1
|
Goldfarb JW, Mossa-Basha M, Nguyen KL, Hecht EM, Finn JP. Trends in magnetic resonance and computed tomography angiography utilization among Medicare beneficiaries between 2013 and 2020. Clin Imaging 2024; 107:110088. [PMID: 38277858 DOI: 10.1016/j.clinimag.2024.110088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To evaluate relative and absolute utilization trends and practice patterns in the United States for MRA and CTA. METHODS Using Medicare Part B physician payment databases (2013-2020), MRA and CTA interpreting physicians and exams were identified using the unique MRA and CTA Healthcare Common Procedure Coding System codes. The number of exams, physicians, demographics, use of contrast, and payments were summarized annually and analyzed to evaluate trends before and during the first year of the COVID-19 pandemic. RESULTS From 2013 to 2019, the annual number of MRA exams performed decreased by 17.9 %, while the number of CTA exams increased by 90.3 %. The number of physicians interpreting MRA decreased in both hospital (-17.2 %) and outpatient (-7.5 %) environments. The number of physicians interpreting CTA increased in both hospital (+29.4 %) and outpatient (+54.3 %) environments. During the first year of the COVID-19 pandemic, MRA utilization decreased across all imaging environments by 25.0 % whereas CTA only decreased by 5.5 %. Intracranial MRA studies were most often performed without contrast, while contrast use for neck MRA was performed at similar rates as non-contrast exams. CONCLUSION The overall utilization of MRA and the number of interpreting physicians are decreasing. On the other hand, CTA use and its number of interpreting physicians are increasing. During the first year of the COVID-19 pandemic, use of both MRA and CTA decreased, but the utilization of MRA decreased at five times the rate of CTA.
Collapse
Affiliation(s)
- James W Goldfarb
- Division of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, NY, USA.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kim-Lien Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - J Paul Finn
- Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
2
|
Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
Collapse
Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| |
Collapse
|
3
|
Zanon C, Cademartiri F, Toniolo A, Bini C, Clemente A, Colacchio EC, Cabrelle G, Mastro F, Antonello M, Quaia E, Pepe A. Advantages of Photon-Counting Detector CT in Aortic Imaging. Tomography 2023; 10:1-13. [PMID: 38276249 PMCID: PMC10821336 DOI: 10.3390/tomography10010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Photon-counting Computed Tomography (PCCT) is a promising imaging technique. Using detectors that count the number and energy of photons in multiple bins, PCCT offers several advantages over conventional CT, including a higher image quality, reduced contrast agent volume, radiation doses, and artifacts. Although PCCT is well established for cardiac imaging in assessing coronary artery disease, its application in aortic imaging remains limited. This review summarizes the available literature and provides an overview of the current use of PCCT for the diagnosis of aortic imaging, focusing mainly on endoleaks detection and characterization after endovascular aneurysm repair (EVAR), contrast dose volume, and radiation exposure reduction, particularly in patients with chronic kidney disease and in those requiring follow-up CT.
Collapse
Affiliation(s)
- Chiara Zanon
- Department of Radiology, University of Padua, 35128 Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | | | - Costanza Bini
- Department of Radiology, University of Padua, 35128 Padua, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Elda Chiara Colacchio
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University of Padua, 35128 Padua, Italy
| | - Florinda Mastro
- Division of Cardiac Surgery, University of Padua, 35128 Padua, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padua, 35128 Padua, Italy
| | - Alessia Pepe
- Department of Radiology, University of Padua, 35128 Padua, Italy
| |
Collapse
|
4
|
Kahraman AT, Fröding T, Toumpanakis D, Sladoje N, Sjöblom T. Automated detection, segmentation and measurement of major vessels and the trachea in CT pulmonary angiography. Sci Rep 2023; 13:18407. [PMID: 37891213 PMCID: PMC10611811 DOI: 10.1038/s41598-023-45509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Mediastinal structure measurements are important for the radiologist's review of computed tomography pulmonary angiography (CTPA) examinations. In the reporting process, radiologists make measurements of diameters, volumes, and organ densities for image quality assessment and risk stratification. However, manual measurement of these features is time consuming. Here, we sought to develop a time-saving automated algorithm that can accurately detect, segment and measure mediastinal structures in routine clinical CTPA examinations. In this study, 700 CTPA examinations collected and annotated. Of these, a training set of 180 examinations were used to develop a fully automated deterministic algorithm. On the test set of 520 examinations, two radiologists validated the detection and segmentation performance quantitatively, and ground truth was annotated to validate the measurement performance. External validation was performed in 47 CTPAs from two independent datasets. The system had 86-100% detection and segmentation accuracy in the different tasks. The automatic measurements correlated well to those of the radiologist (Pearson's r 0.68-0.99). Taken together, the fully automated algorithm accurately detected, segmented, and measured mediastinal structures in routine CTPA examinations having an adequate representation of common artifacts and medical conditions.
Collapse
Affiliation(s)
- Ali T Kahraman
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Tomas Fröding
- Department of Radiology, Nyköping Hospital, 611 39, Nyköping, Sweden
| | - Dimitrios Toumpanakis
- Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Nataša Sladoje
- Centre for Image Analysis, Department of Information Technology, Uppsala University, 751 05, Uppsala, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden.
| |
Collapse
|
5
|
Tserioti E, Chana H, Salmasi AM. Hypertensive Subjects are More Likely to Develop Coronary Artery Lesions: A Study by Computerised Tomography Coronary Angiography. Angiology 2023:33197231200774. [PMID: 37678558 DOI: 10.1177/00033197231200774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Coronary Computed Tomography Angiography (CCTA) is commonly used to identify coronary artery disease. In this study, the indications for CCTA referrals are reviewed, to identify the strongest predictors of CAD, as seen on CCTA. A retrospective study, reviewing the electronic health records of consecutive patients who underwent CCTA between July and November 2020 at our Trust, was conducted. A total of 485 patient reports were reviewed. Of patients with moderate-to-severe CAD, 128 (73.6%) were hypertensive. Of those with severe CAD, 79 patients (76%) were hypertensive. Univariate analysis for comparison of patients with absent (n = 219), mild (n = 92), moderate (n = 70) and severe (n = 104) CAD revealed that hypertension (P < .001), diabetes mellitus (P < .001), gender (P < .001), dyslipidemia (P < .001) and smoking (P = .006), were each significantly associated with the presence of CAD on CCTA. However, multiple logistic regression analysis confirmed that hypertension has the strongest association with CAD (OR = 2.22, P < .001) Furthermore, the presence of typical chest pain in hypertensive patients was strongly associated with significant CAD, on CCTA. Among all risk factors, hypertension is the strongest independent predictor for the presence of CAD on CCTA. These results suggest that hypertension is a significant factor when considering referral for CCTA, particularly when associated with chest pain.
Collapse
Affiliation(s)
| | - Harmeet Chana
- London North West University Healthcare Hospital NHS Trust, London, UK
| | - Abdul-Majeed Salmasi
- London North West University Healthcare Hospital NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
6
|
Faruk M, Satria B, Alwi A, Cahyaningtyas C. A rare case of femoral artery saccular aneurysm caused by tuberculosis in a male patient: A case report and review of literature. Int J Surg Case Rep 2023; 106:108143. [PMID: 37062194 PMCID: PMC10139898 DOI: 10.1016/j.ijscr.2023.108143] [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: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is still a major global health issue. In over 75 % of all cases of mycotic aneurysm, TB spreads directly by eroding through the vascular wall. Aortic and innominate arteries are frequently the sites of tubercular aneurysms, primarily due to contiguous dissemination from pulmonary infection sites. We report a case of a saccular aneurysm at the distal common femoral artery associated with tuberculosis. CASE PRESENTATION A 34-year-old man had the chief complaint of a voluminous pulsatile mass in the left thigh. We found a bruit on auscultation examination at the site of the mass. A computed tomography (CT) angiography showed a saccular aneurysm at the distal common femoral artery and stenosis at the proximal femoral profunda artery. A chest CT scan was conducted, and the result showed a ground-glass appearance and multiple enlarged lymph nodes. CLINICAL DISCUSSION The patient was treated surgically by resection of the aneurysm and reconstruction with an inter-positional saphenous vein graft. Later, he was treated with a drug regimen for tuberculosis by pulmonologist. The patient was discharged with no post-operative complications. CONCLUSION Patients with femoral artery aneurysms are at high risk of rupture and death by exsanguination. It can be a severe complication of tuberculosis, especially in immunocompromised patients. Although this was a very rare case, all surgeons must be aware. A combination of medical and surgical intervention is imperative. Careful clinical care postoperatively is mandatory because of the risk of repetitive anastomotic aneurysms and recurrent aneurysms in another vessel.
Collapse
Affiliation(s)
- Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Bayu Satria
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ahmadi Alwi
- Department of Surgery, Tadjuddin Chalid Hospital, Makassar, Indonesia
| | - Cheria Cahyaningtyas
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
7
|
Gupta S, Dixit R, Prakash A, Daga MK, Mishra A. Can Sublingual Nitrate Improve Visualization of Lower Limb Arteries on Computed Tomography Angiography? J Comput Assist Tomogr 2023:00004728-990000000-00152. [PMID: 36877793 DOI: 10.1097/rct.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA). METHODS Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done. RESULTS Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group. CONCLUSIONS Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.
