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Schulz A, Otton J, Hussain T, Miah T, Schuster A. Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments. Curr Cardiol Rep 2024:10.1007/s11886-024-02110-w. [PMID: 39162955 DOI: 10.1007/s11886-024-02110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to provide a profound overview on most recent studies on the clinical significance of Cardiovascular Computed Tomography (CCT) in diagnostic and therapeutic pathways. Herby, this review helps to pave the way for a more extended but yet purposefully use in modern day cardiovascular medicine. RECENT FINDINGS In recent years, new clinical applications of CCT have emerged. Major applications include the assessment of coronary artery disease and structural heart disease, with corresponding recommendations by major guidelines of international societies. While CCT already allows for a rapid and non-invasive diagnosis, technical improvements enable further in-depth assessments using novel imaging parameters with high temporal and spatial resolution. Those developments facilitate diagnostic and therapeutic decision-making as well as improved prognostication. This review determined that recent advancements in both hardware and software components of CCT allow for highly advanced examinations with little radiation exposure. This particularly strengthens its role in preventive care and coronary artery disease. The addition of functional analyses within and beyond coronary artery disease offers solutions in wide-ranging patient populations. Many techniques still require improvement and validation, however, CCT possesses potential to become a "one-stop-shop" examination.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - James Otton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Tayaba Miah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany.
- FORUM Cardiology, Rosdorf, Germany.
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Andreini D, Conte E, Monizzi G, Prestini B, Ratti A, Belmonte M, Melotti E, Doldi M, Marchetti D, Schillaci M, Nicoli F, Mastrangelo A, Paolisso P, Gigante C, Novembre ML, Baggiano A, Mancini ME, Annoni A, Formenti A, Pizzamiglio F, Pontone G, Zeppilli P, Bartorelli AL, Mushtaq S. Predictors of adverse cardiac events of coronary myocardial bridging diagnosed with computed tomography angiography. Int J Cardiol 2024; 406:131997. [PMID: 38556216 DOI: 10.1016/j.ijcard.2024.131997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
AIMS Myocardial bridging (MB) is a frequent congenital anomaly of the epicardial coronary arteries commonly considered a benign condition. However, in some cases a complex interplay between anatomical, clinical and physiology factors may lead to adverse events, including sudden cardiac death. Coronary CT angiography (CCTA) emerged as the gold standard noninvasive imaging technique for the evaluation of MB. Aim of the study was to evaluate MB prevalence and anatomical features in a large population of patients who underwent CCTA for suspected CAD and to identify potential anatomical and clinical predictors of adverse cardiac events at long-term follow-up. METHODS AND RESULTS Two-hundred and six patients (mean age 60.3 ± 11.8 years, 128 male) with MB diagnosed at CCTA were considered. A long MB was defined as ≥25 mm of overlying myocardium, whereas a deep MB as ≥2 mm of overlying myocardium. The study endpoint was the sum of the following adverse events: cardiac death, bridge-related acute coronary syndrome, hospitalization for angina or bridge-related ventricular arrhythmias and MB surgical treatment. Of the 206 patients enrolled in the study, 9 were lost to follow-up, whereas 197 (95.6%) had complete follow-up (mean 7.01 ± 3.0 years) and formed the analytic population. Nineteen bridge-related events occurred in 18 patients (acute coronary syndrome in 7, MB surgical treatment in 2 and hospitalization for bridge-related events in 10). Typical angina at the time of diagnosis and long MB resulted as significant independent predictors of adverse outcome. CONCLUSIONS Typical angina and MB length ≥ 25 mm were independent predictors of cardiac events.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giovanni Monizzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Blanca Prestini
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Angelo Ratti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Eleonora Melotti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Marco Doldi
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Flavia Nicoli
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Angelo Mastrangelo
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Pasquale Paolisso
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Carlo Gigante
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Maria Laura Novembre
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | - Paolo Zeppilli
- Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Omaygenc MO, Kadoya Y, Small GR, Chow BJW. Cardiac CT: Competition, complimentary or confounder. J Med Imaging Radiat Sci 2024; 55:S31-S38. [PMID: 38433089 DOI: 10.1016/j.jmir.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
Coronary CT angiography (CCTA) has been gradually adopted into clinical practice over the last two decades. CCTA has high diagnostic accuracy, prognostic value, and unique features such as assessment of plaque composition. CCTA-derived functional assessment techniques such as fractional flow reserve and CT perfusion are also available and can increase the diagnostic specificity of the modality. These properties propound CCTA as a competitor of functional testing in diagnosis of obstructive CAD, however, utilizing CCTA in a concomitant fashion to potentiate the performance of the latter can lead to better patient care and may provide more accurate prognostic information. Although multiple diagnostic challenges such as evaluation of calcified segments, stents, and small distal vessels still exist, the technologic developments in hardware as well as growing incorporation of artificial intelligence to daily practice are all set to augment the diagnostic and prognostic role of CCTA in cardiovascular disorders.
