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Vogelgesang F, Coenen MH, Schueler S, Schlattmann P, Dewey M. An exemplary reanalysis of coronary computed tomography angiography diagnostic meta-analyses shows insufficient data sharing and incorrect sensitivity and specificity estimates. J Clin Epidemiol 2024; 170:111306. [PMID: 38428541 DOI: 10.1016/j.jclinepi.2024.111306] [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: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses. STUDY DESIGN AND SETTING We conducted an exemplary systematic review of diagnostic meta-analyses comparing coronary computed tomography angiography to invasive coronary angiography in patients with suspected coronary artery disease. The objectives were to assess 1) the reproducibility of contingency tables, 2) the reproducibility of pooled sensitivity and specificity, and 3) differences to reported results when applying a recommended bivariate binomial model for pooling sensitivity and specificity. Therefore, we reproduced the contingency tables and recalculated sensitivity and specificity by utilizing both the pooling method of each meta-analysis and a bivariate binomial model. We used linear trends to assess the improvement of these objectives over time. RESULTS We identified 38 diagnostic meta-analyses, each including on average 19 primary studies (range: 3 to 89 studies; total: 715-including duplicates) with an average of approximately 1800 patients per meta-analysis (range: 118 to 7516 patients). For 31 meta-analyses (82%, 95% CI: 65%, 91%), the contingency tables were reproducible; however, only 15 published them. Using the pooling method of each meta-analysis, we obtained comparable recalculated sensitivities/specificities for 28 meta-analyses (74% [57%, 86%]). Only 11 meta-analyses pooled sensitivity/specificity using a bivariate binomial model (29% [16%, 46%]). When all meta-analyses were pooled with this model, published sensitivities/specificities were confirmed for 19 of 38 meta-analyses (50% [34%, 66%]). There was only marginal improvement in data availability and application of recommended pooling methods over time. CONCLUSION Data sharing should become standard practice along with the use of appropriate pooling methods. Journal publication requirements may play a key role in enhancing the quality of scientific reporting and methodological standards which may lead to more reliable and consistent outcomes. The ability to reproduce sensitivity and specificity estimates in diagnostic imaging meta-analyses is dependent on the availability of contingency tables and the explicit reporting of pooling methods and software used.
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Affiliation(s)
- Felicitas Vogelgesang
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health and Berlin University Alliance, Berlin, Germany.
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Mori T, Matsushita S, Morita T, Abudurezake A, Mochizuki J, Amano A. Evaluation of mitral chordae tendineae length using four-dimensional computed tomography. World J Cardiol 2024; 16:274-281. [PMID: 38817650 PMCID: PMC11135327 DOI: 10.4330/wjc.v16.i5.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/16/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation. Achieving precise measurements of artificial chordae tendineae length (CL) is an important factor in the procedure; however, no objective index currently exists to facilitate this measurement. Therefore, preoperative assessment of CL is critical for surgical planning and support. Four-dimensional x-ray micro-computed tomography (4D-CT) may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional (3D) evaluation compared to that with transthoracic echocardiography, a conventional inspection method. AIM To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT. METHODS Eleven adults aged > 70 years without mitral valve disease were evaluated. A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization. The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image. The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP, respectively. The behavior and maximum lengths [cA (ma), cP (max)] were compared, and the correlation with body surface area (BSA) was evaluated. RESULTS In all cases, the mitral anterior leaflet chordae tendineae could be measured. In most cases, the cA and cP chordae tendineae could be measured visually. The mean cA (max) and cP (max) were 20.2 mm ± 1.95 mm and 23.5 mm ± 4.06 mm, respectively. cP (max) was significantly longer. The correlation coefficients (r) with BSA were 0.60 and 0.78 for cA (max) and cP (max), respectively. Both cA and cP exhibited constant variation in CL during systole, with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole. For cP, CL reached a plateau at 15% and remained elongated until end-systole, whereas for cA, after peaking at 15%, CL shortened slightly and then moved toward its peak again as end-systole approached. CONCLUSION The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.
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Affiliation(s)
- Takuya Mori
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Department of Cardiovascular Surgery, JACCT Japan Animal Cardiovascular Care Team, Osaka 533-0033, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan.
| | - Terumasa Morita
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Abulaiti Abudurezake
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Junji Mochizuki
- Department of Radiology, Minamino Cardiovascular Hospital, Tokyo 192-0918, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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Powell AC, Long JW, Deshmukh UU, Simmons JD. The Association Between the Use of Low-Slice Computed Tomography Machines and Downstream Care: Comparative Study of 16-Slice and 64-Slice Computed Tomography Angiography. JMIR Form Res 2022; 6:e32892. [PMID: 35771601 PMCID: PMC9284351 DOI: 10.2196/32892] [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: 08/13/2021] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although computed tomography (CT) studies on machines with more slices have reported higher positive and negative predictive values, the impact of using low-slice (16-slice) CT machines on downstream testing has not been well studied. In community outpatient settings, low-slice CT machines remain in use, although many hospitals have adopted higher-slice machines. Objective This study examines the association between the use of low-slice CT machines and downstream invasive testing in the context of the CT angiography of the neck. Methods Included health insurance claims pertained to adults with commercial or Medicare Advantage health plans who underwent the CT angiography of the neck. Site certification data were used to assign counts of slices to claims. Claims that were made in the 60 days after CT were examined for cervicocerebral angiography. The association between the number of slices and cervicocerebral angiography was evaluated by using a chi-square test and multivariate logistic regression. Results Claims for 16-slice CT had a 5.1% (33/641) downstream cervicocerebral angiography rate, while claims for 64-slice CT had a 3.1% (35/1125) rate, and a significant difference (P=.03) was observed. An analysis that was adjusted for patient demographics also found a significant relationship (odds ratio 1.64, 95% CI 1.00-2.69; P=.047). Conclusions The use of low-slice CT machines in the community may impact the quality of care and result in more downstream testing.
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Souto RM, Santos AASMDD, Nacif MS. Clinical experience regarding the diagnostic value of segment-by-segment coronary computed tomography angiography in comparison with that of invasive coronary angiography. Radiol Bras 2022; 55:156-160. [PMID: 35795603 PMCID: PMC9254710 DOI: 10.1590/0100-3984.2021.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the degree of coronary stenosis (≥ 50% luminal narrowing)
determined by coronary computed tomography angiography (CCTA) with that
determined by invasive coronary angiography (ICA), using segment-by-segment
analysis. Materials and Methods This was a retrospective study of the records of patients who underwent CCTA
and ICA between January 2014 and June 2018 at a general hospital in Brazil.
