraction techniques and post-processing techniques, with a special emphasis on deep learning (DL) techniques. The partial volume effect is the leading cause of blooming artifacts. The partial volume effect can be minimized by increasing the CT spatial resolution through higher-resolution CT hardware or advanced high-resolution CT reconstruction. In addition, DL techniques have shown great promise to correct for blooming artifacts. A combination of these techniques could avoid repeat scans for subtraction techniques.
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Affiliation(s)
- Jed D. Pack
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
| | - Mufeng Xu
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Ge Wang
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Lohendran Baskaran
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,grid.419385.20000 0004 0620 9905National Heart Centre, Singapore, 169609 Singapore
| | - James Min
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,Cleerly, New York, NY 10065 USA
| | - Bruno De Man
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
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Xu C, Xu M, Yan J, Li YY, Yi Y, Guo YB, Wang M, Li YM, Jin ZY, Wang YN. The impact of deep learning reconstruction on image quality and coronary CT angiography-derived fractional flow reserve values. Eur Radiol 2022; 32:7918-7926. [PMID: 35596780 DOI: 10.1007/s00330-022-08796-2] [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: 09/22/2021] [Revised: 03/20/2022] [Accepted: 04/03/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To explore the impact of deep learning reconstruction (DLR) on image quality and machine learning-based coronary CT angiography (CTA)-derived fractional flow reserve (CT-FFRML) values. METHODS Thirty-three consecutive patients with known or suspected coronary artery disease who underwent coronary CTA and subsequent invasive coronary angiography were enrolled. DLR was compared with filtered back projection (FBP), statistical-based iterative reconstruction (SBIR), model-based iterative reconstruction (MBIR) Cardiac, and MBIR Cardiac sharp for objective image qualities of coronary CTA. Invasive fractional flow reserve (FFR) and quantitative flow ratio (QFR) were used as the reference standards. The diagnostic performances of different reconstruction approach-based CT-FFRML were calculated. RESULTS A total of 182 lesions in 33 patients were enrolled for analysis. The image quality of DLR was superior to the others. There were no significant differences in the CT-FFRML values among these five approaches (all p > 0.05). Of the 182 lesions, 17 had invasive FFR results, and 70 had QFR results. Using FFR as a reference, MBIR Cardiac, MBIR Cardiac sharp, and DLR achieved equal diagnostic performance, slightly higher than the other reconstruction approaches (MBIR Cardiac, MBIR Cardiac sharp, and DLR: AUC = 0.82, FBP and AIDR: AUC = 0.78, all p > 0.05). Using QFR as a reference, the AUCs of FBP, SBIR, MBIR Cardiac, MBIR Cardiac sharp, and DLR were 0.83, 0.81, 0.86, 0.84, and 0.83, respectively (all p > 0.05). CONCLUSIONS Our study showed that the DLR algorithm improved image quality, but there were no significant differences in the CT-FFRML values and diagnostic performance among different reconstruction approaches. KEY POINTS • Deep learning-based image reconstruction (DLR) improves the image quality of coronary CTA. • CT-FFRML values and diagnostic performance of DLR revealed no significant differences compared to other reconstruction approaches.
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Affiliation(s)
- Cheng Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Min Xu
- Canon Medical System, Beijing, 100015, China
| | - Jing Yan
- Canon Medical System, Beijing, 100015, China
| | - Yan-Yu Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yan Yi
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yu-Bo Guo
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ming Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yu-Mei Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zheng-Yu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yi-Ning Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Soschynski M, Hagen F, Baumann S, Hagar MT, Weiss J, Krauss T, Schlett CL, von zur Mühlen C, Bamberg F, Nikolaou K, Greulich S, Froelich MF, Riffel P, Overhoff D, Papavassiliu T, Schoenberg SO, Faby S, Ulzheimer S, Ayx I, Krumm P. High Temporal Resolution Dual-Source Photon-Counting CT for Coronary Artery Disease: Initial Multicenter Clinical Experience. J Clin Med 2022; 11:jcm11206003. [PMID: 36294324 PMCID: PMC9604695 DOI: 10.3390/jcm11206003] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this paper is to evaluate the diagnostic image quality of spectral dual-source photon-counting detector coronary computed tomography angiography (PCD-CCTA) for coronary artery disease in a multicenter study. The image quality (IQ), assessability, contrast-to-noise ratio (CNR), Agatston score, and radiation exposure were measured. Stenoses were quantified and compared with invasive coronary angiography, if available. A total of 92 subjects (65% male, age 58 ± 14 years) were analyzed. The prevalence of significant coronary artery disease (CAD) (stenosis ≥ 50%) was 17% of all patients, the range of the Agatston score was 0−2965 (interquartile range (IQR) 0−135). The IQ was very good (one, IQR one−two), the CNR was very high (20 ± 10), and 5% of the segments were rated non-diagnostic. The IQ and assessability were higher in proximal coronary segments (p < 0.001). Agatston scores up to 600 did not significantly affect the assessability of the coronary segments (p = 0.3). Heart rate influenced assessability only at a high-pitch mode (p = 0.009). For the invasive coronary angiography (ICA) subgroup (n = nine), the diagnostic performance for CAD per segment was high (sensitivity 92%, specificity 96%), although the limited number of patients who underwent both diagnostic modalities limits the generalization of this finding at this stage. PCD-CCTA provides good image quality for low and moderate levels of coronary calcifications.
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Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Florian Hagen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Stefan Baumann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Constantin von zur Mühlen
- Department of Cardiology and Angiology I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tuebingen, Otfried-Müller-Str. 10, 72076 Tuebingen, Germany
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Philipp Riffel
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, 91301 Forchheim, Germany
| | - Stefan Ulzheimer
- Computed Tomography, Siemens Healthcare GmbH, 91301 Forchheim, Germany
| | - Isabelle Ayx
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-62-1383-2067
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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10
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Ayx I, Tharmaseelan H, Hertel A, Nörenberg D, Overhoff D, Rotkopf LT, Riffel P, Schoenberg SO, Froelich MF. Myocardial Radiomics Texture Features Associated with Increased Coronary Calcium Score—First Results of a Photon-Counting CT. Diagnostics (Basel) 2022; 12:diagnostics12071663. [PMID: 35885567 PMCID: PMC9320412 DOI: 10.3390/diagnostics12071663] [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: 06/10/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
The coronary artery calcium score is an independent risk factor of the development of adverse cardiac events. The severity of coronary artery calcification may influence the myocardial texture. Due to higher spatial resolution and signal-to-noise ratio, new CT technologies such as PCCT may improve the detection of texture alterations depending on the severity of coronary artery calcification. In this retrospective, single-center, IRB-approved study, left ventricular myocardium was segmented and radiomics features were extracted using pyradiomics. The mean and standard deviation with the Pearson correlation coefficient for correlations of features were calculated and visualized as boxplots and heatmaps. Random forest feature selection was performed. Thirty patients (26.7% women, median age 58 years) were enrolled in the study. Patients were divided into two subgroups depending on the severity of coronary artery calcification (Agatston score 0 and Agatston score ≥ 100). Through random forest feature selection, a set of four higher-order features could be defined to discriminate myocardial texture between the two groups. When including the additional Agatston 1–99 groups as a validation, a severity-associated change in feature intensity was detected. A subset of radiomics features texture alterations of the left ventricular myocardium was associated with the severity of coronary artery calcification estimated by the Agatston score.
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Affiliation(s)
- Isabelle Ayx
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
- Correspondence: ; Tel.: +49-62-1383-2067
| | - Hishan Tharmaseelan
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
| | - Alexander Hertel
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
| | - Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Lukas T. Rotkopf
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
| | - Philipp Riffel
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
| | - Stefan O. Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (H.T.); (A.H.); (D.N.); (D.O.); (P.R.); (S.O.S.); (M.F.F.)