Collapse
Affiliation(s)
- Sanchita Gupta
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Anjali Prakash
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Mradul Kumar Daga
- Department of Internal Medicine and Infectious disease, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
8
|
Afkhami N, Aghasizadeh M, Ghiasi Hafezi S, Zare-Feyzabadi R, Saffar Soflaei S, Rashidmayvan M, Rastegarmoghadam-Ebrahimian A, Khanizadeh K, Safari N, Ferns GA, Esmaily H, Darban RA, Ghayour-Mobarhan M. Evaluation of rs1748195 ANGPTL3 gene polymorphism in patients with angiographic coronary artery disease compared to healthy individuals. Mol Genet Genomic Med 2023; 11:e2105. [PMID: 36416040 PMCID: PMC10009914 DOI: 10.1002/mgg3.2105] [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: 05/11/2022] [Revised: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022] Open
Abstract
SUBJECT The Angiopoietin-like 3 (ANGPTL3) gene has been reported to be associated with cardiovascular risk. This study is designed to compare the genetic variant (rs1748195) of the ANGPTL3 gene and the presence of a coronary artery occlusion of >50% in Iranian nation. METHOD In this study, 184 patients underwent angiography and 317 healthy individuals were evaluated for polymorphism of rs1748195 the ANGPTL3 gene using Tetra-ARMs PCR. Coronary patients who experience angiography were categorized into two groups: 54 patients who had an angiography indication for the first time and coronary occlusion was <50% (Angio-) and 134 patients who formerly underwent coronary stent implanting at least 1 month before with coronary occlusion of ≥50% that again have an angiography indication (Angio+). In addition, individuals with angio+ are categorized in two groups: (1) non-in-stent restenosis (NISR); patient with a patent stent (N = 92). (2) in-stent restenosis (ISR); in-stent stenosis >50% (N = 42). RESULT The fundamental of characteristics of our study design population was categorized based on undergoing angiography or not. In the present study, we investigated that the CC genotype, and also the A allele corresponding to rs1748195 at the ANGPTL3 gene loci, was associated with negative angiogram and directly related to the risk of coronary occlusion >50%. In contrast, this result was not significant in genotypes of ANGPTL3 between non-ISR and ISR groups. CONCLUSION The outcomes of this study showed that rs1748195 polymorphism at the ANGPTL3 gene loci is associated with an elevated risk for the existence of a coronary occlusion of >50%.
Collapse
Affiliation(s)
- Nafise Afkhami
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Malihe Aghasizadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Ghiasi Hafezi
- Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Zare-Feyzabadi
- Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Saffar Soflaei
- Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Rashidmayvan
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Khashayar Khanizadeh
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Nilufar Safari
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Sussex, UK
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Assaran Darban
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
9
|
Brolund-Napier CN, Ffrench-Constant AE, Neumann S, Paull JC, Fenton NK, Jones CA, Lyen S, Manghat NE, Hamilton MCK. CT pulmonary angiography: optimising acute thoracic imaging by fixed-timing contrast medium delivery with a modified breathing instruction. Clin Radiol 2023; 78:e237-e242. [PMID: 36588065 DOI: 10.1016/j.crad.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 12/31/2022]
Abstract
AIM To compare the thoracic vascular opacification achieved using the standard bolus-tracking protocol (BTP) with a fixed-timing protocol (FTP) with a modified breathing instruction during computed tomography pulmonary angiography (CTPA) examinations. MATERIALS AND METHODS A single-centre review of CTPA examinations performed between July 2018 and January 2019 using the BTP or FTP and weight-based contrast dosing of 20 mg iodine/kg body weight/s for 20 seconds at 100 kV tube potential. Radiodensity (in Hounsfield units) was analysed in the right ventricle, main pulmonary artery (MPA), left atrium, left ventricle, and ascending and descending thoracic aorta (DTA). A p-value of <0.05 was considered significant. RESULTS Of 782 examinations, 88 BTP and 90 FTP examinations were included. Mean attenuation of the MPA was similar in the FTP (396 ± 106 HU) and BTP (362 ± 119 HU; p=0.06); however, good-quality (≥250 HU) MPA opacification was achieved in more FTP examinations (87/90, 96.7%) compared to the BTP (73/88, 82.9%; p=0.002). Mean attenuation of the DTA was better in the FTP (325 ± 72 HU) than the BTP (228 ± 75 HU; p <0.0001), with good-quality opacification (≥250 HU) in 76/90 (84.4%) FTP examinations compared with 36/88 (40.9%) BTP examinations (p <0.001). CONCLUSION The FTP achieves better opacification of the MPA and DTA compared to the BTP.
Collapse
Affiliation(s)
- C N Brolund-Napier
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - A E Ffrench-Constant
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - S Neumann
- University of Bristol, Faculty of Health Sciences, Queens Road, Bristol BS8 1QU, UK
| | - J C Paull
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - N K Fenton
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - C A Jones
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - S Lyen
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - N E Manghat
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M C K Hamilton
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK.
| |
Collapse
|
10
|
Cayron AF, Morel S, Allémann E, Bijlenga P, Kwak BR. Imaging of intracranial aneurysms in animals: a systematic review of modalities. Neurosurg Rev 2023; 46:56. [PMID: 36786880 PMCID: PMC9928939 DOI: 10.1007/s10143-023-01953-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Intracranial aneurysm (IA) animal models are paramount to study IA pathophysiology and to test new endovascular treatments. A number of in vivo imaging modalities are available to characterize IAs at different stages of development in these animal models. This review describes existing in vivo imaging techniques used so far to visualize IAs in animal models. We systematically searched for studies containing in vivo imaging of induced IAs in animal models in PubMed and SPIE Digital library databases between 1 January 1945 and 13 July 2022. A total of 170 studies were retrieved and reviewed in detail, and information on the IA animal model, the objective of the study, and the imaging modality used was collected. A variety of methods to surgically construct or endogenously induce IAs in animals were identified, and 88% of the reviewed studies used surgical methods. The large majority of IA imaging in animals was performed for 4 reasons: basic research for IA models, testing of new IA treatment modalities, research on IA in vivo imaging of IAs, and research on IA pathophysiology. Six different imaging techniques were identified: conventional catheter angiography, computed tomography angiography, magnetic resonance angiography, hemodynamic imaging, optical coherence tomography, and fluorescence imaging. This review presents and discusses the advantages and disadvantages of all in vivo IA imaging techniques used in animal models to help future IA studies finding the most appropriate IA imaging modality and animal model to answer their research question.
Collapse
Affiliation(s)
- Anne F Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
11
|
Lee YC, Cha J, Shim I, Park WY, Kang SW, Lim DH, Won HH. Multimodal deep learning of fundus abnormalities and traditional risk factors for cardiovascular risk prediction. NPJ Digit Med 2023; 6:14. [PMID: 36732671 PMCID: PMC9894867 DOI: 10.1038/s41746-023-00748-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Cardiovascular disease (CVD), the leading cause of death globally, is associated with complicated underlying risk factors. We develop an artificial intelligence model to identify CVD using multimodal data, including clinical risk factors and fundus photographs from the Samsung Medical Center (SMC) for development and internal validation and from the UK Biobank for external validation. The multimodal model achieves an area under the receiver operating characteristic curve (AUROC) of 0.781 (95% confidence interval [CI] 0.766-0.798) in the SMC and 0.872 (95% CI 0.857-0.886) in the UK Biobank. We further observe a significant association between the incidence of CVD and the predicted risk from at-risk patients in the UK Biobank (hazard ratio [HR] 6.28, 95% CI 4.72-8.34). We visualize the importance of individual features in photography and traditional risk factors. The results highlight that non-invasive fundus photography can be a possible predictive marker for CVD.
Collapse
Affiliation(s)
- Yeong Chan Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jiho Cha
- Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Injeong Shim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hong-Hee Won
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
12
|
Higashigaito K, Mergen V, Eberhard M, Jungblut L, Hebeisen M, Rätzer S, Zanini B, Kobe A, Martini K, Euler A, Alkadhi H. CT Angiography of the Aorta Using Photon-counting Detector CT with Reduced Contrast Media Volume. Radiol Cardiothorac Imaging 2023; 5:e220140. [PMID: 36860835 PMCID: PMC9969214 DOI: 10.1148/ryct.220140] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Abstract
Purpose To develop and evaluate a low-volume contrast media protocol for thoracoabdominal CT angiography (CTA) with photon-counting detector (PCD) CT. Materials and Methods This prospective study included consecutive participants (April-September 2021) who underwent CTA with PCD CT of the thoracoabdominal aorta and previous CTA with energy-integrating detector (EID) CT at equal radiation doses. In PCD CT, virtual monoenergetic images (VMI) were reconstructed in 5-keV intervals from 40 to 60 keV. Attenuation of the aorta, image noise, and contrast-to-noise ratio (CNR) were measured, and subjective image quality was rated by two independent readers. In the first group of participants, the same contrast media protocol was used for both scans. CNR gain in PCD CT compared with EID CT served as the reference for contrast media volume reduction in the second group. Noninferiority analysis was used to test noninferior image quality of the low-volume contrast media protocol with PCD CT. Results The study included 100 participants (mean age, 75 years ± 8 [SD]; 83 men). In the first group (n = 40), VMI at 50 keV provided the best trade-off between objective and subjective image quality, achieving 25% higher CNR compared with EID CT. Contrast media volume in the second group (n = 60) was reduced by 25% (52.5 mL). Mean differences in CNR and subjective image quality between EID CT and PCD CT at 50 keV were above the predefined boundaries of noninferiority (-0.54 [95% CI: -1.71, 0.62] and -0.36 [95% CI: -0.41, -0.31], respectively). Conclusion CTA of the aorta with PCD CT was associated with higher CNR, which was translated into a low-volume contrast media protocol demonstrating noninferior image quality compared with EID CT at the same radiation dose.Keywords: CT Angiography, CT-Spectral, Vascular, Aorta, Contrast Agents-Intravenous, Technology Assessment© RSNA, 2023See also the commentary by Dundas and Leipsic in this issue.
