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Tian X, Chen Y, Pan S, Lan H, Cheng L. Enhanced in-stent luminal visualization and restenosis diagnosis in coronary computed tomography angiography via coronary stent decomposition algorithm from dual-energy image. Comput Biol Med 2024; 171:108128. [PMID: 38342047 DOI: 10.1016/j.compbiomed.2024.108128] [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: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
Stent implantation is a principal therapeutic approach for coronary artery diseases. Nonetheless, the presence of stents significantly interferes with in-stent luminal (ISL) visualization and complicates the diagnosis of in-stent restenosis (ISR), thereby increasing the risk of misdiagnoses and underdiagnoses in coronary computed tomography angiography (CCTA). Dual-energy (DE) CT could calculate the volume fraction for voxels from low- and high-energy images (LHEI) and provide information on specific three basic materials. In this study, the innovative coronary stent decomposition algorithm (CSDA) was developed from the DECT three materials decomposition (TMD), through spectral simulation to determine the scan and attenuation coefficient for the stent, and preliminary execution for an in vitro sophisticated polyether ether ketone (PEEK) 3D-printed right coronary artery (RCA) replica. Furthermore, the whole-coronary-artery replica with multi-stent implantation, the RCA replica with mimetic plaque embedded, and two patients with stent further validated the effectiveness of CSDA. Post-CSDA images manifested no weakened attenuation values, no elevated noise values, and maintained anatomical integrity in the coronary lumen. The stents were effectively removed, allowing for the ISL and ISR to be clearly visualized with a discrepancy in diameters within 10%. We believe that CSDA presents a promising solution for enhancing CCTA diagnostic accuracy post-stent implantation.
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Affiliation(s)
- Xin Tian
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China.
| | - Yunbing Chen
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People's Hospital, Jincheng, 048000, China
| | - Honglin Lan
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Lei Cheng
- The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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2
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Notsuda H, Tomiyama F, Onodera K, Watanabe T, Watanabe Y, Oishi H, Niikawa H, Inoue C, Ota H, Noda M, Okada Y. Systemic-to-pulmonary artery shunt treated with transcatheter arterial embolization and subsequent lung segmentectomy. Egypt Heart J 2023; 75:103. [PMID: 38123754 PMCID: PMC10733262 DOI: 10.1186/s43044-023-00431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy. CASE PRESENTATION A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS. CONCLUSION We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition.
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Affiliation(s)
- Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Fumiko Tomiyama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Chihiro Inoue
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Bressan A, Faggin E, Donato M, Tonon L, Buso R, Nardin C, Tiepolo M, Cinetto F, Scarpa R, Agostini C, Pauletto P, Ventura L, Fusaro M, Felice C, Rattazzi M. NETosis in Acute Thrombotic Disorders. Semin Thromb Hemost 2023; 49:709-715. [PMID: 37308098 DOI: 10.1055/s-0043-1769510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The release of extracellular traps by neutrophils (NETs) represents a novel active mechanism of cell death that has been recently implicated in the pathogenesis of thrombotic disorders. The aim of this study was to investigate the generation of NETs in different groups of patients with acute thrombotic events (ATEs) and to establish whether NETs markers can predict the risk of new cardiovascular events. We performed a case-control study of patients with ATE, including acute coronary syndrome (n = 60), cerebrovascular accident (n = 50), and venous thromboembolism (n = 55). Control subjects (n = 70) were identified among patients admitted for acute chest pain and in which a diagnosis of ATE was excluded. Serum levels of NET markers and neutrophil activation, such as myeloperoxidase (MPO)-DNA complexes, neutrophil gelatinase-associated lipocalin, polymorphonuclear neutrophil elastase, lactoferrin, and MPO, were measured in each patient. We found that circulating levels of MPO-DNA complexes were significantly increased in patients with ATE (p < 0.001) compared with controls and that this association remained significant even after fully adjustment for traditional risk factors (p = 0.001). A receiver operating characteristics analysis of circulating MPO-DNA complexes in discriminating between controls and patients with ATE showed a significant area under the curve of 0.76 (95% confidence interval: 0.69-0.82). After a median follow-up of 40.7 (± 13.8) months, 24 out of the 165 patients with ATE presented a new cardiovascular event and 18 patients died. None of the markers under investigation influenced survival or the incidence of new cardiovascular events. In conclusion, we found that increase of markers of NETosis can be observed in acute thrombotic conditions, occurring both on the arterial and venous site. Nevertheless, the level of neutrophil markers measured during the ATE is not predictive of future risk of mortality and cardiovascular events.
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Affiliation(s)
| | | | - Maristella Donato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Luca Tonon
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberta Buso
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Chiara Nardin
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Marta Tiepolo
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Carlo Agostini
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Paolo Pauletto
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Carla Felice
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Marcello Rattazzi
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
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Cetin T, Kantarci M, Irgul B, Aydin S, Aydin F, Koseturk T, Levent A. Quadruple-Rule-Out Computed Tomography Angiography (QRO-CT): A Novel Dual-Energy Computed Tomography Technique for the Diagnostic Work-Up of Acute Chest Pain. Diagnostics (Basel) 2023; 13:2799. [PMID: 37685337 PMCID: PMC10486597 DOI: 10.3390/diagnostics13172799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Computerized tomography (CT) has been increasingly utilized in the differential diagnosis of acute chest pain. Combining the triple rule out CT angiography (TRO-CT) approach with dual-energy CT (DECT) can enhance the diagnostic capability by identifying myocardial perfusion deficiencies. This combination can yield a quadruple-rule-out computed tomography angiography (QRO-CT) technique. The aim of this study is to determine the efficacy of the QRO-CT. METHODS Intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. The myocardial dark spots on the color-coded iodine map were identified as perfusion deficiencies. Pulmonary arteries and aorta were also evaluated. RESULTS The study population consisted of 211 patients. The sensitivity, specificity, and positive and negative predictive values of QRO-CT for pulmonary embolism were 93.5%, 100%, 100%, and 95.3%, respectively. For obstructive coronary artery disease, the values were 96.1%, 93.4%, 89.2%, and 97.7%, respectively. For myocarditis, the values were 69.2%, 100%, 100%, and 93.6%, respectively. CONCLUSIONS the QRO-CT method may successfully evaluate myocardial perfusion deficits, hence expanding the differential diagnosis capabilities of the standard TRO-CT method for myocarditis. It can provide useful information on myocardial perfusion, which may influence the choice to perform invasive catheterization in cases of coronary artery obstruction.
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Affiliation(s)
- Turkhun Cetin
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Mecit Kantarci
- Department of Radiology, Ataturk University, Erzurum 25100, Turkey; (M.K.); (F.A.)
| | - Baris Irgul
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Fahri Aydin
- Department of Radiology, Ataturk University, Erzurum 25100, Turkey; (M.K.); (F.A.)
| | - Taner Koseturk
- Department of Anatomy, Erzincan Binali Yidirim University, Erzincan 24100, Turkey;
| | - Akin Levent
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
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Bothwell KD, Ling FS, Ambrosini R, Baran TM, Lorca MC, Chaturvedi A. Standardized Criteria for Identification of Cardiac Tamponade on Non-Electrocardiogram-gated Computed Tomography: Correlation With Echocardiographic Findings. J Thorac Imaging 2023; 38:W44-W51. [PMID: 36546839 DOI: 10.1097/rti.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify imaging parameters that can help in the diagnosis of cardiac tamponade on non-electrocardiogram (ECG)-gated computed tomography (CT) of the chest. MATERIALS AND METHODS Retrospective analysis of 64 patients who had undergone CT and echocardiography for evaluation of cardiac tamponade. Of 64 patients, 34 were diagnosed with tamponade and underwent pericardiocentesis for further diagnosis and treatment. CT measurements obtained were: pericardial effusion (PeEff) pocket size in 6 locations (anterior, posterior, superior, inferior, right, and left lateral), pericardial thickening, diameters of the coronary sinus, upper superior vena cava, lower superior vena cava, and inferior vena cava. In addition, cardiac chamber sizes were measured. Subjective assessment of coronary sinus compression, pericardial enhancement, and pericardial thickening were also recorded. RESULTS Measurement of the sum of the right lateral and left lateral PeEff thickness resulted in 91.2% sensitivity and 86.7% specificity for cardiac tamponade with a threshold of 30 mm (receiver-operating characteristic area under the curve=0.94 [0.84 to 0.98], P <0.0001). Using the combination of inferior PeEff >16 mm, sum of right lateral and left lateral PeEff>30 mm, and presence of pericardial thickening resulted in 56% sensitivity and 100% specificity and positive predictive value for the determination of cardiac tamponade. CONCLUSIONS Our study suggests that CT measurements related to PeEff size and thickness aid in the diagnosis of cardiac tamponade.