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11
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Allmendinger T, Nowak T, Flohr T, Klotz E, Hagenauer J, Alkadhi H, Schmidt B. Photon-Counting Detector CT-Based Vascular Calcium Removal Algorithm: Assessment Using a Cardiac Motion Phantom. Invest Radiol 2022; 57:399-405. [PMID: 35025834 PMCID: PMC9071027 DOI: 10.1097/rli.0000000000000853] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The diagnostic performance of coronary computed tomography angiography is known to be negatively affected by the presence of severely calcified plaques in the coronary arteries. In this article, the performance of a novel image reconstruction algorithm (PureLumen) based on spectral CT data of a first-generation dual-source photon-counting detector computed tomography (PCD-CT) system was assessed in a phantom study. PureLumen tries to remove only the calcified contributions from the image while leaving the rest unmodified. MATERIALS AND METHODS The study uses 2 iodine contrast filled vessel phantoms (diameter 4 mm) filled with different concentrations of iodine and equipped with calcified stenosis inserts. Each phantom features 2 separate calcified lesions of 25% and 50% percentage diameter stenosis (PDS) size. The vessel phantoms were mounted inside an anthropomorphic thorax phantom attached to an artificial motion device, simulating realistic cardiac motion at heart rates between 50 beats per minute and 100 beats per minute. Acquisitions were performed using a prospectively electrocardiogram triggered dual-source sequence mode on a PCD-CT system (NAEOTOM Alpha, Siemens Healthineers). Images were reconstructed at 80% of the RR interval with virtual monoenergetic images (Mono) and with additional calcium-removal (PureLumen), both at 65 keV. PureLumen is based on a spectral base material decomposition into iodine and calcium, which aims to reconstruct images without calcium contributions, while leaving all other material contribution unchanged. Stenosis grade was assessed individually for each vessel insert in all reconstructed image series by 2 readers. RESULTS The measured median PDS values for the 50% lesion were 56.0% (52.0%, 57.0%) for the Mono case and 50.0% (48.5%, 51.0%) for PureLumen. The 25% lesion median PDS values were 36.0% (29.5%, 39.5%) for Mono and 31.5% (30.5%, 34.0%) for PureLumen. Both lesion sizes demonstrate a significant difference between Mono and PureLumen in their result (P < 0.05) with PureLumen median values being closer to the actual true stenosis size for the 50% and 25% lesion. A visual assessment of the image quality depending on the heart rate yielded good image quality up to a heart rate of 80 beats per minute in the PureLumen case. CONCLUSIONS This phantom study shows that a novel calcium-removal image reconstruction algorithm (PureLumen) using a first-generation dual-source PCD-CT effectively decreases blooming artifacts caused by heavily calcified plaques and improves image interpretability. It also shows that PureLumen retains its performance in the presence of motion with simulated heart rates up to 80 beats per minute. Future in vivo clinical studies are needed to confirm the benefits of this type of reconstruction in terms of coronary computed tomography angiography quality and accuracy.
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Affiliation(s)
| | | | - Thomas Flohr
- From Siemens Healthcare GmbH, Forchheim
- University Tübingen, Tübingen
| | | | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard Schmidt
- From Siemens Healthcare GmbH, Forchheim
- University Erlangen, Erlangen, Germany
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12
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de Jong DJ, van der Star S, Bleys RLAW, Schilham AMR, Kuijf HJ, de Jong PA, Kok M. Computed tomography-based calcium scoring in cadaver leg arteries: Influence of dose, reader, and reconstruction algorithm. Eur J Radiol 2021; 146:110080. [PMID: 34875474 DOI: 10.1016/j.ejrad.2021.110080] [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: 06/08/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Computed tomography (CT) might be a good diagnostic test to accurately quantify calcium in vascular beds but there are multiple factors influencing the quantification. The aim of this study was to investigate the influence of different computed tomography protocol settings in the quantification of calcium in the lower extremities using modified Agatston and volume scores. METHODS Fresh-frozen human legs were scanned at different tube current protocols and reconstructed at different slice thickness. Two different iterative reconstruction protocols for conventional CT images were compared. Calcium was manually scored using modified Agatston and volume scores. Outcomes were statistically analyzed using Wilcoxon signed-rank tests and mean absolute and relative differences were plotted in Bland-Altman plots. RESULTS Of the 20 legs, 16 had CT detectable calcifications. Differences between thick and thin slice reconstruction protocols were 129 Agatston units and 125% for Agatston and 78.4 mm3 and 57.8% for volume (all p ≤ 0.001). No significant differences were found between low and high tube current protocols. Differences between iDose4 and IMR reconstruction protocols for modified Agatston were 34.2 Agatston units and 17.7% and the volume score 33.5 mm3 and 21.2% (all p ≤ 0.001). CONCLUSIONS Slice thickness reconstruction and reconstruction method protocols influenced the modified Agatston and volume scores in leg arteries, but tube current and different observers did not have an effect. This data emphasizes the need for standardized quantification of leg artery calcifications. Possible implications are in the development of a more universal quantification method, independent of the type of scan and vasculature.
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Affiliation(s)
- Daan J de Jong
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Simone van der Star
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Arnold M R Schilham
- Image Sciences Institute, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Madeleine Kok
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
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13
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Sun Z, Ng CKC, Wong YH, Yeong CH. 3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts. Biomolecules 2021; 11:biom11091307. [PMID: 34572520 PMCID: PMC8468360 DOI: 10.3390/biom11091307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
- Correspondence: ; Tel.: +61-8-9266-7509; Fax: +61-8-9266-2377
| | - Curtise Kin Cheung Ng
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Yin How Wong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
| | - Chai Hong Yeong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
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Gu J, Yang TS, Ye JC, Yang DH. CycleGAN denoising of extreme low-dose cardiac CT using wavelet-assisted noise disentanglement. Med Image Anal 2021; 74:102209. [PMID: 34450466 DOI: 10.1016/j.media.2021.102209] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
In electrocardiography (ECG) gated cardiac CT angiography (CCTA), multiple images covering the entire cardiac cycle are taken continuously, so reduction of the accumulated radiation dose could be an important issue for patient safety. Although ECG-gated dose modulation (so-called ECG pulsing) is used to acquire many phases of CT images at a low dose, the reduction of the radiation dose introduces noise into the image reconstruction. To address this, we developed a high performance unsupervised deep learning method using noise disentanglement that can effectively learn the noise patterns even from extreme low dose CT images. For noise disentanglement, we use a wavelet transform to extract the high-frequency signals that contain the most noise. Since matched low-dose and high-dose cardiac CT data are impossible to obtain in practice, our neural network was trained in an unsupervised manner using cycleGAN for the extracted high frequency signals from the low-dose and unpaired high-dose CT images. Once the network is trained, denoised images are obtained by subtracting the estimated noise components from the input images. Image quality evaluation of the denoised images from only 4% dose CT images was performed by experienced radiologists for several anatomical structures. Visual grading analysis was conducted according to the sharpness level, noise level, and structural visibility. Also, the signal-to-noise ratio was calculated. The evaluation results showed that the quality of the images produced by the proposed method is much improved compared to low-dose CT images and to the baseline cycleGAN results. The proposed noise-disentangled cycleGAN with wavelet transform effectively removed noise from extreme low-dose CT images compared to the existing baseline algorithms. It can be an important denoising platform for low-dose CT.
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Affiliation(s)
- Jawook Gu
- Bio Imaging, Signal Processing and Learning Laboratory, Department of Bio and Brain Engineering, KAIST, 291, Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
| | - Tae Seong Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jong Chul Ye
- Bio Imaging, Signal Processing and Learning Laboratory, Department of Bio and Brain Engineering, KAIST, 291, Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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15
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Image quality and diagnostic performance evaluation in transcatheter aortic valve implantation candidates with atrial fibrillation using a whole-heart coverage CT scanner. Eur Radiol 2021; 32:1034-1043. [PMID: 34338842 DOI: 10.1007/s00330-021-08187-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the image quality and diagnostic performance for obstructive coronary artery disease of transcatheter aortic valve implantation (TAVI) patients with atrial fibrillation (AF) during TAVI planning CT using a whole-heart coverage CT scanner. METHODS Eighty-eight consecutive TAVI candidates with AF (50 men, 74 ± 6 years) who underwent both TAVI planning CT and invasive coronary catheter angiography (ICA) were retrospectively analyzed. With ICA results as the reference standard, the accuracy of TAVI planning CT for lesion detection on a per-vessel and per-patient level was calculated. Meanwhile, image quality, contrast volume, and effective dose (ED) were evaluated. A 5-point visual scale (1-5) was used to assess the subjective image quality. The CT value and signal-to-noise ratio were measured for the left main coronary artery (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). RESULTS The ED for CCTA was 3.25 ± 1.39 mSv and contrast volume was 58.14 ± 12.34 mL. A total of 1371 (1371/1408 = 97.4%) segments with diameter > 1.5 mm were analyzed. For the subjective evaluation, the mean score was 3.99 ± 0.96 for overall image quality. The mean CT values in LM, RCA, LCX, and LAD were all above 400 HU. For the detection of > 50% stenosis, TAVI planning CT provided on the per-vessel and per-patient basis 97.06% and 100% in sensitivity, 96.23% and 89.06% in specificity, 99.7% and 100% in negative predictive value, and 73.3% and 77.4% in positive predictive value, respectively. CONCLUSION TAVI planning CT with whole-heart coverage demonstrates good CCTA image quality and a high sensitivity and NPV in excluding obstructive CAD in TAVI candidates with AF. KEY POINTS • Transcatheter aortic valve implantation planning (TAVI) CT with whole-heart coverage enables good image quality of CCTA in TAVI candidates with atrial fibrillation. • Obstructive coronary artery disease may be excluded with high accuracy in transcatheter aortic valve implantation (TAVI) candidates with atrial fibrillation with the usage of whole-heart coverage TAVI planning CT.