Receiver operating characteristic curve analysis was applied, and the areas
under the curve were used in order to assess the overall accuracy of the
methods. Results The degree of coronary stenosis was evaluated in a total of 844 arterial
segments. The diagnostic performance of CCTA was good, with a sensitivity of
82.3%, a specificity of 96.4%, and a negative predictive value of 97.7% (95%
CI: 96.5-98.5). In the segment-by-segment analysis, CCTA had excellent
accuracy for the left main coronary artery and for other segments. Conclusion In clinical practice at general hospitals, CCTA appears to have diagnostic
performance comparable to that of ICA.
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Souto RM, Dos Santos AASMD, Nacif MS. Computed tomography angiography of the coronary arteries: major findings in the clinical routine of a general hospital. Radiol Bras 2021; 54:261-264. [PMID: 34393294 PMCID: PMC8354187 DOI: 10.1590/0100-3984.2020.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022] Open
Abstract
Almost two decades ago, it became possible to use coronary computed tomography for the noninvasive assessment of the coronary arteries. That is an extremely accurate method for detecting or excluding coronary artery disease, even the subclinical forms. This pictorial essay aims to show the main imaging findings in 47 coronary computed tomography scans acquired at a general hospital between January 2014 and June 2018. The most common findings were atheromatous plaques (in 87%) and stents (in 34%). There were also incidental findings, not directly related to coronary artery disease, such as pulmonary nodules and aortic stenosis.
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Affiliation(s)
- Rafael Mansur Souto
- Hospital Universitário Antônio Pedro - Universidade Federal Fluminense (HUAP-UFF), Niterói, RJ, Brazil
| | | | - Marcelo Souto Nacif
- Hospital Universitário Antônio Pedro - Universidade Federal Fluminense (HUAP-UFF), Niterói, RJ, Brazil
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Fukuoka R, Kawasaki T, Umeji K, Okonogi T, Koga N. The diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve. Comparison with myocardium perfusion imaging. Heart Vessels 2021; 37:22-30. [PMID: 34263357 DOI: 10.1007/s00380-021-01897-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
To compare the diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve (CT-FFR)Few data of CT-FFR were reported regarding the diagnostic performance for detecting hemodynamically significant coronary artery disease (CAD). This retrospective single-center analysis included 132 vessels in 77 patients who underwent CT angiography, myocardial perfusion imaging (MPI), and invasive FFR. The correlation coefficient between CT-FFR and invasive FFR and optimal cut-off value for CT-FFR to identify invasive FFR ≤ 0.8 were evaluated. The diagnostic accuracies of CT- FFR, and MPI were evaluated using an area under the receiver-operating characteristic curve (AUC) with invasive FFR as a reference standard. Diagnostic performance of CT-FFR was also evaluated concerning lesion characteristics, including intermediate lesions, left main lesions, tandem lesions, and/or diffuse lesions, and coronary calcium (Agatston score over 400). The Receiver Operating Characteristic curve analysis showed that the optimal cut-off value of CT-FFR for detecting invasive FFR ≤ 0.80 was 0.80 [AUC = 0.83, 95%CI: 0.76-0.90). Diagnostic sensitivity, specificity, positive and negative predictive value, and accuracy of CT-FFR when compared with those of MPI regarding per-patient analysis were 93% vs. 63%, 48% vs. 61%, 81% vs. 79%, 73% vs. 41%, and 79% vs. 62%, respectively, and for per-vessel analysis were 89% vs. 24%, 66% vs. 82%, 75% vs. 61%, 83% vs. 48%, and 78% vs. 51%, respectively. The AUC of the CT-FFR was significantly higher than MPI (0.83 vs. 0.57, p < 0.0001) regarding the per-vessel analysis. No differences in the diagnostic performance of CT-FFR were noted in the presence of intermediate lesions, left main lesions, tandem lesions, and/or diffuse lesions, and severe coronary calcium. On-site CT-FFR delivered a higher diagnostic performance than MPI for detecting CAD with invasive FFR ≤ 0.8, indicating the potential of CT-FFR as the gatekeeper of invasive coronary angiogram as well as percutaneous coronary intervention.
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Affiliation(s)
- Ryota Fukuoka
- Department of Cardiology Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan.
| | - Tomohiro Kawasaki
- Department of Cardiology Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan
| | - Kyoko Umeji
- Department of Cardiology Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan
| | - Taichi Okonogi
- Department of Emergency, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan
| | - Nobuhiko Koga
- Department of Cardiology Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan
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Effect of energy difference in the evaluation of calcification size and luminal diameter in calcified coronary artery plaque using spectral CT. Jpn J Radiol 2020; 38:1142-1149. [PMID: 32767199 DOI: 10.1007/s11604-020-01027-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study evaluated the calcium blooming-reducing effect and the differences of luminal diameter among various-energy virtual monochromatic images (VMIs) using rapid kilovolt-switching dual-energy computed tomography (DECT). MATERIALS AND METHODS Forty-five calcified segments in 31 patients were analyzed. For the analysis, 40- to 140-keV VMIs on both non-contrast CT and coronary CT angiography were generated at 10-keV steps, and calcification size and luminal diameter were measured using CT number profile curve and full-width at half-maximum method. We compared calcification size and luminal diameter on each keV VMIs with those on 70-keV VMI. RESULTS There was no significant differences among the 40- to 140-keV VMIs regarding calcification size or luminal diameter. CONCLUSION The 40- to 140-keV VMIs produced by single-source DECT had no effect on the calcification size or luminal diameter in the coronary artery.
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On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve. Heart Vessels 2020; 35:1331-1340. [DOI: 10.1007/s00380-020-01606-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
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Abd alamir M, Noack P, Jang KH, Moore JA, Goldberg R, Poon M. Computer-aided analysis of 64- and 320-slice coronary computed tomography angiography: a comparison with expert human interpretation. Int J Cardiovasc Imaging 2018; 34:1473-1483. [DOI: 10.1007/s10554-018-1361-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
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Takagi H, Tanaka R, Nagata K, Ninomiya R, Arakita K, Schuijf JD, Yoshioka K. Diagnostic performance of coronary CT angiography with ultra-high-resolution CT: Comparison with invasive coronary angiography. Eur J Radiol 2018; 101:30-37. [PMID: 29571798 DOI: 10.1016/j.ejrad.2018.01.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Recently, ultra-high-resolution computed tomography (U-HRCT) with a 0.25 mm × 128-row detector was introduced. The purpose of this study was to evaluate the diagnostic performance of coronary CT angiography (CCTA) using U-HRCT. METHODS This retrospective study included 38 consecutive patients with suspected coronary artery disease (CAD) who underwent CCTA with U-HRCT followed by invasive coronary angiography (ICA). Per-segment diameter stenosis was calculated. Diagnostic performance of CCTA relative to ICA as the reference standard was determined. For segments with >30% diameter stenosis, the correlation and agreement of percent diameter stenosis between CCTA and ICA were calculated. RESULTS Obstructive CAD was observed in 65 segments (12%) of 51 vessels (45%) in 32 patients (84%) during ICA. The per-patient, vessel, and segment analyses showed a sensitivity of 100% (95% confidence interval [CI], 95%-100%), 96% (95% CI: 89%-99%) and 95% (95% CI: 89%-98%), respectively, and a specificity of 67% (95% CI: 38%-67%), 81% (95% CI: 75%-83%) and 96% (95% CI: 96%-97%), respectively. The percentage of diameter stenosis, as determined by CCTA, demonstrated an excellent correlation with ICA (R = 0.90; 95% CI: 0.83-0.95) and a slight significant overestimation (mean: 4% ± 7%, p < .01), with the agreed range of limits being ± 16%. The median effective radiation dose for CCTA was 5.4 mSv (range: 2.9-18.0 mSv). CONCLUSIONS CCTA with U-HRCT demonstrated an excellent correlation and agreement with ICA in the quantification of coronary artery stenosis.