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Affiliation(s)
| | - Frederick S Ling
- Medicine, Cardiology, University of Rochester Medical Center, Rochester, NY
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6
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Chen D, Schonberger AR, Ye K, Levsky JM. Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome. Radiol Cardiothorac Imaging 2023; 5:e220188. [PMID: 37404788 PMCID: PMC10316301 DOI: 10.1148/ryct.220188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/28/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population. MATERIALS AND METHODS A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed. RESULTS The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities. CONCLUSION Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.
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7
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Pattereth N, Chaliyadan S, Mathew R, Kumar S, Das CJ, Aggarwal P, Jamshed N. The Role of Triple Rule-out CT in an Indian Emergency Setting. Indian J Crit Care Med 2023; 27:190-194. [PMID: 36960114 PMCID: PMC10028717 DOI: 10.5005/jp-journals-10071-24423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
Background Emergency physicians are acutely aware of the consequences of missing fatal diagnoses for acute non-traumatic chest pain and subjecting patients to over-testing. In the large arsenal of tests that are available to us, a triple rule-out computed tomography (TRO-CT) Angiography is often less pursued, due to concerns about their efficacy and safety or because of nescience. We aim to find the yield of the test in an Indian emergency setting and impart some knowledge about it along the way. Materials and methods Twenty-six patients who presented to the emergency department of our institute with acute chest pain, with non-specific electrocardiogram (ECG) findings and negative serial troponin I, underwent TRO-CT. HEART scores of all patients, calculated at their presentation, were correlated with TRO-CT findings. Results Triple rule-out computed tomography angiography was positive in 5 patients (20%), of which 4 cases (16%) were diagnosed to have significant coronary artery disease and one had an acute pulmonary embolism. All 4 patients who had significant coronary artery disease (CAD) diagnosed by TRO-CT had a HEART score of intermediate risk. The mean effective radiation dose of the entire TRO study was 19.024 ± 3.319 mSv (range = 13.89-25.95 mSv). Conclusion Triple rule-out CT angiography is a useful tool in the evaluation of patients presenting with acute chest pain in the emergency and can be an important adjunct in ruling out significant CAD in intermediate-risk patients. Emergency physicians and young residents need to know about this tool in their armamentarium to tackle doubtful cases. How to cite this article Pattereth N, Chaliyadan S, Mathew R, Kumar S, Das CJ, Aggarwal P. et al. The Role of Triple Rule-out CT in an Indian Emergency Setting. Indian J Crit Care Med 2023;27(3):190-194.
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Affiliation(s)
- Navaneeth Pattereth
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shafneed Chaliyadan
- Department of Surgery, Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
- Shafneed Chaliyadan, Department of Surgery, Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India, Phone: +91 9560819324, e-mail:
| | - Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardio-radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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Wang K, Wang X, Zheng S, Li C, Jin L, Li M. Dedicated CCTA Followed by High-Pitch Scanning versus TRO-CT for Contrast Media and Radiation Dose Reduction: A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12112647. [PMID: 36359488 PMCID: PMC9688948 DOI: 10.3390/diagnostics12112647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to compare dedicated coronary computed tomography angiography (CCTA) followed by high-pitch scanning and triple-rule-out computed tomography angiography (TRO-CTA) in terms of radiation dose, contrast media (CM) use, and image quality. Patients with acute chest pain were retrospectively enrolled and assigned to group A (n = 55; scanned with dedicated CCTA followed by high-pitch scanning) or group B (n = 45; with TRO-CTA). Patient characteristics, radiation dose, CM use, and quantitative parameters (CT value, image noise, signal-to-noise ratio, contrast-to-noise ratio, and image quality score) of pulmonary arteries (PAs), thoracic aortae (TAs), and coronary arteries (CAs) were compared. The total effective dose was significantly lower in group A (6.25 ± 2.94 mSv) than B (8.93 ± 4.08 mSv; p < 0.001). CM volume was significantly lower in group A (75.7 ± 8.9 mL) than B (95.0 ± 0 mL; p < 0.001). PA and TA image quality were significantly better in group B, whereas that of CA was significantly better in group A. Qualitative image scores of PA and TA scans rated by radiologists were similar, whereas that of CA scans was significantly higher in group A than B (p < 0.001). Dedicated CCTA followed by high-pitch scanning demonstrated lower radiation doses and CM volume without debasing qualities of PA, TA, and CA scans than did TRO-CTA.
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Affiliation(s)
- Kun Wang
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Xiaodong Wang
- Shanghai Changfeng Community Health Service Center of Putuo District, Shanghai 200062, China
| | - Shaoqiang Zheng
- Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Cheng Li
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Liang Jin
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-137-6114-8449 (L.J.); +86-138-1662-0371 (M.L.); Fax: +86-021-6248-3180 (L.J. & M.L.)
| | - Ming Li
- Radiology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai 200040, China
- Correspondence: (L.J.); (M.L.); Tel.: +86-137-6114-8449 (L.J.); +86-138-1662-0371 (M.L.); Fax: +86-021-6248-3180 (L.J. & M.L.)
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10
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Fiore G, Di Maio S, Oppizzi M, De Angelis M, Spessot M, Spoladore R, Slavich M, Bianchi G, Setti E, Di Napoli D, Margonato A, Fragasso G. Role of cardiological specialistic evaluation in patients with chest pain presenting in the emergency department. J Cardiovasc Med (Hagerstown) 2022; 23:363-370. [PMID: 35081073 DOI: 10.2459/jcm.0000000000001299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Aim of this study was to evaluate the impact of cardiological and echocardiographic evaluation in addition to a standard clinical and instrumental approach on diagnostic and prognostic accuracy in patients presenting in the emergency department (ED) with chest pain (CP). Acute coronary syndromes, pulmonary embolism and acute aortic syndromes (AAS) (triple-rule-out/TRO) were considered. METHODS From 7040 patients presenting with CP from 1 January 2015 to 31 December 2017, we randomly selected a sample of 1119. We retrospectively evaluated the clinical course and definitive diagnosis according to the ED final report. A 6-month follow-up to assess incident acute cardiovascular events was made by telephone interview in discharged patients; in hospitalized patients, clinical records were analyzed to evaluate the appropriateness of admissions. Diagnostic and prognostic accuracy wasd estimated through sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, according to the presence or absence of cardiological and echocardiographic consultation. RESULTS Complete information of 1099 patients out of 1119 was retrieved. Seven hundred and eighty-eight patients (71.70%) had been discharged, eight inappropriately (0.73%). Three hundred eleven (28.30%) had been hospitalized, 14 (1.27%) inappropriately. Diagnostic performance showed 97.38% sensitivity, 98.24% specificity, 95.5% PPV and 99% NPV, with an overall accuracy of 98.00%. In patients evaluated by the cardiologist in addition to the ED physician (n = 387) we observed an improvement of sensitivity and NPV at the expense of specificity. Among improperly discharged patients, 7/8 had normal troponin, 7/8 normal ECG and only 1 was evaluated by a cardiologist. Only one inappropriately hospitalized patient was not evaluated by a cardiologist. CONCLUSIONS Early consultation with a cardiologist and echocardiography improves clinical judgment in doubtful cases of CP, increasing diagnostic performance mainly by reducing inappropriate patient discharge and guaranteeing a low rate of inappropriate hospitalizations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Davide Di Napoli
- Health Directorate, University Hospital San Raffaele, Milano, Italy
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11
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Kul M, Kuru Öz D, Gürsoy Coruh A, Özalp Ateş F, Gülpınar B, Uzun Ç, Atasoy K. Biphasic split-bolus injection protocol for routine contrast-enhanced chest CT: comparison with conventional early-phase single bolus technique. Br J Radiol 2022; 95:20210775. [PMID: 35171718 PMCID: PMC10996411 DOI: 10.1259/bjr.20210775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To present a routine contrast-enhanced chest CT protocol with a split-bolus injection technique achieving combined early- and delayed phase images with a single aquisition, and to compare this technique with a conventional early-phase single-bolus chest CT protocol we formerly used at our institution, in terms of attenuation of great thoracic vessels, pleura, included hepatic and portal venous enhancement, contrast-related artifacts, and image quality. METHODS A total of 202 patients, who underwent routine contrast-enhanced chest CT examination aquired with either conventional early-phase single-bolus technique (group A,n = 102) or biphasic split-bolus protocol (group B,n = 100), were retrospectively included. Attenuation measurements were made by two radiologists independently on mediastinal window settings using a circular ROI at the following sites: main pulmonary artery (PA) at its bifurcation level, thoracal aorta (TA) at the level of MPA bifurcation,portal vein (PV) at porta hepatis, left and right hepatic lobe, and if present, thickened pleura (>2 mm) at the level with the most intense enhancement. Respective normalized enhancement values were also calculated. Contrast-related artifacts were graded and qualitative evaluation of mediastinal lymph nodes was performed by both reviewers independently. Background noise was measured and contrast-to-noise ratios (CNRs) of the liver and TA were calculated. RESULTS While enhancement of thoracic vessels and normalised MPA enhancement did not differ significantly between both groups (p > 0.05), enhancement and normalised enhancement of pleura, liver parenchyma and PV was significantly greater in group B (p < 0.001). Perivenous artifacts limiting evaluation were less frequent in group B than in A and mediastinal lymph nodes were judged to be evaluated worse in group A than in group B with an excellent agreement between both observers. No significant difference was detected in CNRTA (p = 0.633), whereas CNR liver was higher in group B (p < 0.001). CONCLUSION Our split-bolus chest CT injection protocol enables simultaneous enhancement for both vascular structures and soft tissues, and thus, might raise diagnostic confidence without the need of multiple acquisitions. ADVANCES IN KNOWLEDGE We think that this CT protocol might also be a promising alternative in lung cancer staging, where combined contrast-enhanced CT of the chest and abdomen is indicated. We therefore suggest to further evaluate its diagnostic utility in this setting, in particular in comparison with a late delayed chest-upper abdominal CT imaging protocol.
