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Orii M, Sone M, Osaki T, Ueyama Y, Chiba T, Sasaki T, Yoshioka K. Super-resolution deep learning reconstruction at coronary computed tomography angiography to evaluate the coronary arteries and in-stent lumen: an initial experience. BMC Med Imaging 2023; 23:171. [PMID: 37904089 PMCID: PMC10617195 DOI: 10.1186/s12880-023-01139-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/25/2023] [Indexed: 11/01/2023] Open
Abstract
A super-resolution deep learning reconstruction (SR-DLR) algorithm trained using data acquired on the ultrahigh spatial resolution computed tomography (UHRCT) has the potential to provide better image quality of coronary arteries on the whole-heart, single-rotation cardiac coverage on a 320-detector row CT scanner. However, the advantages of SR-DLR at coronary computed tomography angiography (CCTA) have not been fully investigated. The present study aimed to compare the image quality of the coronary arteries and in-stent lumen between SR-DLR and model-based iterative reconstruction (MBIR). We prospectively enrolled 70 patients (median age, 69 years; interquartile range [IQR], 59-75 years; 50 men) who underwent CCTA using a 320-detector row CT scanner between January and August 2022. The image noise in the ascending aorta, left atrium, and septal wall of the ventricle was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal coronary arteries were calculated. Of the twenty stents, stent strut thickness and luminal diameter were quantitatively evaluated. The image noise on SR-DLR was significantly lower than that on MBIR (median 22.1 HU; IQR, 19.3-24.9 HU vs. 27.4 HU; IQR, 24.2-31.2 HU, p < 0.01), whereas the SNR (median 16.3; IQR, 11.8-21.8 vs. 13.7; IQR, 9.9-18.4, p = 0.01) and CNR (median 24.4; IQR, 15.5-30.2 vs. 19.2; IQR, 14.1-23.2, p < 0.01) on SR-DLR were significantly higher than that on MBIR. Stent struts were significantly thinner (median, 0.68 mm; IQR, 0.61-0.78 mm vs. 0.81 mm; IQR, 0.72-0.96 mm, p < 0.01) and in-stent lumens were significantly larger (median, 1.84 mm; IQR, 1.65-2.26 mm vs. 1.52 mm; IQR, 1.28-2.25 mm, p < 0.01) on SR-DLR than on MBIR. Although further large-scale studies using invasive coronary angiography as the reference standard, comparative studies with UHRCT, and studies in more challenging population for CCTA are needed, this study's initial experience with SR-DLR would improve the utility of CCTA in daily clinical practice due to the better image quality of the coronary arteries and in-stent lumen at CCTA compared with conventional MBIR.
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Affiliation(s)
- Makoto Orii
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan.
| | - Misato Sone
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takeshi Osaki
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Yuta Ueyama
- Center for Radiological Science, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takuya Chiba
- Center for Radiological Science, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Tadashi Sasaki
- Center for Radiological Science, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Kunihiro Yoshioka
- Department of Radiology, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
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Tatsugami F, Higaki T, Nakamura Y, Yu Z, Zhou J, Lu Y, Fujioka C, Kitagawa T, Kihara Y, Iida M, Awai K. Deep learning-based image restoration algorithm for coronary CT angiography. Eur Radiol 2019; 29:5322-5329. [PMID: 30963270 DOI: 10.1007/s00330-019-06183-y] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/09/2019] [Accepted: 03/19/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the image quality of coronary computed tomography angiography (CTA) subjected to deep learning-based image restoration (DLR) method with images subjected to hybrid iterative reconstruction (IR). METHODS We enrolled 30 patients (22 men, 8 women) who underwent coronary CTA on a 320-slice CT scanner. The images were reconstructed with hybrid IR and with DLR. The image noise in the ascending aorta, left atrium, and septal wall of the ventricle was measured on all images and the contrast-to-noise ratio (CNR) in the proximal coronary arteries was calculated. We also generated CT attenuation profiles across the proximal coronary arteries and measured the width of the edge rise distance (ERD) and the edge rise slope (ERS). Two observers visually evaluated the overall image quality using a 4-point scale (1 = poor, 4 = excellent). RESULTS On DLR images, the mean image noise was lower than that on hybrid IR images (18.5 ± 2.8 HU vs. 23.0 ± 4.6 HU, p < 0.01) and the CNR was significantly higher (p < 0.01). The mean ERD was significantly shorter on DLR than on hybrid IR images, whereas the mean ERS was steeper on DLR than on hybrid IR images. The mean image quality score for hybrid IR and DLR images was 2.96 and 3.58, respectively (p < 0.01). CONCLUSIONS DLR reduces the image noise and improves the image quality at coronary CTA. KEY POINTS • Deep learning-based image restoration is a new technique that employs the deep convolutional neural network for image quality improvement. • Deep learning-based restoration reduces the image noise and improves image quality at coronary CT angiography. • This method may allow for a reduction in radiation exposure.
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Affiliation(s)
- Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Toru Higaki
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Zhou Yu
- Canon Medical Research USA, Inc., 706 N Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - Jian Zhou
- Canon Medical Research USA, Inc., 706 N Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - Yujie Lu
- Canon Medical Research USA, Inc., 706 N Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - Chikako Fujioka
- Department of Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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3
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Koenig W, Giovas P, Nicholls SJ. Combining cholesterol-lowering strategies with imaging data: a visible benefit? Eur J Prev Cardiol 2018; 26:365-379. [PMID: 30160512 DOI: 10.1177/2047487318798059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary artery disease is characterised by the development of atherosclerotic plaques and is associated with significant morbidity and mortality on a global level. However, many patients with atherosclerosis are asymptomatic and the prediction of acute coronary events is challenging. The role of imaging studies in characterising plaque morphology and stability is emerging as a valuable prognostic tool, while providing evidence for the beneficial effects of cholesterol-lowering therapy on plaque burden. This review provides an overview of contemporary studies describing the value of imaging strategies for atherosclerotic plaques. Coronary angiography is commonly used in the clinical setting, but requires a significant radiation dose (similar to computed tomography). Magnetic resonance imaging evaluation of coronary vessels would avoid exposure to ionising radiation, but is not yet feasible due to motion artefacts. The roles of alternative imaging techniques, including grey-scale intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy have emerged in recent years. In particular, grey-scale intravascular ultrasound has been effectively applied to detect changes in plaque burden and features of plaques predictive of rupture, as well as plaque characteristics during cholesterol-lowering therapy, providing novel insights into factors that may contribute to treatment effectiveness. Challenges and limitations to the use of imaging techniques are considered in this context, along with future imaging strategies.