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Affiliation(s)
- Hidenobu Takagi
- Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, Japan.
| | - Ryoichi Tanaka
- Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, Japan.
| | - Kyohei Nagata
- Department of Cardiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, Japan.
| | - Ryo Ninomiya
- Department of Cardiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, Japan.
| | - Kazumasa Arakita
- Center for Medical Research and Development, Toshiba Medical Systems Corporation, 1385, Shimoishigami, Otawara, Japan.
| | - Joanne D Schuijf
- Center for Medical Research and Development Europe, Toshiba Medical Systems Europe, Zilverstraat 1, 2718 RP Zoetermeer, Netherlands.
| | - Kunihiro Yoshioka
- Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, Japan.
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Yu M, Li Y, Li W, Lu Z, Wei M, Zhang J. Calcification remodeling index assessed by cardiac CT predicts severe coronary stenosis in lesions with moderate to severe calcification. J Cardiovasc Comput Tomogr 2018; 12:42-49. [DOI: 10.1016/j.jcct.2017.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/25/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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Weatherspoon K, Gilbertie W, Catanzano T. Emergency Computed Tomography Angiogram of the Chest, Abdomen, and Pelvis. Semin Ultrasound CT MR 2017; 38:370-383. [PMID: 28865527 DOI: 10.1053/j.sult.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.
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Affiliation(s)
- Kimberly Weatherspoon
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA.
| | - Wayne Gilbertie
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
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Stănescu A, Himcinschi E, Morariu M, Rat N, Bordi L, Rațiu M, Benedek A, Benedek I, Benedek T. Cardiac Computed Tomography Assessment in Acute Coronary Syndromes — Do We Have Time for It in Emergency Settings? JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The diagnosis and treatment of acute coronary syndrome remain a challenge for clinicians in many clinical settings, especially in patients with previous low-to-intermediate risk. Due to its high specificity and sensitivity for detecting significant coronary artery stenoses, cardiac computed tomography angiography (CCTA) tends to be used more frequently in the emergency room (ER) in the last years. This technique has been associated with a higher rate of safe discharge in patients with chest pain, less time spent in the ER, and decreased costs related to further investigations. In cases positive for coronary artery stenosis, CCTA can accurately evaluate the indication for percutaneous coronary angioplasty and can offer relevant information related to the characteristics of the coronary plaques, being able to detect vulnerable coronary plaques. The aim of this manuscript is to highlight the possibility of using CCTA in the ER in the assessment of patients with chest pain and to show the benefits of the procedure regarding safety, costs, accuracy, and time.
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Affiliation(s)
- Alexandra Stănescu
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elisabeta Himcinschi
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Mirabela Morariu
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Nora Rat
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Mihaela Rațiu
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | | | - Imre Benedek
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Theodora Benedek
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
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Wang H, Xu L, Fan Z, Liang J, Yan Z, Sun Z. Clinical evaluation of new automatic coronary-specific best cardiac phase selection algorithm for single-beat coronary CT angiography. PLoS One 2017; 12:e0172686. [PMID: 28231322 PMCID: PMC5322912 DOI: 10.1371/journal.pone.0172686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/08/2017] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to evaluate the workflow efficiency of a new automatic coronary-specific reconstruction technique (Smart Phase, GE Healthcare—SP) for selection of the best cardiac phase with least coronary motion when compared with expert manual selection (MS) of best phase in patients with high heart rate. A total of 46 patients with heart rates above 75 bpm who underwent single beat coronary computed tomography angiography (CCTA) were enrolled in this study. CCTA of all subjects were performed on a 256-detector row CT scanner (Revolution CT, GE Healthcare, Waukesha, Wisconsin, US). With the SP technique, the acquired phase range was automatically searched in 2% phase intervals during the reconstruction process to determine the optimal phase for coronary assessment, while for routine expert MS, reconstructions were performed at 5% intervals and a best phase was manually determined. The reconstruction and review times were recorded to measure the workflow efficiency for each method. Two reviewers subjectively assessed image quality for each coronary artery in the MS and SP reconstruction volumes using a 4-point grading scale. The average HR of the enrolled patients was 91.1±19.0bpm. A total of 204 vessels were assessed. The subjective image quality using SP was comparable to that of the MS, 1.45±0.85 vs 1.43±0.81 respectively (p = 0.88). The average time was 246 seconds for the manual best phase selection, and 98 seconds for the SP selection, resulting in average time saving of 148 seconds (60%) with use of the SP algorithm. The coronary specific automatic cardiac best phase selection technique (Smart Phase) improves clinical workflow in high heart rate patients and provides image quality comparable with manual cardiac best phase selection. Reconstruction of single-beat CCTA exams with SP can benefit the users with less experienced in CCTA image interpretation.