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Affiliation(s)
- Melahat Kul
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - Diğdem Kuru Öz
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | | | - Funda Özalp Ateş
- Department of Biostatistics, School of Medicine, Manisa Celal
Bayar University, Manisa,
Turkey
| | - Başak Gülpınar
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - Çağlar Uzun
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - K.Çetin Atasoy
- Department of Radiology, School of Medicine, Koç
University, İstanbul,
Turkey
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12
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Looi JL, Chan C, Bridgman P, Kerr AJ. Takotsubo Syndrome in New Zealand: Current Knowledge and Future Challenges. Intern Med J 2022; 52:1863-1876. [PMID: 35289058 DOI: 10.1111/imj.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TS), also known as apical ballooning syndrome is a transient stress-related cardiomyopathy characterised by acute but reversible left ventricular dysfunction. The condition tends to occur in postmenopausal women after a stressful event. At presentation TS typically mimics acute myocardial infarction (MI) and the incidence of TS has been increasing worldwide. This is likely a consequence of an improved awareness of the existence of this syndrome and easier access to early echocardiography and coronary angiography. However, its aetiology remains poorly understood and it is probably still underdiagnosed. Similar to other countries. TS is being increasingly recognised in New Zealand. In this review, we discuss the demographics, clinical features and outcomes of patients with TS in New Zealand. Doing so informs us not only of the pattern of disease in New Zealand but it also provides insights into the condition itself. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand
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13
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An J, Nam Y, Cho H, Chang J, Kim DK, Lee KS. Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: Clinical and Serial CT Pulmonary Angiographic Features. J Korean Med Sci 2022; 37:e76. [PMID: 35289137 PMCID: PMC8921210 DOI: 10.3346/jkms.2022.37.e76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/09/2022] [Indexed: 11/22/2022] Open
Abstract
In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot loads can be an indicator of the severity of current episode of PE or treatment effectiveness, they may not be used directly as an indicator of right ventricular (RV) failure or patient death. In other words, pulmonary vascular resistance or patient prognosis may not be determined only with mechanical obstruction of PAs and their branches by intravascular clot loads on computed tomography pulmonary angiography (CTPA), but determined also with vasoactive amines, reflex PA vasoconstriction, and systemic arterial hypoxemia occurring during acute PE. Large RV diameter with RV/left ventricle (LV) ratio > 1.0 and/or the presence of occlusive clot and pulmonary infarction on initial CTPA, and clinically determined high baseline PA pressure and RV dysfunction are independent predictors of oncoming chronic thromboembolic pulmonary hypertension (CTEPH). In this pictorial review, authors aimed to demonstrate clinical and serial CTPA features in patients with acute massive and submassive PE and to disclose acute CTPA and clinical features that are related to the prediction of oncoming CTEPH.
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Affiliation(s)
- Junho An
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yoojin Nam
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyoun Cho
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonga Chang
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
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14
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Alsagaff MY, Wardhani LFK, Pratanu I, Kartikasari DP, Doevendans PA. NSTEMI with total left circumflex occlusion: how the N-wave might help (case report). Oxf Med Case Reports 2022; 2022:omac010. [PMID: 35198230 PMCID: PMC8858395 DOI: 10.1093/omcr/omac010] [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: 08/09/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
A rise and/or fall in troponin level is an indication of type 1 or 2 myocardial infarct. A 62-year-old male physician presented to emergency room with chest discomfort followed by thought to be normal electrocardiogram (ECG) and normal echocardiography results. His serial hs-troponin test showed remarkable escalation three hours from the initial (107 ng/l into 4.978 ng/l), suggesting a high-risk non-ST-segment myocardial infarction (NSTEMI). An early invasive procedure was performed, showing acute total occlusion (TO) in the obtuse marginal 1 branch. We retrospectively reviewed our examination to diagnose better the presence of TO in NSTEMI patients presented with non-diagnostic examination. Our evaluation showed a minor change in the form of an ‘N-wave’ pattern on the ECG, which was not yet an established guideline criterion for prompt angiography. Although ECG pattern is often normal in LCx occlusion, recent study shows the presence of ‘N-wave’ ECG pattern in 10% of NSTEMI cases following TO at LCx.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr Soetomo General Hospital Surabaya, Surabaya, Indonesia
- Cardiology Department, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Louisa Fadjri Kusuma Wardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr Soetomo General Hospital Surabaya, Surabaya, Indonesia
| | - Iswanto Pratanu
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr Soetomo General Hospital Surabaya, Surabaya, Indonesia
| | - Dian Paramita Kartikasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr Soetomo General Hospital Surabaya, Surabaya, Indonesia
- Cardiology Department, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherland
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15
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Usefulness of the patient-specific contrast enhancement optimizer simulation software during the whole-body computed tomography angiography. Heart Vessels 2022; 37:1446-1452. [PMID: 35028684 DOI: 10.1007/s00380-022-02024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
Abstract
To evaluate whether the patient-specific contrast enhancement optimizer simulation software (p-COP) is useful for predicting contrast enhancement during whole-body computed tomography angiography (WBCTA). We randomly divided the patients into two groups using a random number table. We used the contrast material (CM) injection protocol selected by p-COP in group A (n = 52). The p-COP used an algorithm including data on the individual patient's cardiac output. Group B (n = 50) was assigned to the conventional CM injection protocol based on body weight. We compared the CT number in the abdominal aorta at the celiac artery level between the two groups and classified them as acceptable (> 280 HU) and unacceptable (< 279 HU) based on the optimal CT number for the WBCTA scans. To evaluate the difference in both injection protocols, we compared the visual inspection of the images of the artery of Adamkiewicz in both protocols. The CM dosage and injection rate in group A were significantly lower than those in group B (480.8 vs. 501.1 mg I/kg and 3.1 vs. 3.3 ml/s, p < 0.05). The CT number of the abdominal aorta at the celiac level was 382.4 ± 62.3 HU in group A and 363.8 ± 71.3 HU in group B (p = 0.23). CM dosage and injection rate were positively correlated to cardiac output for group A (r = 0.80, p < 0.05) and group B (r = 0.16, p < 0.05). The number of patients with an acceptable CT number was higher in group A [46/6 (86.7%)] than in group B [43/7 (71.4%)], but not significant (p = 0.71). The visualization rate for the Adamkiewicz artery was not significantly different between groups A and B (p = 0.89). The p-COP was useful for predicting contrast enhancement during WBCTA with a lower CM dosage and a lower contrast injection rate than that based on the body weight protocol. In patients with lower cardiac output a reduction in contrast injection rate and CM dosage did not lead to a reduced imaging quality, thus particularly in this group CM dosage can be reduced by p-COP.