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Affiliation(s)
- Wolfgang Koenig
- 1 Deutsches Herzzentrum München, Technische Universität München, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | | | - Stephen J Nicholls
- 4 South Australian Health and Medical Research Institute, University of Adelaide, Australia
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4
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Abstract
PURPOSE OF REVIEW To compare outcomes between registries and randomized controlled trials of coronary computed tomographic angiography (CCTA)-based versus standard of care approaches to the initial evaluation of patients with acute chest pain. RECENT FINDINGS Randomized trials have demonstrated CCTA to be a safe and efficient tool for triage of low- to intermediate-risk patients presenting to the emergency department with chest pain. Recent studies demonstrate heterogeneous result using different standard of care approaches for evaluation of hard endpoints in comparison with standard evaluation. Also, there has been continued concern for increase in subsequent testing after coronary CTA. Although CCTA improves detection of coronary artery disease, it is uncertain if it will bring improvement of long-term health outcomes at this point of time. Careful analysis of the previous results and further investigation will be required to validate evaluation of hard endpoints.
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5
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Aorta Ascending Aneurysm Analysis Using CFD Models towards Possible Anomalies. FLUIDS 2017. [DOI: 10.3390/fluids2020031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Utility of coronary artery calcium scores in predicting coronary atherosclerosis amongst patients with moderate risk of coronary artery disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jicc.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Martínez-González B, Reyes-Hernández CG, Quiroga-Garza A, Rodríguez-Rodríguez VE, Esparza-Hernández CN, Elizondo-Omaña RE, Guzmán-López S. Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies. Ann Thorac Cardiovasc Surg 2017; 23:55-65. [PMID: 28202895 DOI: 10.5761/atcs.ra.16-00178] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a significant variety of vascular conduits options for coronary bypass surgery. Adequate graft selection is the most important factor for the success of the intervention. To ensure durability, permeability, and bypass function, there must be a morphological similarity between the graft and the coronary artery. The objective of this review was to analyze the morphological characteristics of the grafts that are most commonly used in coronary bypass surgery and the coronary arteries that are most frequently occluded. We included clinical information regarding the characteristics that determine the behavior of the grafts and its permeability over time. Currently, the internal thoracic artery is the standard choice for bypass surgery because of the morphological characteristics of the wall that makes less prone to developing atherosclerosis and hyperplasia. The radial and right gastroepiploic arteries are the following second and third best options, respectively. The ulnar artery is the preferred choice when other conduits are not feasible.
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Affiliation(s)
- Brenda Martínez-González
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Cynthia Guadalupe Reyes-Hernández
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Alejandro Quiroga-Garza
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Víctor E Rodríguez-Rodríguez
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Claudia N Esparza-Hernández
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Rodrigo E Elizondo-Omaña
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Santos Guzmán-López
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
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Mahdavi A, Mohammadzadeh A, Joodi G, Tabatabaei MR, Sheikholeslami F, Motevalli M. Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e24350. [PMID: 27679698 PMCID: PMC5035936 DOI: 10.5812/iranjradiol.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 10/21/2014] [Accepted: 11/11/2014] [Indexed: 12/21/2022]
Abstract
Background There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. Objectives To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Patients and Methods Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. Results In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. Conclusion Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.
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Affiliation(s)
- Arash Mahdavi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mohammadzadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golsa Joodi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Sheikholeslami
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Motevalli
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Marzieh Motevalli, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2122042026, Fax: +98-21-22042026, E-mail:
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9
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Tatsugami F, Higaki T, Sakane H, Fukumoto W, Iida M, Baba Y, Fujioka C, Kihara Y, Tsushima S, Awai K. Coronary CT angiography in patients with implanted cardiac devices: initial experience with the metal artefact reduction technique. Br J Radiol 2016; 89:20160493. [PMID: 27626704 DOI: 10.1259/bjr.20160493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Single-energy metal artefact reduction (SEMAR), a new technique that can now be used in routine CT examinations, has recently become applicable to volume data acquired with electrocardiography gating. We evaluated the effect of this technique on the visualization of the coronary arteries in patients harboring cardiac devices. METHODS We subjected 8 patients (7 males, 1 female; mean age 65.5 ± 11.3 years) with implanted cardiac devices to coronary CT angiography on a 320-slice CT scanner (Aquilion ONE Vision™; Toshiba Medical Systems Corp., Tokyo, Japan). Image data sets were reconstructed with and without SEMAR. Two radiologists visually evaluated the image quality based on metal artefacts from the electronic device leads using a four-point scale (1 = vessel not visible to 4 = minimal or no metal artefacts). Images with a score of 3 or 4 were considered diagnostic. RESULTS In both SEMAR and non-SEMAR data sets, 94 coronary artery segments were available for evaluation. Without SEMAR, 11 segments (11.7%) were rated as non-diagnostic; SEMAR improved the image quality of 9 of the 11 segments (81.8%), and the images became diagnostic. CONCLUSION SEMAR reduced metal artefacts from the electronic device leads and improved the image quality of the coronary arteries in patients with cardiac devices. Advances in knowledge: SEMAR has recently become applicable to volume data acquired with electrocardiography gating. SEMAR reduces metal artefacts elicited by electronic device leads and improves the image quality of the coronary arteries in patients with cardiac devices.