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16
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Shwaiki O, Rashwan B, Fink MA, Kirksey L, Gadani S, Karuppasamy K, Melzig C, Thompson D, D'Amico G, Rengier F, Partovi S. Lower extremity CT angiography in peripheral arterial disease: from the established approach to evolving technical developments. Int J Cardiovasc Imaging 2021; 37:3101-3114. [PMID: 33997924 DOI: 10.1007/s10554-021-02277-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
With the advent of multidetector computed tomography (CT), CT angiography (CTA) has gained widespread popularity for noninvasive imaging of the arterial vasculature. Peripheral extremity CTA can nowadays be performed rapidly with high spatial resolution and a decreased amount of both intravenous contrast and radiation exposure. In patients with peripheral artery disease (PAD), this technique can be used to delineate the bilateral lower extremity arterial tree and to determine the amount of atherosclerotic disease while differentiating between acute and chronic changes. This article provides an overview of several imaging techniques for PAD, specifically discusses the use of peripheral extremity CTA in patients with PAD, clinical indications, established technical considerations and novel technical developments, and the effect of postprocessing imaging techniques and structured reporting.
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Affiliation(s)
- Omar Shwaiki
- Department of Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Basem Rashwan
- Department of Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Matthias A Fink
- Section of Emergency Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Levester Kirksey
- Department of Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sameer Gadani
- Department of Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | | | - Claudius Melzig
- Section of Emergency Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dustin Thompson
- Department of Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Giuseppe D'Amico
- Department of Transplant Surgery, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Fabian Rengier
- Section of Emergency Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sasan Partovi
- Department of Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH, USA.
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17
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Liu H, Wingert A, Wang J, Zhang J, Wang X, Sun J, Chen F, Khalid SG, Jiang J, Zheng D. Extraction of Coronary Atherosclerotic Plaques From Computed Tomography Imaging: A Review of Recent Methods. Front Cardiovasc Med 2021; 8:597568. [PMID: 33644127 PMCID: PMC7903898 DOI: 10.3389/fcvm.2021.597568] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Atherosclerotic plaques are the major cause of coronary artery disease (CAD). Currently, computed tomography (CT) is the most commonly applied imaging technique in the diagnosis of CAD. However, the accurate extraction of coronary plaque geometry from CT images is still challenging. Summary of Review: In this review, we focused on the methods in recent studies on the CT-based coronary plaque extraction. According to the dimension of plaque extraction method, the studies were categorized into two-dimensional (2D) and three-dimensional (3D) ones. In each category, the studies were analyzed in terms of data, methods, and evaluation. We summarized the merits and limitations of current methods, as well as the future directions for efficient and accurate extraction of coronary plaques using CT imaging. Conclusion: The methodological innovations are important for more accurate CT-based assessment of coronary plaques in clinical applications. The large-scale studies, de-blooming algorithms, more standardized datasets, and more detailed classification of non-calcified plaques could improve the accuracy of coronary plaque extraction from CT images. More multidimensional geometric parameters can be derived from the 3D geometry of coronary plaques. Additionally, machine learning and automatic 3D reconstruction could improve the efficiency of coronary plaque extraction in future studies.
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Affiliation(s)
- Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.,Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Aleksandra Wingert
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Jian'an Wang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jucheng Zhang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xinhong Wang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianzhong Sun
- Department of Radiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Syed Ghufran Khalid
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Jun Jiang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
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18
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Engelkes K. Accuracy of bone segmentation and surface generation strategies analyzed by using synthetic CT volumes. J Anat 2020; 238:1456-1471. [PMID: 33325545 DOI: 10.1111/joa.13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Different kinds of bone measurements are commonly derived from computed-tomography (CT) volumes to answer a multitude of questions in biology and related fields. The underlying steps of bone segmentation and, optionally, polygon surface generation are crucial to keep the measurement error small. In this study, the performance of different, easily accessible segmentation techniques (global thresholding, automatic local thresholding, weighted random walk, neural network, and watershed) and surface generation approaches (different algorithms combined with varying degrees of simplification) was analyzed and recommendations for minimizing inaccuracies were derived. The different approaches were applied to synthetic CT volumes for which the correct segmentation and surface geometry were known. The most accurate segmentations of the synthetic volumes were achieved by setting a case-specific window to the gray value histogram and subsequently applying automatic local thresholding with appropriately chosen thresholding method and radius. Surfaces generated by the Amira® module Generate Lego Surface in combination with careful surface simplification were the most accurate. Surfaces with sub-voxel accuracy were obtained even for synthetic CT volumes with low contrast-to-noise ratios. Segmentation trials with real CT volumes supported the findings. Very accurate segmentations and surfaces can be derived from CT volumes by using readily accessible software packages. The presented results and derived recommendations will help to reduce the measurement error in future studies. Furthermore, the demonstrated strategies for assessing segmentation and surface qualities can be adopted to quantify the performance of new segmentation approaches in future studies.
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Affiliation(s)
- Karolin Engelkes
- Center of Natural History (CeNak), Universität Hamburg, Hamburg, Germany
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Choi KS, Lee W, Jung JH, Park EA. Reproducibility of calcium scoring of the coronary arteries: comparison between different vendors and iterative reconstructions. Acta Radiol Open 2020; 9:2058460120922147. [PMID: 32426164 PMCID: PMC7218275 DOI: 10.1177/2058460120922147] [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: 10/22/2019] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background The coronary artery calcium scoring (CCS) has been widely used for cardiac risk stratification for asymptomatic patients. Purpose To assess the reproducibility of CCS performed on four different computed tomography (CT) scanners, and compare the variability between two reconstruction algorithms, filtered back projection (FBP), and iterative reconstruction (IR). Material and Methods A CCS phantom was made from agar and contained 23 pieces of chicken bones. The phantom was repeatedly scanned using four different CT scanners: Toshiba; GE; Philips; and Siemens. Images were reconstructed using FBP and IR. Agatston and volume scores of total bone fragments were calculated and the overall differences between the instruments were evaluated using the Friedman test. Comparison of the Agatston and volume scores between the two reconstruction algorithms, for each instrument, was evaluated using the Wilcoxon signed rank test. Results The difference in the Agatston scores was significantly different between the four machines (P = 0.001). The Toshiba scanner yielded the highest score followed by Philips, GE, and Siemens scanners. There was no difference in the CCS evaluated using the two reconstruction algorithms, except in case of the Siemens scanner (P = 0.032). Conclusion CCS performed on different scanners varied significantly. In the Toshiba, Philips, and GE scanners, there was no significant difference in the CCS determined using either an IR or the FBP algorithm. In the Siemens scanner, applying the IR algorithm resulted in a slightly different scores, which might not be clinically significant.