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Morisaka H, Matsuura K, Yamaguchi H, Ichikawa T, Onishi H. Effect of decreased contrast injection flow rate on aortic enhancement in 80-KV peak CT with contrast dose reduction. Acta Radiol 2021; 64:353-359. [PMID: 34923851 DOI: 10.1177/02841851211067144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effect of decreased injection flow rate of contrast agent at the same iodine dose and delivery rate on aortic enhancement has not been clearly elucidated. PURPOSE To evaluate the effect of decreased injection flow rate of contrast agent on aortic peak enhancement in a dynamic flow phantom and on aortic enhancement in clinical dynamic 80-kVp computed tomography (CT) with contrast dose reduction. MATERIAL AND METHODS In the dynamic flow phantom experiment, the effect of a decreased injection flow rate at the same total iodine dose and delivery rate on simulated aortic peak enhancement was evaluated. In the clinical retrospective study, we searched 312 patients with renal dysfunction who underwent an 80-kVp abdominal dynamic CT with 40% reduction of contrast agent from a standard 120-kVp protocol and measured the aortic enhancement at the level of the hepatic hilum. Independent predictors for aortic enhancement were determined by multiple linear regression analysis, and after adjustment of significant predictors, independent variables for acquiring optimal aortic enhancement, ≥300 HU, were determined by multiple logistic regression analysis. RESULTS In the phantom experiment, decreased flow rate showed a significant but small descent effect (6%-9%) on simulated aortic peak enhancement. In the multiple linear regression analysis, only age was an independent predictor of aortic enhancement; there was no independent predictor for optimal age-adjusted aortic enhancement of ≥300 HU. CONCLUSIONS Decreased injection flow rate had a small influence on aortic enhancement in vitro but had no significant effect on the aortic enhancement in clinical dynamic 80-kVp CT.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Koichiro Matsuura
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Haruomi Yamaguchi
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoaki Ichikawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
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17
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Matuskowitz AJ, Obeid JS, Jennings L, Bayer RR, Ramakrishnan V, Schoepf UJ, Jauch EC. Feasibility and Impact of the Combined Application of Coronary CT Angiography With the HEART Pathway in Patients With Suspected Acute Coronary Syndrome. Crit Pathw Cardiol 2021; 20:185-191. [PMID: 33660627 PMCID: PMC8408286 DOI: 10.1097/hpc.0000000000000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study examines the feasibility and utility of integrating coronary computed tomography angiography and the HEART Pathway into a novel accelerated diagnostic protocol-called HEART-CT-and assesses its impact as an optional interactive decision support tool (smart form) in the electronic health record. METHODS This was a retrospective observational study performed in 2 adult emergency departments (ED) among patients evaluated for suspected acute coronary syndrome. Primary outcomes included the rate of discharge from the ED following HEART-CT Smart Form use, 30-day major adverse cardiac events (MACE), and ED length of stay (LOS). Hypothesis-generating outcomes included the rate of Smart Form use by ED providers and whether adhering to the HEART-CT recommendations was associated with improved outcomes. RESULTS The study included 672 subjects, 78.1% of whom were discharged from the ED. HEART-CT identified 76.7% of patients with increased risk HEAR scores as safe for discharge. No patients identified as low risk by HEART-CT had MACE within 30 days. Total mean ED LOS was 4.6 hours. ED providers used the HEART-CT smart form in 19.7% of eligible patients. ED providers who followed the HEART-CT recommendations had 3.41 times higher odds of ED discharging patients with increased risk HEAR scores than nonadherent providers (95% CI, 2.20-5.27). CONCLUSIONS HEART-CT reclassified a large proportion of patients as safe for discharge, maintained a high sensitivity for detecting 30-day MACE, and had an acceptable ED LOS. Future studies should test the extent to which more automated clinical decision support improves provider adoption and clinical outcomes of HEART-CT.
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Affiliation(s)
- Andrew J. Matuskowitz
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Jihad S. Obeid
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Lindsey Jennings
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Richard R. Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Edward C. Jauch
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
- Mission Research Institute, Mission Health, Asheville, NC
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18
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Botwe BO, Schandorf C, Inkoom S, Faanu A. Variability of redundant scan coverages along the Z-axis and dose implications for common computed tomography examinations. J Med Imaging Radiat Sci 2021; 53:113-122. [PMID: 34836834 DOI: 10.1016/j.jmir.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scan length optimization is a method of optimization which ensures that, imaging is performed to cover just the area of interest without unnecessarily exposing structures that would not add value to answer a given clinical question. PURPOSE This study assessed the variability and degree of redundant scan coverages along the z-axis of CT examinations of common indications and the associated radiation dose implications in CT facilities in Ghana for optimization measures to be recommended. METHODS On reconstructed acquired CT images, the study measured extra distances covered above and below anatomical targets for common indications with calibrated calipers across 25 CT facilities. The National Cancer Institute Dosimetry System for CT (NCICT) (Monte Carlo-based-software) was used to simulate the scanning situations and organ dose implications for scans with and without the inclusion of the redundant scan areas. RESULTS A total of 1,640 patients' CT data sets were used in this study. The results demonstrated that CT imaging utilized varying scan lengths (16.45±21.0-45.99±4.3 cm), and 70.6% of the scans exceeded their pre-defined anatomic boundaries by a mean range of 2.86±1.07-5.81±1.66 cm, thereby resulting in extra patient radiation dose. Hence, scanning without the redundant coverages could generate a dose length product (DLP) reduction of 17.5%, 18.8%, 15.5% and 9.0% without degrading image quality for brain lesion, lung lesion, pulmonary embolism and abdominopelvic lesion CT imaging, respectively, whilst ensuring organ dose reduction of0.8%-79.1%. CONCLUSION The study strongly recommends that radiographers should avoid the inclusion of redundant areas in CT examinations to reduce organ doses.
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Affiliation(s)
- Benard Ohene Botwe
- Radiography Department, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O Box KB 143, Korle-Bu Campus, Accra, Ghana..
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana, Legon
| | - Stephen Inkoom
- Medical Physics Department, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana.; Radiation Protection Institute (RPI), Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- Radiation Protection Institute (RPI), Ghana Atomic Energy Commission, Accra, Ghana.; Radiological and Non-ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
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Kicska GA, Hurwitz Koweek LM, Ghoshhajra BB, Beache GM, Brown RKJ, Davis AM, Hsu JY, Khosa F, Kligerman SJ, Litmanovich D, Lo BM, Maroules CD, Meyersohn NM, Rajpal S, Villines TC, Wann S, Abbara S. ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome. J Am Coll Radiol 2021; 18:S474-S481. [PMID: 34794601 DOI: 10.1016/j.jacr.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 01/17/2023]
Abstract
Acute aortic syndrome (AAS) includes the entities of acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. AAS typically presents with sudden onset of severe, tearing, anterior, or interscapular back pain. Symptoms may be dominated by malperfusion syndrome, due to obstruction of the lumen of the aorta and/or a side branch when the intimal and medial layers are separated. Timely diagnosis of AAS is crucial to permit prompt management; for example, early mortality rates are reported to be 1% to 2% per hour after the onset of symptoms for untreated ascending aortic dissection. The appropriateness assigned to each imaging procedure was based on the ability to obtain key information that is used to plan open surgical, endovascular, or medical therapy. This includes, but is not limited to, confirming the presence of AAS; classification; characterization of entry and reentry sites; false lumen patency; and branch vessel compromise. Using this approach, CT, CTA, and MRA are all considered usually appropriate in the initial evaluation of AAS if those procedures include intravenous contrast administration. Ultrasound is also considered usually appropriate if the acquisition is via a transesophageal approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Brian B Ghoshhajra
- Panel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts; Executive Committee, Society of Cardiovascular Computed Tomography
| | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | | | - Andrew M Davis
- Associate Vice-Chair, Quality, Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois; and American College of Physicians
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada; and Co-Chair of Equity, Diversity and Inclusion Committee, UBC
| | | | - Diana Litmanovich
- Harvard Medical School, Boston, Massachusetts; and Past-President, NASCI
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; Board Member, American Academy of Emergency Medicine; and American College of Emergency Physicians
| | | | - Nandini M Meyersohn
- Massachusetts General Hospital, Boston, Massachusetts; and AMA Delegate, RSNA
| | - Saurabh Rajpal
- Ohio State University, Nationwide Children's Hospital, Columbus, Ohio; Society for Cardiovascular Magnetic Resonance
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear cardiology expert
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas; and BOD SCCT
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20
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Hsieh CC, Zeng AB, Chen CH, Jhou ZY, Wang CH, Yang YL, Hsieh FC, Lin JK, Yeh JY, Huang CC. A practical biphasic contrast media injection protocol strongly enhances the aorta and pulmonary artery simultaneously using a single CT angiography scan. BMC Med Imaging 2021; 21:160. [PMID: 34717585 PMCID: PMC8557493 DOI: 10.1186/s12880-021-00691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Enhancement profiles of the pulmonary artery (PA) and aorta differ when using computed tomography (CT) angiography. Our aim was to determine the optimal CT protocol for a one-time CT scan that assesses both blood vessels. Methods We prospectively enrolled 101 cases of CT angiography in patients with suspected pulmonary embolism or aortic dissection from our center between 2018 and 2020. We also retrospectively collected the data of 40 patients who underwent traditional two-time CT scans between 2015 and 2018. Patients were divided into four groups: test bolus (TB) I, TB II, bolus-tracking (BT) I, and BT II. The enhancement of the PA and aorta, and the radiation doses used in the four groups were collected. Those who underwent two-time scans were classified into the traditional PA or aorta scan groups. Data were compared between the BT and traditional groups. Results The aortic enhancement was highest in BT II (294.78 ± 64.48 HU) followed BT I (285.18 ± 64.99 HU), TB II (186.58 ± 57.53 HU), and TB I (173.62 ± 69.70 HU). The radiation dose used was lowest in BT I (11.85 ± 5.55 mSv) and BT II (9.07 ± 3.44 mSv) compared with that used in the traditional groups (20.07 ± 7.78 mSv) and accounted for half of the traditional group (45.17–59.02%). The aortic enhancement was also highest in BT II (294.78 ± 64.48 HU) followed by BT I (285.18 ± 64.99 HU) when compared with that in the traditional aorta scan group (234.95 ± 94.18 HU). Conclusion Our CT protocol with a BT technique allows for a lower radiation dose and better image quality of the PA and aorta than those obtained using traditional CT scans. Trial registration: NCT04832633, retrospectively registered in April 2021 to the clinical trial registry.