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Affiliation(s)
- Fuminari Tatsugami
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Toru Higaki
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Hiroaki Sakane
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Wataru Fukumoto
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Makoto Iida
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yasutaka Baba
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Chikako Fujioka
- 2 Department of Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yasuki Kihara
- 3 Department of Cardiovascular Medicine, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - So Tsushima
- 4 Toshiba Medical Systems Corporation, Otawara-shi, Tochigi, Japan
| | - Kazuo Awai
- 1 Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
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10
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Behaviour of two typical stents towards a new stent evolution. Med Biol Eng Comput 2016; 55:1019-1037. [PMID: 27669700 DOI: 10.1007/s11517-016-1574-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022]
Abstract
This study explores the analysis of a new stent geometry from two typical stents used to treat the coronary artery disease. Two different finite element methods are applied with different boundary conditions to investigate the stenosis region. Computational fluid dynamics (CFD) models including fluid-structure interaction are used to assess the haemodynamic impact of two types of coronary stents implantation: (1) type 1-based on a strut-link stent geometry and (2) type 2-a continuous helical stent. Using data from a recent clinical stenosis, flow disturbances and consequent shear stress alterations introduced by the stent treatment are investigated. A relationship between stenosis and the induced flow fields for the two types of stent designs is analysed as well as the correlation between haemodynamics and vessel wall biomechanical factors during the initiation and development of stenosis formation in the coronary artery. Both stents exhibit a good performance in reducing the obstruction artery. However, stent type 1 presents higher radial deformation than the type 2. This deformation can be seen as a limitation with a long-term clinical impact.
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Effect of the Motion Correction Technique on Image Quality at 320-Detector Computed Tomography Coronary Angiography in Patients With Atrial Fibrillation. J Comput Assist Tomogr 2016; 40:603-8. [DOI: 10.1097/rct.0000000000000414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Lee NJ, Litt H. Cardiac CT angiography for evaluation of acute chest pain. Int J Cardiovasc Imaging 2015; 32:101-12. [PMID: 26342713 DOI: 10.1007/s10554-015-0763-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 01/23/2023]
Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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13
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Diagnostic performance of quantitative coronary computed tomography angiography and quantitative coronary angiography to predict hemodynamic significance of intermediate-grade stenoses. Int J Cardiovasc Imaging 2015; 31:1651-61. [DOI: 10.1007/s10554-015-0748-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/17/2015] [Indexed: 01/14/2023]
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14
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Assessment of Single-Bolus Contrast Administration Technique Using Hybrid Dual-Source ECG-Gated Thoracic and Dual-Source Non–ECG-Gated High-Pitch Abdominopelvic CT Acquisitions for Procedural Planning Before Transcatheter Aortic Valve Replacement. J Comput Assist Tomogr 2015; 39:207-12. [DOI: 10.1097/rct.0000000000000194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Aydın AM, Kayalı A, Poyraz AK, Aydın K. The relationship between coronary artery disease and pericoronary epicardial adipose tissue thickness. J Int Med Res 2014; 43:17-25. [PMID: 25476799 DOI: 10.1177/0300060514558323] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES A retrospective study to investigate the relationship between epicardial adipose tissue thickness (EATT) and presence of coronary artery plaque, coronary artery disease (CAD) and CAD risk factors. METHODS Multidetector computed tomography (MDCT) coronary angiography images were reviewed. Left anterior decending artery, right coronary artery and left circumflex artery pericoronary EATT were measured. Demographic, clinical and CAD risk factor data were obtained from medical records. RESULTS Patients with CAD (n = 49) had significantly larger mean EATT than those without CAD (n = 101). Pericoronary EATT was significantly correlated with body mass index, total cholesterol level, coronary artery calcium score, hypertension and diabetes mellitus history. CONCLUSIONS There is an association between pericoronary EATT and CAD, as well as CAD risk factors. Pericoronary EATT measurement may become a widely used, easy-to-perform method for determining CAD risk.
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Affiliation(s)
- Ayşe Murat Aydın
- Department of Radiology, School of Medicine, Fırat University, Elazig, Turkey
| | - Alperen Kayalı
- Department of Radiology, School of Medicine, Fırat University, Elazig, Turkey
| | - Ahmet Kurşad Poyraz
- Department of Radiology, School of Medicine, Fırat University, Elazig, Turkey
| | - Kemal Aydın
- Department of Cardiology, Elazig Training and Research Hospital, Elazig, Turkey
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Thilo C, Gebregziabher M, Meinel FG, Goldenberg R, Nance JW, Arnoldi EM, Soma LD, Ebersberger U, Blanke P, Coursey RL, Rosenblum MA, Zwerner PL, Schoepf UJ. Computer-aided stenosis detection at coronary CT angiography: effect on performance of readers with different experience levels. Eur Radiol 2014; 25:694-702. [DOI: 10.1007/s00330-014-3460-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/13/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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17
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Najafi M, Ghasemi H, Roustazadeh A, Farajollahi M. Lack of association between glutathione peroxidase1 (GPx1) activity, Pro198Leu polymorphism and stenosis of coronary arteries: A population-based prediction. Meta Gene 2014; 2:722-9. [PMID: 25606455 PMCID: PMC4287826 DOI: 10.1016/j.mgene.2014.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/04/2014] [Accepted: 09/11/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We studied the association between erythrocyte glutathione peroxidase1 (GPx1) activity and rs1050450 (Pro198Leu) site with the stenosis of coronary arteries and, evaluated the Pro/Leu position within the predicted tertiary structure. METHODS Subjects were recruited from who underwent coronary angiography (controls; n = 55, Stenosis < 5% and Patients; n = 95, Stenosis ≥ 50%). The GPx1 activity and rs1050450 C/T variants were determined using enzyme assay and RFLP-PCR techniques, respectively. The conserved regions and GPx1 tertiary structure were predicted using bioinformatics tools. RESULTS We did not find significant association between GPx1 activity (P = 0.96), rs1050450 genotype distribution and coronary artery disease (adjusted OR = 0.79; 95%CI 0.28-2.2, P = 0.6). The polymorphic variants were not located at the predicted structural and functional domains so that it had not the significant role on the GPx1stability and function. CONCLUSIONS In agreement with the results predicted from bioinformatics tools, we suggested that the GPx1 activity and rs1050450 (Pro198Leu) site are not involved in the development of stenosis of coronary arteries in the study population.