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Affiliation(s)
- Mehmet Onur Omaygenc
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Yoshito Kadoya
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Gary Robert Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Benjamin Joe Wade Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada; Department of Radiology, University of Ottawa, Ottawa, Canada
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Cui K, Liang S, Hua M, Gao Y, Feng Z, Wang W, Zhang H. Diagnostic Performance of Machine Learning-Derived Radiomics Signature of Pericoronary Adipose Tissue in Coronary Computed Tomography Angiography for Coronary Artery In-Stent Restenosis. Acad Radiol 2023; 30:2834-2843. [PMID: 37268514 DOI: 10.1016/j.acra.2023.04.006] [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: 01/18/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 06/04/2023]
Abstract
RATIONALE AND OBJECTIVES Coronary inflammation can alter the perivascular fat phenotype. Hence, we aimed to assess the diagnostic performance of radiomics features of pericoronary adipose tissue (PCAT) in coronary computed tomography angiography (CCTA) for in-stent restenosis (ISR) after percutaneous coronary intervention. MATERIALS AND METHODS In this study, 165 patients with 214 eligible vessels were included, and ISR was found in 79 vessels. After evaluating clinical and stent characteristics, peri-stent fat attenuation index, and PCAT volume, 1688 radiomics features were extracted from each peri-stent PCAT segmentation. The eligible vessels were randomly categorized into training and validation groups in a ratio of 7:3. After performing feature selection using Pearson's correlation, F test, and least absolute shrinkage and selection operator analysis, radiomics models and integrated models that combined selected clinical features and Radscore were established using five different machine learning algorithms (logistic regression, support vector machine, random forest, stochastic gradient descent, and XGBoost). Subgroup analysis was performed using the same method for patients with stent diameters of ≤ 3 mm. RESULTS Nine significant radiomics features were selected, and the areas under the curves (AUCs) for the radiomics model and the integrated model were 0.69 and 0.79, respectively, for the validation group. The AUCs of the subgroup radiomics model based on 15 selected radiomics features and the subgroup integrated model were 0.82 and 0.85, respectively, for the validation group, which showed better diagnostic performance. CONCLUSION CCTA-based radiomics signature of PCAT has the potential to identify coronary artery ISR without additional costs or radiation exposure.
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Affiliation(s)
- Keyi Cui
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Shuo Liang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Minghui Hua
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Yufan Gao
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China (Y.G.)
| | - Zhenxing Feng
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Wenjiao Wang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Hong Zhang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.).
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Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, Varzideh F, Eacobacci M, Gambardella J, Lombardi A, Santulli G. Diabetes and restenosis. Cardiovasc Diabetol 2022; 21:23. [PMID: 35164744 PMCID: PMC8845371 DOI: 10.1186/s12933-022-01460-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 01/05/2023] Open
Abstract
Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.
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Affiliation(s)
- Scott Wilson
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Pasquale Mone
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Urna Kansakar
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Stanislovas S Jankauskas
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Kwame Donkor
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Ayobami Adebayo
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Fahimeh Varzideh
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael Eacobacci
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Jessica Gambardella
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA.
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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Andreini D, Mushtaq S, Conte E, Mei M, Nicoli F, Melotti E, Pompilio G, Pepi M, Bartorelli AL, Onuma Y, Serruys PW. The usefulness of cardiac CT integrated with FFRCT for planning myocardial revascularization in complex coronary artery disease: a lesson from SYNTAX studies. Cardiovasc Diagn Ther 2020; 10:2036-2047. [PMID: 33381442 PMCID: PMC7758756 DOI: 10.21037/cdt.2019.11.07] [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: 09/30/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
After two decades of clinical use, during which coronary CT angiography (CCTA) was considered an appropriate method for the non-invasive assessment of patients with suspected stable coronary artery disease (CAD) and low-to-intermediate pretest likelihood of CAD, a growing body of literature is showing that CCTA may have also a clinical role in patients with high pretest likelihood of CAD, known CAD and complex and diffuse CAD. Particularly, the SYNTAX studies demonstrated the usefulness of CCTA in the field of non-invasive assessment of these patients and planning of interventional and surgical coronary procedures, thanks to its ability to combine, in a single method, precise stenosis quantification, accurate plaque characterization, functional assessment and selection of the revascularization modality for any individual patient and of the vessels that need to be revascularized. Of note, the SYNTAX III Revolution trial showed, in patients with three-vessel CAD, that treatment decision-making between PCI and CABG based on CCTA only has an almost perfect agreement with the treatment decision derived from invasive coronary angiography (ICA). Moreover, the SYNTAX Score II demonstrated a high degree of correlation between the two diagnostic strategies, suggesting the potential feasibility of a treatment decision-making based solely on non-invasive imaging and clinical information. New research prospects have opened up for the future to demonstrate the true feasibility and safety of this innovative approach in the clinical arena.