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Affiliation(s)
- Cheng-Chih Hsieh
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - An-Bang Zeng
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chia-Hung Chen
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Zong-Yi Jhou
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chih-Hsin Wang
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ya-Ling Yang
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan
| | - Feng-Chuan Hsieh
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan
| | - Jing-Kai Lin
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan
| | - Ju-Yen Yeh
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan
| | - Chun-Chao Huang
- Department of Radiology, MacKay Memorial Hospital, No.92, Sec.2, Zhongshan North Rd., Taipei, 10449, Taiwan. .,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). J Echocardiogr 2020; 18:199-224. [PMID: 32886290 PMCID: PMC7471594 DOI: 10.1007/s12574-020-00480-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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22
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Masarapu V, Xia E, Son H. Esophageal emergencies: another important cause of acute chest pain. Insights Imaging 2020; 11:109. [PMID: 33034721 PMCID: PMC7547061 DOI: 10.1186/s13244-020-00915-1] [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: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
A variety of esophageal pathologies can present emergently with a chief complaint of acute chest pain. Computed tomography (CT) is often the first line of imaging in esophageal emergencies and provides useful information-even without an initial suspicion-when used in conjunction with other imaging modalities such as esophagography and direct visualization. We review various urgent and emergent esophageal disease entities which may manifest as acute chest pain, with an emphasis on CT and ancillary imaging appearances, while discussing management according to their emergency. Radiologists should be familiar with the imaging findings of these esophageal emergencies in order to provide an accurate diagnosis and recommend timely and appropriate management.
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Affiliation(s)
- Venkat Masarapu
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Eva Xia
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Hongju Son
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
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23
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA, Bertrand P, Donal E, Dweck M, Galderisi M, Haugaa KH, Sade LE, Stankovic I, Cosyns B, Edvardsen T. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging 2020; 21:1184-1207. [DOI: 10.1093/ehjci/jeaa149] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila,” Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
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24
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Coronary computed tomography angiography (CCTA): effect of bolus-tracking ROI positioning on image quality. Eur Radiol 2020; 31:1110-1118. [PMID: 32809163 PMCID: PMC7813743 DOI: 10.1007/s00330-020-07131-x] [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: 01/01/2020] [Revised: 05/29/2020] [Accepted: 07/31/2020] [Indexed: 12/03/2022]
Abstract
Objectives The aim of the study was to evaluate the effect of bolus-tracking ROI positioning on coronary computed tomography angiography (CCTA) image quality. Methods In this retrospective monocentric study, all patients had undergone CCTA by step-and-shoot mode to rule out coronary artery disease within a cohort at intermediate risk. Two groups were formed, depending on ROI positioning (left atrium (LA) or ascending aorta (AA)). Each group contained 96 patients. To select pairs of patients, propensity score matching was used. Image quality with regard to coronary arteries as well as pulmonary arteries was evaluated using quantitative and qualitative scores. Results In terms of the coronary arteries, there was no significant difference between both groups using quantitative (SNR AA 14.92 vs. 15.46; p = 0.619 | SNR LM 19.80 vs. 20.30; p = 0.661 | SNR RCA 24.34 vs. 24.30; p = 0.767) or qualitative scores (4.25 vs. 4.29; p = 0.672), respectively. With regard to pulmonary arteries, we found significantly higher quantitative (SNR RPA 8.70 vs. 5.89; p < 0.001 | SNR LPA 9.06 vs. 6.25; p < 0.001) and qualitative scores (3.97 vs. 2.24; p < 0.001) for ROI positioning in the LA than for ROI positioning in the AA. Conclusions ROI positioning in the LA or the AA results in comparable image quality of CT coronary arteriography, while positioning in the LA leads to significantly higher image quality of the pulmonary arteries. These results support ROI positioning in the LA, which also facilitates triple-rule-out CT scanning. Key Points • ROI positioning in the left atrium or the ascending aorta leads to comparable image quality of the coronary arteries. • ROI positioning in the left atrium results in significantly higher image quality of the pulmonary arteries. • ROI positioning in the left atrium is feasible to perform triple-rule-out CTA.
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25
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Martin SS, Mastrodicasa D, van Assen M, De Cecco CN, Bayer RR, Tesche C, Varga-Szemes A, Fischer AM, Jacobs BE, Sahbaee P, Griffith LP, Matuskowitz AJ, Vogl TJ, Schoepf UJ. Value of Machine Learning-based Coronary CT Fractional Flow Reserve Applied to Triple-Rule-Out CT Angiography in Acute Chest Pain. Radiol Cardiothorac Imaging 2020; 2:e190137. [PMID: 33778579 DOI: 10.1148/ryct.2020190137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/18/2020] [Accepted: 02/17/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the additional value of noninvasive artificial intelligence (AI)-based CT-derived fractional flow reserve (CT FFR), derived from triple-rule-out coronary CT angiography for acute chest pain (ACP) in the emergency department (ED) setting. Materials and Methods AI-based CT FFR from triple-rule-out CT angiography data sets was retrospectively obtained in 159 of 271 eligible patients (102 men; mean age, 57.0 years ± 9.7 [standard deviation]) presenting to the ED with ACP. The agreement between CT FFR (≤ 0.80) and stenosis at triple-rule-out CT angiography (≥ 50%), as well as downstream cardiac diagnostic testing, was investigated. Furthermore, the predictive value of CT FFR for coronary revascularization and major adverse cardiac events (MACE) was assessed over a 1-year follow-up period. Results CT FFR and triple-rule-out CT angiography demonstrated agreement in severity of coronary artery disease (CAD) in 52% (82 of 159) of all cases. CT FFR of 0.80 and less served as a better predictor for coronary revascularization and MACE than stenosis of 50% and greater at triple-rule-out CT angiography (odds ratio, 3.4; 95% confidence interval: 1.4, 8.2 vs odds ratio, 2.2; 95% confidence interval: 0.9, 5.3) (P < .01). In the subgroup of patients with additional noninvasive cardiac testing (94 of 159), there was higher agreement as to the presence or absence of significant disease with CT FFR (55%) than with coronary triple-rule-out CT angiography (47%) (P = .23). Conclusion CT FFR derived from triple-rule-out CT angiography was a better predictor for coronary revascularization and MACE and showed better agreement with additional diagnostic testing than triple-rule-out CT angiography. Therefore, CT FFR may improve the specificity in identifying patients with ACP with significant CAD in the ED setting and reduce unnecessary downstream testing.© RSNA, 2020See also the commentary by Ihdayhid and Ben Zekry in this issue.
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Affiliation(s)
- Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Domenico Mastrodicasa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Brian E Jacobs
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Pooyan Sahbaee
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - L Parkwood Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Andrew J Matuskowitz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Thomas J Vogl
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
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26
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Ioan AM, Durante-López A, Martínez-Milla J, Pérez-Calvo C, Santos A. [Pulmonary embolism in COVID-19. When nothing is what it seems]. Rev Esp Cardiol 2020; 73:665-667. [PMID: 32834360 PMCID: PMC7254023 DOI: 10.1016/j.recesp.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Ana-Maria Ioan
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España
| | | | | | - César Pérez-Calvo
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España
| | - Arnoldo Santos
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
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27
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Zhang YF, Zhao Q, Huang R. Computed tomography angiography for presence of systemic-to-pulmonary artery shunt in transpleural systemic arterial supply. Eur J Radiol 2020; 129:109060. [PMID: 32446128 DOI: 10.1016/j.ejrad.2020.109060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate radiographic indications and relevant clinical symptoms of retrograde systemic-to-pulmonary artery shunt (RSPAS). METHODS Forty-six consecutive patients, with transpleural systemic arterial supply to the lung confirmed by surgery or conventional angiography, underwent chest computed tomography angiography (CTA). Patients with the finding of RSPAS in CT scans were compared with those among whom no retrograde systemic-to-pulmonary artery shunt (NRSPAS) was present. Differences in clinical features, distribution and diameters of systemic supplying arteries between RSPAS and NRSPAS were assessed. RESULTS RSPAS in twenty patients (8 left and 12 right) and NRSPAS in 26 patients (14 left and 12 right) were detected at CTA. Hemoptysis and sputum were more frequent in RSPAS (85 % and 60 %, respectively) than in NRSPAS (46 % and 31 %, respectively) (P < 0.05). Single systemic supplying artery was more common in NRSPAS (65 %) while multiple systemic arteries were more frequent in RSPAS (65 %) (P < 0.05). The mean diameter of systemic arteries (6.13 ± 0.57 mm) in RSPAS was significantly larger than that (4.26 ± 0.55 mm) in NRSPAS (P < 0.0001). The anatomic location of systemic arteries crossing the thickened pleura distributed more intensively in apical and costal pleura in RSPAS than that in NRSPAS (P < 0.05). The distribution of systemic arteries adjacent to left or right lung was not statistically significant between RSPAS and NRSPAS. CONCLUSION Radiographic features of RSPAS are different from NRSPAS. RSPAS may include enlarged and multiple systemic supplying arteries. And that may suggest greater risk of hemoptysis.