Collapse
Affiliation(s)
- Kai Higashigaito
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Victor Mergen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Lisa Jungblut
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Monika Hebeisen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Susan Rätzer
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Bettina Zanini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Katharina Martini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| |
Collapse
|
13
|
Lamy J, Merveille O, Kerautret B, Passat N. A Benchmark Framework for Multiregion Analysis of Vesselness Filters. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3649-3662. [PMID: 35857732 DOI: 10.1109/tmi.2022.3192679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vessel enhancement (aka vesselness) filters, are part of angiographic image processing for more than twenty years. Their popularity comes from their ability to enhance tubular structures while filtering out other structures, especially as a preliminary step of vessel segmentation. Choosing the right vesselness filter among the many available can be difficult, and their parametrization requires an accurate understanding of their underlying concepts and a genuine expertise. In particular, using default parameters is often not enough to reach satisfactory results on specific data. Currently, only few benchmarks are available to help the users choosing the best filter and its parameters for a given application. In this article, we present a generic framework to compare vesselness filters. We use this framework to compare seven gold standard filters. Our experiments are performed on three public datasets: the hepatic Ircad dataset (CT images), the Bullit dataset (brain MRA images) and the synthetic VascuSynth dataset. We analyse the results of these seven filters both quantitatively and qualitatively. In particular, we assess their performances in key areas: the organ of interest, the whole vascular network neighbourhood and the vessel neighbourhood split into several classes, based on their diameters. We also focus on the vessels bifurcations, which are often missed by vesselness filters. We provide the code of the benchmark, which includes up-to-date C++ implementations of the seven filters, as well as the experimental setup (parameter optimization, result analysis, etc.). An online demonstrator is also provided to help the community apply and visually compare these vesselness filters.
Collapse
|
14
|
Automatic Plaque Removal Using Dual-Energy Computed Tomography Angiography: Diagnostic Accuracy and Utility in Patients with Peripheral Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101435. [PMID: 36295595 PMCID: PMC9609865 DOI: 10.3390/medicina58101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This study aimed to evaluate the utility and accuracy of dual-energy automatic plaque removal (DE-APR) in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography (DSA) as the reference standard. Materials and Methods: We retrospectively analyzed 100 patients with PAD who underwent DE computed tomography angiography (DE-CTA) and DSA of the lower extremities. DE-CTA was used to generate APR subtracted images. In the three main arterial segments (aorto-iliac segment, femoro-popliteal segment, and below-the-knee segment), the presence or absence of hemodynamically significant stenosis (>50%) and calcification was assessed using the images. CTA data were analyzed using different imaging approaches (DE-standard reconstruction image (DE-SR), DE-APR maximum intensity projection image (APR), and DE-SR with APR). Results: For all segments evaluated, the sensitivity, specificity, and accuracy for detecting significant stenosis were 98.16%, 81.01%, and 89.58%, respectively, with DE-SR; 97.79%, 83.33%, and 90.56%, respectively, with APR; and 98.16%, 92.25%, and 95.20%, respectively, with DE-SR with APR. DE-SR with APR had greater accuracy than DE-SR or APR alone (p < 0.001 and p < 0.001, respectively). When analyzed based on vascular wall calcification, the accuracy of DE-SR with APR remained greater than 90% regardless of calcification severity, whereas DE-SR showed a considerable reduction in accuracy in moderate to severe calcification. In the case of APR, the degree of vascular wall calcification did not significantly influence the accuracy in the aorto-iliac and femoro-popliteal segments. DE-SR with APR achieved significantly higher diagnostic accuracy for all lower extremity segments in evaluating hemodynamically significant stenosis in patients with symptomatic PAD and transcended the impact of vascular wall calcification compared with DE-SR. Conclusions: APR demonstrated favorable diagnostic performance in the aorto-iliac and femoro-popliteal segments, exhibiting good agreement with DSA even in cases of moderate to severe vascular wall calcification.
Collapse
|
15
|
Sun Z, Wee C. 3D Printed Models in Cardiovascular Disease: An Exciting Future to Deliver Personalized Medicine. MICROMACHINES 2022; 13:1575. [PMID: 36295929 PMCID: PMC9610217 DOI: 10.3390/mi13101575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
3D printing has shown great promise in medical applications with increased reports in the literature. Patient-specific 3D printed heart and vascular models replicate normal anatomy and pathology with high accuracy and demonstrate superior advantages over the standard image visualizations for improving understanding of complex cardiovascular structures, providing guidance for surgical planning and simulation of interventional procedures, as well as enhancing doctor-to-patient communication. 3D printed models can also be used to optimize CT scanning protocols for radiation dose reduction. This review article provides an overview of the current status of using 3D printing technology in cardiovascular disease. Limitations and barriers to applying 3D printing in clinical practice are emphasized while future directions are highlighted.
Collapse
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Cleo Wee
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
| |
Collapse
|
16
|
Keddie D, Abdulrehman Y, Shiau G. Reporting lower extremity CT angiography for treatment planning. Diagn Interv Imaging 2022; 103:387-393. [PMID: 35843841 DOI: 10.1016/j.diii.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
Diagnostic radiologists play an important role in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease, including critical limb ischemia in both acute and chronic settings, and intermittent claudication. The complications associated with tissue and/or limb loss related to acute limb ischemia and critical limb ischemia of the lower extremity make rapid diagnosis and early intervention critical in the management of these patients. Computed tomography angiography (CTA) is an effective, widely available, easily reproducible, non-invasive imaging modality that offers a rapid and accurate means to diagnose and grade the extent of vascular disease. However, CTA run-off reports are usually dictated in free text form, and referring and treating physicians may be unsure whether an anatomic structure has been evaluated if it has not been specifically mentioned in the report. In this article, the vascular anatomy and anatomic variants of the lower extremity, the most common lower extremity vascular pathologies are reviewed and clinically important CTA imaging findings are outlined. This provides a framework for radiologists to accurately evaluate lower extremity vascular pathologies and convey clinically relevant imaging findings for management by vascular surgeons or interventional radiologists.
Collapse
Affiliation(s)
- Danae Keddie
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
| | - Yaasin Abdulrehman
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Surgery, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Gillian Shiau
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Radiology and Diagnostic Imaging Department, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| |
Collapse
|
17
|
Impact of the COVID-19 Pandemic on Trends in Cardiothoracic Imaging. Radiol Res Pract 2022; 2022:7923228. [PMID: 35756751 PMCID: PMC9225849 DOI: 10.1155/2022/7923228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Here, we evaluate the effect of the COVID-19 pandemic on utilization of cardiothoracic imaging studies. Methods We queried our radiology record system to retrospectively identify numbers of specific key cardiothoracic imaging studies for five years prior and during the COVID-19 pandemic. Statistical analysis was performed to evaluate changes in the number of exams in 2020 and 2021 compared to 2019. Results Five-year retrospective analysis demonstrated progressive increases in nearly all cross-sectional studies. In 2020, daily chest radiograph utilization decreased with an overall number of daily radiographs of 406 (SD = 73.1) compared to 480 per day in 2019 (SD = 82.6) (p < 0.0001). Portable radiograph utilization was increased in 2020 averaging 320 (SD = 68.2) films daily in 2020 compared to 266 (SD = 29.1) in 2019 (p < 0.0001). Utilization of thoracic CT was decreased during the pandemic, with 21.8 (SD = 12.9) studies daily compared to 52.0 (SD = 21.4) (p < 0.0001) studies daily in 2019. Cardiac imaging utilization was also substantially decreased in 2020 compared to 2019, averaging a total of 3.8 (SD = 3.2) versus 10.8 (SD = 6.6) studies daily and 0.88 (SD = 1.7) versus 2.5 (SD = 2.3) studies daily for CT and MRI, respectively. Evaluation of cardiothoracic imaging for the subsequent 18 months after New York's entry to phase I recovery in June 2020 demonstrated that by one year after the emergence of COVID-19 imaging utilization had recovered to prepandemic levels. Cardiac imaging continued to increase throughout the chronic phase of the COVID-19 pandemic, reaching almost twice the prepandemic levels by the end of 2021. Conclusion COVID-19 has had far-reaching effects on medicine and public health. Here, we demonstrate decreases in all cross-sectional cardiothoracic imaging studies, closely mirroring findings in other fields during the height of the pandemic, which have since rebounded.
Collapse
|
18
|
Prospective Study of Low-Radiation and Low-Iodine Dose Aortic CT Angiography in Obese and Non-Obese Patients: Image Quality and Impact of Patient Characteristics. Diagnostics (Basel) 2022; 12:diagnostics12030675. [PMID: 35328228 PMCID: PMC8947155 DOI: 10.3390/diagnostics12030675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to prospectively analyse image quality and radiation dose of body mass index (BMI)-adapted low-radiation and low-iodine dose CTA of the thoracoabdominal aorta in obese and non-obese patients. This prospective, single-centre study included patients scheduled for aortic CTA between November 2017 and August 2020 without symptoms of high-grade heart failure. A BMI-adapted protocol was used: Group A/Group B, BMI < 30/≥ 30 kg/m2, tube potential 80/100 kVp, total iodine dose 14.5/17.4 g. Intraindividual comparison with the institutional clinical routine aortic CTA protocol was performed. The final study cohort comprised 161 patients (mean 71.1 ± 9.4 years, 32 women), thereof 126 patients in Group A (mean BMI 25.4 ± 2.8 kg/m2) and 35 patients in Group B (34.0 ± 3.4 kg/m2). Mean attenuation over five aortoiliac measurement positions for Group A/B was 354.9 ± 78.2/262.1 ± 73.0 HU. Mean effective dose for Group A/B was 3.05 ± 0.46/6.02 ± 1.14 mSv. Intraindividual comparison in 50 patients demonstrated effective dose savings for Group A/B of 34.4 ± 14.5/25.4 ± 14.1% (both p < 0.001), and iodine dose savings for Group A/B of 54/44.8%. Regression analysis showed that female sex and increasing age were independently associated with higher vascular attenuation. In conclusion, BMI-adapted, low-radiation and low-iodine dose CTA of the thoracoabdominal aorta delivers diagnostic image quality in non-obese and obese patients without symptoms of high-grade heart failure, with superior image quality in females and the elderly.