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Affiliation(s)
- Daniele Andreini
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | | | - Giulio Pompilio
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Antonio L. Bartorelli
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | | | - Patrick W. Serruys
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK
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Garcia AM, Assunção-Jr AN, Dantas-Jr RN, Parga JR, Ganem F. Stent evaluation by coronary computed tomography angiography: a comparison between Iopamidol-370 and Ioversol-320 hypo-osmolar iodine concentration contrasts. Br J Radiol 2020; 93:20200078. [PMID: 32816561 DOI: 10.1259/bjr.20200078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Qualitative and quantitative image analysis between Iopamidol-370 and Ioversol-320 in stents´ evaluation by coronary computed tomography angiography (CTA). METHODS Sixty-five patients with low-risk stable angina undergoing stent follow-up with coronary CTA were assigned to Iopamidol I-370 (n = 33) or Ioversol I-320 (n = 32) in this prospective, double-blind, non-inferiority, randomized trial. Stent lumen image quality was graded by 5-point Likert Scale. Lumen mean attenuation was measured at native coronary segments: pre-stent, post-stent, distal segments and at coronary plaques. Lumen attenuation increase (LAI) ratio was calculated for all stents. Heart rate (HR) variation, premature heart beats (PHB), heat sensation (HS), blooming and beam hardening were also assessed. RESULTS Image quality was similar between groups, with no significant difference (Likert score 4.48 ± 0.75 vs 4.54 ± 0.65, p = 0.5). There were similarities in LAI ratio between I-370 and I-320 (0.39 ± 0.42 vs 0.48 ± 0.44 HU, p = 0.08). Regarding lumen mean attenuation at native coronary segments, a significant difference was observed, with I-320 presenting lower values, including contrast mean attenuation in distal segments. After statistical multivariate analysis, three variables correlated with stent image quality: 1) stent diameter, 2) HR variation and 3) stent lumen LAI ratio. CONCLUSIONS There was no significant difference between Iopamidol-370 mgI ml-1 and Ioversol-320 mgI ml-1 contrasts regarding overall stent lumen image quality, which was mainly influenced by stent diameter, HR and LAI ratio.Advances in knowledge:Coronary CTA allows adequate stents' visualization and image quality is influenced by stent diameter, HR variation and LAI ratio.Stents' image quality showed no difference between different concentration contrasts (I-370 vs. I-320); however, higher concentration contrasts may provide an improved overall visualization, especially regarding coronary distal segments.
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Holland I, McCormick C, Connolly P. Towards non-invasive characterisation of coronary stent re-endothelialisation - An in-vitro, electrical impedance study. PLoS One 2018; 13:e0206758. [PMID: 30395632 PMCID: PMC6218196 DOI: 10.1371/journal.pone.0206758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022] Open
Abstract
The permanent implantation of a stent has become the most common method for ameliorating coronary artery narrowing arising from atherosclerosis. Following the procedure, optimal arterial wall healing is characterised by the complete regrowth of an Endothelial Cell monolayer over the exposed stent surface and surrounding tissue, thereby reducing the risk of thrombosis. However, excessive proliferation of Smooth Muscle Cells, within the artery wall can lead to unwanted renarrowing of the vessel lumen. Current imaging techniques are unable to adequately identify re-endothelialisation, and it has previously been reported that the stent itself could be used as an electrode in combination with electrical impedance spectroscopic techniques to monitor the post-stenting recovery phase. The utility of such a device will be determined by its ability to characterise between vascular cell types. Here we present in-vitro impedance spectroscopy measurements of pulmonary artery porcine Endothelial Cells, Human Umbilical Vein Endothelial Cells and coronary artery porcine Smooth Muscle Cells grown to confluence over platinum black electrodes in clinically relevant populations. These measurements were obtained, using a bespoke impedance spectroscopy system that autonomously performed impedance sweeps in the 1kHz to 100kHz frequency range. Analysis of the reactance component of impedance revealed distinct frequency dependent profiles for each cell type with post confluence reactance declines in Endothelial Cell populations that have not been previously reported. Such profiles provide a means of non-invasively characterising between the cell types and give an indication that impedance spectroscopic techniques may enable the non-invasive characterisation of the arterial response to stent placement.
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Affiliation(s)
- Ian Holland
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom
- * E-mail:
| | - Christopher McCormick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Patricia Connolly
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom
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9
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Andreini D, Pontone G, Mushtaq S, Conte E, Guglielmo M, Mancini ME, Annoni A, Baggiano A, Formenti A, Montorsi P, Magatelli M, Di Odoardo L, Melotti E, Resta M, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner. Int J Cardiol 2018; 274:382-387. [PMID: 30219253 DOI: 10.1016/j.ijcard.2018.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF). MATERIALS AND METHODS We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded. RESULTS Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv. CONCLUSIONS A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm. TRANSLATIONAL ASPECT The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | | | | | | | | | | | | | | | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Marco Magatelli
- Department of Clinical Cardiology, University of Brescia, Brescia, Italy
| | | | | | - Marta Resta
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study. J Cardiovasc Comput Tomogr 2018; 12:411-417. [PMID: 29933938 DOI: 10.1016/j.jcct.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. AIM OF THE STUDY We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. METHODS We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. RESULTS The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. invasive FFR as standard of reference in a territory-based analysis. CONCLUSIONS The ADVANTAGE study aims to provide an answer to the intriguing question whether the combined anatomical and functional assessment with CCTA plus CTP may have higher diagnostic performance as compared to CCTA alone in identifying stented patients with significant ISR or CAD progression.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | | | | | - Jeroen Sonck
- Department of Interventional Cardiology, CHVZ, UZ Brussel, Belgium
| | - Carlos Collet
- Department of Cardiology, University of Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marta Resta
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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11
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Wen D, Li J, Zhao H, Li J, Zheng M. Diagnostic performance of two corrected transluminal attenuation gradient metrics in coronary CT angiography for the evaluation of significant in-stent restenosis by dual-source CT: a validation study with invasive coronary angiography. Clin Radiol 2018; 73:592.e1-592.e8. [PMID: 29454588 DOI: 10.1016/j.crad.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
AIM To determine the diagnostic potential of transluminal attenuation gradients (TAG) with exclusion of stented coronary segments (TAG-ExS) and TAG-corrected contrast opacification (CCO) excluding stented coronary segments (TAG-CCO-ExS) for the assessment of in-stent restenosis (ISR). MATERIALS AND METHODS TAG-ExS and TAG-CCO-ExS were calculated in 93 coronary arteries with 190 stents. The diagnostic performances and the incremental values of the two metrics to coronary computed tomography angiography (CCTA) were analysed and compared. RESULTS For all stents and stents >3 mm in diameter, TAG-ExS and TAG-CCO-ExS were significantly lower in ≥50% than that in <50% of ISR (both p<0.05). For stent diameters ≤3 mm, significantly lower TAG-CCO-ExS (p=0.000), but not TAG-ExS (p=0.059), was found in ≥50% than in <50% of ISR. Addition of TAG-ExS or TAG-CCO-ExS to CCTA, did not improve the diagnostic accuracy of CCTA significantly (all p>0.05). Only TAG-CCO-ExS had a significant impact on CCTA for the reclassifications of ISR (p=0.046) in stent diameters ≤3 mm. CONCLUSIONS TAG-ExS and TAG-CCO-ExS did not provide incremental diagnostic value over CCTA in assessing ISR. TAG-CCO-ExS slightly enhanced the reclassifications of ISR for stents ≤3 mm in diameter.