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Affiliation(s)
- Yi-Fan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Qiong Zhao
- Department of Ultrasound, The Fifth Hospital in Wuhan, Wuhan, 430050, China
| | - Rui Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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28
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In-Hospital Cost Comparison of Triple-Rule-Out Computed Tomography Angiography Versus Standard of Care in Patients With Acute Chest Pain. J Thorac Imaging 2020; 35:198-203. [PMID: 32032251 DOI: 10.1097/rti.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the utilization of invasive and noninvasive tests and compare cost in patients presenting with chest pain to the emergency department (ED) who underwent either triple-rule-out computed tomography angiography (TRO-CTA) or standard of care. MATERIALS AND METHODS We performed a retrospective single-center analysis of 2156 ED patients who presented with acute chest pain with a negative initial troponin and electrocardiogram for myocardial injury. Patient cohorts matched by patient characteristics who had undergone TRO-CTA as a primary imaging test (n=1139) or standard of care without initial CTA imaging (n=1017) were included in the study. ED visits, utilization of tests, and costs during the initial episode of hospital care were compared. RESULTS No significant differences in the diagnosis of coronary artery disease, pulmonary embolism, or aortic dissection were observed. Median ED waiting time (4.5 vs. 7.0 h, P<0.001), median total length of hospital stay (5.0 vs. 32.0 h, P<0.001), hospital admission rate (12.6% vs. 54.2%, P<0.001), and ED return rate to our hospital within 30 days (3.5% vs. 14.6%, P<0.001) were significantly lower in the TRO-CTA group. Moreover, reduced rates of additional testing and invasive coronary angiography (4.9% vs. 22.7%, P<0.001), and ultimately lower total cost per patient (11,783$ vs. 19,073$, P<0.001) were observed in the TRO-CTA group. CONCLUSIONS TRO-CTA as an initial imaging test in ED patients presenting with acute chest pain was associated with shorter ED and hospital length of stay, fewer return visits within 30 days, and ultimately lower ED and hospitalization costs.
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29
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Ioan AM, Durante-López A, Martínez-Milla J, Pérez-Calvo C, Santos A. Pulmonary embolism in COVID-19. When nothing is what it seems. ACTA ACUST UNITED AC 2020; 73:665-667. [PMID: 32376225 PMCID: PMC7184010 DOI: 10.1016/j.rec.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ana-Maria Ioan
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - César Pérez-Calvo
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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30
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Monica MP, Merkely B, Szilveszter B, Drobni ZD, Maurovich-Horvat P. Computed Tomographic Angiography for Risk Stratification in Patients with Acute Chest Pain - The Triple Rule-out Concept in the Emergency Department. Curr Med Imaging 2020; 16:98-110. [PMID: 32003310 DOI: 10.2174/1573405614666180604095120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/20/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute chest pain is one of the most common reasons for Emergency Department (ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening condition, urgent identification of the etiology of chest pain is of utmost importance in emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes (AAS). DISCUSSION The concept of Triple Rule-out Computed Tomographic Angiography (TRO-CTA) for patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic angiography as a single imaging technique, able to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical evaluation and outcomes of these patients. CONCLUSION This review aims to summarize the main indications and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest pain.
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Affiliation(s)
- Marton-Popovici Monica
- Department of Internal Medicine and Critical Care, Swedish Medical Center, Edmonds, Washington, United States
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dora Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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31
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Khan-Kheil AM, Moss AS, Stephens L, Khan JN. The central role of CT coronary angiography in postcardiac arrest care in the young adult. BMJ Case Rep 2019; 12:12/12/e232104. [PMID: 31892623 DOI: 10.1136/bcr-2019-232104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 32-year-old man with no medical history went into ventricular fibrillation while running at the gym. He was transferred to our tertiary centre post successful resuscitation where admission electrocardiography and echocardiography were unremarkable. The initial cause of cardiac arrest was suspected arrhythmogenic and he was admitted for further investigations including exercise testing, ajmaline challenge, CT coronary angiography (CTCA) and cardiovascular MRI, with the likely outcome of cardioverter-defibrillator implantation. CTCA, however, revealed significant stenosis in the proximal left anterior descending artery as the likely cause for his arrest. Invasive coronary angiography confirmed this and facilitated successful stent implantation, avoiding the need for implantable cardioverter-defibrillator implantation. This case highlights the importance of CTCA, a non-invasive and readily-available test in the investigation of young patients postcardiac arrest, who require active exclusion of coronary artery disease and anomalous coronary anatomy, though they represent a low-risk population group.
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Affiliation(s)
| | | | - Leanne Stephens
- Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jamal Nasir Khan
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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32
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Martinetti C, Romano N, Bianco M, Casalini G, Losacco C, Derchi LE. Chest Pain Imaging: Expect the Unexpected. J Emerg Med 2019; 57:e193-e195. [PMID: 31594744 DOI: 10.1016/j.jemermed.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Carola Martinetti
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
| | - Nicola Romano
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
| | - Matteo Bianco
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giordano Casalini
- Department of Anesthesia and Intensive Care, San Martino Policlinico Hospital, Genoa, Italy
| | - Caterina Losacco
- Department of Radiology, San Martino Policlinico Hospital, Genoa, Italy
| | - Lorenzo Egildo Derchi
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy; Department of Emergency Radiology, San Martino Policlinico Hospital, Genoa, Italy
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33
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Bhalla AS, Das A, Naranje P, Irodi A, Raj V, Goyal A. Imaging protocols for CT chest: A recommendation. Indian J Radiol Imaging 2019; 29:236-246. [PMID: 31741590 PMCID: PMC6857267 DOI: 10.4103/ijri.ijri_34_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022] Open
Abstract
Computed Tomography (CT) is the mainstay of diagnostic imaging evaluation of thoracic disorders. However, there are a number of CT protocols ranging from a simple non-contrast CT at one end of the spectrum, and CT perfusion as a complex protocol available only on high-end scanners. With the growing diversity, there is a pressing need for radiologists, and clinicians to have a basic understanding of the recommended CT examinations for individual indications. This brief review aims to summarise the currently prevalent CT examination protocols, including their recommended indications, as well as technical specifications for performing them.
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Affiliation(s)
- Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
| | - Abanti Das
- Department of Radiodiagnosis, Safdarjung Hospital and Vardhaman Mahavir Medical College, Vellore, Tamil Nadu, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vimal Raj
- Department of Radiology, Narayana Institute of Cardiac Sciences, 258A, Hosur Rd, Bommasandra Industrial Area, Bengaluru, Karnataka, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
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34
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Duran ES, Ahmad F, Elshikh M, Masood I, Duran C. Computed Tomography Imaging Findings of Acute Aortic Pathologies. Cureus 2019; 11:e5534. [PMID: 31687308 PMCID: PMC6819069 DOI: 10.7759/cureus.5534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Acute aortic syndromes (AAS) encompass a spectrum of life-threatening conditions characterized by acute aortic pain. AAS include acute aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aneurysm rupture. The prognosis of AAS is clearly related to prompt diagnosis and appropriate management. The different types of AAS cannot be reliably differentiated solely based on clinical presentation since the clinical features are indistinguishable. Multidetector-row computed tomography (MDCT) with electrocardiographic gating (ECG-gated MDCT) has been used in the acute emergency setting as a powerful clinical tool, which enables rapid and specific diagnosis of aortic pathologies. ECG-gated MDCT significantly reduces motion artifact and avoids potential pitfalls in the diagnosis of AAS. The aim of this review is to evaluate the role of MDCT imaging in the assessment of AAS and to discuss the differentiation of this spectrum of aortic diseases with reference to the key imaging findings.
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Affiliation(s)
- Elif S Duran
- Radiology, University of Texas Health Rio Grande Valley School of Medicine, Edinburg, USA
| | - Farhan Ahmad
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Mohamed Elshikh
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Irfan Masood
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Cihan Duran
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
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35
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Abstract
Diagnosis of the inflammatory aortopathies and importantly, their distinction in the later stages of disease from genetically mediated or acquired (degenerative) aortopathy remains a challenging clinical problem. Historically, the diagnosis of inflammatory aortopathy has required tissue sampling and pathological assessment. Although histological diagnosis remains an important diagnostic criterion, the ability to obtain sufficient tissue samples is problematic and requires invasive approaches that pose important risk. Continuing refinement in the capabilities of multimodality imaging, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography provides important insights into the broad spectrum of disease which comprise the inflammatory aortopathies. This review examines the current and emerging role of multimodality imaging in the evaluation of aortitis.