Collapse
|
19
|
Humphries H, Chung J, Pirzadeh R, Jones W, Ezzeldin M. Thyroid Steal Syndrome Secondary to Active Hyperthyroid State. Cureus 2022; 14:e22529. [PMID: 35345735 PMCID: PMC8955917 DOI: 10.7759/cureus.22529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Thyroid steal syndrome (TSS) is a rare condition characterized by recurrent transient ischemic attack (TIA) that is found to be due to a large thyroid goiter or thyroid hormone derangement causing a diversion of blood flow from the cerebral circulation. Here we report a patient with a history of multiple TIAs thought initially to be due to intracranial arterial stenosis based on CT angiography (CTA) findings, but later found to be secondary to hyperthyroid state causing TSS. To our knowledge, this is the first-ever reported case of TSS secondary to hyperthyroidism and only the second case of TSS secondary to any thyroid hormone derangement.
Collapse
|
20
|
Heinrich A, Streckenbach F, Beller E, Groß J, Weber MA, Meinel FG. Deep Learning-Based Image Reconstruction for CT Angiography of the Aorta. Diagnostics (Basel) 2021; 11:diagnostics11112037. [PMID: 34829383 PMCID: PMC8622129 DOI: 10.3390/diagnostics11112037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
To evaluate the impact of a novel, deep-learning-based image reconstruction (DLIR) algorithm on image quality in CT angiography of the aorta, we retrospectively analyzed 51 consecutive patients who underwent ECG-gated chest CT angiography and non-gated acquisition for the abdomen on a 256-dectector-row CT. Images were reconstructed with adaptive statistical iterative reconstruction (ASIR-V) and DLIR. Intravascular image noise, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) were quantified for the ascending aorta, the descending thoracic aorta, the abdominal aorta and the iliac arteries. Two readers scored subjective image quality on a five-point scale. Compared to ASIR-V, DLIR reduced the median image noise by 51–54% for the ascending aorta and the descending thoracic aorta. Correspondingly, median CNR roughly doubled for the ascending aorta and descending thoracic aorta. There was a 38% reduction in image noise for the abdominal aorta and the iliac arteries, with a corresponding improvement in CNR. Median subjective image quality improved from good to excellent at all anatomical levels. In CT angiography of the aorta, DLIR substantially improved objective and subjective image quality beyond what can be achieved by state-of-the-art iterative reconstruction. This can pave the way for further radiation or contrast dose reductions.
Collapse
Affiliation(s)
- Andra Heinrich
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, 18057 Rostock, Germany; (A.H.); (F.S.); (E.B.); (M.-A.W.)
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, 18057 Rostock, Germany; (A.H.); (F.S.); (E.B.); (M.-A.W.)
- Center for Transdisciplinary Neurosciences Rostock, University Medical Center Rostock, 18057 Rostock, Germany
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, 18057 Rostock, Germany; (A.H.); (F.S.); (E.B.); (M.-A.W.)
| | - Justus Groß
- Division of Vascular Surgery, Department of Surgery, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, 18057 Rostock, Germany; (A.H.); (F.S.); (E.B.); (M.-A.W.)
| | - Felix G. Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, 18057 Rostock, Germany; (A.H.); (F.S.); (E.B.); (M.-A.W.)
- Correspondence: ; Tel.: +49-381-494-9275
| |
Collapse
|
21
|
Ciulla C. Inverse Fourier transformation of combined first order derivative and intensity-curvature functional of magnetic resonance angiography of the human brain. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106384. [PMID: 34537491 DOI: 10.1016/j.cmpb.2021.106384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE This paper reports a novel image processing technique based on inverse Fourier transformation and its validation procedure. METHODS Magnetic Resonance Angiography (MRA) data of the human brain is fitted on a pixel-by-pixel basis with bivariate linear model polynomial function. Polynomial fitting allows the formulation of two measures: the first order derivative (FOD), which is an edge finder, and the intensity-curvature functional (ICF), which is a high pass filter. The calculation of FOD and ICF uses knowledge provided by existing research and is performed through resampling. ICF and FOD are direct Fourier transformed, and their k-space is combined through a nonlinear convolution of terms. The resulting k-space is inverse Fourier transformed so to obtain a novel image called Fourier Convolution Image (FCI). RESULTS FCI possesses the characteristics of an edge finder (FOD) and a high pass filter (ICF). CONCLUSIONS FC images yield the following properties versus MRA: 1. Change of the contrast; 2. Increased sharpness in the proximity of human brain vessels; 3. Increased visualization of vessel connectivity. The implication of this study is to provide FCI as another viable option for MRA evaluation.
Collapse
Affiliation(s)
- Carlo Ciulla
- Department of Computer Engineering, Epoka University, Rr. Tiranë-Rinas, Km. 12, Vorë, Tirana 1032, Albania.
| |
Collapse
|
22
|
Mehdipoor G, Jimenez D, Bertoletti L, Del Toro J, Fernández-Capitán C, Bura-Riviere A, Amado C, Valero B, Blanco-Molina Á, Otero R, Imbalzano E, Khorasani R, Prince MR, Bikdeli B, Monreal M. Imaging modalities for confirming pulmonary embolism during pregnancy: results from a multicenter international study. Eur Radiol 2021; 32:1238-1246. [PMID: 34331113 DOI: 10.1007/s00330-021-08161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy. METHODS We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001-02/2020). Imaging modalities included computed tomography pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scan, or presence of signs of acute PE along with imaging-confirmed proximal deep vein thrombosis (pDVT) without pulmonary vascular imaging. We compared the imaging modalities to postpartum patients with PE, and other non-pregnant women with PE. RESULTS There were 157 pregnant patients (age: 32.7 ± 0.5), 228 postpartum patients (age: 33.9 ± 0.5), and 23,937 non-pregnant non-postpartum women (age: 69.5 ± 0.1). CTPA was the most common modality for confirming PE, from 55.7% in first trimester to 58.3% in second trimester, and 70.0% in third trimester. From first trimester to third trimester, V/Q scanning was used in 21.3%, 16.7%, and 18.3% of cases, respectively. Confirmed pDVT along with the presence of signs/symptoms of PE was the confirmatory modality for PE in 21.3% of patients in first trimester, 19.4% in second trimester, and 6.7% in third trimester. The proportion of postpartum patients confirmed with CTPA (85.5%) was comparable to that of non-pregnant non-postpartum women (83.2%). From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with PE diagnosed with CTPA (p = 0.039). CONCLUSION CTPA was the primary modality for confirming PE in all trimesters of pregnancy, although its proportional use was higher in later stages of pregnancy. KEY POINTS • Computed tomography pulmonary angiography (CTPA) was the primary modality of diagnosis in all trimesters of pregnancy among patients with confirmed pulmonary embolism, even in the first trimester. • From the first trimester of pregnancy to postpartum period, there was a linear increase in the proportion of patients with pulmonary embolism who were diagnosed based on CTPA. • In the postpartum period, use of CTPA as the modality to confirm pulmonary embolism was comparable to non-pregnant patients.
Collapse
Affiliation(s)
- Ghazaleh Mehdipoor
- Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA
- Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá, (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France
| | - Jorge Del Toro
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Cristina Amado
- Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
| | - Beatriz Valero
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Remedios Otero
- Department of Pneumonology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, A.O.U Policlinico "G. Martino", Messina, Italy
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, USA
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Behnood Bikdeli
- Cardiovascular Research Foundation (CRF), New York, NY, USA
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Badalona, Spain.
| |
Collapse
|
23
|
Jeng GS, Wang YA, Liu PY, Li PC. Laser-Generated Leaky Acoustic Wave Imaging for Interventional Guidewire Guidance. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2496-2506. [PMID: 33780337 DOI: 10.1109/tuffc.2021.3069474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ultrasound (US) is widely used to visualize both tissue and the positions of surgical instruments in real time during surgery. Previously we proposed a new method to exploit US imaging and laser-generated leaky acoustic waves (LAWs) for needle visualization. Although successful, that method only detects the position of a needle tip, with the location of the entire needle deduced from knowing that the needle is straight. The purpose of the current study was to develop a beamforming-based method for the direct visualization of objects. The approach can be applied to objects with arbitrary shapes, such as the guidewires that are commonly used in interventional guidance. With this method, illumination by a short laser pulse generates photoacoustic waves at the top of the guidewire that propagate down its metal surface. These waves then leak into the surrounding tissue, which can be detected by a US array transducer. The time of flight consists of two parts: 1) the propagation time of the guided waves on the guidewire and 2) the propagation time of the US that leaks into the tissue. In principle, an image of the guidewire can be formed based on array beamforming by taking the propagation time on the metal into consideration. Furthermore, we introduced directional filtering and a matched filter to compress the dispersion signal associated with long propagation times. The results showed that guidewires could be detected at depths of at least 70 mm. The maximum detectable angle was 56.3°. LAW imaging with a 1268-mm-long guidewire was also demonstrated. The proposed method has considerable potential in new clinical applications.
Collapse
|
24
|
Euler A, Taslimi T, Eberhard M, Kobe A, Reeve K, Zimmermann A, Krauss A, Gutjahr R, Schmidt B, Alkadhi H. Computed Tomography Angiography of the Aorta-Optimization of Automatic Tube Voltage Selection Settings to Reduce Radiation Dose or Contrast Medium in a Prospective Randomized Trial. Invest Radiol 2021; 56:283-291. [PMID: 33226202 DOI: 10.1097/rli.0000000000000740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the image quality of low-kV protocols with optimized automatic tube voltage selection (ATVS) settings to reduce either radiation dose or contrast medium (CM) with that of a reference protocol for computed tomography angiography (CTA) of the thoracoabdominal aorta. MATERIALS AND METHODS In this institutional review board-approved, single-center, prospective randomized controlled trial, 126 patients receiving CTA of the aorta were allocated to one of three computed tomography protocols: (A) reference protocol at 120 kVp and standard weight-adapted CM dose; (B) protocol at 90 kVp, reduced radiation and standard CM dose; and (C) protocol at 90 kVp, standard radiation and reduced CM dose. All three protocols were performed on a third-generation dual-source computed tomography scanner using the semimode of the ATVS system. The image-task-dependent optimization settings of the ATVS (slider level) were adjusted to level 11 (high-contrast task) for protocols A and B and level 3 (low-contrast task) for protocol C. Radiation dose parameters were assessed. The contrast-to-noise ratios (CNRs) of protocols B and C were tested for noninferiority compared with A. Subjective image quality was assessed using a 5-point Likert scale. RESULTS Size-specific dose estimate was 34.3% lower for protocol B compared with A (P < 0.0001). Contrast medium was 20.2% lower for protocol C compared with A (P < 0.0001). Mean CNR in B and C was noninferior to protocol A (CNR of 30.2 ± 7, 33.4 ± 6.7, and 30.5 ± 8.9 for protocols A, B, and C, respectively). There was no significant difference in overall subjective image quality among protocols (4.09 ± 0.21, 4.03 ± 0.19, and 4.08 ± 0.17 for protocols A, B, and C, respectively; P = 0.4). CONCLUSIONS The slider settings of an ATVS system can be adjusted to optimize either radiation dose or CM at noninferior image quality in low-kV CTA of the aorta. This optimization could be used to extend future ATVS algorithms to take clinical risk factors like kidney function of individual patients into account.