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Affiliation(s)
- D Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - H Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - M Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China.
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Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute. J Thorac Imaging 2018; 33:225-231. [PMID: 29346192 DOI: 10.1097/rti.0000000000000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm. MATERIALS AND METHODS One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant. RESULTS cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01). CONCLUSION MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.
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Ragusi MAAD, van der Meer RW, Joemai RMS, van Schaik J, van Rijswijk CSP. Evaluation of CT Angiography Image Quality Acquired with Single-Energy Metal Artifact Reduction (SEMAR) Algorithm in Patients After Complex Endovascular Aortic Repair. Cardiovasc Intervent Radiol 2017; 41:323-329. [PMID: 29086057 PMCID: PMC5758681 DOI: 10.1007/s00270-017-1812-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Abstract
Purpose To evaluate the value of single-energy metal artifact reduction (SEMAR) algorithm on image quality in patients after complex endovascular aortic repair (EVAR) with fenestrated and branched devices. Methods Routine follow-up computed tomography angiography (CTA) examinations were performed between February 2016 and May 2017 in 18 patients who underwent a complex EVAR procedure at our institution. Objective analysis was performed by measuring the standard deviation (SD) of attenuation (Hounsfield Units), and the contrast-to-noise ratio (CNR) in regions of interests in the stented visceral arteries. Subjective analysis of the degree of artifacts and stent visualization was performed independently by two interventional radiologists, blinded to the image reconstruction. Results The SD of attenuation was significantly lower in all target visceral arteries (p < .001), the celiac artery (p = .002), the superior mesenteric artery (SMA; p = .043), and renal arteries (p < .001) in the CT images with SEMAR reconstruction. The CNR significantly increased in all SEMAR-reconstructed target visceral arteries (overall: p < .001, celiac artery: p = .009; SMA: p = .003; renal arteries: p < .001). The reviewers rated a significantly lower artifact degree in all target vessels (overall: p < .001, celiac artery: p = .001; SMA: p = .008; renal arteries: p < .001) and a significantly improved visualization of the stent patency in all target vessels (overall: p < .001, celiac artery: p = .031; SMA: p = .047; renal arteries: p < .001) in the SEMAR images. Overall preference of both reviewers was in favor of the SEMAR reconstruction in 15/18 cases (83%). Conclusion Reconstruction with SEMAR algorithm significantly improves CTA image quality in patients after complex EVAR. Level of Evidence Level 4, Case series.
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Affiliation(s)
- M A A D Ragusi
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC, Leiden, The Netherlands.
| | - R W van der Meer
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - R M S Joemai
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - J van Schaik
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - C S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300RC, Leiden, The Netherlands
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Pontone G, Guaricci A, Neglia D, Andreini D. State of the art: non-invasive imaging in ischaemic heart disease. EUROINTERVENTION 2017; 13:654-665. [DOI: 10.4244/eij-d-17-00466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Iterative reconstruction improves detection of in-stent restenosis by high-pitch dual-source coronary CT angiography. Sci Rep 2017; 7:6956. [PMID: 28761180 PMCID: PMC5537291 DOI: 10.1038/s41598-017-07499-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/27/2017] [Indexed: 01/13/2023] Open
Abstract
Recent studies demonstrated that sinogram affirmed iterative reconstructions (SAFIRE) can produce higher-resolution images with greater robustness for the reduction of various imaging artefacts. Eighty-five patients were prospectively evaluated and underwent a high-pitch spiral acquisition CT scan. In-stent noise, signal-to-noise ratio(SNR), stent-lumen attenuation increase ratio (SAIR), and subjective image quality score were measured and compared between the SAFIRE and Filter back projection (FBP) reconstructions. Conventional coronary angiography served as the standard of reference. In 159 evaluated stents, SAFIRE was superior to FBP with regards to in-stent noise, SNR, SAIR, and image quality score. On per-stent analysis, SAFIRE vs. FBP reconstruction yielded 85% vs. 85%sensitivity, 89% vs. 78%specificity, 73% vs. 57%positive predictive value, 95% vs. 94%negative predictive value, and 0.87 vs. 0.82 area under curve, although these improvements did not reach statistical significance (P > 0.05). However, in the subgroup of small diameter stents (≤3 mm; n = 95), specificity(82% vs. 62%), positive predictive value(66% vs. 50%) and area under curve (0.81 vs. 0.70) improved significantly (P < 0.05) with SAFIRE. SAFIRE image reconstruction can thus improve the evaluation for ISR, especially in smaller stents.