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Affiliation(s)
- John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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36
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Higashigaito K, Hinzpeter R, Baumueller S, Benz D, Manka R, Keller DI, Alkadhi H, Morsbach F. Chest pain CT in the emergency department: Watch out for the myocardium. Eur J Radiol Open 2018; 5:202-208. [PMID: 30456219 PMCID: PMC6232643 DOI: 10.1016/j.ejro.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/31/2022] Open
Abstract
Hypodense myocardium (HM) can be observed often in chest pain CT examinations of patients presenting to the emergency department with chest pain. There is benefit when the myocardium is also analyzed for the presence of HM, even when the heart and coronary arteries were not specifically asked-for. Sensitivity, specificity, PPV and NPV for the detection of acute myocardial infarction by assessing HM was 52%, 100%, 100% and 95% respectively. Assessment of hypodense myocardium may increase the diagnostic confidence in ambiguous coronary findings in chest pain CT.
Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CTcoronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CTw/o coronary, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CTw/o coronary (7%) and 15/121 in chest-pain CTcoronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients’ history. Chest-pain CTw/o coronary identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CTw/o coronary when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.
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Key Words
- AAC/AHA, American College of Cardiology / American Heart Association
- AAS, acute aortic syndrome
- ACS, acute coronary syndrome
- Acute chest pain
- BPM, beats per minute
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CX, circumflex artery
- Cardiac
- Computed tomography
- ECG, electrocardiography
- ED, emergency department
- Emergency department
- HU, hounsfield unit
- ICC, intraclass correlation coefficients
- LAD, left anterior descending artery
- MH, hypodense myocardium
- MI, myocardial infarction
- NPV, negative predictive value
- NSTEMI, non-ST elevation myocardial infarction
- PE, pulmonary embolism
- PPV, positive predictive value
- RCA, right coronary artery
- ROI, region of interest
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Affiliation(s)
- Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephan Baumueller
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - David Benz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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37
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Abstract
Multidetector-row computed tomography (MDCT) can provide crucial information and rapid triage of emergency department patients with suspected acute coronary syndrome (ACS) or acute aortic syndrome (AAS). Coronary computed tomography angiography has high negative predictive value to rule out ACS, and MDCT is diagnostic for AAS and its variants. Optimization of acquisition technique and up-to-date knowledge of the pathophysiology of these conditions can improve study and interpretation quality for diagnosis of ACS or AAS.
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Affiliation(s)
- Avanti Gulhane
- Cardiovascular Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Harold Litt
- Cardiothoracic Imaging Division, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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38
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Abstract
Today medical imaging is an essential component of the entire health-care continuum, from wellness and screening, to early diagnosis, treatment selection, and follow-up. Patient triage in both acute care and chronic disease, imaging-guided interventions, and optimization of treatment planning are now integrated into routine clinical practice in all subspecialties. This paper provides a brief review of major milestones in medical imaging from its inception to date, with a few considerations regarding future directions in this important field.
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Affiliation(s)
- Eyal Bercovich
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Marcia C. Javitt
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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39
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Song I, Kang JH, Kim MY, Hwang HK, Kim HY, Ko SM. Diagnostic Accuracy of Electrocardiogram-Gated Thoracic Computed Tomography Angiography without Heart Rate Control for Detection of Significant Coronary Artery Stenosis in Patients with Acute Ischemic Stroke: A Comparative Study. Korean J Radiol 2018; 19:905-915. [PMID: 30174480 PMCID: PMC6082753 DOI: 10.3348/kjr.2018.19.5.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 03/03/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the diagnostic performance of electrocardiogram (ECG)-gated thoracic computed tomography angiography (TCTA) without heart rate (HR) control in ischemic stroke patients with coronary CTA (CCTA) in non-stroke patients for detection of significant coronary artery stenosis. Materials and Methods From September 2009 through August 2014, we retrospectively enrolled 138 consecutive patients diagnosed with acute ischemic stroke who had undergone ECG-gated TCTA and conventional coronary angiography (CCA). Over the same period, we selected 167 non-stroke patients with suspected or known coronary artery disease who had undergone CCTA and CCA. With CCA as the reference standard, the diagnostic performance of TCTA and CCTA for identification of significant coronary stenosis (diameter reduction ≥ 50%) was calculated. Results There was no significant difference in baseline characteristics between TCTA (n = 132) and CCTA (n = 164), except for the higher prevalence of atrial fibrillation in the stroke group. There was significant difference (p < 0.001) between TCTA and CCTA in average HR (68 ± 12 vs. 61 ± 10 beats per minute) and image quality score (1.3 ± 0.6 vs. 1.2 ± 0.6). Significant coronary stenosis was identified in 101 (77%) patients, 179 (45%) vessels, and 293 (15%) segments of stroke patients, and in 136 (83%) patients, 259 (53%) vessels, and 404 (16%) segments of non-stroke patients. Diagnostic performance on a per-vessel and per-patient basis was similar in both TCTA and CCTA groups. There was only significant difference in area under receiver-operating characteristic curve between TCTA and CCTA groups (0.79 vs. 0.87, p < 0.001) on per-segment basis. Conclusion Electrocardiogram-gated TCTA without HR control facilitates the identification of significant coronary stenosis in patients with ischemic stroke.
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Affiliation(s)
- Inyoung Song
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Ji Hun Kang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hweung Kon Hwang
- Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Han Young Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
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40
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Martin SS, van Assen M, Griffith LP, De Cecco CN, Varga-Szemes A, Bauer MJ, Wichmann JL, Vogl TJ, Schoepf UJ. Dual-Energy CT Pulmonary Angiography: Quantification of Disease Burden and Impact on Management. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0297-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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41
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Single-phase Split-bolus Dual Energy Computed Tomography Angiography for Evaluation of Hemoptysis: A Novel Application. J Thorac Imaging 2018; 33:366-376. [PMID: 29979241 DOI: 10.1097/rti.0000000000000337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess feasibility and overall utility of single-phase split-bolus dual energy computed tomography (DECT) angiography (DECTA) for evaluation of hemoptysis, and to establish an injection protocol for evaluation of hemoptysis, by comparing 2 contrast injection protocols. MATERIALS AND METHODS Using dual-source (80 and 140 kV), 2×128-slice equipment, DECTA was performed using 400 mg iodine/mL, 50 to 80 mL iodinated contrast in 257 patients (189 male individuals, 68 female individuals, age range: 15 to 76 y) presenting with hemoptysis. Initially, 50 patients were randomized into 2 groups for 2 different injection protocols (A and B). Images were assessed quantitative and qualitatively. Later, 207 patients were randomized using protocol B, which was technically simpler, and single-CT acquisition, for simultaneous opacification of systemic and pulmonary vessels. RESULTS Injection protocol A resulted in higher vessel attenuation, both in the aorta and in the pulmonary artery and its segmental branches; however, the difference was not statistically significant. No significant difference was noted in signal-to-noise ratio, contrast-to-noise ratio, as well as subjective image quality parameters. Overall optimal opacification of both systemic and pulmonary arteries was achieved in 247/257 patients. A total of 308 abnormal bronchial arteries were noted. A total of 392 nonbronchial systemic arteries were noted, the majority arising from posterior intercostals and subclavian artery branches. The pulmonary source of hemoptysis was identified in 9 patients (3 pulmonary thromboembolisms, 5 pulmonary artery pseudoaneurysms, and 1 pulmonary venous ectasia). CONCLUSION Combined DECTA is a novel technique that enables simultaneous evaluation of both systemic and pulmonary vascular cause of hemoptysis in a single acquisition with small contrast dose. Both injection protocols "A" and "B" were equally efficacious in simultaneous opacification of both the aorta and pulmonary arteries. To the best of our knowledge, such a protocol has never been described for hemoptysis evaluation.