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Affiliation(s)
- Mohammad Najafi
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author. Tel./fax: + 98 2188622742.
| | - Hassan Ghasemi
- Biochemistry Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abazar Roustazadeh
- Biochemistry Department, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Farajollahi
- Cellular and Molecular Research Center, School of Medical Biotechnology, Iran University of Medical Sciences, Tehran, Iran
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A new technique for noise reduction at coronary CT angiography with multi-phase data-averaging and non-rigid image registration. Eur Radiol 2014; 25:41-8. [PMID: 25113650 DOI: 10.1007/s00330-014-3381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 07/09/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the feasibility of a newly developed noise reduction technique at coronary CT angiography (CTA) that uses multi-phase data-averaging and non-rigid image registration. METHODS Sixty-five patients underwent coronary CTA with prospective ECG-triggering. The range of the phase window was set at 70-80% of the R-R interval. First, three sets of consecutive volume data at 70%, 75% and 80% of the R-R interval were prepared. Second, we applied non-rigid registration to align the 70% and 80% images to the 75% image. Finally, we performed weighted averaging of the three images and generated a de-noised image. The image noise and contrast-to-noise ratio (CNR) in the proximal coronary arteries between the conventional 75% and the de-noised images were compared. Two radiologists evaluated the image quality using a 5-point scale (1, poor; 5, excellent). RESULTS On de-noised images, mean image noise was significantly lower than on conventional 75% images (18.3 HU ± 2.6 vs. 23.0 HU ± 3.3, P < 0.01) and the CNR was significantly higher (P < 0.01). The mean image quality score for conventional 75% and de-noised images was 3.9 and 4.4, respectively (P < 0.01). CONCLUSIONS Our method reduces image noise and improves image quality at coronary CTA. KEY POINTS • We introduce a new method for image noise reduction at cardiac CT. • Multiple data acquisitions of an object and their averaging yield lower noise. • Our method uses multi-phase images reconstructed from unused redundant imaging data. • It reduces image noise by averaging multi-phase images transformed by non-rigid registration. • This method achieves a 20% image noise reduction at cardiac CT.
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Walther S, Schueler S, Tackmann R, Schuetz GM, Schlattmann P, Dewey M. Compliance with STARD Checklist among Studies of Coronary CT Angiography: Systematic Review. Radiology 2014; 271:74-86. [DOI: 10.1148/radiol.13121720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Li M, Du XM, Jin ZT, Peng ZH, Ding J, Li L. The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis. PLoS One 2014; 9:e84937. [PMID: 24465453 PMCID: PMC3897406 DOI: 10.1371/journal.pone.0084937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/20/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. MATERIALS AND METHODS PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. RESULTS 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%. CONCLUSION The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
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Affiliation(s)
- Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Xiang-min Du
- Department of Medical Engineering, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Zhi-tao Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - Zhao-hui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Juan Ding
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Li Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
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21
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Hong YJ, Jeong MH, Choi YH, Park SY, Seon HJ, Lee HS, Kim YH, Cho SC, Cho JY, Jeong HC, Jang SY, Yoo JH, Song JE, Lee KH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Comparison of Coronary Plaque and Stenosis Between Coronary Computed Tomography Angiography and Virtual Histology-Intravascular Ultrasound in Asymptomatic Patients with Risk Factors for Coronary Artery Disease. J Lipid Atheroscler 2014. [DOI: 10.12997/jla.2014.3.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Ha Choi
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Sung Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Hyun Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Cheol Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Young Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Jang
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Hyun Yoo
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ji Eun Song
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Influence of observer experience and training on proficiency in coronary CT angiography interpretation. Eur J Radiol 2013; 82:1240-7. [DOI: 10.1016/j.ejrad.2013.02.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 01/25/2023]
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Rong J, Yu CQ, Yang P, Chen J. Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes. Diab Vasc Dis Res 2013; 10:161-8. [PMID: 22906861 DOI: 10.1177/1479164112454755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although there are substantial analyses for association of coronary artery disease (CAD) with diabetic retinopathy (DR), which was recognized as an indicator of risk for CAD in diabetes mellitus (DM), there is as yet little rigorous evaluation of the relationship between DR and subclinical coronary atherosclerosis (CAS) determined by coronary 64-slice multidetector computed tomography angiography (MDCTA) in persons with type 2 DM. In this article, we found that CAS associated with DR was independent of the traditional risk factors for CAD [odds ratio (OR): 5.1; 95% confidence interval (CI): 2.6-10.1; p < 0.001], and the severity and extent of CAS were significantly increased with the incidence and progression of DR (all p < 0.001). An independent association between hypertension, obesity, renal dysfunction and DR was also found (all p < 0.05). The relationship of CAS with DR was relatively continuous and graded under the diabetes status. Therefore, much of CAS and DR could be still multifactorial with common pathway.
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Affiliation(s)
- Jian Rong
- Geriatric Department, Military General Hospital of Chengdu PLA, Chengdu, Sichuan, People's Republic of China.
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25
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Diagnostic performance of computed tomography coronary angiography (from the Prospective National Multicenter Multivendor EVASCAN Study). Am J Cardiol 2013; 111:471-8. [PMID: 23261002 DOI: 10.1016/j.amjcard.2012.10.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/17/2012] [Accepted: 10/17/2012] [Indexed: 11/21/2022]
Abstract
Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity.