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16
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Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Solbiati A, Segurini C, Conte E, Gripari P, Annoni A, Formenti A, Petulla' M, Lombardi F, Muscogiuri G, Bartorelli AL, Pepi M. The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients): Resources and Outcomes Impact. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005171. [PMID: 27894070 DOI: 10.1161/circimaging.116.005171] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. METHODS AND RESULTS Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P=0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P=0.0009), invasive coronary angiography (31% versus 20%; P=0.0009), and revascularization procedures (24% versus 16%; P=0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P<0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P<0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P<0.001). CONCLUSIONS Compared with cTCA, stress-CMR is more cost-effective in symptomatic revascularized patients.
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Affiliation(s)
- Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.).
| | - Daniele Andreini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Andrea I Guaricci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Cristina Rota
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Marco Guglielmo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Saima Mushtaq
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Andrea Baggiano
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Virginia Beltrama
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Laura Fusini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Anna Solbiati
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Chiara Segurini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Edoardo Conte
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Paola Gripari
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Andrea Annoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Alberto Formenti
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Maria Petulla'
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Federico Lombardi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Giuseppe Muscogiuri
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Antonio L Bartorelli
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
| | - Mauro Pepi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., C.R., M.G., S.M., A.B., V.B., L.F., A.S., C.S., E.C., P.G., A.A., A.F., M.P., A.L.B., M.P.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., C.R., A.B., A.S., C.S., F.L.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); and Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy (G.M.); Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy (A.L.B.)
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Gassenmaier T, Petri N, Allmendinger T, Flohr T, Weng AM, Kunz AS, Petritsch B, Voelker W, Bley TA. In Vitro Comparison of Second- and Third-generation Dual-source CT for Coronary Stent Visualization at Different Tube Potentials. Acad Radiol 2016; 23:961-8. [PMID: 27236611 DOI: 10.1016/j.acra.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/14/2015] [Accepted: 03/14/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to evaluate in vitro stent lumen visibility of coronary stents in a second- and third-generation dual-source computed tomography (CT) system at 100 and 120 kVp tube potential. MATERIALS AND METHODS Twenty-six coronary stents ranging from 2.25 to 4.0 mm in diameter were implanted in a coronary vessel phantom. Scans were performed at 100 and 120 kVp tube potential. Evaluation was performed using a medium-sharp kernel in both systems (B46f in the second-generation and Bv49 in the third-generation model) and a sharp (Bv59) convolution kernel optimized for vascular imaging in the third-generation CT. RESULTS The median visible stent lumen diameter in the second-generation system was higher at 120 kVp with a median of 62.0% compared to 56.3% at 100 kVp (P < 0.001). The median visible diameter in the third-generation system was significantly higher applying the Bv49 kernel with 66.7% at 120 kVp and 61.1% at 100 kVp (both P < 0.001). When applying the Bv59 kernel, visible stent lumen further increased to 69.3% at 120 kVp and 66.7% at 100 kVp. Additionally, stent lumen was assessed using full width at half maximum, resulting in a comparable increase in luminal diameter at corresponding tube potential. CONCLUSIONS Third-generation dual-source CT provides superior stent lumen visibility at equivalent tube potential and at reduced tube potential of 100 kVp when compared to 120 kVp in a second-generation system, at least when manually assessed.