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Coronary CT Angiography: Use in Patients With Chest Pain Presenting to Emergency Departments. AJR Am J Roentgenol 2018; 210:816-820. [PMID: 29446681 DOI: 10.2214/ajr.17.18740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previously published reports have shown that coronary CT angiography (CCTA) is a more efficient method of diagnosis than myocardial perfusion imaging (MPI) and stress echocardiography for patients presenting to emergency departments (EDs) with acute chest pain. In light of this evidence, the objective of this study was to examine recent trends in the use of these techniques in EDs. MATERIALS AND METHODS The nationwide Medicare Part B databases for 2006-2015 were the data source. The Current Procedural Terminology, version 4, codes for CCTA, MPI, and stress echocardiography were selected. Medicare place-of-service codes were used to determine procedure volumes in EDs. Medicare specialty codes were used to ascertain how many of these examinations were interpreted by radiologists, cardiologists, and other physicians as a group. RESULTS From 2006 to 2015, there was essentially no change in the number of MPI examinations performed in EDs for patients using Medicare (22,342 in 2006, 22,338 in 2015) or in the number of stress echocardiograms (3544 in 2006, 3520 in 2015). By contrast, the number of CCTA examinations increased rapidly, from 126 in 2006 to 1919 in 2015 (compound annual growth rate, 35%). Despite this rapid growth, patients in EDs underwent 11.6 times as many MPI as CCTA examinations in 2015. In that last year of the study, radiologists interpreted 78% of ED MPI and 83% of ED CCTA examinations. CONCLUSION Use of CCTA in EDs has increased rapidly, but far more MPI examinations are still being performed. This finding suggests that recently acquired evidence is not yet being fully acted upon.
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Miura Y, Ichikawa K, Fujimura I, Hara T, Hoshino T, Niwa S, Funahashi M. Comparative evaluation of image quality among different detector configurations using area detector computed tomography. Radiol Phys Technol 2018; 11:54-60. [PMID: 29297139 DOI: 10.1007/s12194-017-0437-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 11/30/2022]
Abstract
The 320-detector row computed tomography (CT) system, i.e., the area detector CT (ADCT), can perform helical scanning with detector configurations of 4-, 16-, 32-, 64-, 80-, 100-, and 160-detector rows for routine CT examinations. This phantom study aimed to compare the quality of images obtained using helical scan mode with different detector configurations. The image quality was measured using modulation transfer function (MTF) and noise power spectrum (NPS). The system performance function (SP), based on the pre-whitening theorem, was calculated as MTF2/NPS, and compared between configurations. Five detector configurations, i.e., 0.5 × 16 mm (16 row), 0.5 × 64 mm (64 row), 0.5 × 80 mm (80 row), 0.5 × 100 mm (100 row), and 0.5 × 160 mm (160 row), were compared using a constant volume CT dose index (CTDIvol) of 25 mGy, simulating the scan of an adult abdomen, and with a constant effective mAs value. The MTF was measured using the wire method, and the NPS was measured from images of a 20-cm diameter phantom with uniform content. The SP of 80-row configuration was the best, for the constant CTDIvol, followed by the 64-, 160-, 16-, and 100-row configurations. The decrease in the rate of the 100- and 160-row configurations from the 80-row configuration was approximately 30%. For the constant effective mAs, the SPs of the 100-row and 160-row configurations were significantly lower, compared with the other three detector configurations. The 80- and 64-row configurations were adequate in cases that required dose efficiency rather than scan speed.
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Affiliation(s)
- Yohei Miura
- Department of Medical Technology, Osaka General Medical Center, Osaka, Japan.,Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Ichikawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Ichiro Fujimura
- Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Radiological Technology, Rinku General Medical Center, Izumisano, Japan
| | - Takanori Hara
- Department of Medical Technology, Nakatsugawa Municipal General Hospital, Nakatsugawa, Japan
| | - Takashi Hoshino
- Department of Radiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Shinji Niwa
- Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Medical Technology, Nakatsugawa Municipal General Hospital, Nakatsugawa, Japan
| | - Masao Funahashi
- Department of Medical Technology, Osaka General Medical Center, Osaka, Japan
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44
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Abstract
Acute chest pain is a leading cause of Emergency Department visits. Computed tomography angiography plays a vital diagnostic role in such cases, but there are several common challenges associated with the imaging of acute chest pain, which, if unrecognized, can lead to an inconclusive or incorrect diagnosis. These imaging challenges fall broadly into 3 categories: (1) image acquisition, (2) image interpretation (including physiological and pathologic mimics), and (3) result communication. The aims of this review are to describe and illustrate the most common challenges in the imaging of acute chest pain and to provide solutions that will facilitate accurate diagnosis of the causes of acute chest pain in the emergency setting.
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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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Dobra M, Bordi L, Nyulas T, Stănescu A, Morariu M, Condrea S, Benedek T. Clinical update. Computed Tomography — an Emerging Tool for Triple Rule-Out in the Emergency Department. A Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
New imaging tools have been developed in recent years to rapidly and accurately diagnose life-threatening diseases associated with high mortality rates, such as acute coronary syndromes, acute aortic dissection, or pulmonary embolism. The concept of using computed tomographic (CT) assessment in emergency settings is based on the possibility of excluding multiple acute pathologies within one scan. It can be used for patients complaining of acute chest pain of unclear etiology with the possible association of acute coronary dissection or pulmonary embolism, but only a low to moderate risk of developing an acute coronary syndrome. One of the benefits of this protocol is the possibility of decreasing the number of patients who are hospitalized for further investigations. The technique also allows the rapid triage of patients and the safe discharge of those who show negative results. The aim of this review is to summarize the current medical literature regarding the potential use of CT for the triple rule-out (TRO) of coronary etiologies.
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Affiliation(s)
- Mihaela Dobra
- 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
| | - Tiberiu Nyulas
- University of Medicine and Pharmacy, Tîrgu Mureș , Romania
| | - Alexandra Stănescu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Mirabela Morariu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Sebastian Condrea
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș , Romania
- University of Medicine and Pharmacy, Tîrgu Mureș , Romania
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Imaging of nontraumatic thoracic emergencies. Curr Opin Pulm Med 2016; 23:184-192. [PMID: 28009644 DOI: 10.1097/mcp.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute chest symptoms form an important incentive for imaging in the emergency setting. This review discusses the radiologic features of various vascular and pulmonary diseases leading to acute respiratory distress and recent developments on important emergency radiologic examinations. RECENT FINDINGS Recently, triple-rule-out computed tomography protocol was introduced in diagnosis of chest pain, and advancing computed tomography technology and knowledge have led to discussion on treatment of pulmonary embolism. Diffuse pulmonary opacities remain a diagnostic dilemma in the emergency setting and although imaging findings can often be nonspecific, they help in guiding toward accurate diagnosis and timely management. SUMMARY Though promising, triple-rule-out is not yet justified because of low incidence of additional findings compared with conventional computed tomography angiography in chest pain, but it might be suited for clinical practice in the near future. Relevance of isolated subsegmental pulmonary embolism is unknown and research on this topic is needed and on its way. We provided some key findings in differentiating diffuse pulmonary opacities and describe the additional value of chest ultrasound in this clinical dilemma. A brief sidestep to pneumothorax is made, as this is also a frequent finding in the acute dyspneic patient, as well as in patients with acute chest pain.
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Yassin F, Sawh C, Garg P. Chest Pain of Uncertain Aetiology: Role of Contrast Enhanced Computed Tomography in the Emergency Department. Open Cardiovasc Med J 2016; 10:205-211. [PMID: 27733870 PMCID: PMC5054506 DOI: 10.2174/1874192401610010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect.
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Affiliation(s)
- Firas Yassin
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chris Sawh
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pankaj Garg
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Multidisciplinary Cardiovascular Research Centre & Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Mahdavi A, Mohammadzadeh A, Joodi G, Tabatabaei MR, Sheikholeslami F, Motevalli M. Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e24350. [PMID: 27679698 PMCID: PMC5035936 DOI: 10.5812/iranjradiol.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 10/21/2014] [Accepted: 11/11/2014] [Indexed: 12/21/2022]
Abstract
Background There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. Objectives To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Patients and Methods Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. Results In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. Conclusion Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.
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Affiliation(s)
- Arash Mahdavi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mohammadzadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golsa Joodi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Sheikholeslami
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Motevalli
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Marzieh Motevalli, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2122042026, Fax: +98-21-22042026, E-mail:
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50
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Takx RAP, Krissak R, Fink C, Bachmann V, Henzler T, Meyer M, Nance JW, Schoenberg SO, Apfaltrer P. Low-tube-voltage selection for triple-rule-out CTA: relation to patient size. Eur Radiol 2016; 27:2292-2297. [PMID: 27686566 PMCID: PMC5408040 DOI: 10.1007/s00330-016-4607-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/08/2022]
Abstract
Objectives To investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA). Methods We retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients’ chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA. Results There was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m2), PC (103 ± 7 vs. 104 ± 10 cm2) and TSA (92 ± 15 vs. 91 ± 19 cm2) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001). Conclusions 100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction. Key Points • 100 kV protocols result in a significantly lower radiation dose. • Mean vascular attenuation is significantly higher using 100 kV. • SNR and CNR are not significantly different between 100 kV and 120 kV. • 100 kV CTA is feasible regardless of patient size while maintaining image quality.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands.
| | - Radko Krissak
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Hufeland Klinikum GmbH, Bad Langensalza, Germany
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Radiology, General Hospital Celle, Celle, Germany
| | - Valentin Bachmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Paul Apfaltrer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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