Collapse
Affiliation(s)
- André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tilo Taslimi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
25
|
Zhang X, Chen J, Yu N, Ren Z, Tian Q, Tian X, Jia Y, He T, Guo C. Reducing contrast medium dose with low photon energy images in renal dual-energy spectral CT angiography and adaptive statistical iterative reconstruction (ASIR). Br J Radiol 2021; 94:20200974. [PMID: 33684310 DOI: 10.1259/bjr.20200974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the value of using low energy (keV) images in renal dual-energy spectral CT angiography (CTA) and adaptive statistical iterative reconstruction (ASIR) to reduce contrast medium dose. METHODS 40 patients with renal CTA on a Discovery CT750HD were randomly divided into two groups: 20 cases (Group A) with 600 mgI kg-1 and 20 cases (Group B) with 300 mgI kg-1. The scan protocol for both groups was: dual-energy mode with mA selection for noise index of 10 HU, pitch 1.375:1, rotating speed 0.6 s/r. Images were reconstructed at 0.625 mm thickness with 40%ASIR, Group A used the conventional 70keV monochromatic images, and Group B used monochromatic images from 40 to 70 keV at 5 keV interval for analysis. The CT values and standard deviation (SD) values of the renal artery and erector spine in the plain and arterial phases were measured with the erector spine SD value representing image noise. The enhancement degree of the renal artery (ΔCT = CT(arterial) -CT(plain)), signal-to-noise ratio (SNR=CTrenal-artery/SDrenal-artery) and contrast-to-noise ratio (CNR=(CTrenal-artery-CTerector spine)/SDerector-spine) were calculated. The single factor analysis of variance was used to analyze the difference of ΔCT, SNR and CNR among image groups with p < 0.05 being statistically significant. The subjective image scores of the groups were assessed blindly by two experienced physicians using a 5-point system and the score consistency was compared by the κ test. RESULTS Contrast medium dose in the 300 mgI kg-1 group was reduced by 50% compared with the 600 mgI kg-1 group, while radiation dose was similar between the two groups. The subjective scores were 4.00 ± 0.65, 4.50 ± 0.60 and 3.70 ± 0.80 for images at 70 keV (600 mgI kg-1 group), 40 keV (300 mgI kg-1 group) and 45 keV (300 mgI kg-1 group), respectively with good consistency between the two reviewers (p > 0.05). The 40 keV images in the 300 mgI kg-1 group had similar ΔCT (469.77 ± 86.95 HU vs 398.54 ± 73.68 HU) and CNR (15.52 ± 3.32 vs 18.78 ± 6.71) values as the 70 keV images in the 600 mgI kg-1) group but higher SNR values (30.19 ± 4.41 vs 16.91 ± 11.12, p < 0,05). CONCLUSION Contrast dose may be reduced by 50% while maintaining image quality by using lower energy images combined with ASIR in renal dual-energy CTA. ADVANCES IN KNOWLEDGE Combined with ASIR and energy spectrum, can reduce the amount of contrast dose in renal CTA.
Collapse
Affiliation(s)
- Xirong Zhang
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Jing Chen
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Nan Yu
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Zhanli Ren
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Qian Tian
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Xin Tian
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Yongjun Jia
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Taiping He
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Changyi Guo
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| |
Collapse
|
26
|
Du H, Shao K, Bao F, Zhang Y, Gao C, Wu W, Zhang C. Automated coronary artery tree segmentation in coronary CTA using a multiobjective clustering and toroidal model-guided tracking method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105908. [PMID: 33373814 DOI: 10.1016/j.cmpb.2020.105908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Accurate coronary artery tree segmentation can now be developed to assist radiologists in detecting coronary artery disease. In clinical medicine, the noise, low contrast, and uneven intensity of medical images along with complex shapes and vessel bifurcation structures make coronary artery segmentation challenging. In this work, we propose a multiobjective clustering and toroidal model-guided tracking method that can accurately extract coronary arteries from computed tomography angiography (CTA) imagery. METHODS Utilizing integrated noise reduction, candidate region detection, geometric feature extraction, and coronary artery tracking techniques, a new segmentation framework for 3D coronary artery trees is presented. The candidate regions are extracted using a multiobjective clustering method, and the coronary arteries are tracked by a toroidal model-guided tracking method. RESULTS The qualitative and quantitative results demonstrate the effectiveness of the presented framework, which achieves better performance than the compared segmentation methods in three widely used evaluation indices: the Dice similarity coefficient (DSC), Jaccard index and Recall across the CTA data. The proposed method can accurately identify the coronary artery tree with a mean DSC of 84%, a Jaccard index of 74%, and a Recall of 93%. CONCLUSIONS The proposed segmentation framework effectively segments the coronary tree from the CTA volume, which improves the accuracy of 3D vascular tree segmentation.
Collapse
Affiliation(s)
- Hongwei Du
- School of Mathmatics, Shandong University, Jinan, Shandong 250100, China; Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China
| | - Kai Shao
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University of Finance and Economics, Jinan, Shandong 250014, China
| | - Fangxun Bao
- School of Mathmatics, Shandong University, Jinan, Shandong 250100, China.
| | - Yunfeng Zhang
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University of Finance and Economics, Jinan, Shandong 250014, China
| | - Chengyong Gao
- School of Physics, Shandong University, Jinan, Shandong 250100, China
| | - Wei Wu
- Department of Cerebrovascular Diseases, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Caiming Zhang
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University, Jinan, Shandong 250101, China
| |
Collapse
|
27
|
Shah NR, Pierce JD, Kikano EG, Rahnemai-Azar AA, Gilkeson RC, Gupta A. CT Coronary Angiography Fractional Flow Reserve: New Advances in the Diagnosis and Treatment of Coronary Artery Disease. Curr Probl Diagn Radiol 2020; 50:925-936. [PMID: 33041159 DOI: 10.1067/j.cpradiol.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
Coronary artery disease (CAD) remains the most common cardiovascular disease, accounting for 6% of all Emergency Department visits and 27% of all Emergency Department hospitalizations.1 Invasive coronary angiography with fractional flow reserve (FFR) remains the gold standard to assess for hemodynamically stenosis in CAD patients. However, for low- and intermediate-risk patients, noninvasive modalities have started to gain favor as patients with stable CAD who received optimal medical therapy did as well as patients who underwent percutaneous coronary intervention.2 This led to the incorporation of FFRCT. cCTA provides good spatial resolution for evaluating stenosis. FFR provides additional information regarding whether the stenosis is hemodynamically significant. FFR is the ratio of maximum blood flow in a stenotic artery to the maximum blood flow through that artery without stenosis.3 Computational fluid dynamics involved in FFRCT is based on Navier-Stokes equations, allowing the assessment of pressure and flow across coronary arteries. Limitations do exist with FFRCT which includes false-positive results due to step artifact and left ventricular hypertrophy, as well as manual segmentation and ostial stenosis, which can cause false-negative results. However, there are improvements on the horizon including artificial intelligence-driven computation of FFR and the utilization of virtual stenting for surgical planning. The purpose of this review is to describe the clinical validation, underlying mechanism, and implementation of FFRCT.
Collapse
Affiliation(s)
- Neal R Shah
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH.
| | - Jonathan D Pierce
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH
| | - Elias G Kikano
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH
| | - Amir Ata Rahnemai-Azar
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH
| | - Robert C Gilkeson
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH
| | - Amit Gupta
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH
| |
Collapse
|
28
|
Yadav V, Khanduri S, Yadav P, Pandey S, Tyagi E, Yadav H, Krishnam A, Hamza M. Diagnostic Accuracy of Color Doppler and Calcium Scoring versus Dual-Energy Computed Tomography Angiography in the Assessment of Peripheral Arterial Diseases of Lower Limb. J Clin Imaging Sci 2020; 10:45. [PMID: 32874750 PMCID: PMC7451140 DOI: 10.25259/jcis_77_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/29/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Peripheral arterial disease (PAD) leads to narrowing and hardening of arteries which leads to increased risk of lower extremity amputation. Hence, the accuracy of non-invasive diagnostic methods such as calcium scoring and color Doppler needs to be assessed in comparison to the gold standard dual-energy computed tomography (DECT) angiography. This study aims to evaluate the accuracy of color Doppler and calcium scoring when compared to DECT angiography in the assessment of PAD of the lower limb. It is a cross- sectional retrospective study. Material and Methods The study included 55 patients aged between 40 and 70 years. All the patients with symptoms suggestive of PAD underwent color Doppler study of lower limb arterial system. Afterward, the patient underwent CT angiography. The first plain images were taken for calcium scoring following which contrast was given and further images were taken. Results As compared to CT angiography assessment, Doppler assessment was 88.1% sensitive but only 69.2% specific with diagnostic accuracy of 83.6%. For angiographically detected atheromatous changes, color Doppler had sensitivity and specificity of 86.2% and 76.9%. The derived cutoff value >149.1 of calcium score in lower limb arteries was in 100% agreement with CT angiography detected PAD, whereas, for atheromatous changes, total calcium score at a cutoff value of >842.2 had sensitivity and specificity of 75.9% and 80.8%. Conclusion Calcium scoring as compared to color Doppler has a higher diagnostic efficacy for the detection of DECT angiography confirmed PAD, whereas calcium score lacks adequate sensitivity at projected cutoff in the evaluation of atheromatous changes.