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Affiliation(s)
- Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
| | - Nils Petri
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Wolfram Voelker
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Rubert N, Szczykutowicz T, Ranallo F. Improvement in CT image resolution due to the use of focal spot deflection and increased sampling. J Appl Clin Med Phys 2016; 17:452-466. [PMID: 27167276 PMCID: PMC5690917 DOI: 10.1120/jacmp.v17i3.6039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/07/2016] [Accepted: 12/30/2015] [Indexed: 11/23/2022] Open
Abstract
When patient anatomy is positioned away from a CT scanner's isocenter, scans of limited diagnostic value may result. Yet in some cases, positioning of patient anatomy far from isocenter is unavoidable. This study examines the effect of position and reconstruction algorithm on image resolution achieved by a CT scanner operating in a high resolution (HR) scan mode which incorporates focal spot deflection and acquires an increased number of projections per rotation. Images of a metal bead contained in a phantom were acquired on a GE CT750 HD scanner with multiple reconstruction algorithms, in the normal and HR scan mode, and at two positions, scanner isocenter and 15 cm directly above isocenter. The images of the metal bead yielded two‐dimensional point spread functions which were averaged along two perpendicular directions to yield line spread functions. Fourier transforms of the line spread functions yielded radial and azimuthal modulation transfer functions (MTFs). At isocenter, the radial and azimuthal MTFs were averaged. MTF improvement depended on image position and modulation direction. The results from a single algorithm, Edge, can be generalized to other algorithms. At isocenter, the 10% MTF cutoff was 14.4 cycles/cm in normal and HR mode. At 15 cm above isocenter, the 10% cutoff was 6.0 and 8.5 cycles/cm for the azimuthal and radial MTFs in normal mode. In HR mode, the azimuthal and radial MTF 10% cutoff was 8.3 and 10.3 cycles/cm. Our results indicate that the best image resolution is achieved at scanner isocenter and that the azimuthal resolution degrades more significantly than the radial resolution. For the GE CT750 HD CT scanner, the resolution is significantly enhanced by the HR scan mode away from scanner isocenter, and the use of the HR scan mode has much more of an impact on image resolution away from isocenter than the choice of algorithm. PACS number(s): 87.57.Q‐
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19
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Tan S, Soulez G, Diez Martinez P, Larrivée S, Stevens LM, Goussard Y, Mansour S, Chartrand-Lefebvre C. Coronary Stent Artifact Reduction with an Edge-Enhancing Reconstruction Kernel - A Prospective Cross-Sectional Study with 256-Slice CT. PLoS One 2016; 11:e0154292. [PMID: 27128507 PMCID: PMC4851391 DOI: 10.1371/journal.pone.0154292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Metallic artifacts can result in an artificial thickening of the coronary stent wall which can significantly impair computed tomography (CT) imaging in patients with coronary stents. The objective of this study is to assess in vivo visualization of coronary stent wall and lumen with an edge-enhancing CT reconstruction kernel, as compared to a standard kernel. Methods This is a prospective cross-sectional study involving the assessment of 71 coronary stents (24 patients), with blinded observers. After 256-slice CT angiography, image reconstruction was done with medium-smooth and edge-enhancing kernels. Stent wall thickness was measured with both orthogonal and circumference methods, averaging thickness from diameter and circumference measurements, respectively. Image quality was assessed quantitatively using objective parameters (noise, signal to noise (SNR) and contrast to noise (CNR) ratios), as well as visually using a 5-point Likert scale. Results Stent wall thickness was decreased with the edge-enhancing kernel in comparison to the standard kernel, either with the orthogonal (0.97 ± 0.02 versus 1.09 ± 0.03 mm, respectively; p<0.001) or the circumference method (1.13 ± 0.02 versus 1.21 ± 0.02 mm, respectively; p = 0.001). The edge-enhancing kernel generated less overestimation from nominal thickness compared to the standard kernel, both with the orthogonal (0.89 ± 0.19 versus 1.00 ± 0.26 mm, respectively; p<0.001) and the circumference (1.06 ± 0.26 versus 1.13 ± 0.31 mm, respectively; p = 0.005) methods. The edge-enhancing kernel was associated with lower SNR and CNR, as well as higher background noise (all p < 0.001), in comparison to the medium-smooth kernel. Stent visual scores were higher with the edge-enhancing kernel (p<0.001). Conclusion In vivo 256-slice CT assessment of coronary stents shows that the edge-enhancing CT reconstruction kernel generates thinner stent walls, less overestimation from nominal thickness, and better image quality scores than the standard kernel.
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Affiliation(s)
- Stéphanie Tan
- Radiology, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Gilles Soulez
- Radiology, University of Montreal Medical Center (CHUM), Montreal, Canada
- University of Montreal Medical Center Research Center, Montreal, Canada
| | | | - Sandra Larrivée
- University of Montreal Medical Center Research Center, Montreal, Canada
- Biostatistics, Pennington Biomedical Research Center, Bâton Rouge, Louisiana, United States of America
| | - Louis-Mathieu Stevens
- University of Montreal Medical Center Research Center, Montreal, Canada
- Cardiac Surgery, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Yves Goussard
- Electrical Engineering, Ecole Polytechnique de Montréal, Montreal, Canada
| | - Samer Mansour
- University of Montreal Medical Center Research Center, Montreal, Canada
- Cardiology, University of Montreal Medical Center (CHUM), Montreal, Canada
| | - Carl Chartrand-Lefebvre
- Radiology, University of Montreal Medical Center (CHUM), Montreal, Canada
- University of Montreal Medical Center Research Center, Montreal, Canada
- * E-mail:
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20
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Akhtar M, Liu W. Use of intravascular ultrasound vs. optical coherence tomography for mechanism and patterns of in-stent restenosis among bare metal stents and drug eluting stents. J Thorac Dis 2016; 8:E104-8. [PMID: 26904234 DOI: 10.3978/j.issn.2072-1439.2016.01.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article is a perspective responses to the "Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents" by Goto et al., The above mentioned article outlines the use of intravascular ultrasound (IVUS) in visualizing the patterns and mechanisms of in-stent restenosis (ISR) post percutaneous coronary intervention (PCI). Although IVUS is an appropriate method of choice for this scenario, IVUS has certain limitations which can be overcome by using optical coherent tomography (OCT). OCT is not only able to overcome IVUS's limitations but is also able to provide additional information to enhance the understanding of in-stent restenotic lesions. This article also outlines the future directions for OCT both in clinical and investigation settings.