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Affiliation(s)
- Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- * E-mail:
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junfu Liang
- Department of Radiology, Beijing Huairou Hospital, Beijing, China
| | - Zixu Yan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Department of medical radiation Sciences, Curtin University, Perth, Western Australia, Australia
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Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT. Eur Radiol 2016; 27:2794-2801. [DOI: 10.1007/s00330-016-4675-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
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Tang PH, Du BJ, Fang XM, Hu XY, Qian PY, Gao QS. Submillisievert coronary CT angiography with adaptive prospective ECG-triggered sequence acquisition and iterative reconstruction in patients with high heart rate on the dual-source CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:807-820. [PMID: 27612046 DOI: 10.3233/xst-160589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess the application value of submillisievert coronary CT angiography (CCTA) in patients with a high heart rate (HR) acquired with adaptive prospective ECG-triggered sequence acquisition and iterative reconstruction on the secondary generation dual-source CT. MATERIALS AND METHODS A total of 120 consecutive high-HR patients suspected with coronary artery disease underwent CCTA and invasive coronary angiography (ICA) within two weeks. Patients were randomly assigned into three groups: group A (n = 40), where the patients underwent retrospectively ECG-triggered acquisition CCTA at 100 kVp; group B (n = 40), where the patients received adaptive prospective ECG-triggered sequence acquisition at 100 kVp; and group C (n = 40), where the patients performed adaptive prospective ECG-triggered sequence acquisition at 80 kVp with iterative reconstruction. The mean CT values, signal noise ratios (SNR) and contrast noise ratios (CNR) in the ascending aorta and coronary arteries of the three groups were measured and compared. The image quality and radiation dose among the three groups were compared. The consistency of displaying the coronary stenosis of each group was assessed compared with the results of ICA as the gold standard. RESULTS There was no significant difference in gender, age and body mass index (BMI) (all P > 0.05). The mean attenuations, SNRs and CNRs in the ascending aorta and coronary artery were not significantly different between group A and group B (P > 0.05). The mean attenuations of group C were significantly higher than group A and group B (P < 0.01), but the image noise and CNR were significantly lower in group C (P < 0.01). The number of appreciable segments among the three groups was not significantly different on a per-segment and per-vessel basis (P > 0.05). The subjective image quality among the three groups was not significantly different (P > 0.05). With the ICA result as a reference standard, there was good consistency in the evaluation of the coronary stenosis degree between CCTA and ICA (r > 0.75), as well as in the assessment of the coronary stenosis rate using the Bland- Altman analysis. The mean radiation dose in group B was half of that in group A. Moreover, the mean radiation dose in group C was less than one sixth of that in group A and less than 1 mSv (0.7±0.2 mSv). CONCLUSIONS For patients with high HR, adaptive prospective ECG-triggered sequence acquisition on the FLASH dual-source CT results in equal image quality and half of the radiation dose reduction compared with retrospectively ECG-triggered spiral acquisition at the same tube voltage (100 kVp) and same R-R interval of exposure. In addition, adaptive prospective ECG-triggered sequence acquisition combined with low tube voltage and iterative reconstruction can further reduce the radiation dose to the submillisievert level without compromising image quality and the accuracy of assessing the coronary stenosis degree, and can be popularized as a routine technique.
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Affiliation(s)
- Pei-Hua Tang
- Department of Radiology, Department of Electrocardiogram, Wuxi No.4 People's Hospital, Binghu District, Wuxi, China
| | - Ben-Jun Du
- Department of Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiang-Ming Fang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Xiao-Yun Hu
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Ping-Yan Qian
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Quan-Sheng Gao
- Laboratory of the Animal Center, Academy of Military Medical Sciences, Haidian District, Beijing, China
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Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT versus First-Generation 64-Slice Dual-Source CT. Sci Rep 2016; 6:34795. [PMID: 27752040 PMCID: PMC5067634 DOI: 10.1038/srep34795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/19/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to compare the image quality and radiation dose of coronary computed tomography angiography (CCTA) from prospectively triggered 128-slice CT (128-MSCT) versus dual-source 64-slice CT (DSCT). The study was approved by the Medical Ethics Committee at Tongji Medical College of Huazhong University of Science and Technology. Eighty consecutive patients with stable heart rates lower than 70 bpm were enrolled. Forty patients were scanned with 128-MSCT, and the other 40 patients were scanned with DSCT. Two radiologists independently assessed the image quality in segments (diameter >1 mm) according to a three-point scale (1: excellent; 2: moderate; 3: insufficient). The CCTA radiation dose was calculated. Eighty patients with 526 segments in the 128-MSCT group and 544 segments in the DSCT group were evaluated. The image quality 1, 2 and 3 scores were 91.6%, 6.9% and 1.5%, respectively, for the 128-MSCT group and 97.6%, 1.7% and 0.7%, respectively, for the DSCT group, and there was a statistically significant inter-group difference (P ≤ 0.001). The effective doses were 3.0 mSv in the 128-MSCT group and 4.5 mSv in the DSCT group (P ≤ 0.001). Compared with DSCT, CCTA with prospectively triggered 128-MSCT had adequate image quality and a 33.3% lower radiation dose.
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Lee WW. Recent Advances in Nuclear Cardiology. Nucl Med Mol Imaging 2016; 50:196-206. [PMID: 27540423 DOI: 10.1007/s13139-016-0433-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine.
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Affiliation(s)
- Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
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Aghayev A, Murphy DJ, Keraliya AR, Steigner ML. Recent developments in the use of computed tomography scanners in coronary artery imaging. Expert Rev Med Devices 2016; 13:545-53. [PMID: 27140944 DOI: 10.1080/17434440.2016.1184968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Within the past decade, substantial evolution of Coronary CT Angiography (CCTA) has affected evaluation and management of coronary artery disease. In particular, technical advancement of hardware technology and image reconstruction of CT scanners have played an important role in this context making it possible to acquire abundant data with excellent temporal and spatial resolution within a shorter scan time. In addition, a concern related to the high radiation exposure in the initial noninvasive coronary artery imaging has triggered improvement in dose reduction techniques. AREAS COVERED In this review article, we have focused on recent technological developments in CT scanners and the impact of these developments on CCTA parameters. Expert Commentary: CCTA plays an important role in coronary artery disease management, and technical development of the CT scanners can be expected to address and remedy technical limitations.
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Affiliation(s)
- Ayaz Aghayev
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - David J Murphy
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Abhishek R Keraliya
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Michael L Steigner
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
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Mahadevappa M, Hegde M, Math R. Normal Proximal Coronary Artery Diameters in Adults from India as Assessed by Computed Tomography Angiography. J Clin Diagn Res 2016; 10:TC10-3. [PMID: 27437324 DOI: 10.7860/jcdr/2016/18096.7849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The normative data of coronary artery size among Indians are sparse. It is often essential to know the coronary dimensions especially during interventions such as stenting to choose the appropriate size of the stent and to decide the very need for stenting. In current practice it is the luminal angiography which is most widely employed to assess the coronary artery size. However, luminal angiography is not very accurate in estimating the epicardial coronary artery size as it does not take into account the mural thickness of the arterial wall. Hence it is prudent to assess coronary artery size by other methods such as Computed Tomography (CT) coronary angiography, quantitative coronary angiogram, Magnetic Resonanace (MR) angiogram, etc. In this study we chose computed tomography as it demonstrates mural thickness along with lumen of the vessels and hence measures the diameter more accurately. AIM To establish normative data for diameters of the proximal coronary artery segments during life by using MDCT in a cohort of individuals without any structural heart disease. MATERIALS AND METHODS Between October 2012 and April 2013, 168 consecutive patients who did not have any structural heart disease underwent CT coronary angiography for evaluation of Coronary Artery Disease (CAD) with atypical symptoms with low pretest probability. Patients who were found to have no coronary artery disease on CT-CAG were recruited in this study. The baseline clinical status and demographic data were obtained from the hospital records. RESULTS In our study we found that the mean indexed diameter to BSA among females for LMCA 2.32±0.12mm, LAD 1.95±0.15mm, LCX 1.73±0.20mm and RCA 1.84±0.22mm. For males the values were LMCA 2.33±0.13mm, LAD 1.94±0.16mm, LCX 1.74±0.21mm, and RCA 1.79±0.20mm. These values are comparable to other studies. CONCLUSION We attempted to establish normative data for normal proximal coronary artery dimensions among South Indian population. Coronary artery dimensions in Indians (in-dexed to BSA) for proximal major epicardial coronary arteries are similar to that reported in the West.