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Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity. Eur Radiol 2013; 23:1603-22. [PMID: 23322410 DOI: 10.1007/s00330-012-2763-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/29/2012] [Accepted: 12/10/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool. METHODS Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy. RESULTS The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item ("Uninterpretable Results") showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with "no fulfilment" increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy. CONCLUSIONS The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies. KEY POINTS • Good methodological quality is a basic requirement in diagnostic accuracy studies. • Most coronary CT angiography studies have only been of moderate design quality. • Weak methodological quality will affect the sensitivity and specificity. • No improvement in methodological quality was observed over time. • Authors should consider the QUADAS checklist when undertaking accuracy studies.
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Reduction of Interpatient Variability of Arterial Enhancement Using a New Bolus Tracking System in 320-Detector Computed Tomographic Coronary Angiography. J Comput Assist Tomogr 2013; 37:79-83. [DOI: 10.1097/rct.0b013e318278e996] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Schuetz GM, Schlattmann P, Dewey M. Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies. BMJ 2012; 345:e6717. [PMID: 23097549 PMCID: PMC3480336 DOI: 10.1136/bmj.e6717] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether a 3 × 2 table, using an intention to diagnose approach, is better than the "classic" 2 × 2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. DESIGN Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3 × 2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. DATA SOURCES Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. ELIGIBILITY CRITERIA Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. RESULTS 120 studies (10,287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2 × 2 tables and 3 × 2 tables. Using a bivariate random effects model, we compared the 2 × 2 table with the 3 × 2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P<0.05)). CONCLUSION Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3 × 2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.
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Affiliation(s)
- Georg M Schuetz
- Department of Radiology, The Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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Implications of 25% to 50% coronary stenosis with cardiac computed tomographic angiography in ED patients. Am J Emerg Med 2012; 30:597-605. [DOI: 10.1016/j.ajem.2011.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
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64-slice multidetector-row computed tomography in the diagnosis of coronary artery disease: interobserver agreement among radiologists with varied levels of experience on a per-patient and per-segment basis. J Thorac Imaging 2012; 27:29-35. [PMID: 21102356 DOI: 10.1097/rti.0b013e3181f82805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the interobserver variability of 4 radiologists with different levels of experience in the evaluation of 64-slice coronary computed tomographic angiography (cCTA). MATERIALS AND METHODS Two board-certified radiologists with 10 and 8 years of experience in reading cCTA and 2 radiology residents, 1 with 3 years of experience in reading cCTA and 1 with experience in reading general computed tomographic scans but without dedicated cCTA training, participated in the study. All the observers independently analyzed 50 cCTA studies for signs of coronary artery disease (stenosis of 0%, ≤49%, 50% to 74%, 75% to 99%, or 100%). Diagnostic accuracy of the 4 readers for stenosis detection on cCTA was compared with that of conventional angiography on a per-segment and per-patient basis. No patients, vessels, or segments were excluded from analysis. RESULTS On a per-segment basis, correlation between cCTA and invasive coronary angiography was good for readers with more than 10 (r=0.75), more than 8 (r=0.75), and more than 3 (r=0.73) years of cCTA experience. The correlation coefficient was poor (r=0.39) for the untrained reader. Sensitivity was not significantly (P=0.56) different between observers with more than 8 and more than 10 years of experience but was significantly (P>0.05) lower for the reader with less than 3 years experience and for the untrained reader. However, we found no significant difference in overall diagnostic accuracy on a per-patient (P=0.86) and on a per-segment level (P=0.72) among the 4 readers. CONCLUSION The level of experience significantly influences the sensitivity of coronary artery stenosis detection at cCTA, and thus highlights the need for dedicated training in cCTA interpretation.
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Tatsugami F, Matsuki M, Nakai G, Inada Y, Kanazawa S, Takeda Y, Morita H, Takada H, Yoshikawa S, Fukumura K, Narumi Y. The effect of adaptive iterative dose reduction on image quality in 320-detector row CT coronary angiography. Br J Radiol 2012; 85:e378-82. [PMID: 22253355 DOI: 10.1259/bjr/10084599] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effect of adaptive iterative dose reduction (AIDR) on image noise and image quality as compared with standard filtered back projection (FBP) in 320-detector row CT coronary angiography (CTCA). METHODS 50 patients (14 females, mean age 68 ± 9 years) who underwent CTCA (100 kV or 120 kV, 400-580 mA) within a single heartbeat were enrolled. Studies were reconstructed with FBP and subsequently AIDR. Image noise, vessel contrast and contrast-to-noise ratio (CNR) in the coronary arteries were evaluated. Overall image quality for coronary arteries was assessed using a five-point scale (1, non-diagnostic; 5, excellent). RESULTS All the examinations were performed in a single heartbeat. Image noise in the aorta was significantly lower in data sets reconstructed with AIDR than in those reconstructed with FBP (21.4 ± 3.1 HU vs 36.9 ± 4.5 HU; p<0.001). No significant differences were observed between FBP and AIDR for the mean vessel contrast (HU) in the proximal coronary arteries. Consequently, CNRs in the proximal coronary arteries were higher in the AIDR group than in the FBP group (p<0.001). The mean image quality score was improved by AIDR (3.75 ± 0.38 vs 4.24 ± 0.38; p<0.001). CONCLUSION The use of AIDR reduces image noise and improves image quality in 320-detector row CTCA.
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Affiliation(s)
- F Tatsugami
- Department of Radiology, Osaka Medical College, Takatsuki City, Osaka, Japan.