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Affiliation(s)
- Muzina Akhtar
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wei Liu
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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21
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Iyengar SS, Morgan-Hughes G, Ukoumunne O, Clayton B, Davies EJ, Nikolaou V, Hyde CJ, Shore AC, Roobottom CA. Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients. Clin Radiol 2015; 71:151-8. [PMID: 26703115 DOI: 10.1016/j.crad.2015.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 09/09/2015] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD). MATERIALS AND METHODS Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥ 50%) stenosis and secondarily as the presence of severe (≥ 70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard. RESULTS No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis. CONCLUSION The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role.
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Affiliation(s)
- S S Iyengar
- Department of Radiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
| | - G Morgan-Hughes
- Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - O Ukoumunne
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), NIHR CLAHRC South West Peninsula, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK
| | - B Clayton
- Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - E J Davies
- Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
| | - V Nikolaou
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), NIHR CLAHRC South West Peninsula, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK
| | - C J Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK
| | - A C Shore
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Royal Devon and Exeter Foundation NHS Trust, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - C A Roobottom
- Department of Radiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK
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[Coronary stent evaluation with cardiac CT: Literature review]. Ann Cardiol Angeiol (Paris) 2015; 64:362-7. [PMID: 26492985 DOI: 10.1016/j.ancard.2015.09.041] [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: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
Abstract
Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted. This is a literature review of stent evaluation with cardiac CT.
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Evaluation of collateral channel classification by computed tomography: the feasibility study with reference to invasive coronary angiography. Int J Cardiovasc Imaging 2015; 31:1643-50. [DOI: 10.1007/s10554-015-0747-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022]
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Harris BS, De Cecco CN, Schoepf UJ, Steinberg DH, Bayer RR, Krazinski AW, Dyer KT, Sandhu MK, Zile MR, Meinel FG. Dual-Source CT Imaging to Plan Transcatheter Aortic Valve Replacement: Accuracy for Diagnosis of Obstructive Coronary Artery Disease. Radiology 2015; 275:80-8. [DOI: 10.1148/radiol.14140763] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Yoshimura M, Nao T, Miura T, Okada M, Nakashima Y, Fujimura T, Okamura T, Yamada J, Matsunaga N, Matsuzaki M, Yano M. New quantitative method to diagnose coronary in-stent restenosis by 64-multislice computed tomography. J Cardiol 2015; 65:57-62. [DOI: 10.1016/j.jjcc.2014.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 02/12/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Munnur RK, Cameron JD, Ko BS, Meredith IT, Wong DTL. Cardiac CT: atherosclerosis to acute coronary syndrome. Cardiovasc Diagn Ther 2014; 4:430-48. [PMID: 25610801 PMCID: PMC4278045 DOI: 10.3978/j.issn.2223-3652.2014.11.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA.
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Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement. Am Heart J 2014; 168:332-9. [PMID: 25173545 DOI: 10.1016/j.ahj.2014.04.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) provides detailed assessment of valve annulus and iliofemoral vessels in transcatheter aortic valve replacement (TAVR) patients. However, data on diagnostic performance of MDCT coronary angiography (MDCT-CA) are scarce. The aim of the study is to assess diagnostic performance of MDCT for coronary artery evaluation before TAVR. METHODS A total of 325 consecutive patients (234 without previous myocardial revascularization, 49 with previous coronary stenting, and 42 with previous coronary artery bypass graft [CABG]) underwent invasive coronary angiography and MDCT before TAVR. MDCT-CA was performed using the same data set dedicated to standard MDCT aortic annulus evaluation. Multidetector computed tomography-CA evaluability and diagnostic accuracy in comparison with invasive coronary angiography as criterion standard were assessed. RESULTS The MDCT-CA evaluability of native coronaries was 95.6%. The leading cause of unevaluability was beam-hardening artifact due to coronary calcifications. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting ≥50% stenosis of 91%, 99.2%, 83.4%, 99.6% and 98.8%, respectively. The MDCT-CA evaluability of coronary stents was 82.1%. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy for detecting ≥50% in-stent restenosis of 94.1%, 86.7%, 66.7%, 98.1%, and 88.3%, respectively. All CABGs were correctly assessed by MDCT-CA. In a patient-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy of 89.7%, 90.8%, 80.6%, 95.4%, and 90.5%, respectively. CONCLUSIONS Multidetector computed tomography-CA allows to correctly rule out the presence of significant native coronary artery stenosis, significant in-stent restenosis, and CABG disease in patients referred for TAVR.
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Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GBJ, Nieman K, Pontone G, Raff GL. SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8:342-58. [PMID: 25301040 DOI: 10.1016/j.jcct.2014.07.003] [Citation(s) in RCA: 689] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/21/2014] [Indexed: 12/18/2022]
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Alani A, Nakanishi R, Budoff MJ. Recent improvement in coronary computed tomography angiography diagnostic accuracy. Clin Cardiol 2014; 37:428-33. [PMID: 24756932 DOI: 10.1002/clc.22286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/13/2014] [Indexed: 01/07/2023] Open
Abstract
Although invasive coronary angiography has been the gold standard for evaluating coronary artery disease (CAD), it should not be routinely performed as an initial test to assess CAD in subjects with suspected CAD by the recent guidelines, due to cost, invasiveness, and measurable risk. Coronary computed tomography angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of CAD becomes of great promise with high diagnostic accuracy. Although artifact issues have created some challenges for CCTA, recent advances-including the introduction of more detectors, leading to broader coverage, and faster and higher-definition scanners-allow improved precision and fewer uninterpretable studies. This review article summarizes the current key literature regarding the diagnostic accuracy of CCTA in native coronary arteries, stents, coronary artery bypass grafts, lesions with high calcification, and the functional assessment of CAD.