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Affiliation(s)
- Manjappa Mahadevappa
- Assistant Professor, Department of Cardiology, JSS Medical College , Mysore, Karnataka, India
| | - Madhav Hegde
- Associate Professor, Department of Radiology, Dr. B.R. Ambedkar Medical College , Bengaluru, Karnataka, India
| | - Ravi Math
- Associate Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research Institute , Bengaluru, Karnataka, India
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Zimarino M, Prati F, Marano R, Angeramo F, Pescetelli I, Gatto L, Marco V, Bruno I, De Caterina R. The value of imaging in subclinical coronary artery disease. Vascul Pharmacol 2016; 82:20-9. [PMID: 26851577 DOI: 10.1016/j.vph.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
Although the treatment of acute coronary syndromes (ACS) has advanced considerably, the ability to detect, predict, and prevent complications of atherosclerotic plaques, considered the main cause of ACS, remains elusive. Several imaging tools have therefore been developed to characterize morphological determinants of plaque vulnerability, defined as the propensity or probability of plaques to complicate with coronary thrombosis, able to predict patients at risk. By utilizing both intravascular and noninvasive imaging tools, indeed prospective longitudinal studies have recently provided considerable knowledge, increasing our understanding of determinants of plaque formation, progression, and instabilization. In the present review we aim at 1) critically analyzing the incremental utility of imaging tools over currently available "traditional" methods of risk stratification; 2) documenting the capacity of such modalities to monitor atherosclerosis progression and regression according to lifestyle modifications and targeted therapy; and 3) evaluating the potential clinical relevance of advanced imaging, testing whether detection of such lesions may guide therapeutic decisions and changes in treatment strategy. The current understanding of modes of progression of atherosclerotic vascular disease and the appropriate use of available diagnostic tools may already now gauge the selection of patients to be enrolled in primary and secondary prevention studies. Appropriate trials should now, however, evaluate the cost-effectiveness of an aggressive search of vulnerable plaques, favoring implementation of such diagnostic tools in daily practice.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - Francesco Prati
- San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy
| | - Riccardo Marano
- Department of Radiological Sciences, Institute of Radiology "A. Gemelli" University Polyclinic Foundation, Catholic University, Rome, Italy
| | - Francesca Angeramo
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Irene Pescetelli
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Laura Gatto
- San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy
| | - Valeria Marco
- San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy
| | - Isabella Bruno
- Institute of Nuclear Medicine, "A. Gemelli" University Polyclinic Foundation, Catholic University, Rome, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
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Cheezum MK, Subramaniyam PS, Bittencourt MS, Hulten EA, Ghoshhajra BB, Shah NR, Forman DE, Hainer J, Leavitt M, Padmanabhan R, Skali H, Dorbala S, Hoffmann U, Abbara S, Di Carli MF, Gewirtz H, Blankstein R. Prognostic value of coronary CTA vs. exercise treadmill testing: results from the Partners registry. Eur Heart J Cardiovasc Imaging 2015; 16:1338-46. [PMID: 25899714 PMCID: PMC4668770 DOI: 10.1093/ehjci/jev087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/02/2015] [Accepted: 03/18/2015] [Indexed: 12/25/2022] Open
Abstract
AIMS We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. METHODS AND RESULTS We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patients were followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (>90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54 ± 13 years (63% male). In median follow-up of 40 months, there were 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETT was inconclusive in 23%, positive in 31%, and negative in 46%. CTA demonstrated no CAD in 37%, non-obstructive CAD in 28%, and obstructive CAD in 35%. Among low-risk ETT patients (n = 326), there were 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e., angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0-23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0-15.2), P = 0.049] predicted increased risk for CV death or MI. CONCLUSION Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate- to high-risk ETT (DTS <5), CTA can provide incremental risk stratification for future CV events.
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Affiliation(s)
- Michael K Cheezum
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Prem Srinivas Subramaniyam
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcio S Bittencourt
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | - Edward A Hulten
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant R Shah
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Daniel E Forman
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Jon Hainer
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Marcia Leavitt
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ram Padmanabhan
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hicham Skali
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Sharmila Dorbala
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcelo F Di Carli
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
| | - Henry Gewirtz
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA
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Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up. J Am Coll Cardiol 2015. [PMID: 26205589 DOI: 10.1016/j.jacc.2015.05.069] [Citation(s) in RCA: 588] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS). OBJECTIVES This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS. METHODS The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years). RESULTS ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%). CONCLUSIONS CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.
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Coronary computed tomography angiography for the assessment of chest pain: current status and future directions. Int J Cardiovasc Imaging 2015; 31 Suppl 2:125-43. [DOI: 10.1007/s10554-015-0698-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 02/02/2023]
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Alexanderson-Rosas E, Guinto-Nishimura GY, Cruz-Mendoza JR, Oropeza-Aguilar M, De La Fuente-Mancera JC, Barrero-Mier AF, Monroy-Gonzalez A, Juarez-Orozco LE, Cano-Zarate R, Meave-Gonzalez A. Current and future trends in multimodality imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:715-31. [PMID: 25912725 DOI: 10.1586/14779072.2015.1039991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.
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Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico
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He G, Liu X, Liu Y, Wang W, Ke Z. Dose study of electrocardiogram automatic tube current modulation technology in prospective coronary computed tomography angiography scans of overweight patients. Exp Ther Med 2015; 9:2384-2388. [PMID: 26136992 DOI: 10.3892/etm.2015.2412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/06/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the X-ray absorption dose and clinical applications of electrocardiogram (ECG)-gated automatic tube current modulation (ATCM) technology in prospective sequential computed tomography coronary angiography (CTCA) scans of overweight patients. A total of 40 patients with a body mass index of >24 were divided at random into groups A and B. Group A consisted of 20 patients, who were examined using ECG-ATCM scanning. For the patients in group A with heart rates <70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose X-rays for 60-80% of the R-R interval. For the group A patients with heart rates >70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose scanning for 35-55% of the R-R interval. For the 20 patients in group B, the scanning range was 20-80% of the R-R interval and patients received a full dose of X-ray radiation for the entire scanning period. The image quality and radiation dose was compared between the two groups. The average radiation dose in groups A and B was 6.91±2.78 and 10.43±3.36, respectively. The radiation doses in group A were reduced by 33.77% when compared with group B (P<0.05). However, there was no marked difference observed in image quality. In summary, using ECG-ATCM technology in prospective sequential CTCA scanning may significantly reduce the radiation dose required for overweight patients.