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Takakuwa KM, Keith SW, Estepa AT, Shofer FS. A meta-analysis of 64-section coronary CT angiography findings for predicting 30-day major adverse cardiac events in patients presenting with symptoms suggestive of acute coronary syndrome. Acad Radiol 2011; 18:1522-8. [PMID: 22055795 DOI: 10.1016/j.acra.2011.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 08/15/2011] [Accepted: 09/11/2011] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the accuracy of 64-section coronary computed tomography angiography (CCTA) in predicting 30 day major adverse cardiac events (MACE) for patients presenting with symptoms concerning for acute coronary syndrome (ACS). MATERIALS AND METHODS Electronic databases between January 1, 2005, and May, 1, 2011, and reference lists from relevant published research articles were searched. We included studies on adult patients who presented with active symptoms suggestive of ACS, had immediate 64-section CCTA performed and were assessed for MACE at a minimum of 30 days past their initial presentation. Studies had to report or provide sufficient detail to determine sensitivity, specificity, positive predictive value, and negative predictive value in relation to MACE using a 50% diameter stenosis as cutoff criterion for coronary artery disease. RESULTS Nine studies were included for a total of 1559 patients studied (42.3% women, mean age 51.9 ± 10.6). Patients ranged from low to intermediate risk for ACS. All had initial inconclusive electrocardiograms and negative cardiac biomarker results. A total of 14.8% of patients had a positive CCTA result. The pooled sensitivity was 93.3% (95% CI 88.3%-96.6%), specificity was 89.9% (95% CI 88.3%-91.3%), positive predictive value was 48.1% (95% CI 42.5%-53.8%), and negative predictive value was 99.3% (95% CI 98.7%-99.6%). CONCLUSION Sixty-four section CCTA had a 99.3% negative predictive value in excluding MACE for 30 days after initial symptom presentation in 85.2% of our study population. Although the value of 64-section CCTA is best for identifying patients who can safely be discharged home, it is less useful for patients who have positive results.
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Affiliation(s)
- Kevin M Takakuwa
- Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107, USA.
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Napoli A, Anzidei M, Zaccagna F, Cavallo Marincola B, Zini C, Brachetti G, Cartocci G, Fanelli F, Catalano C, Passariello R. Peripheral Arterial Occlusive Disease: Diagnostic Performance and Effect on Therapeutic Management of 64-Section CT Angiography. Radiology 2011; 261:976-86. [DOI: 10.1148/radiol.11103564] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carbone I, Cannata D, Algeri E, Galea N, Napoli A, De Zorzi A, Bosco G, D'Agostino R, Menezes L, Catalano C, Passariello R, Francone M. Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation. Pediatr Radiol 2011; 41:1165-73. [PMID: 21717166 DOI: 10.1007/s00247-011-2141-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 03/03/2011] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. OBJECTIVE To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. MATERIALS AND METHODS The study group comprised 12 patients (age 17.6 ± 2.9 years, mean ± SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6 ± 13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. RESULTS Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56 ± 0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n = 32), stenoses (n = 3) and occlusions (n = 9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. CONCLUSION Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.
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Affiliation(s)
- Iacopo Carbone
- Department of Radiological, Onchological and Anatomopathological Sciences, Policlinico Umberto I, Sapienza University of Rome, viale Regina Elena, 324, Rome, 00161, Italy.
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Bardo DME, Brown P. Cardiac multidetector computed tomography: basic physics of image acquisition and clinical applications. Curr Cardiol Rev 2011; 4:231-43. [PMID: 19936200 PMCID: PMC2780825 DOI: 10.2174/157340308785160615] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 11/22/2022] Open
Abstract
Cardiac MDCT is here to stay. And, it is more than just imaging coronary arteries. Understanding the differences in and the benefits of one CT scanner from another will help you to optimize the capabilities of the scanner, but requires a basic understanding of the MDCT imaging physics. This review provides key information needed to understand the differences in the types of MDCT scanners, from 64 – 320 detectors, flat panels, single and dual source configurations, step and shoot prospective and retrospective gating, and how each factor influences radiation dose, spatial and temporal resolution, and image noise.
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Affiliation(s)
- Dianna M E Bardo
- Director of Cardiac Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd - CR 135, Portland, OR 97239, USA
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Multicenter Comparison of High Concentration Contrast Agent Iomeprol-400 With Iso-osmolar Iodixanol-320. Invest Radiol 2011; 46:457-64. [DOI: 10.1097/rli.0b013e31821c7ff4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee JH, Chun EJ, Choi SI, Vembar M, Lim C, Park KH, Choi DJ. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography for evaluation of coronary artery bypass graft patency: comparison of image quality, radiation dose and diagnostic accuracy. Int J Cardiovasc Imaging 2011; 27:657-67. [PMID: 21678128 DOI: 10.1007/s10554-011-9904-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 05/27/2011] [Indexed: 01/21/2023]
Abstract
We aimed to evaluate image quality, radiation dose and diagnostic accuracy of coronary CT angiography (CCTA) with a prospectively gated transverse-axial scan (PGT) compared with a retrospectively gated helical scan (RGH), using a 64-slice scanner in patients who underwent coronary artery bypass graft (CABG). Of the 131 consecutive patients that underwent CABG using 64-slice multidetector row computed tomography during 2008, patients with heart rate (HR) of <75 beats/minute (bpm), and HR variation <10 bpm were included in the study. PGT was performed on 39 patients with 93 grafts, with RGH performed on 43 patients with 102 grafts. Image quality (1: excellent-4: poor) and estimated radiation dose were compared between the two groups. Of these, a total of 64 segments in 26 patients were subjected to invasive coronary angiography (ICA) for clinical reasons. Diagnostic accuracy of CCTA for evaluation of graft was performed between the two groups with ICA as a reference standard in terms of significant stenosis (≥ 50% of luminal stenosis). The image quality was not statistically different in the two groups. Mean effective radiation dose was 6.5 mSv in PGT-group, which was significantly lower than that in the RGH-group (21.2 mSv; P < 0.001). There was no statistically significant difference in diagnostic accuracy between the two groups (PGT-group versus RGH-group; 93.1% versus 91.4%). PGT can achieve dose reductions of up to 70% compared to RGH while maintaining image quality and high diagnostic accuracy in patients undergoing CABG.