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Affiliation(s)
- Kyu Sung Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Joon Hyung Jung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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20
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Li S, Chen C, Qin L, Gu S, Zhang H, Yan F, Yang W. The impact of iterative reconstruction algorithms on machine learning-based coronary CT angiography-derived fractional flow reserve (CT-FFR ML) values. Int J Cardiovasc Imaging 2020; 36:1177-1185. [PMID: 32130576 DOI: 10.1007/s10554-020-01807-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/24/2020] [Indexed: 12/17/2022]
Abstract
To evaluate the impact of an iterative reconstruction (IR) algorithm (advanced modeled iterative reconstruction, ADMIRE) on machine learning-based coronary computed tomography angiography-derived fractional flow reserve (CT-FFRML) measurements compared with filtered back projection (FBP). 170 plaque-containing vessels in 107 patients were included. CT-FFRML values were measured and compared among 5 imaging reconstruction algorithms (FBP and ADMIRE at strength levels of 1, 2, 3 and 5). The plaques were classified as, 'calcified" or "noncalcified" and "≥ 50% stenosis" or "< 50% stenosis', a total of four subgroups by consensus. There were no significant differences of CT-FFRML values among the FBP and ADMIRE 1, 2, 3 and 5 groups wherever comparisons were done at the level of subgroups (P = 0.676, 0.414, 0.849, 0.873, respectively) or overall (P = 0.072). There were 20, 21, 19, 19 and 29 vessels with lesion-specific ischemia (CT-FFRML ≤ 0.80) in FBP and ADMIRE 1, 2, 3 and 5 datasets, respectively, but no statistical differences were found (P = 0.437). Compared with CT-FFRML value of FBP dataset, the CT-FFRML values of 9 (5.3%) vessels from 8 patients (7.5%) in ADMIRE5 dataset switched from above 0.8 to below or equal to 0.8. There were no significant differences of the CT-FFRML values among the FBP and IR image algorithms at different strength levels. However, high iterative strength level (ADMIRE 5) was not recommended, which might have an impact on diagnosis of lesion-specific ischemia, although changes only occurred in a modest number of subjects.
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Affiliation(s)
- Shujiao Li
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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21
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Third generation dual source CT with ultra-high pitch protocol for TAVI planning and coronary tree assessment: feasibility, image quality and diagnostic performance. Eur J Radiol 2020; 122:108749. [DOI: 10.1016/j.ejrad.2019.108749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 01/14/2023]
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22
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Kim J, Goo BS, Cho YS, Youn TJ, Choi DJ, Dhanantwari A, Vembar M, Chun EJ. Diagnostic performance and image quality of iterative model-based reconstruction of coronary CT angiography using 100 kVp for heavily calcified coronary vessels. PLoS One 2019; 14:e0222315. [PMID: 31504074 PMCID: PMC6736300 DOI: 10.1371/journal.pone.0222315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic performance and image quality of an iterative model-based reconstruction (IMR) using a 100-kVp protocol for the assessment of heavily calcified coronary vessels, compared to those of filtered back projection (FBP) and hybrid iterative technique (iDose4), and also compared to those of IMR with standard 120 kVp protocol. METHODS Among patients with Agatston scores ≥ 400 who had undergone both coronary CT angiography (CCTA) and invasive coronary angiography (ICA), age- and sex-matched patients with body mass index < 30 were retrospectively enrolled from CCTA with low-kVp protocol (100 kVp, n = 30) and with standard-kVp protocol (120 kVp, n = 30). Image data were all reconstructed with FBP, iDose4, and IMR. In each dataset, the objective and subjective image quality, and diagnostic accuracy (> 50% in luminal reduction as compared with ICA) were assessed. RESULTS IMR showed better objective and subjective image quality than FBP and iDose4 in both 100 kVp and 120 kVp groups (all p < 0.05). IMR showed a significantly improved all diagnostic performance compared with FBP (p < 0.05). Compared with iDose4, IMR significantly improved positive predictive value (85.0% vs. 80.5%; p < 0.05). There was no significant difference in image quality and diagnostic performance using IMR between the 100 kVp and 120 kVp groups. CONCLUSIONS 100 kVp IMR may be useful for the assessment of heavily calcified coronary vessels, providing better diagnostic performance than FBP or iDose4 at the same dose, while maintaining similar diagnostic accuracy to 120 kVp IMR.
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Affiliation(s)
- Junwoo Kim
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Bon Seung Goo
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Dong Jun Choi
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Amar Dhanantwari
- CT/AMI Clinical Science, Philips Healthcare, Highland Heights, OH, United States of America
| | - Mani Vembar
- CT/AMI Clinical Science, Philips Healthcare, Highland Heights, OH, United States of America
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
- * E-mail:
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23
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Zhao L, Bao J, Guo Y, Li J, Yang X, Lv T, Hao F, Wang Z, Yang Z, Liu A. Ultra-low dose one-step CT angiography for coronary, carotid and cerebral arteries using 128-slice dual-source CT: A feasibility study. Exp Ther Med 2019; 17:4167-4175. [PMID: 30988794 PMCID: PMC6447913 DOI: 10.3892/etm.2019.7420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
Atherosclerotic diseases are systemic and patient outcomes depend on comprehensive imaging evaluation. Computed tomography angiography (CTA) is a powerful tool used to assess atherosclerosis. However, the scanning protocol is designed for cardiovascular and cerebrovascular imaging, which require considerations into the radiation dose, contrast agent and image quality. The purpose of the present study was to evaluate ultra-low dose one-step CTA for coronary, carotid and cerebral arteries with a low concentration contrast agent. A total of 78 patients were enrolled and randomly divided into two groups: Group A (n=38) and B (n=40). High-pitch CTA for coronary, carotid and cerebral arteries with a tube voltage of 70 or 80 kVp and 40 ml contrast agent (270 mgI/ml) was performed by a 128-slice dual-source CT scanner for group A. Standard high-pitch CTA with a tube voltage of 100 kVp and 60 ml contrast agent (370 mgI/ml) was conducted for group B. The image quality, radiation dose and amount of contrast agent in group A were evaluated and compared with group B. The dose length product for groups A and B was 62.95±21.54 vs. 160.15±15.13 mGy cm, respectively (t=−23.157, P<0.001). The mean total iodine content was 10.8±0 mg for group A and 22.2±0 mg for group B. In total, 99.4% of the arterial segments could be assessed for the two groups (χ2=0.267, P=0.606). The results revealed that ultra-low dose one-step high-pitch CTA can provide assessable image quality, and minimize the radiation dose and contrast agent.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Jiaqi Bao
- Department of Cardiology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia 010020, P.R. China
| | - Youmin Guo
- Department of Radiology, The Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jianbo Li
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Xiaoguang Yang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Tiegang Lv
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Fen'E Hao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Zefeng Wang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Zhenxing Yang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Aishi Liu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
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Sun Z, Ng CKC, Squelch A. Synchrotron radiation computed tomography assessment of calcified plaques and coronary stenosis with different slice thicknesses and beam energies on 3D printed coronary models. Quant Imaging Med Surg 2019; 9:6-22. [PMID: 30788242 DOI: 10.21037/qims.2018.09.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background To investigate the effect of different slice thicknesses and beam energies on the visualization and assessment of coronary artery stenosis caused by calcified plaques using synchrotron radiation computed tomography (CT) based on 3D printed coronary artery models. Methods Patient-specific 3D coronary models were created based on 3 sample coronary CT angiographic cases with calcified plaques in the left coronary arteries. In addition to the original significant coronary stenosis (>70%) shown on these CT images, stenoses of <50% and >90% were created in the segmented coronary models for simulation of different degrees of stenosis. The coronary lumen and calcification were printed with soft and rigid materials to simulate properties of coronary wall and calcified plaque, respectively. The models were scanned with synchrotron radiation CT with beam energies of 30, 40 and 50 keV and spatial resolution of 0.019×0.019×0.019 mm3 voxel size. Original high-resolution images were reconstructed with slice thicknesses of 0.095, 0.208, 0.302 and 0.491 mm to determine the effect of spatial resolution on plaque and coronary stenosis assessment based on 2D axial and 3D virtual intravascular endoscopy (VIE) images. Results Three coronary artery models were successfully printed with plaques placed in the coronary arteries to simulate different degrees of stenosis. 2D and 3D VIE images reconstructed with slice thicknesses of 0.095, 0.208 and 0.302 mm allowed for accurate assessment of coronary plaques and lumen stenosis with no significant differences (P>0.05). Synchrotron radiation CT images reconstructed with a slice thickness of 0.491 mm resulted in overestimation of coronary stenosis when compared to other images on 2D and 3D VIE views (<50% vs. 55-72%; 70-79% vs. 80-90%) with significant differences (P<0.05). Similarly, irregular plaque appearances were observed on 2D and 3D VIE images with a slice thickness of 0.491 mm when compared to others using thin slice thicknesses. The scanning protocol with beam energy of 30 keV provided optimal visualization of coronary lumen and plaque appearances. Conclusions This study shows the feasibility of using 3D printed coronary artery models to simulate calcifications and different degrees of coronary stenosis. High resolution synchrotron radiation CT imaging with the 30 keV beam energy enables accurate assessment of coronary stenosis in the presence of calcification, thus highlighting the importance of high spatial resolution in the diagnosis of calcified coronary plaques.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, Western Australia, Australia.,Computational Image Analysis Group, Curtin Institute for Computation, Curtin University, Perth, Western Australia, Australia
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25
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Kang E, Koo HJ, Yang DH, Seo JB, Ye JC. Cycle-consistent adversarial denoising network for multiphase coronary CT angiography. Med Phys 2018; 46:550-562. [PMID: 30449055 DOI: 10.1002/mp.13284] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/10/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE In multiphase coronary CT angiography (CTA), a series of CT images are taken at different levels of radiation dose during the examination. Although this reduces the total radiation dose, the image quality during the low-dose phases is significantly degraded. Recently, deep neural network approaches based on supervised learning technique have demonstrated impressive performance improvement over conventional model-based iterative methods for low-dose CT. However, matched low- and routine-dose CT image pairs are difficult to obtain in multiphase CT. To address this problem, we aim at developing a new deep learning framework. METHOD We propose an unsupervised learning technique that can remove the noise of the CT images in the low-dose phases by learning from the CT images in the routine dose phases. Although a supervised learning approach is not applicable due to the differences in the underlying heart structure in two phases, the images are closely related in two phases, so we propose a cycle-consistent adversarial denoising network to learn the mapping between the low- and high-dose cardiac phases. RESULTS Experimental results showed that the proposed method effectively reduces the noise in the low-dose CT image while preserving detailed texture and edge information. Moreover, thanks to the cyclic consistency and identity loss, the proposed network does not create any artificial features that are not present in the input images. Visual grading and quality evaluation also confirm that the proposed method provides significant improvement in diagnostic quality. CONCLUSIONS The proposed network can learn the image distributions from the routine-dose cardiac phases, which is a big advantage over the existing supervised learning networks that need exactly matched low- and routine-dose CT images. Considering the effectiveness and practicability of the proposed method, we believe that the proposed can be applied for many other CT acquisition protocols.