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Affiliation(s)
- Anas Alani
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, California
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Pontone G, Bertella E, Mushtaq S, Loguercio M, Cortinovis S, Baggiano A, Conte E, Annoni A, Formenti A, Beltrama V, Guaricci AI, Andreini D. Coronary artery disease: diagnostic accuracy of CT coronary angiography--a comparison of high and standard spatial resolution scanning. Radiology 2014; 271:688-94. [PMID: 24520943 DOI: 10.1148/radiol.13130909] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the image quality, evaluability, diagnostic accuracy, and radiation exposure of high-spatial-resolution (HR, 0.23-mm) computed tomographic (CT) coronary angiography with standard spatial resolution (SR, 0.625-mm) 64-section imaging in patients at high risk for coronary artery disease (CAD) by using invasive coronary angiography (ICA) as the reference method. MATERIALS AND METHODS Written informed consent was obtained from all patients, and the study protocol was approved by the institutional ethical committee. Patients at high risk for CAD (n = 184) who were scheduled for ICA were randomly assigned for study with SR (n = 91) or HR (n = 93) coronary CT angiography before they underwent ICA. To compare the two groups, the Student t test or Wilcoxon test were used to evaluate differences in continuous variables. The χ(2) test or Fisher exact test were used, as appropriate, for categorical data. The McNemar test was used to compare the diagnostic performance of coronary CT angiography versus that of ICA in each group. RESULTS HR coronary CT angiography showed a higher image quality score (3.7 vs 3.4, P < .001) and evaluability (97% vs 92%, P < .002). In a segment-based analysis, HR coronary CT angiography showed a higher specificity, positive predictive value, and accuracy in comparison with SR coronary CT angiography (98%, 91%, and 99% vs 95%, 80%, and 95%, respectively; P < .001). Moreover, HR coronary CT angiography showed a better agreement with ICA for calcified plaques compared with SR coronary CT angiography and ICA (83% vs 53%, P < .001). In a patient-based analysis, HR coronary CT angiography showed higher specificity and accuracy compared with SR coronary CT angiography (91% and 98% vs 46% and 92%, respectively; P < .01). No differences in radiation exposure were found between the two groups. CONCLUSION Improved evaluability and accuracy were seen with HR compared with SR coronary CT angiography of calcified coronary artery lesions, suggesting a potential use for this technology in patients at high risk for CAD.
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Affiliation(s)
- Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., E.B., S.M., M.L., S.C., A.B., E.C., A.A., A.F., V.B., D.A.); Department of Cardiology, University of Foggia, Foggia, Italy (A.I.G.); and Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy (D.A.)
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Andreini D, Pontone G, Mushtaq S, Bertella E, Conte E, Baggiano A, Veglia F, Agostoni P, Annoni A, Formenti A, Montorsi P, Ballerini G, Bartorelli AL, Fiorentini C, Pepi M. Prognostic value of multidetector computed tomography coronary angiography in diabetes: excellent long-term prognosis in patients with normal coronary arteries. Diabetes Care 2013; 36:1834-41. [PMID: 23801796 PMCID: PMC3687262 DOI: 10.2337/dc12-2123] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prognostic role of multidetector computed tomography coronary angiography (MDCT-CA) in patients with diabetes with suspected coronary artery disease (CAD). Use of MDCT-CA is increasing in patients with suspected CAD. However, data supporting its prognostic value in patients with diabetes are limited. RESEARCH DESIGN AND METHODS Between January 2006 and September 2007, 429 consecutive diabetic patients were prospectively studied with MDCT-CA for detecting the presence and assessing the extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronary arteries and nonobstructive (<50%) and obstructive (≥50%) coronary lesions. The composite rates of hard cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina) and all cardiac events (including revascularization) were the end points of the study. RESULTS Twenty-four patients were excluded because MDCT-CA data were not able to be interpreted. Of the remaining 405 patients, clinical follow-up (mean 62 ± 9 months) was obtained in 390 (98%). Multivariate analysis showed that predictors of hard and all events were obstructive CAD, three-vessel CAD, and left main coronary artery (LMCA) disease. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 78% for hard events and 56% for all events in patients with nonobstructive CAD, and 60% for hard events and 16% for all events in patients with obstructive CAD. Three-vessel CAD and LMCA disease were associated with a higher rate of hard cardiac events. CONCLUSIONS MDCT-CA provides long-term prognostic information for patients with diabetes with suspected CAD, showing excellent prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, Istituto Di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
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Fuchs TA, Stehli J, Fiechter M, Dougoud S, Sah BR, Gebhard C, Bull S, Gaemperli O, Kaufmann PA. First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography. Int J Cardiovasc Imaging 2013; 29:1409-16. [DOI: 10.1007/s10554-013-0225-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Ding J, Li M, Sun G. Accuracy of New CT Scanner in the Diagnosis of Coronary In-Stent Restenosis. Radiology 2013; 267:315-6. [DOI: 10.1148/radiol.13122368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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