Collapse
Affiliation(s)
- Vivek Yadav
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Sachin Khanduri
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Poonam Yadav
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Sushma Pandey
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Ekta Tyagi
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Harsh Yadav
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Anvit Krishnam
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Minal Hamza
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| |
Collapse
|
29
|
Adekanmi A, Balogun J, Adenigba P. Cranial tomographic angiographic evaluation of suspected intracranial vascular abnormalities among a Nigerian cohort. WEST AFRICAN JOURNAL OF RADIOLOGY 2020. [DOI: 10.4103/wajr.wajr_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Of Mice and Roentgen: Radiologist Satisfaction with a Non-conventional 13-Button Mouse-One Institution's Experience. J Digit Imaging 2019; 31:776-782. [PMID: 29869010 DOI: 10.1007/s10278-018-0094-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Increasing radiologic exam volume and complexity necessitates leveraging advanced hardware solutions to optimize workflow efficiency. We evaluated radiologist satisfaction of a programmable 13-button non-conventional mouse compared to a conventional three-button mouse in daily interpretation workflow following a brief 2-day trial period. A prospective study was conducted with radiology staff and residents in a tertiary care center from 2015 to 2016. A survey was distributed prior to and after a tutorial and a 2-day non-conventional mouse trial period. The post-survey evaluated usage time, device settings, satisfaction, preferences, and perceived efficiency of both mice. Descriptive analyses, correlations, the Sign test, and the Wilcoxon signed-rank test were used to evaluate responses. Fifty-nine participants completed pre- and post-surveys. Several (41%, n = 24) had prior experience with a non-conventional mouse. Prior to the trial, one third of all participants (35.6%, n = 21) reported being satisfied or very satisfied with their conventional mouse. After spending an average of 9.8 h using the non-conventional mouse, there were no statistically significant changes in overall satisfaction with either conventional or non-conventional mice (p = 0.84 and p = 0.39, respectively). However, 76.3% (n = 45) agreed/somewhat agreed they preferred to use the non-conventional mouse in their daily workflow as opposed to the conventional mouse. The non-conventional mouse was also perceived as more efficient (66.1%, n = 39), required less time (62.7%, n = 37) and effort (74.6%, n = 44) to view images, allowed for easier manipulation of windows/images (76.3%, n = 45), and was more comfortable to use (78.0%, n = 46). Although there were no statistically significant shifts in overall satisfaction, participants reported a higher level of satisfaction, perceived efficiency, and preference for a non-conventional 13-button mouse compared to a conventional three-button mouse following a brief, 2-day trial period.
Collapse
|
31
|
Zealley I, Wang H, Donnan PT, Bell S. Exposure to contrast media in the perioperative period confers no additional risk of acute kidney injury in surgical patients. Nephrol Dial Transplant 2019; 33:1751-1756. [PMID: 29237046 DOI: 10.1093/ndt/gfx325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Iodinated contrast media (CM) used in angiography and computed tomography (CT) scans is an important cause of acute kidney injury (AKI) in hospitalized patients undergoing surgery. Contrast-induced nephropathy leads to AKI soon after CM administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate perioperative period influences the risk of post-operative AKI. Methods All patients aged 18 years or above who underwent diagnostic imaging within 7 days of non-cardiac surgery between 1 January 2003 and 31 December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the Kidney Disease: Improving Global Outcomes creatinine-based criteria. Multiple logistic regressions were performed to identify predictors for AKI. Results Of 9300 patients, 6224 were exposed to CM in the immediate perioperative period and 3076 were not. Post-operative AKI occurred in 678 (10.9%) of the 6224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Timing of CM exposure did not affect risk of developing AKI, odds ratio 0.972 (95% confidence interval 0.935-1.010), P = 0.146. Conclusions For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of CM. These patients may benefit from the increased diagnostic utility of contrast-enhanced CT scans without increasing their risk of perioperative AKI.
Collapse
Affiliation(s)
- Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Huan Wang
- Population Health Sciences, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Population Health Sciences, University of Dundee, Dundee, UK
| | - Samira Bell
- Population Health Sciences, University of Dundee, Dundee, UK.,Renal Unit, Ninewells Hospital, Dundee, UK
| |
Collapse
|
32
|
Harvey EC, Feng M, Ji X, Zhang R, Li Y, Chen GH, Li K. Impacts of photon counting CT to maximum intensity projection (MIP) images of cerebral CT angiography: theoretical and experimental studies. Phys Med Biol 2019; 64:185015. [PMID: 31315093 DOI: 10.1088/1361-6560/ab32fe] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While CTA is an established clinical gold standard for imaging large cerebral arteries and veins, an important challenge that currently remains for CTA is its limited performance in imaging small perforating arteries with diameters below 0.5 mm. The purpose of this work was to theoretically and experimentally study the potential benefits of using photon counting detector (PCD)-based CT (PCCT) to improve the performance of CTA in imaging these small arteries. In particular, the study focused on an important component of the CTA image package known as the maximum intensity projection (MIP) image. To help understand how the physical properties of a detector quantitatively influence the MIP image quality, a theoretical model on the statistical properties of MIP images was developed. After validating this model, it was used to explore the individual and joint contribution of the following detector properties to the MIP signal-to-noise ratio (SNR): inter-slice noise covariance, spatial resolution along the z direction, and native pixel pitch along z. The model demonstrated that superior slice sensitivity, reduced inter-slice noise correlation, and smaller native pixel pitch along z provided by PCDs lead to improved vessel SNR in MIP images. Finally, experiments were performed by scanning an anthropomorphic cerebral angiographic phantom using a benchtop PCCT system and a commercial MDCT system. The experimental MIP results consistently demonstrated that compared with MDCT, PCCT provides superior vessel conspicuity and reduced artifactual stenosis.
Collapse
Affiliation(s)
- Evan Cary Harvey
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
| | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Background 3D printing has shown great promise in cardiovascular disease, with reports mainly focusing on pre-surgical planning and medical education. Research on utilization of 3D printed models in simulating coronary stenting has not been reported. In this study, we presented our experience of placing coronary stents into personalized 3D printed coronary models with the aim of determining stent lumen visibility with images reconstructed with different postprocessing views and algorithms. Methods A total of six coronary stents with diameter ranging from 2.5 to 4.0 mm were placed into 3 patient-specific 3D printed coronary models for simulation of coronary stenting. The 3D printed models were placed in a plastic container and scanned on a 192-slice third generation dual-source CT scanner with images reconstructed with soft (Bv36) and sharp (Bv59) kernel algorithms. Thick and thin slab maximum-intensity projection (MIP) images were also generated from the original CT data for comparison of stent lumen visibility. Stent lumen diameter was measured on 2D axial and MIP images, while stent diameter was measured on 3D volume rendering images. 3D virtual intravascular endoscopy (VIE) images were generated to provide intraluminal views of the coronary wall and stent appearances. Results All of these stents were successfully placed into the right and left coronary arteries but 2 of them did not obtain wall apposition along the complete length. The stent lumen visibility ranged from 54 to 97%, depending on the stent location in the coronary arteries. The mean stent lumen diameters measured on 2D axial, thin and thick slab MIP images were found to be significantly smaller than the actual size (P<0.01). Thick slab MIP images resulted in measured stent lumen diameters smaller than those from thin slab MIP images, with significant differences noticed in most of the measurements (4 out of 6 stents) (P<0.05), and no significant differences in the remaining 2 stents (P=0.19-0.38). In contrast, 3D volume rendering images allowed for more accurate measurements with measured stent diameters close to the actual dimensions in most of these coronary stents, except for the stent placed at the right coronary artery in one of the models due to insufficient expansion of the stent. Images reconstructed with sharp kernel Bv59 significantly improved stent lumen visibility when compared to the smooth Bv36 kernel (P=0.01). 3D VIE was successfully generated in all of the datasets with clear visualization of intraluminal views of the stents in relation to the coronary wall. Conclusions This preliminary report shows the feasibility of using 3D printed coronary artery models in coronary stenting for investigation of optimal coronary CT angiography protocols. Future studies should focus on placement of more stents with a range of stent diameters in the quest to reduce the need for invasive angiography for surveillance.
Collapse
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, 6845, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia 6845, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia 6009, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Perth, Western Australia 6009, Australia
| |
Collapse
|
34
|
Son GM, Kim TU, Park BS, Jung HJ, Lee SS, Yoon JU, Lee JW. Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients. Ann Surg Treat Res 2019; 97:74-82. [PMID: 31388509 PMCID: PMC6669131 DOI: 10.4174/astr.2019.97.2.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. Methods This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. Results Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. Conclusion Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.
Collapse
Affiliation(s)
- Gyung Mo Son
- Department of Surgery, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, School of Medicine, Pusan National University, Yangsan, Korea
| | - Byung-Soo Park
- Department of Surgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hyuk Jae Jung
- Department of Surgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Su Lee
- Department of Surgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Jun Woo Lee
- Department of Radiology, School of Medicine, Pusan National University, Yangsan, Korea
| |
Collapse
|
35
|
Tzolos E, Newby DE. Coronary Computed Tomography Angiography Improving Outcomes in Patients with Chest Pain. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12:15. [PMID: 33442442 PMCID: PMC7116579 DOI: 10.1007/s12410-019-9492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of Review To provide an overview of recent studies of coronary computed tomography angiography (CCTA) and how it has helped to improve clinical outcomes for patients presenting with chest pain. Recent Findings Randomised controlled trials have uniformly demonstrated that the use of CCTA is associated with improvements in patient diagnosis, management and treatments as well as the avoidance of unnecessary invasive coronary angiography. These changes have been associated with consistent reductions in long-term rates of fatal or non-fatal myocardial infarction. Summary Major beneficial effects in clinical management and patient outcomes are seen with the use of coronary computed tomography angiography. CCTA might be considered to be the first test of choice for the investigation of coronary heart disease.