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Affiliation(s)
- Eunhee Kang
- Bio Imaging and Signal Processing Laboratory, Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Seo
- Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Chul Ye
- Bio Imaging and Signal Processing Laboratory, Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
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Heavily Calcified Coronary Arteries: Advanced Calcium Subtraction Improves Luminal Visualization and Diagnostic Confidence in Dual-Energy Coronary Computed Tomography Angiography. Invest Radiol 2018; 53:103-109. [PMID: 29016370 DOI: 10.1097/rli.0000000000000416] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate a prototype dual-energy computed tomography calcium subtraction algorithm and its impact on luminal visualization in patients with heavily calcified coronary arteries. MATERIALS AND METHODS Twenty-nine patients (62% male; mean age, 64 ± 7 years) who had undergone dual-energy coronary computed tomography angiography were retrospectively included in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Linearly blended (M_0.6) and calcium-subtracted images were reconstructed. Two independent observers assessed luminal visualization of the coronary arteries in a segment-based analysis, subjective image quality, and diagnostic confidence using 5-point Likert scales. Contrast-to-noise ratios for both data sets were calculated. Wilcoxon testing and Cohen's κ were used for statistical comparisons. RESULTS Calcium-subtracted image series showed improved lumen visualization of the coronary arteries (P = 0.008), with excellent interreader agreement (mean score, 3.3; κ = 0.82), compared with M_0.6 series (mean score, 2.9; κ = 0.77). The calcium subtraction algorithm improved diagnostic confidence compared with the M_0.6 reconstructions (mean scores, 4.0 and 3.1, respectively; all P ≤ 0.002). The image quality analysis showed no significant differences between calcium-subtracted and M_0.6 data sets (subjectively: mean scores, 4.1 and 4.2, respectively, P = 0.442; objectively: mean contrast-to-noise ratio, 37.0 and 38.2, respectively, P = 0.733). CONCLUSIONS A prototype algorithm for calcium subtraction improves coronary lumen visualization and diagnostic confidence in patients with heavy coronary calcifications without differences in conventional subjective and objective measures of image quality.
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Filtered back projection revisited in low-kilovolt computed tomography angiography: sharp filter kernel enhances visualization of the artery of Adamkiewicz. Neuroradiology 2018; 61:305-311. [DOI: 10.1007/s00234-018-2136-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
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Wallace A, Pershad Y, Saini A, Alzubaidi S, Naidu S, Knuttinen G, Oklu R. Computed tomography angiography evaluation of acute limb ischemia. VASA 2018; 48:57-64. [PMID: 30376423 DOI: 10.1024/0301-1526/a000759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.
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Mastrodicasa D, Albrecht MH, Schoepf UJ, Varga-Szemes A, Jacobs BE, Gassenmaier S, De Santis D, Eid MH, van Assen M, Tesche C, Mantini C, De Cecco CN. Artificial intelligence machine learning-based coronary CT fractional flow reserve (CT-FFR ML): Impact of iterative and filtered back projection reconstruction techniques. J Cardiovasc Comput Tomogr 2018; 13:331-335. [PMID: 30391256 DOI: 10.1016/j.jcct.2018.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The influence of computed tomography (CT) reconstruction algorithms on the performance of machine-learning-based CT-derived fractional flow reserve (CT-FFRML) has not been investigated. CT-FFRML values and processing time of two reconstruction algorithms were compared using an on-site workstation. METHODS CT-FFRML was computed on 40 coronary CT angiography (CCTA) datasets that were reconstructed with both iterative reconstruction in image space (IRIS) and filtered back-projection (FBP) algorithms. CT-FFRML was computed on a per-vessel and per-segment basis as well as distal to lesions with ≥50% stenosis on CCTA. Processing times were recorded. Significant flow-limiting stenosis was defined as invasive FFR and CT-FFRML values ≤ 0.80. Pearson's correlation, Wilcoxon, and McNemar statistical testing were used for data analysis. RESULTS Per-vessel analysis of IRIS and FBP reconstructions demonstrated significantly different CT-FFRML values (p ≤ 0.05). Correlation of CT-FFRML values between algorithms was high for the left main (r = 0.74), left anterior descending (r = 0.76), and right coronary (r = 0.70) arteries. Proximal and middle segments showed a high correlation of CT-FFRML values (r = 0.73 and r = 0.67, p ≤ 0.001, respectively), despite having significantly different averages (p ≤ 0.05). No difference in diagnostic accuracy was observed (both 81.8%, p = 1.000). Of the 40 patients, 10 had invasive FFR results. Per-lesion correlation with invasive FFR values was moderate for IRIS (r = 0.53, p = 0.117) and FBP (r = 0.49, p = 0.142). Processing time was significantly shorter using IRIS (15.9 vs. 19.8 min, p ≤ 0.05). CONCLUSION CT reconstruction algorithms influence CT-FFRML analysis, potentially affecting patient management. Additionally, iterative reconstruction improves CT-FFRML post-processing speed.
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Affiliation(s)
- Domenico Mastrodicasa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, Division of Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, USA; Department of Neuroscience and Imaging, Section of Diagnostic Imaging and Therapy - Radiology Division, SS. Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Jacobs
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Sebastian Gassenmaier
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Domenico De Santis
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Marwen H Eid
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Center for Medical Imaging - North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Chris Tesche
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Cesare Mantini
- Department of Neuroscience and Imaging, Section of Diagnostic Imaging and Therapy - Radiology Division, SS. Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA
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Annoni AD, Andreini D, Pontone G, Mancini ME, Formenti A, Mushtaq S, Baggiano A, Conte E, Guglielmo M, Muscogiuri G, Muratori M, Fusini L, Trabattoni D, Teruzzi G, Coutinho Santos AI, Agrifoglio M, Pepi M. CT angiography prior to TAVI procedure using third-generation scanner with wide volume coverage: feasibility, renal safety and diagnostic accuracy for coronary tree. Br J Radiol 2018; 91:20180196. [PMID: 30004788 DOI: 10.1259/bjr.20180196] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. METHODS: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. RESULTS: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88% respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl-1. Mean DLP was 442.4 ± 21.2 mGy/cm. CONCLUSION: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. ADVANCES IN KNOWLEDGE: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.