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Affiliation(s)
- Guiru He
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Xiaopei Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Yan Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Wei Wang
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Zhiliang Ke
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
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van der Pol CB, McInnes MDF, Petrcich W, Tunis AS, Hanna R. Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates? PLoS One 2015; 10:e0119892. [PMID: 25775455 PMCID: PMC4361663 DOI: 10.1371/journal.pone.0119892] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/20/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates. Methods All SR and MA published in English between Jan 2007–Dec 2011, in radiology journals with an IF >2.75, were identified on Ovid MEDLINE. The Assessing the Methodologic Quality of Systematic Reviews (AMSTAR) checklist for study quality, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for study completeness, was applied to each SR & MA. Each SR & MA was then searched in Google Scholar to yield a citation rate. Spearman correlation coefficients were used to assess the relationship between AMSTAR and PRISMA results with citation rate. Multivariate analyses were performed to account for the effect of journal IF and journal 5-year IF on correlation with citation rate. Values were reported as medians with interquartile range (IQR) provided. Results 129 studies from 11 journals were included (50 SR and 79 MA). Median AMSTAR result was 8.0/11 (IQR: 5–9) and median PRISMA result was 23.0/27 (IQR: 21–25). The median citation rate for SR & MA was 0.73 citations/month post-publication (IQR: 0.40–1.17). There was a positive correlation between both AMSTAR and PRISMA results and SR & MA citation rate; ρ=0.323 (P=0.0002) and ρ=0.327 (P=0.0002) respectively. Positive correlation persisted for AMSTAR and PRISMA results after journal IF was partialed out; ρ=0.243 (P=0.006) and ρ=0.256 (P=0.004), and after journal 5-year IF was partialed out; ρ=0.235 (P=0.008) and ρ=0.243 (P=0.006) respectively. Conclusion There is a positive correlation between the quality and the completeness of a reported SR or MA with citation rate which persists when adjusted for journal IF and journal 5-year IF.
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Affiliation(s)
| | - Matthew D. F. McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - William Petrcich
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adam S. Tunis
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramez Hanna
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.
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Affiliation(s)
- Albert de Roos
- From the Department of Radiology, Leiden University Medical Center, C2-S, Albinusdreef 2, Leiden, South-Holland 2333 ZA, the Netherlands (A.d.R); and Department of Radiology, University of California-San Francisco, San Francisco, Calif (C.B.H.)
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Carrascosa P, Deviggiano A, Capunay C, De Zan MC, Goldsmit A, Rodriguez-Granillo GA. Effect of intracycle motion correction algorithm on image quality and diagnostic performance of computed tomography coronary angiography in patients with suspected coronary artery disease. Acad Radiol 2015; 22:81-6. [PMID: 25281361 DOI: 10.1016/j.acra.2014.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to explore the impact of intracycle motion correction algorithms (MCA) in the interpretability and diagnostic accuracy of computed tomography coronary angiography (CTCA) performed in patients suspected of coronary artery disease (CAD) referred to invasive coronary angiography. MATERIALS AND METHODS Patients with suspected CAD referred to invasive coronary angiography previously underwent CTCA. Patients under rate-control medications were advised to withhold for the previous 24 hours. The primary end point of the study was to evaluate image interpretability and diagnostic performance of MCA compared to conventional reconstructions in patients referred to invasive angiography because of suspected CAD. RESULTS Thirty-five patients were prospectively included in the study protocol. The mean age was 61.4 ± 9.4 years. Twenty-seven (77%) patients were men. A total of 533 coronary segments were evaluated using conventional and MCA reconstructions. MCA reconstructions were associated to higher interpretability rates (525 of 533, 98.5% vs. 515 of 533, 96.6 %; P < .001) and image quality scores (3.88 ± 0.54 vs. 3.78 ± 0.76; P < .0001) compared to conventional reconstructions. Although only mild, a significant difference was observed regarding the diagnostic performance between reconstruction modes, with an area under the curve of 0.90 (0.87-0.92) versus 0.89 (0.86-0.92), respectively, for MCA and conventional reconstructions (P = .0447). CONCLUSIONS In this pilot investigation, MCA reconstructions performed in patients with suspected CAD were associated to higher interpretability rates and image quality scores compared to conventional reconstructions, although only mild differences were observed regarding the diagnostic performance between reconstruction modes.
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Affiliation(s)
- Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina.
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
| | - Macarena C De Zan
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
| | - Alejandro Goldsmit
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ Buenos Aires, Argentina; Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
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Motoyama S, Ito H, Ozaki Y. Can Lipid Tissues Including Epicardial Adipose Tissue (EAT), Visceral Adipose Tissue (VAT) and Coronary Plaque Be Moving in the Same Direction? Circ J 2015; 79:969-71. [DOI: 10.1253/circj.cj-15-0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sadako Motoyama
- Division of Cariology, Mount Sinai Hospital
- Department of Cardiology, Fujita Health University
| | - Hajime Ito
- Department of Cardiology, Fujita Health University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
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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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35
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Jiang B, Wang J, Lv X, Cai W. Prognostic value of cardiac computed tomography angiography in patients with suspected coronary artery disease: a meta-analysis. Cardiology 2014; 128:304-12. [PMID: 24903842 DOI: 10.1159/000360131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The diagnostic accuracy of cardiac computed tomography angiography (CCTA) is well reported. The prognostic value of CCTA has been described in several studies, but many of these were underpowered and an update of the meta-analysis is necessary to increase the power to predict rare events. The purpose of this study was to perform a meta-analysis of the ability of CCTA to predict future cardiovascular events. METHODS We searched multiple databases for longitudinal studies of CCTA with a follow-up of at least 12 months of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), death, myocardial infarction and revascularization. Summary test parameters and receiver-operating characteristic curves were calculated. RESULTS Eighteen studies evaluated 29,243 patients with a median follow-up of 25 months. For MACE in patients with negative findings on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95% confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI 1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of 0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI 22.20-1,139.80). The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no CAD, nonobstructive CAD or obstructive CAD, there were incrementally increasing adverse events. CONCLUSIONS Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.