Collapse
Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, Edinburgh EH16 4SA, Scotland, UK
| | - David E. Newby
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, Edinburgh EH16 4SA, Scotland, UK
| |
Collapse
|
36
|
Individualized Delay for Abdominal Computed Tomography Angiography Bolus-Tracking Based on Sequential Monitoring. J Comput Assist Tomogr 2019; 43:612-618. [DOI: 10.1097/rct.0000000000000874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Abstract
Computed tomography angiography (CTA) has the ability to evaluate the aortic wall and the lumen easily, quickly, and reproducibly without the need for invasive techniques. The images are isotropic, allowing several reconstructions. When imaging the aorta, CTA has replaced catheter angiography in the diagnosis of acquired disease such as aortoiliac disease, aneurysm, and infectious and inflammatory disease of the aorta.
Collapse
Affiliation(s)
- Xhorlina Marko
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL 33176, USA
| | - Constantino S Peña
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL 33176, USA.
| |
Collapse
|
38
|
Zhao F, Wu B, Chen F, Cao X, Yi H, Hou Y, He X, Liang J. An automatic multi-class coronary atherosclerosis plaque detection and classification framework. Med Biol Eng Comput 2018; 57:245-257. [PMID: 30088125 DOI: 10.1007/s11517-018-1880-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Detection of different classes of atherosclerotic plaques is important for early intervention of coronary artery diseases. However, previous methods focused either on the detection of a specific class of coronary plaques or on the distinction between plaques and normal arteries, neglecting the classification of different classes of plaques. Therefore, we proposed an automatic multi-class coronary atherosclerosis plaque detection and classification framework. Firstly, we retrieved the transverse cross sections along centerlines from the computed tomography angiography. Secondly, we extracted the region of interests based on coarse segmentation. Thirdly, we extracted a random radius symmetry (RRS) feature vector, which incorporates multiple descriptions into a random strategy and greatly augments the training data. Finally, we fed the RRS feature vector into the multi-class coronary plaque classifier. In experiments, we compared our proposed framework with other methods on the cross sections of Rotterdam Coronary Datasets, including 729 non-calcified plaques, 511 calcified plaques, and 546 mixed plaques. Our RRS with support vector machine outperforms the intensity feature vector and the random forest classifier, with the average precision of 92.6 ± 1.9% and average recall of 94.3 ± 2.1%. The proposed framework provides a computer-aided diagnostic method for multi-class plaque detection and classification. Graphical abstract Diagram of the proposed automatic multi-class coronary atherosclerosis plaque detection and classification framework. ᅟ.
Collapse
Affiliation(s)
- Fengjun Zhao
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Bin Wu
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Fei Chen
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710071, Shaanxi, China
| | - Xin Cao
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Huangjian Yi
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Yuqing Hou
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Xiaowei He
- School of Information Sciences and Technology, Northwest University, Xi'an, 710069, Shaanxi, China.
| | - Jimin Liang
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710071, Shaanxi, China.
| |
Collapse
|
39
|
Fang W, Wang CH, Yu YF, Wang LH, Tang DH, Xu DB, Ding ZY, Gu WH. The feasibility of 1-stop examination of coronary CT angiography and abdominal enhanced CT. Medicine (Baltimore) 2018; 97:e11651. [PMID: 30095622 PMCID: PMC6133558 DOI: 10.1097/md.0000000000011651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the feasibility of performing coronary computed tomography angiography (CCTA) and abdominal enhanced computed tomography (CT) with 1-time injection of the agent.CCTA images (right coronary artery, left anterior descending coronary artery, and left circumflex coronary artery) were collected from 20 patients who completed a 1-stop combined examination of CCTA and abdominal enhanced CT (group A), 20 patients who only underwent abdominal enhanced CT (group B1), and 20 patients who only underwent CCTA (group B2). These images were interpreted using the 5-point Likert scale system by 2 experienced radiologists, and abdominal images were observed for breathing artifact. CT value, signal-to-noise ratio (SNR), and CTDI were recorded and compare among the 3 groups.The difference in image quality of the coronary and total volume of the contrast agent between group A and group B1 was not statistical significant (P > .05). The CT value and SNR in group B1 (CCTA) (CT: 394.65 ± 59.23, SNR: 17.38 ± 4.13) increased, compare with Group A (CT: 360.35 ± 34.16, SNR: 13.76 ± 1.84, P = .03, .01), while CTDI was undifferentiated between group A (17.14 ± 6.20) and group B1 (18.38 ± 9.79) (P = .64). The difference in CT value and SNR at the arterial phase and CT value at the venous phase between group A (abdomen) and group B2 were statistically significant, the CTDI in group A (9.09 ± 1.05) increased, compared with group B2 (8.23 ± 1.33) (P = .03), and SNR at the venous phase in group B2 (12.50 ± 2.43) increased, compared with group A (10.89 ± 2.03) (P = .03).Revolution CT can capture full images and very rapidly switch to the scan mode, enabling a 1-stop axial CCTA and enhanced helical abdominal scan. The 1-stop combined scan resulted in a satisfactory image quality, which reduced the contrast agent dose and simplified the workflow.The 1-stop combined scan allows for the high success rate of the examination, reduces the number of examinations, and decreases the dose and risk of injection of the contrast agent. This would be helpful for patients to obtain diagnostic images in time.
Collapse
|
40
|
De Santis D, Eid M, De Cecco CN, Jacobs BE, Albrecht MH, Varga-Szemes A, Tesche C, Caruso D, Laghi A, Schoepf UJ. Dual-Energy Computed Tomography in Cardiothoracic Vascular Imaging. Radiol Clin North Am 2018; 56:521-534. [PMID: 29936945 DOI: 10.1016/j.rcl.2018.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual energy computed tomography is becoming increasingly widespread in clinical practice. It can expand on the traditional density-based data achievable with single energy computed tomography by adding novel applications to help reach a more accurate diagnosis. The implementation of this technology in cardiothoracic vascular imaging allows for improved image contrast, metal artifact reduction, generation of virtual unenhanced images, virtual calcium subtraction techniques, cardiac and pulmonary perfusion evaluation, and plaque characterization. The improved diagnostic performance afforded by dual energy computed tomography is not associated with an increased radiation dose. This review provides an overview of dual energy computed tomography cardiothoracic vascular applications.
Collapse
Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Marwen Eid
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Lazarettstraße 36, Munich 80636, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
| |
Collapse
|
41
|
Riffel P, Haubenreisser H, Higashigaito K, Alkadhi H, Morelli JN, Alber B, Schoenberg SO, Henzler T. Combined Static and Dynamic Computed Tomography Angiography of Peripheral Artery Occlusive Disease: Comparison with Magnetic Resonance Angiography. Cardiovasc Intervent Radiol 2018; 41:1205-1213. [PMID: 29484465 DOI: 10.1007/s00270-018-1911-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare in patients with known peripheral artery occlusive disease (PAOD), image quality of a combined CTA to a combined MRA protocol, including both static and dynamic acquisitions. MATERIALS AND METHODS Twenty-two patients with PAOD were examined with a combined CTA and MRA protocol consisting of static acquisitions (s-CTA, s-MRA) of the entire runoff and dynamic acquisitions (d-CTA, d-MRA) of the calves. Two radiologists compared image quality of the s-MRA versus s-CTA as well as d-MRA versus d-CTA. Image quality was assessed on a segmental basis using a 4-point Likert scale. RESULTS For s-CTA, 76% of segments were rated as excellent or good. For s-MRA, 50% of segments were rated as excellent or good (p < 0.0001). For d-CTA, median image quality score for all segments was rated as excellent for both readers. For d-MRA, median image quality for the different segments ranged from moderate to good. For both d-CTA and d-MRA, the median image quality scores were significantly higher for all segments of the lower limb compared with the static examinations of the lower limb segments (all p values < 0.0001). In patients with PAOD category 4-6, 80% of segments were rated as excellent or good for d-CTA, while 45% of segments were rated as poor or non-diagnostic for d-MRA. CONCLUSION In patients with known PAOD, a combined static and dynamic CTA examination improves image quality relative to static and dynamic MRA and should be considered as an alternative to MRA, particularly in patients with advanced stage PAOD.
Collapse
Affiliation(s)
- Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Bettina Alber
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
42
|
Multipath Curved Planar Reformations of Peripheral CT Angiography: Diagnostic Accuracy and Time Efficiency. Cardiovasc Intervent Radiol 2017; 41:718-725. [PMID: 29218656 PMCID: PMC5876266 DOI: 10.1007/s00270-017-1846-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022]
Abstract
Objectives To compare diagnostic performance and time efficiency between 3D multipath curved planar reformations (mpCPRs) and axial images of CT angiography for the pre-interventional assessment of peripheral arterial disease (PAD), with digital subtraction angiography as the standard of reference. Methods Forty patients (10 females, mean age 72 years), referred to CTA prior to endovascular treatment of PAD, were prospectively included and underwent peripheral CT angiography. A semiautomated toolbox was used to render mpCPRs. Twenty-one arterial segments were defined in each leg; for each segment, the presence of stenosis > 70% was assessed on mpCPRs and axial images by two readers, independently, with digital subtraction angiography as gold standard. Results Both readers reached lower sensitivity (Reader 1: 91 vs. 94%, p = 0.08; Reader 2: 89 vs. 93%, p = 0.03) but significantly higher specificity (Reader 1: 94 vs. 89%, p < 0.01; Reader 2: 96 vs. 95%, p = 0.01) with mpCPRs than with axial images. Reader 1 achieved significantly higher accuracy with mpCPRs (93 vs. 91%, p = 0.02), and Reader 2 had similar overall accuracy in both evaluations (94 vs. 94%, p = 0.96). Both readers read mpCPRs significantly faster than axial images (Reader 1: 5′45″ based on mpCPRs vs. 7′40″ based on axial images; Reader 2: 4′41″ based on mpCPRs vs. 6′57″ based on axial images; p < 0.01). Conclusions mpCPRs are a promising 3D reformation technique that facilitates a fast assessment of PAD with high diagnostic accuracy. Electronic supplementary material The online version of this article (10.1007/s00270-017-1846-3) contains supplementary material, which is available to authorized users.