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Affiliation(s)
- Andrea D Annoni
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Daniele Andreini
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Gianluca Pontone
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | | | - Alberto Formenti
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Saima Mushtaq
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | | | - Edoardo Conte
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Marco Guglielmo
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Giuseppe Muscogiuri
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Manuela Muratori
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Laura Fusini
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Daniela Trabattoni
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Giovanni Teruzzi
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Ana I Coutinho Santos
- 2 Imaging Department, Centro Hospitalar de Lisboa Ocidental, E.P.E , Lisboa , Portugal
| | - Marco Agrifoglio
- 3 Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy.,4 Cardiac Surgery Department, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Mauro Pepi
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
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Tesche C, Duguay TM, Schoepf UJ, van Assen M, De Cecco CN, Albrecht MH, Varga-Szemes A, Bayer RR, Ebersberger U, Nance JW, Thilo C. Current and future applications of CT coronary calcium assessment. Expert Rev Cardiovasc Ther 2018; 16:441-453. [PMID: 29734858 DOI: 10.1080/14779072.2018.1474347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Computed tomographic (CT) coronary artery calcium scoring (CAC) has been validated as a well-established screening method for cardiovascular risk stratification and treatment management that is used in addition to traditional risk factors. The purpose of this review is to present an update on current and future applications of CAC. Areas covered: The topic of CAC is summarized from its introduction to current application with focus on the validation and clinical integration including cardiovascular risk prediction and outcome, cost-effectiveness, impact on downstream medical testing, and the technical advances in scanner and software technology that are shaping the future of CAC. Furthermore, this review aims to provide guidance for the appropriate clinical use of CAC. Expert commentary: CAC is a well-established screening test in preventive care that is underused in daily clinical practice. The widespread clinical implementation of CAC will be decided by future technical advances in CT image acquisition, cost-effectiveness, and reimbursement status.
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Affiliation(s)
- Christian Tesche
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,b Department of Cardiology and Intensive Care Medicine , Heart Center Munich-Bogenhausen , Munich , Germany
| | - Taylor M Duguay
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - U Joseph Schoepf
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Marly van Assen
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,d Center for Medical Imaging North East Netherlands , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Carlo N De Cecco
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Moritz H Albrecht
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,e Department of Diagnostic and Interventional Radiology , University Hospital Frankfurt , Frankfurt , Germany
| | - Akos Varga-Szemes
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Richard R Bayer
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Ullrich Ebersberger
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA.,b Department of Cardiology and Intensive Care Medicine , Heart Center Munich-Bogenhausen , Munich , Germany
| | - John W Nance
- a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Christian Thilo
- f Department of Internal Medicine I - Cardiology , Central Hospital of Augsburg , Augsburg , Germany
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Blooming Artifact Reduction in Coronary Artery Calcification by A New De-blooming Algorithm: Initial Study. Sci Rep 2018; 8:6945. [PMID: 29720611 PMCID: PMC5931966 DOI: 10.1038/s41598-018-25352-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/16/2018] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to investigate the use of de-blooming algorithm in coronary CT angiography (CCTA) for optimal evaluation of calcified plaques. Calcified plaques were simulated on a coronary vessel phantom and a cardiac motion phantom. Two convolution kernels, standard (STND) and high-definition standard (HD STND), were used for imaging reconstruction. A dedicated de-blooming algorithm was used for imaging processing. We found a smaller bias towards measurement of stenosis using the de-blooming algorithm (STND: bias 24.6% vs 15.0%, range 10.2% to 39.0% vs 4.0% to 25.9%; HD STND: bias 17.9% vs 11.0%, range 8.9% to 30.6% vs 0.5% to 21.5%). With use of de-blooming algorithm, specificity for diagnosing significant stenosis increased from 45.8% to 75.0% (STND), from 62.5% to 83.3% (HD STND); while positive predictive value (PPV) increased from 69.8% to 83.3% (STND), from 76.9% to 88.2% (HD STND). In the patient group, reduction in calcification volume was 48.1 ± 10.3%, reduction in coronary diameter stenosis over calcified plaque was 52.4 ± 24.2%. Our results suggest that the novel de-blooming algorithm could effectively decrease the blooming artifacts caused by coronary calcified plaques, and consequently improve diagnostic accuracy of CCTA in assessing coronary stenosis.
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Riffel P, Haubenreisser H, Higashigaito K, Alkadhi H, Morelli JN, Alber B, Schoenberg SO, Henzler T. Combined Static and Dynamic Computed Tomography Angiography of Peripheral Artery Occlusive Disease: Comparison with Magnetic Resonance Angiography. Cardiovasc Intervent Radiol 2018; 41:1205-1213. [PMID: 29484465 DOI: 10.1007/s00270-018-1911-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare in patients with known peripheral artery occlusive disease (PAOD), image quality of a combined CTA to a combined MRA protocol, including both static and dynamic acquisitions. MATERIALS AND METHODS Twenty-two patients with PAOD were examined with a combined CTA and MRA protocol consisting of static acquisitions (s-CTA, s-MRA) of the entire runoff and dynamic acquisitions (d-CTA, d-MRA) of the calves. Two radiologists compared image quality of the s-MRA versus s-CTA as well as d-MRA versus d-CTA. Image quality was assessed on a segmental basis using a 4-point Likert scale. RESULTS For s-CTA, 76% of segments were rated as excellent or good. For s-MRA, 50% of segments were rated as excellent or good (p < 0.0001). For d-CTA, median image quality score for all segments was rated as excellent for both readers. For d-MRA, median image quality for the different segments ranged from moderate to good. For both d-CTA and d-MRA, the median image quality scores were significantly higher for all segments of the lower limb compared with the static examinations of the lower limb segments (all p values < 0.0001). In patients with PAOD category 4-6, 80% of segments were rated as excellent or good for d-CTA, while 45% of segments were rated as poor or non-diagnostic for d-MRA. CONCLUSION In patients with known PAOD, a combined static and dynamic CTA examination improves image quality relative to static and dynamic MRA and should be considered as an alternative to MRA, particularly in patients with advanced stage PAOD.
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Affiliation(s)
- Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Bettina Alber
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Effect of Virtual Monoenergetic Images From Spectral Detector Computed Tomography on Coronary Calcium Blooming. J Comput Assist Tomogr 2018; 42:912-918. [DOI: 10.1097/rct.0000000000000811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Gascho D, Thali MJ, Niemann T. Post-mortem computed tomography: Technical principles and recommended parameter settings for high-resolution imaging. MEDICINE, SCIENCE, AND THE LAW 2018; 58:70-82. [PMID: 29310502 DOI: 10.1177/0025802417747167] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Post-mortem computed tomography (PMCT) has become a standard procedure in many forensic institutes worldwide. However, the standard scan protocols offered by vendors are optimised for clinical radiology and its main considerations regarding computed tomography (CT), namely, radiation exposure and motion artefacts. Thus, these protocols aim at low-dose imaging and fast imaging techniques. However, these considerations are negligible in post-mortem imaging, which allows for significantly increased image quality. Therefore, the parameters have to be adjusted to achieve the best image quality. Several parameters affect the image quality differently and have to be weighed against each other to achieve the best image quality for different diagnostic interests. There are two main groups of parameters that are adjustable by the user: acquisition parameters and reconstruction parameters. Acquisition parameters have to be selected prior to scanning and affect the raw data composition. In contrast, reconstruction parameters affect the calculation of the slice stacks from the raw data. This article describes the CT principles from acquiring image data to post-processing and provides an overview of the significant parameters for increasing the image quality in PMCT. Based on the CT principles, the effects of these parameters on the contrast, noise, resolution and frequently occurring artefacts are described. This article provides a guide for the performance of PMCT in morgues, clinical facilities or private practices.