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Affiliation(s)
- Binghu Jiang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, PR China
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36
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Jiang B, Wang J, Lv X, Cai W. Dual-source CT versus single-source 64-section CT angiography for coronary artery disease: A meta-analysis. Clin Radiol 2014; 69:861-9. [PMID: 24854029 DOI: 10.1016/j.crad.2014.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 01/14/2023]
Abstract
AIM To perform a meta-analysis to compare the diagnostic performance of single-source 64-section computed tomography (CT) versus dual-source CT angiography for diagnosis of coronary artery disease (CAD). MATERIALS AND METHODS The Cochrane Library, MEDLINE, and EMBASE were searched for relevant original papers. Inclusion criteria were (1) significant CAD defined as ≥50% reduction in luminal diameter by invasive coronary angiography as reference standard; (2) single-source 64-section CT or dual-source CT was used; (3) results were reported in absolute numbers of true-positive, false-positive, true-negative, and false-negative results or sufficiently detailed data for deriving these numbers were presented. A random-effects model was used for the meta-analysis. RESULTS Fifty-one papers including 3966 patients who underwent single-source 64-section CT and 2047 patients who underwent dual-source CT at a per-patient level were pooled. The diagnostic values of single-source 64-section CT versus dual-source CT were 97% versus 97% for sensitivity (p = 0.386), 78% versus 86% for specificity (p < 0.001), 90% versus 85% for positive predictive value (PPV; p < 0.001), 93% versus 97% for negative predictive value (NPV; p = 0.001), 6.8 versus 6.5 for positive likelihood ratio (p = 0.018), 0.04 versus 0.04 for negative likelihood ratio (p = 0.625), and 191.59 versus 207.37 for diagnostic odds ratio (p = 0.043), respectively. CONCLUSION Dual-source CT and single-source 64-section CT have similar negative likelihood ratios and, therefore, there was no significant difference in their utility to rule out CAD in intermediate-risk patients. However, compared to single-source 64-section CT, dual-source CT has significantly higher specificity, so that CT-based decisions for subsequent coronary catheter angiography are more accurate.
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Affiliation(s)
- B Jiang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - J Wang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
| | - X Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - W Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
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Jeng CM, Wu MT, Wang PC, Chan T, Wan YL. A survey of the current status of coronary CT angiography using 64-slice multidetector CT in Taiwan. J Formos Med Assoc 2014; 113:124-32. [DOI: 10.1016/j.jfma.2012.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 04/24/2012] [Accepted: 05/08/2012] [Indexed: 01/29/2023] Open
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An individualized contrast material injection protocol with respect to patient-related factors for dual-source CT coronary angiography. Clin Radiol 2014; 69:e86-92. [DOI: 10.1016/j.crad.2013.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/11/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
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Benedek T, Jako B, Benedek I. Plaque quantification by coronary CT and intravascular ultrasound identifies a low CT density core as a marker of plaque instability in acute coronary syndromes. Int Heart J 2014; 55:22-8. [PMID: 24463925 DOI: 10.1536/ihj.13-213] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to demonstrate the relationship between the presence and amount of a low-density core (LDC) with a CT density < 30 Hounsfield units (HU) by coronary computed tomography angiography (CCTA) and IVUS-derived markers of vulnerability in the culprit lesions (CL) of patients with acute coronary syndromes (ACS).In 43 patients with ACS, 105 coronary plaques were scanned using CCTA and IVUS for the quantitative and qualitative assessment of vulnerability markers.The presence of a low attenuation plaque (LAP) was identified in 67.4% of the CL and 29.03% of the non-CL (P = 0.0001). The presence of a LDC > 6.0 mm(3) was significantly correlated with the percentage of the necrotic core (NC) (22.08% versus 7.97%, P = 0.001) and the fibro-fatty tissue by IVUS (18.68% versus 15.87%, P = 0.02). LDC volumes showed a good correlation with the percentage of the NC (r = 0.7303, P < 0.0001) and the fibro-fatty tissue in the CL (r = 0.4928, P < 0.0008). Quantitative plaque analysis revealed a significant difference in plaque composition between CL and non-CL in regards to the LDC (18.45 versus 6.5, P < 0.001), the percentage of NC (20.74 versus 18.74, P = 0.02), fibro-fatty tissue (17.77 versus 15.48, P = 0.002), and fibrotic tissue (51.68 versus 54.8, P = 0.01).VH-IVUS and CCTA plaque quantification showed that the presence of a low-density (< 30 HU) core within the CL of patients with ACS represents a marker of vulnerability and correlates well with other CCTA and IVUS-derived features of vulnerability, particularly the NC of the plaque.
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Affiliation(s)
- Theodora Benedek
- Department of Internal Medicine, University of Medicine and Pharmacy of Tîrgu Mures
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40
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Prevalence and extent of atherosclerotic coronary artery disease and related outcome based on coronary computed tomographic angiography in asymptomatic elderly patients: retrospective cohort study. Int J Cardiovasc Imaging 2014; 30:669-76. [DOI: 10.1007/s10554-014-0366-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/08/2014] [Indexed: 11/25/2022]
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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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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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43
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Sano T. [6. Diagnosis of ischemic heart disease by multidetector computed tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:1444-1454. [PMID: 24366565 DOI: 10.6009/jjrt.2013_jsrt_69.12.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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44
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Tunis AS, McInnes MDF, Hanna R, Esmail K. Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement? Radiology 2013; 269:413-26. [DOI: 10.1148/radiol.13130273] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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45
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dos Prazeres CEE, Cury RC, Carneiro ACDC, Rochitte CE. Coronary computed tomography angiography in the assessment of acute chest pain in the emergency room. Arq Bras Cardiol 2013; 101:562-9. [PMID: 24145392 PMCID: PMC4106815 DOI: 10.5935/abc.20130208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/10/2013] [Indexed: 11/26/2022] Open
Abstract
The coronary computed tomography angiography has recently emerged as an accurate
diagnostic tool in the evaluation of coronary artery disease, providing
diagnostic and prognostic data that correlate directly with the data provided by
invasive coronary angiography. The association of recent technological
developments has allowed improved temporal resolution and better spatial
coverage of the cardiac volume with significant reduction in radiation dose, and
with the crucial need for more effective protocols of risk stratification of
patients with chest pain in the emergency room, recent evaluation of the
computed tomography coronary angiography has been performed in the setting of
acute chest pain, as about two thirds of invasive coronary angiographies show no
significantly obstructive coronary artery disease. In daily practice, without
the use of more efficient technologies, such as coronary angiography by computed
tomography, safe and efficient stratification of patients with acute chest pain
remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable
results with the use of this technology in the emergency department for patients
with low to intermediate likelihood of coronary artery disease. In this review,
we show data resulting from coronary angiography by computed tomography in risk
stratification of patients with chest pain in the emergency room, its diagnostic
value, prognosis and cost-effectiveness and a critical analysis of recently
published multicenter studies.