Collapse
|
43
|
Barrett HE, Cunnane EM, O Brien JM, Moloney MA, Kavanagh EG, Walsh MT. On the effect of computed tomography resolution to distinguish between abdominal aortic aneurysm wall tissue and calcification: A proof of concept. Eur J Radiol 2017; 95:370-377. [PMID: 28987694 DOI: 10.1016/j.ejrad.2017.08.023] [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: 06/03/2017] [Revised: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study is to determine the optimal target CT spatial resolution for accurately imaging abdominal aortic aneurysm (AAA) wall characteristics, distinguishing between tissue and calcification components, for an accurate assessment of rupture risk. MATERIALS AND METHODS Ruptured and non-ruptured AAA-wall samples were acquired from eight patients undergoing open surgical aneurysm repair upon institutional review board approval and informed consent was obtained from all patients. Physical measurements of AAA-wall cross-section were made using scanning electron microscopy. Samples were scanned using high resolution micro-CT scanning. A resolution range of 15.5-155μm was used to quantify the influence of decreasing resolution on wall area measurements, in terms of tissue and calcification. A statistical comparison between the reference resolution (15.5μm) and multi-detector CT resolution (744μm) was also made. RESULTS Electron microscopy examination of ruptured AAAs revealed extremely thin outer tissue structure <200μm in radial distribution which is supporting the aneurysm wall along with large areas of adjacent medial calcifications far greater in area than the tissue layer. The spatial resolution of 155μm is a significant predictor of the reference AAA-wall tissue and calcification area measurements (r=0.850; p<0.001; r=0.999; p<0.001 respectively). The tissue and calcification area at 155μm is correct within 8.8%±1.86 and 26.13%±9.40 respectively with sensitivity of 87.17% when compared to the reference. CONCLUSION The inclusion of AAA-wall measurements, through the use of high resolution-CT will elucidate the variations in AAA-wall tissue and calcification distributions across the wall which may help to leverage an improved assessment of AAA rupture risk.
Collapse
Affiliation(s)
- H E Barrett
- Centre for Applied Biomedical Engineering Research (CABER), Health Research Institute (HRI), School of Engineering, Bernal Institute, University of Limerick, Lonsdale Building, Limerick, Ireland
| | - E M Cunnane
- Centre for Applied Biomedical Engineering Research (CABER), Health Research Institute (HRI), School of Engineering, Bernal Institute, University of Limerick, Lonsdale Building, Limerick, Ireland
| | - J M O Brien
- Department of Radiology, University Hospital Limerick, Ireland
| | - M A Moloney
- Department of Vascular Surgery, University Hospital Limerick, Ireland
| | - E G Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Ireland
| | - M T Walsh
- Centre for Applied Biomedical Engineering Research (CABER), Health Research Institute (HRI), School of Engineering, Bernal Institute, University of Limerick, Lonsdale Building, Limerick, Ireland.
| |
Collapse
|
44
|
Troxler R, Minoiu C, Vaucher P, Michaud K, Doenz F, Ducrot K, Grabherr S. The role of angiography in the congruence of cardiovascular measurements between autopsy and postmortem imaging. Int J Legal Med 2017; 132:249-262. [PMID: 28741057 DOI: 10.1007/s00414-017-1652-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postmortem CT angiography is the method of choice for the postmortem imaging investigations of the cardiovascular (CV) system. However, autopsy still remains the gold standard for CV measurement. Nevertheless, there are not any studies on CV measurements on the multi-phase postmortem angiography (MPMCTA) which includes comparisons with autopsy. Therefore, the aim of this study is to compare CV measurements between the native CT scan and the three phases of the MPMCTA to find out which of these modalities correlate the best with autopsy measurements. METHODS For this study, we selected retrospectively 50 postmortem cases that underwent both MPMCTA and autopsy. A comparison was carried out between the CV measurements obtained with imaging (aorta; heart cavities and cardiac wall thicknesses; maximum cardiac diameter and cardiothoracic ratio) and at the autopsy (aorta; cardiac valves, ventricular thicknesses, and weight). RESULTS Our results show that the dynamic phase displays an advantage for the measurement of the aortas. However, the MPMCTA is not accurate to measure the cardiac wall thicknesses. The measurements of the heart cavities show no correlation with the heart valves. The cardiothoracic ratio measured by the MPMCTA shows no correlation with the heart weight. Nevertheless, the maximum cardiac diameter exhibits a correlation with the latter on the venous and dynamic phase. CONCLUSIONS These results show that only few CV parameters measured with imaging correlate with measurement obtained at the autopsy. These results indicate that in order to better estimate values obtained at the autopsy, we need to define new reference values for the CV measurement on MPMCTA.
Collapse
Affiliation(s)
- Renaud Troxler
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Costin Minoiu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Paul Vaucher
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.,School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Rue des Cliniques 15, 1700, Fribourg, Switzerland
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Francesco Doenz
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kewin Ducrot
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.
| |
Collapse
|
45
|
Baumann S, Kryeziu P, Rutsch M, Lossnitzer D. Coronary Computed Tomography Angiography. Interv Cardiol 2017. [DOI: 10.5772/67800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
46
|
Presence, Characteristics, and Volumes of Coronary Plaque Determined by Computed Tomography Angiography in Young Type 2 Diabetes Mellitus. Am J Cardiol 2017; 119:1566-1571. [PMID: 28343599 DOI: 10.1016/j.amjcard.2017.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/22/2022]
Abstract
Prevention and management of coronary artery disease (CAD) is of great concern in patients with diabetes mellitus. Although the impact of coronary atherosclerosis is described well for subjects older than 40 years, the prevalence and types of coronary atherosclerosis in young patients are not well known. The aim of this study was to evaluate the prevalence, extent, severity, and volumes of coronary plaque in type 2 diabetes mellitus (T2DM) population younger than of 40 years. This prospective study enrolled 181 subjects (25-40 year old) undergoing coronary computed tomography angiography, with 86 T2DM and 95 nondiabetic age/gender-matched subjects. Coronary artery calcium (CAC), plaque assessment including total segment stenosis (sum of individual segmental stenosis), total plaque scores (sum of semiquantitative segmental plaque burden), segment involvement scores (number of segments with plaque) were evaluated. In addition, we quantitatively measured plaque volumes in total, fibrous, fibrous fatty, dense calcified, and low-attenuation plaque using novel plaque software. Compared with nondiabetic patients, the prevalence of CAD, calcified, and noncalcified plaques was higher in patients with T2DM (19% vs 58%; p <0.001). In patients with a zero CAC, T2DM had a higher prevalence (46%) of noncalcified plaque (p <0.0001). In multivariate linear regression models after adjusting for traditional cardiovascular risk factors, increased total segmental stenosis, total plaque scores, and segment involvement scores were associated with T2DM. Regarding quantitative plaque assessment, all volumes in noncalcified plaque type were approximately threefold higher in patients with T2DM. In conclusion, young patients with T2DM are susceptible to premature CAD with more calcified and noncalcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying young diabetic patients with subclinical atherosclerosis.
Collapse
|
47
|
Tailored Duration of Contrast Material Injection in High-Pitch Computed Tomographic Aortography With a Double-Level Test Bolus Method. Invest Radiol 2017; 52:274-280. [DOI: 10.1097/rli.0000000000000340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
48
|
A Comparison of the Image Quality and Radiation Dose With Routine Computed Tomography and the Latest Gemstone Spectral Imaging Combination of Different Scanning Protocols in Computed Tomography Angiography of the Kidney. J Comput Assist Tomogr 2017; 41:263-270. [PMID: 27824666 DOI: 10.1097/rct.0000000000000510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of our study was to compare the image quality and radiation dose of computed tomography angiography (CTA) of the kidney in patients with different body mass indexes using routine CT and the latest gemstone spectral imaging (GSI) combination of different scanning protocols with the adaptive statistical iterative reconstruction 2.0 algorithm. METHODS A total of 90 patients who had undergone a CTA of the kidney were divided into 3 groups (A, B, and C), with 30 patients in each group. Group A underwent a routine CT examination, whereas groups B and C underwent GSI with different scanning protocols. All images were restructured using the adaptive statistical iterative reconstruction 2.0. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were calculated when the kidney CTA was completed. Each subjective image evaluation used a 5-point scoring method and was conducted by 2 independent radiologists. The CT dose index of volume and the dose-length product were recorded, and the mean value was calculated. The dose-length product was converted to the effective dose. All data were compared with a 1-way analysis of variance. RESULTS The SNR, CNR, and subjective image quality in group A were significantly lower than those in groups B and C (P < 0.01). There were no significant differences in SNR, CNR, and subjective image quality between groups B and C. The effective dose of group C decreased by 46.05% and 15.03% relative to those of groups A and B, respectively (P < 0.01). CONCLUSIONS The latest GSI with different scanning protocols can more effectively reduce the radiation dose than can the routine CT scan mode for a kidney CTA while still maintaining diagnostic image quality.
Collapse
|
49
|
CT angiography of the kidney using routine CT and the latest Gemstone Spectral Imaging combination of different noise indexes: image quality and radiation dose. Radiol Med 2017; 122:327-336. [DOI: 10.1007/s11547-017-0739-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
|
50
|
Tailor TD, Kicska GA, Jacobs JE, Pampaloni MH, Litmanovich DE, Reddy GP. Imaging of Heart Disease in Women. Radiology 2017; 282:34-53. [DOI: 10.1148/radiol.2016151643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|