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Affiliation(s)
- Dominic Gascho
- 1 Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Michael J Thali
- 1 Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Tilo Niemann
- 2 Department of Radiology, Cantonal Hospital Baden, Switzerland
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Stellenwert der Herz-CT in der Diagnostik der koronaren Herzerkrankung. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Zhao L, Liu A, Guo Y. Ultra-low-dose CT coronary angiography using 128-slice dual source CT with low concentration contrast agent: initial experience. Jpn J Radiol 2017; 35:724-732. [PMID: 29052025 DOI: 10.1007/s11604-017-0688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To optimize and evaluate an ultra-low-dose (ULD) technique for CT coronary angiography (CTCA). MATERIALS AND METHODS Eighty-two patients were randomly divided into two groups. ULD and routine CTCA were performed in groups A and B. Image quality, radiation dose and contrast agent were evaluated. RESULTS The effective dose (ED) was 0.20 ± 0.01 mSv for the ULD technique, a decrease of 87% (t = - 21.182, P < 0.001) compared with the control group. The total iodine content was 8.10 ± 0 g, a decrease of 62% (t = - 73.458, P < 0.001) compared with 21.10 ± 1.15 g for the control group. The assessment rates for both groups were the same (99.26 vs 99.64%, χ 2 = 0.727, P = 0.394). The contrast-to-noise ratio was 19.31 ± 7.95 for group A and 20.73 ± 5.07 for group B: the difference was not statistically significant (t = - 1.678, P = 0.095). CONCLUSION Using an ultra-low radiation dose and contrast agent technique, while maintaining an assessable image and improving the safety of the medical examination, was a feasible and reliable method for CTCA.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, The First Affiliated Hospital Of Xi'an Jiaotong University, No. 277 Yanta West Street, Xi'an, 710061, Shanxi, China.,Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot, 010050, Inner Mongolia, China
| | - Aishi Liu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot, 010050, Inner Mongolia, China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital Of Xi'an Jiaotong University, No. 277 Yanta West Street, Xi'an, 710061, Shanxi, China.
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Halliburton SS, Tanabe Y, Partovi S, Rajiah P. The role of advanced reconstruction algorithms in cardiac CT. Cardiovasc Diagn Ther 2017; 7:527-538. [PMID: 29255694 DOI: 10.21037/cdt.2017.08.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-linear iterative reconstruction (IR) algorithms have been increasingly incorporated into clinical cardiac CT protocols at institutions around the world. Multiple IR algorithms are available commercially from various vendors. IR algorithms decrease image noise and are primarily used to enable lower radiation dose protocols. IR can also be used to improve image quality for imaging of obese patients, coronary atherosclerotic plaques, coronary stents, and myocardial perfusion. In this article, we will review the various applications of IR algorithms in cardiac imaging and evaluate how they have changed practice.
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Affiliation(s)
| | - Yuki Tanabe
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sasan Partovi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
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Iterative beam-hardening correction with advanced modeled iterative reconstruction in low voltage CT coronary calcium scoring with tin filtration: Impact on coronary artery calcium quantification and image quality. J Cardiovasc Comput Tomogr 2017; 11:354-359. [DOI: 10.1016/j.jcct.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/06/2017] [Accepted: 07/23/2017] [Indexed: 11/23/2022]
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Impact of advanced modeled iterative reconstruction on interreader agreement in coronary artery measurements. Eur J Radiol 2017; 94:201-208. [DOI: 10.1016/j.ejrad.2017.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022]
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Ahmed S, Raman SP, Fishman EK. CT angiography and 3D imaging in aortoiliac occlusive disease: collateral pathways in Leriche syndrome. Abdom Radiol (NY) 2017; 42:2346-2357. [PMID: 28401281 DOI: 10.1007/s00261-017-1137-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Collateral pathways in aortoiliac occlusive disease are essential for arterial blood flow to the abdomen, pelvis, and lower extremities. These pathways can be broadly divided into systemic-systemic, visceral-visceral, and systemic-visceral collateral networks. MDCT angiography is the most commonly used modality for the diagnostic evaluation of patients with aortoiliac occlusive disease, allowing excellent evaluation of stenotic arterial segments, as well as beautifully illustrating resulting collateral pathways (particularly when utilizing 3D reconstruction techniques). This article seeks to familiarize radiologists with the most common patterns of aortoiliac occlusion and associated arterial collateral pathways utilizing CT angiography.
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Affiliation(s)
- Sameer Ahmed
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Consistency of Renal Stone Volume Measurements Across CT Scanner Model and Reconstruction Algorithm Configurations. AJR Am J Roentgenol 2017; 209:116-121. [PMID: 28402129 DOI: 10.2214/ajr.16.16940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this prospective study is to evaluate the consistency of renal stone volume estimation using dual-energy CT across scanner model and reconstruction algorithm configurations. SUBJECTS AND METHODS Patients underwent scanning with routine kidney stone composition protocols on both second- and third-generation dual-source CT scanners. Images were reconstructed using filtered back projection and iterative reconstruction (IR). In addition, a modified IR kernel on the third-generation CT scanner was evaluated. Individual kidney stone volumes were determined and compared. RESULTS No significant difference was noted in measured volumes between filtered back-projection data, IR data from the second-generation scanner, and the modified IR kernel data (p > 0.05). The third-generation commercially available IR kernel yielded lower volumes than did the other configurations (p < 0.0001). CONCLUSION With the use of a modified kernel for the third-generation scanner, patients being monitored for changes in kidney stone volume can undergo scanning performed with second- or third-generation dual-energy CT scanners, and the images obtained can be reconstructed with either filtered back projection or IR without the introduction of bias into kidney stone volume measurements.
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Oda S, Utsunomiya D, Nakaura T, Funama Y, Yuki H, Kidoh M, Hirata K, Taguchi N, Honda K, Takaoka H, Iyama Y, Katahira K, Noda K, Oshima S, Tokuyasu S, Yamashita Y. The Influence of Iterative Reconstruction on Coronary Artery Calcium Scoring-Phantom and Clinical Studies. Acad Radiol 2017; 24:295-301. [PMID: 27913107 DOI: 10.1016/j.acra.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/05/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES We compared the effect of iterative model reconstruction (IMR), filtered back projection (FBP), and hybrid iterative reconstruction (HIR) on coronary artery calcium (CAC) scoring. MATERIALS AND METHODS CAC scans of 30 consecutive patients (18 men and 12 women, age 70.1 ± 12.2 years) were reconstructed with FBP, HIR, and IMR, and the image noise was measured on all images. Two radiologists independently measured the CAC scores using semiautomated software, and interobserver agreement was evaluated. Statistical analysis included the Spearman correlation coefficient and Bland-Altman analysis. RESULTS The mean image noise on FBP, HIR, and IMR images was 48.0 ± 7.9, 29.6 ± 4.8, and 9.3 ± 1.3 Hounsfield units, respectively. The difference among all reconstruction combinations was significant (P < .01). The CAC score on HIR and IMR scans was 4.2% and 8.9% lower, respectively, than the CAC score on FBP images. There was no significant difference in the mean CAC score among the three reconstructions. The interobserver correlation was excellent for all three reconstructions (r2 = 0.96 FBP, 0.99 HIR, 0.99 IMR); the best Bland-Altman measure of agreement was with IMR, followed by HIR and FBP. CONCLUSION For CAC scoring, IMR can reduce the image noise and blooming artifacts, and consequently lowers the measured CAC score. IMR can lessen measurement variability and yield stable, reproducible measurements.