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Affiliation(s)
- Jae Hwan Lee
- Divison of Cardiovascular Imaging, Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
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Paech DC, Weston AR. A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease. BMC Cardiovasc Disord 2011; 11:32. [PMID: 21679468 PMCID: PMC3141758 DOI: 10.1186/1471-2261-11-32] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 06/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background This systematic review summarized recent evidence pertaining to the clinical effectiveness of 64-slice or higher computed tomography angiography (CTA) in patients with suspected coronary artery disease (CAD). If CTA proves to be a successful diagnostic performance measure, it could prevent the use of invasive diagnostic procedures in some patients. This would provide multiple health and cost benefits, particularly for under resourced areas where invasive coronary angiography is not always available. Methods A systematic method of literature searching and selection was employed with searches limited to December 2006 to March 2009. Included studies were quality assessed using National Health and Medical Research Council (NHMRC) diagnostic levels of evidence and a modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Individual and pooled diagnostic performance measures were calculated using standard meta-analytic techniques at the patient, vessel and segment level. A positive result was defined as greater than or equal to 50% stenosis. Results Twenty-eight studies were included in the systematic review examining 3,674 patients. The primary meta-analysis at the patient-level indicated a sensitivity of 98.2% and specificity of 81.6%. The median (range) positive predictive value (PPV) was 90.5% (76%-100%) and negative predictive value (NPV) 99.0% (83%-100%). In all vessels, the pooled sensitivity was 94.9%, specificity 89.5%, and median (range) PPV 75.0% (53%-95%) and NPV 99.0% (93%-100%). At the individual artery level, overall diagnostic accuracy appeared to be slightly higher in the left main coronary artery and slightly lower in the left anterior descending and circumflex artery. In all segments, the sensitivity was 91.3%, specificity 94.0% and median (range) PPV 69.0% (44%-86%) and NPV 99.0% (98%-100%). Conclusions The high sensitivity indicates that CTA can effectively identify the majority of patients with significant coronary artery stenosis. The high NPV at the patient, vessel and segment level establishes CTA as an effective non-invasive alternative to invasive coronary angiography (ICA) for the exclusion of stenosis.
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Affiliation(s)
- Daniel C Paech
- Health Technology Analysts Pty Ltd, 135 Rowntree St, Balmain, NSW 2041, Australia.
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Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis. Eur Radiol 2011; 21:1904-13. [PMID: 21597986 DOI: 10.1007/s00330-011-2142-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 03/09/2011] [Accepted: 03/11/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography. METHODS We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate. RESULTS The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8-94.5%) and 87.5% (95% CI, 86.5-88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18-63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with ≤16 detector rows. CONCLUSION It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease.
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Cardiothoracic CT angiography: current contrast medium delivery strategies. AJR Am J Roentgenol 2011; 196:W260-72. [PMID: 21343473 DOI: 10.2214/ajr.10.5814] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Over the last decade, rapid technologic evolution in CT has resulted in improved spatial and temporal resolution and acquisition speed, enabling cardiothoracic CT angiography to become a viable and effective noninvasive alternative in the diagnostic algorithm. These new technologic advances have imposed new challenges for the optimization of contrast medium delivery and image acquisition strategies. CONCLUSION Thorough understanding of contrast medium dynamics is essential for the design of effective acquisition and injection protocols. This article provides an overview of the fundamentals affecting contrast enhancement, emphasizing the modifications to contrast material delivery protocols required to optimize cardiothoracic CT angiography.
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Jeong DW, Choo KS, Baik SK, Kim YW, Jeon UB, Kim JS, Lim SJ. Step-and-shoot prospectively ECG-gated versus retrospectively ECG-gated with tube current modulation coronary CT angiography using the 128-slice MDCT: comparison of image quality and radiation dose. Acta Radiol 2011; 52:155-60. [PMID: 21498343 DOI: 10.1258/ar.2010.100290] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known regarding image quality and the required radiation dose for step-and-shoot and retrospective coronary computed tomography angiography (CCTA) with tube current modulation (TCM) in 128-slice multidetector CT (MDCT) coronary angiography. PURPOSE To compare image quality and radiation dose in patients who underwent 128-slice MDCT by the step-and-shoot method with those in patients who underwent 128-slice MDCT with retrospective CCTA with TCM. MATERIAL AND METHODS CCTA obtained with 128-slice MDCT was retrospectively evaluated in 160 patients. Two independent reviewers separately scored the subjective image quality of the coronary artery segments (1, excellent; 4, poor) for step-and-shoot (68, mean heart rate [HR]: 59.3 ± 6.8) and retrospective CCTA with TCM (77, mean HR: 59.1 ± 9.8). Interobserver variability was calculated. Effective radiation doses of both scan techniques were calculated with dose-length product. RESULTS There was good agreement for quality scores of coronary artery segment images between the independent reviewers (κ = 0.72). The number of coronary artery segments that could not be evaluated was 2.85% (27 of 947) in the step-and-shoot and 1.87% (20 of 1071) in retrospective CCTA with TCM. Image quality scores were not significantly different (P > .05). Mean patient radiation dose was 63% lower for step-and-shoot (1.94 ± 0.70 mSv) than for retrospective CCTA with TCM (4.51 ± 1.18 mSv) (P < 0.0001). For patients who underwent step-and-shoot or retrospective CCTA with TCM, an average HR of 63.5 beats per minute was identified as the threshold for the prediction of non-diagnostic image quality for both protocols. There were no significant differences in the image quality of both methods between obese (body mass index [BMI] ≥ 25) and non-obese patients (BMI < 25), but radiation doses were higher in the obesity group than in the non-obesity group for both methods. CONCLUSION Both step-and-shoot and retrospective CCTA with TCM using 128-slice MDCT had similar subjective image quality scores, but step-and-shoot required a lower radiation dose than retrospective CCTA with TCM.