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Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração - HCor, Associação do Sanatório Sírio, São
Paulo, SP - Brazil
- Instituto do Coração - InCor - HCFMUSP, São Paulo, SP -
Brazil
- Mailing Address: Prof. Dr. Carlos Eduardo Rochitte, Rua
Desembargardor Eliseu Guilherme, 123, 3o. Subsolo - Ressonância e Tomografia
Cardiovascular, Paraíso, São Paulo - SP - Brazil, Postal Code 04004-030. E-mail:
,
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46
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Li M, Zhang GM, Zhao JS, Jiang ZW, Peng ZH, Jin ZT, Sun G. Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. Clin Radiol 2013; 69:163-71. [PMID: 24268513 DOI: 10.1016/j.crad.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography with and without the application of a β-blocker. MATERIALS AND METHODS An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize diagnostic test data. RESULTS The pooled sensitivity at the patient level was 0.98 [95% confidence intervals (CI): 0.97-0.99], and specificity 0.88 (95% CI: 0.84-0.91). The results showed that without heart rate control, the sensitivity and specificity at the patient level did not decrease (p = 0.27 and 0.56, respectively). At the artery level, no significant differences in sensitivity and specificity for studies with and without heart rate control were detected (p = 0.04 and 0.05, respectively). At the segment level, the specificity decreased without heart rate control (p = 0.03), whereas the sensitivity was not influenced (p = 0.63). The median radiation exposure was 2.6 mSv, with 1.6 mSv and 8 mSv for heart rate-controlled studies and uncontrolled studies, respectively. CONCLUSIONS DSCT coronary angiography without heart rate control has a similar excellent diagnostic performance at the patient level as that of heart rate control groups. However, controlling for heart rate to decrease radiation and to provide effective information for selecting the therapeutic strategy and risk stratification is recommended.
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Affiliation(s)
- M Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - G-M Zhang
- Department of Medical Cardiology, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - J-S Zhao
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, China
| | - Z-W Jiang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Z-H Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Z-T Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - G Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
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Mechtouff L, Boussel L, Cakmak S, Lamboley JL, Bourhis M, Boublay N, Schott AM, Derex L, Cho TH, Nighoghossian N, Douek PC. Multilevel assessment of atherosclerotic extent using a 40-section multidetector scanner after transient ischemic attack or ischemic stroke. AJNR Am J Neuroradiol 2013; 35:568-72. [PMID: 24136645 DOI: 10.3174/ajnr.a3760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The first part of this study assessed the potential of MDCT with a CTA examination of the aorta and the coronary, cervical, and intracranial vessels in the etiologic work-up of TIA or ischemic stroke compared with established imaging methods. The objective of the second part of this study was to assess the atherosclerotic extent by use of MDCT in these patients. MATERIALS AND METHODS From August 2007 to August 2011, a total of 96 patients with ischemic stroke or TIA without an evident cardioembolic source were enrolled. All patients underwent MDCT. Atherosclerotic extent was classified in 0, 1, 2, 3, and 4 atherosclerotic levels according to the number of arterial territories (aortic arch, coronary, cervical, intracranial) affected by atherosclerosis defined as ≥ 50% cervical, intracranial, or coronary stenosis or ≥ 4-mm aortic arch plaque. RESULTS There were 91 patients who had an interpretable MDCT. Mean age was 67.4 years (± 11 years), and 75 patients (83.3%) were men. The prevalence of 0, 1, 2, 3, and 4 atherosclerotic levels was 48.3%, 35.2%, 12.1%, 4.4%, and 0%, respectively. Aortic arch atheroma was found in 47.6% of patients with 1 atherosclerotic level. The combination of aortic arch atheroma and cervical stenosis was found in 63.6% of patients with ≥ 2 atherosclerotic levels. Patients with ≥ 2 atherosclerotic levels were older than patients with < 2 atherosclerotic levels (P = .04) in univariate analysis. CONCLUSIONS MDCT might be useful to assess the extent of atherosclerosis. It could help to screen for high-risk patients who could benefit from a more aggressive preventive strategy.
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Affiliation(s)
- L Mechtouff
- From the Stroke Unit (L.M., L.D., T.-H.C., N.N.), Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography. Eur J Nucl Med Mol Imaging 2013; 40:1894-904. [DOI: 10.1007/s00259-013-2519-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 07/11/2013] [Indexed: 11/30/2022]
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Meyer M, Schoepf UJ, Fink C, Goldenberg R, Apfaltrer P, Gruettner J, Vajcs D, Schoenberg SO, Henzler T. Diagnostic performance evaluation of a computer-aided simple triage system for coronary CT angiography in patients with intermediate risk for acute coronary syndrome. Acad Radiol 2013; 20:980-6. [PMID: 23735619 DOI: 10.1016/j.acra.2013.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES Given the significance of coronary artery disease as the most important socioeconomic health care problem in the Western World, the application of computer-aided simple triage (CAST) systems to this disease would be desirable. MATERIALS AND METHODS In total, 93 patients with acute chest pain and an intermediate risk score for acute coronary syndrome underwent coronary computed tomography angiography (cCTA). Among those, 74 were of adequate image quality for automated analysis by a commercially available CAST system (COR Analyzer, RCADIA, Haifa, Israel). CAST findings were compared to human expert interpretation for the detection of significant stenosis (≥50%) in the left main, left anterior descending, circumflex, right coronary artery, or arterial branches. Further, one inexperienced observer evaluated all studies for significant stenoses alone and after 1 month guided by a CAST system as an initial read. RESULTS Human expert interpretation identified 37/74 patients with stenosis ≥50%, whereas the CAST detected 45 patients. The CAST system demonstrated a sensitivity of 100%/79% and a specificity of 78%/89% on a per-patient/per-vessel level, respectively. With CAST, the inexperienced readers' per-vessel sensitivity and positive predictive values significantly improved (P = .011, P = .009) from 69% and 41% to 91% and 74%, respectively. CONCLUSIONS The investigated CAST system for automatic stenosis detection can accurately identify patients with coronary artery stenosis ≥50% and may be of use as initial interpretation and triage of cCTA studies as well as a second reader for inexperienced readers, in absence of expert readers.
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Duarte R, Miranda D, Fernández-Pérez G, Costa J. Coronariografía mediante tomografía computarizada con sincronización prospectiva. Comparación de la calidad de imagen y dosis de radiación con equipos de 128 detectores de fuente única y doble fuente. RADIOLOGIA 2013; 55:315-22. [DOI: 10.1016/j.rx.2011.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 07/04/2011] [Accepted: 07/09/2011] [Indexed: 11/25/2022]
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