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Chen GZ, Fang XK, Zhou CS, Zhang LJ, Lu GM. Cerebral CT angiography with iterative reconstruction at 70 kVp and 30 mL iodinated contrast agent: Initial experience. Eur J Radiol 2017; 88:102-108. [DOI: 10.1016/j.ejrad.2016.12.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/10/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023]
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Iterative Image Reconstruction Improves the Accuracy of Automated Plaque Burden Assessment in Coronary CT Angiography: A Comparison With Intravascular Ultrasound. AJR Am J Roentgenol 2017; 208:777-784. [PMID: 28177655 DOI: 10.2214/ajr.16.17187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether use of iterative image reconstruction algorithms improves the accuracy of coronary CT angiography (CCTA) compared with intravascular ultrasound (IVUS) in semiautomated plaque burden assessment. MATERIALS AND METHODS CCTA and IVUS images of seven coronary arteries were acquired ex vivo. CT images were reconstructed with filtered back projection (FBP) and adaptive statistical (ASIR) and model-based (MBIR) iterative reconstruction algorithms. Cross-sectional images of the arteries were coregistered between CCTA and IVUS in 1-mm increments. In CCTA, fully automated (without manual corrections) and semiautomated (allowing manual corrections of vessel wall boundaries) plaque burden assessments were performed for each of the reconstruction algorithms with commercially available software. In IVUS, plaque burden was measured manually. Agreement between CCTA and IVUS was determined with Pearson correlation. RESULTS A total of 173 corresponding cross sections were included. The mean plaque burden measured with IVUS was 63.39% ± 10.63%. With CCTA and the fully automated technique, it was 54.90% ± 11.70% with FBP, 53.34% ± 13.11% with ASIR, and 55.35% ± 12.22% with MBIR. With CCTA and the semiautomated technique mean plaque burden was 54.90% ± 11.76%, 53.40% ± 12.85%, 57.09% ± 11.05%. Manual correction of the semiautomated assessments was performed in 39% of all cross sections and improved plaque burden correlation with the IVUS assessment independently of reconstruction algorithm (p < 0.0001). Furthermore, MBIR was superior to FBP and ASIR independently of assessment method (semiautomated, r = 0.59 for FBP, r = 0.52 for ASIR, r = 0.78 for MBIR, all p < 0.001; fully automated, r = 0.40 for FBP, r = 0.37 for ASIR, r = 0.53 for MBIR, all p < 0.001). CONCLUSION For the quantification of plaque burden with CCTA, MBIR led to better correlation with IVUS than did traditional reconstruction algorithms such as FBP, independently of the use of a fully automated or semiautomated assessment approach. The highest accuracy for quantifying plaque burden with CCTA can be achieved by using MBIR data with semiautomated assessment.
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Hou QR, Gao W, Sun AM, Wang Q, Qiu HS, Wang F, Hu LW, Li JY, Zhong YM. A prospective evaluation of contrast and radiation dose and image quality in cardiac CT in children with complex congenital heart disease using low-concentration iodinated contrast agent and low tube voltage and current. Br J Radiol 2016; 90:20160669. [PMID: 27925466 DOI: 10.1259/bjr.20160669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To the assess image quality, contrast dose and radiation dose in cardiac CT in children with congenital heart disease (CHD) using low-concentration iodinated contrast agent and low tube voltage and current in comparison with standard dose protocol. METHODS 110 patients with CHD were randomized to 1 of the 2 scan protocols: Group A (n = 45) with 120 mA tube current and contrast agent of 270 mgI/ml in concentration (Visipaque™; GE Healthcare Ireland, Co., Cork, UK); and Group B (n = 65) with the conventional 160 mA and 370 mgI/ml concentration contrast (Iopamiro®; Shanghai Bracco Sine Pharmaceutical Corp Ltd, Shanghai, China). Both groups used 80 kVp tube voltage and were reconstructed with 70% adaptive statistical iterative reconstruction algorithm. The CT value and noise in aortic arch were measured and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A five-point scale was used to subjectively evaluate image quality. Contrast and radiation dose were recorded. RESULTS There was no difference in age and weight between the two groups (all p > 0.05). The iodine load and radiation dose in Group A were statistically lower (3976 ± 747 mgI vs 5763 ± 1018 mgI in iodine load and 0.60 ± 0.08 mSv vs 0.77 ± 0.10 mSv in effective dose; p < 0.001). However, image noise, CT value, CNR, SNR and subjective image quality for the two groups were similar (all p > 0.05), and with good agreement between the two observers. Comparing the surgery results, the diagnostic accuracy for extracardiac and intracardiac defects for Group A was 96% and 92%, respectively, while the corresponding numbers for Group B were 95% and 93%. CONCLUSION Compared with the standard dose protocol, the use of low tube voltage (80 kVp), low tube current (120 mA) and low-concentration iodinated contrast agent (270 mgI/ml) enables a reduction of 30% in iodine load and 22% in radiation dose while maintaining compatible image quality and diagnostic accuracy. Advances in knowledge: The new cardiac CT scanning protocol can largely reduce the adverse effects of radiation and contrast media to children. Meanwhile, it also can be used effectively to examine complex CHD.
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Affiliation(s)
- Qiao-Ru Hou
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Gao
- 2 Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ai-Min Sun
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Sheng Qiu
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Wang
- 3 Department of Radiology, Wuhan Medical and Healthcare Center for Woman and Children, Hubei, China
| | - Li-Wei Hu
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ying Li
- 4 CT Research Center, GE Healthcare, Shanghai, China
| | - Yu-Min Zhong
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Correction Factors for CT Coronary Artery Calcium Scoring Using Advanced Modeled Iterative Reconstruction Instead of Filtered Back Projection. Acad Radiol 2016; 23:1480-1489. [PMID: 27614365 DOI: 10.1016/j.acra.2016.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Iterative reconstruction (IR) computed tomography (CT) techniques allow for radiation dose reduction while maintaining image quality. However, CT coronary artery calcium (CAC) scores may be influenced by certain IR algorithms. The aim of our study is to identify suitable correction factors to ensure consistency between IR and filtered back projection (FBP)-based CAC scoring. MATERIAL AND METHODS A phantom study was performed to derive suitable correction factors for CAC scores and volume (VOL) values with advanced modeled iterative reconstruction (or ADMIRE) strength level 3 (ADM3) and 5 (ADM5) vs FBP. CT data from 40 patients were retrospectively analyzed, and CAC score and VOL values were obtained following reconstruction with FBP, ADM3, and ADM5. Linear regression analysis was performed to obtain correction factors. Results with and without application of the correction factors were compared. Inter-reader agreement for risk class stratification was analyzed. RESULTS Phantom experiments determined a correction factor of 1.14 for ADM3 and 1.25 for ADM5. FBP-based CAC scores (897 ± 1413) were significantly higher than uncorrected scores with ADM3 (746 ± 1184, P ≤ .001) and ADM5 (640 ± 1036, P ≤ .001). After application of correction factors, no significant differences were found for CAC scores based on FBP (897 ± 1413) and ADM3 (853 ± 1353, P = .07). The inter-reader agreement for risk stratification was excellent (k = 0.91). CONCLUSION ADM3 can be applied to CAC scoring with use of a correction factor. When applying a correction factor of 1.14, excellent agreement with standard FBP for both CAC score and VOL can be achieved.
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Precht H, Kitslaar PH, Broersen A, Dijkstra J, Gerke O, Thygesen J, Egstrup K, Lambrechtsen J. Influence of Adaptive Statistical Iterative Reconstruction on coronary plaque analysis in coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2016; 10:507-516. [DOI: 10.1016/j.jcct.2016.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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Assessment of Coronary Artery Calcium on Low-Dose Coronary Computed Tomography Angiography With Iterative Reconstruction. J Comput Assist Tomogr 2016; 40:266-71. [PMID: 26720203 DOI: 10.1097/rct.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate whether coronary calcium scoring (CCS) is also feasible using low-radiation-dose coronary computed tomography angiography (CCTA) in combination with iterative reconstruction. METHODS Forty-three individuals without known coronary artery disease underwent both noncontrast CCS (±1 mSv) for reference Agatston scores and low-dose CCTA (±3 mSv). Raw CCTA data were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and model-based iterative reconstruction (MIR). Calcification volumes were derived with thresholds of >351 and >600 Hounsfield units (HU) and converted to proxy Agatston scores with linear regression analysis. RESULTS Intraclass correlation coefficients for Agatston scores versus CCTA volumes with FBP and iterative reconstruction were excellent (ranges 0.94-0.99 and 0.96-0.99 for >351 HU and >600 HU thresholds, respectively). The >351 HU threshold resulted in higher CCTA volume scores ranging from 65.9 (15.1-347.0) for HIR to 94.8 (42.0-423.0) for MIR (P = 0.001 and <0.001, respectively). The >600 HU threshold scores ranged from 14.1 (0.0-159.3) for HIR to 28.6 (0.0-215.6) for MIR (P = 0.003 and 0.027, respectively). At >351 HU, reclassification occurred in 21 individuals (49%) for FBP and HIR and 25 individuals (58%) for MIR. Reclassifications decreased with >600 HU to 10 (HIR, 23%), 8 (FBP, 19%), and 4 (MIR, 9%). CONCLUSIONS The CCS is feasible using iteratively reconstructed low-dose CCTA with a calcium threshold of >600 HU. Using MIR, only 9% of individuals were reclassified.
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