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Affiliation(s)
| | | | | | | | | | - Jeong Soo Kim
- Department of Cardiology, Medial Research Institute, Pusan National University Yangsan Hospital, School of Medicine, Gyeongsangnam-do
| | - Soo Jin Lim
- Department of Cardiology, Kim Hae Joongang Hospital, Gyeongsangnam-do, Republic of Korea
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Tang L, Zhu X, Xu Y, Yu T, Xu H, Tang J, Dogra V, Wang D. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT. Acta Radiol 2011; 52:59-63. [PMID: 21498327 DOI: 10.1258/ar.2010.090465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. PURPOSE To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. MATERIAL AND METHODS One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. RESULTS Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. CONCLUSION Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and weight can be used to adjust flow rate and dosage of contrast media before administration of contrast media during coronary CT angiography.
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Affiliation(s)
- Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tongfu Yu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hai Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinhua Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Vikram Dogra
- Department of Radiology, University of Rochester, NY, USA
| | - Dehang Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Isogai T, Jinzaki M, Tanami Y, Kusuzaki H, Yamada M, Kuribayashi S. Body weight-tailored contrast material injection protocol for 64-detector row computed tomography coronary angiography. Jpn J Radiol 2011; 29:33-8. [DOI: 10.1007/s11604-010-0514-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/02/2010] [Indexed: 11/24/2022]
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High-Temporal Resolution Dual-Energy Computed Tomography of the Heart Using a Novel Hybrid Image Reconstruction Algorithm. J Comput Assist Tomogr 2011; 35:119-25. [DOI: 10.1097/rct.0b013e3181f87475] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coronary CT Angiography for the Detection of Obstructive Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9045-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bauer RW, Kerl JM, Fischer N, Burkhard T, Larson MC, Ackermann H, Vogl TJ. Dual-Energy CT for the Assessment of Chronic Myocardial Infarction in Patients With Chronic Coronary Artery Disease: Comparison With 3-T MRI. AJR Am J Roentgenol 2010; 195:639-646. [DOI: 10.2214/ajr.09.3849] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Ralf W. Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - J. Matthias Kerl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Nadine Fischer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Thorsten Burkhard
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Maya C. Larson
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Hanns Ackermann
- Department of Medicine, Institute of Biostatistics and Mathematical Modeling, Clinic of the Goethe University, Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
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Budde RPJ, Huo F, Cramer MJM, Doevendans PAFM, Bots ML, Moll FL, Prokop M. Simultaneous aortic and coronary assessment in abdominal aortic aneurysm patients by thoraco-abdominal 64-detector-row CT angiography: estimate of the impact on preoperative management: a pilot study. Eur J Vasc Endovasc Surg 2010; 40:196-201. [PMID: 20427209 DOI: 10.1016/j.ejvs.2010.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To estimate the influence of information on the coronary arteries obtained from routine thoraco-abdominal CT angiography (CTA) on pre-operative clinical management in abdominal aortic aneurysm (AAA) patients. METHODS Twenty-eight AAA patients underwent pre-operative thoraco-abdominal electrocardiography (ECG)-gated 64-detector-row CTA to evaluate aortic pulsatility for prosthesis size matching. Retrospectively, the coronaries were reconstructed from the same data set and scored on a per segment basis for stenosis (0%, <or=50% or >50%) and grading confidence (poor, adequate or high). An experienced cardiologist was presented information on patient characteristics obtained from patient records and CTA findings. Suggested changes in European Society of Cardiology guidelines based patient management based on CTA information were scored. RESULTS On CTA, 17 patients (61%) had significant coronary disease (>50% stenosis) including left main (n=4), single (n=7) and multiple (n=6) vessel disease. Grading confidence was adequate or high in 86% of proximal and middle segments. Based on CTA findings, patient management would have been changed in 4 out of the 28 patients (14%; 95% CI 1-27%) by adding coronary angiography (n=4). In five patients who underwent coronary artery bypass grafting previously, CT did not change management but confirmed graft patency. CONCLUSIONS Information on coronary pathology and coronary bypass graft patency can be readily obtained from thoraco-abdominal CTA and may alter pre-operative patient management, as shown in 14% of AAA patients in our study.
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Affiliation(s)
- R P J Budde
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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In Vitro Evaluation of Metallic Coronary Artery Stents With 64-MDCT Using an ECG-Gated Cardiac Phantom: Relationship Between In-Stent Visualization, Stent Type, and Heart Rate. AJR Am J Roentgenol 2010; 194:W256-62. [DOI: 10.2214/ajr.09.2318] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ko SM, Kim YJ, Park JH, Choi NM. Assessment of left ventricular ejection fraction and regional wall motion with 64-slice multidetector CT: a comparison with two-dimensional transthoracic echocardiography. Br J Radiol 2010; 83:28-34. [PMID: 19546180 PMCID: PMC3487259 DOI: 10.1259/bjr/38829806] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 02/15/2009] [Accepted: 02/19/2009] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to compare the measurement of left ventricular ejection fraction (LVEF) and regional wall motion using 64-slice multidetector CT (MDCT) with that using two-dimensional transthoracic echocardiography (2D-TTE) in a heterogeneous patient population. In 126 patients with angina pectoris, acute myocardial infarction, chronic myocardial infarction, atypical chest pain without coronary artery disease or valvular heart disease, 64-slice MDCT was performed using retrospective electrocardiography gating without dose modulation. 20 phases of the cardiac cycle were analysed to identify the end-diastolic and end-systolic phases and to assess regional LV wall motion. For these measurements, 2D-TTE served as the reference standard. MDCT and 2D-TTE were performed within 10 days of each other. An excellent correlation between MDCT and 2D-TTE was shown for the evaluation of LVEF (59.2+/-11% vs 57.9+/-10%, respectively; r = 0.87). LVEF was slightly overestimated by MDCT, when compared with 2D-TTE, by an average of 1.4+/-5.6%. Good agreement was obtained between the use of the two techniques, with 94% of the segments scored identically on both modalities (kappa = 0.70). MDCT had a sensitivity of 97% and a specificity of 82% when compared with 2D-TTE as the reference standard. In conclusion, the use of 64-slice MDCT can provide comparable results to those using 2D-TTE for LVEF and regional wall motion assessment in a heterogeneous population.
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Affiliation(s)
- S-M Ko
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea.
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