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Shnayien S, Beetz NL, Bressem KK, Hamm B, Niehues SM. Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR. ROFO-FORTSCHR RONTG 2023; 195:139-147. [PMID: 36063835 DOI: 10.1055/a-1898-6504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Preprocedural computed tomography (CT) imaging before transcatheter aortic valve implantation/replacement (TAVI/TAVR) requires high diagnostic accuracy without motion artifacts. The aim of this retrospective study is to compare the image quality of a high-pitch non-electrocardiography (ECG)-gated CT protocol used in patients with atrial tachyarrhythmias with a prospectively ECG-gated CT protocol used in patients with sinus rhythm. MATERIALS AND METHODS We retrospectively included 108 patients who underwent preprocedural CT imaging before TAVI/TAVR. 52 patients with sinus rhythm were imaged using a prospectively ECG-gated protocol (Group A), and 56 patients with atrial tachyarrhythmias were imaged using the high-pitch non-ECG-gated protocol (Group B). Image quality was rated subjectively by two experienced radiologists and assessed by objective parameters including radiation dose, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) at the levels of the aortic root and abdominal aorta. RESULTS Subjective image quality was equally good with both CT protocols, and interrater agreement was substantial in both groups but tended to be higher in Group B at the level of the aortic root (Group A: κw = 0.644, Group B: κw = 0.741). With the high-pitch non-ECG-gated CT protocol, image noise was significantly increased (p = 0.001), whereas the SNR, CNR, and radiation dose were significantly decreased (p = 0.002, p = 0.003, and p < 0.001, respectively) at the level of the aortic root compared to the prospectively ECG-gated CT protocol. CONCLUSION The high-pitch non-ECG-gated protocol yields images with similar subjective image quality compared with the prospectively ECG-gated CT protocol and allows motion-free assessment of the aortic root for accurate TAVI/TAVR planning. The high-pitch non-ECG-gated protocol may be used as an alternative for preprocedural CT imaging in patients with atrial tachyarrhythmias. KEY POINTS · In patients with atrial tachyarrhythmias, a high-pitch non-ECG-gated CT protocol achieves similar subjective image quality compared to a prospective ECG-gated CT protocol.. · At the level of the aortic root, image noise is significantly increased, whereas SNR and CNR are significantly decreased using the high-pitch non-ECG-gated protocol.. · Radiation dose is reduced by 55 % using the high-pitch non-ECG-gated protocol.. CITATION FORMAT · Shnayien S, Beetz N, Bressem KK et al. Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR. Fortschr Röntgenstr 2023; 195: 139 - 147.
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Affiliation(s)
- Seyd Shnayien
- Department of Radiology, Charite University Hospital Berlin, Germany
| | - Nick Lasse Beetz
- Department of Radiology, Charite University Hospital Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charite University Hospital Berlin, Germany
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Lebedev S, Fournié E, Maier J, Stierstorfer K, Kachelrieß M. Motion compensation for aortic valves using partial angle CT reconstructions motion compensation of cardiac valve CT. Med Phys 2021; 49:1495-1506. [PMID: 34822186 DOI: 10.1002/mp.15379] [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: 03/03/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A motion compensation method that is aimed at correcting motion artifacts of cardiac valves is proposed. The primary focus is the aortic valve. METHODS The method is based around partial angle reconstructions and a cost function including the image entropy. A motion model is applied to approximate the cardiac motion in the temporal and spatial domain. Based on characteristic values for velocities and strain during cardiac motion, penalties for the velocity and spatial derivatives are introduced to maintain anatomically realistic motion vector fields and avoid distortions. The model addresses global elastic deformation, but not the finer and more complicated motion of the valve leaflets. RESULTS The method is verified based on clinical data. Image quality was improved for most artifact impaired reconstructions. An image quality study with Likert scoring of the motion artifact severity on a scale from 1 (highest image quality) to 5 (lowest image quality/extreme artifact presence) was performed. The biggest improvements after applying motion compensation were achieved for strongly artifact impaired initial images scoring 4 and 5, resulting in an average change of the scores by -0.59 ± 0.06 and -1.33 ± 0.03, respectively. In case of artifact free images, a chance to introduce blurring was observed and their average score was raised by 0.42 ± 0.03. CONCLUSION Motion artifacts were consistently removed and image quality improved.
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Affiliation(s)
- Sergej Lebedev
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Siemens Healthineers, Forchheim, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Joscha Maier
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Marc Kachelrieß
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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The Role of Cardiac Computed Tomography in Valve Disease and Valve Intervention Planning. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aremu OO, Samuels P, Jermy S, Lumngwena EN, Mutithu D, Cupido BJ, Skatulla S, Ntusi NAB. Cardiovascular imaging modalities in the diagnosis and management of rheumatic heart disease. Int J Cardiol 2020; 325:176-185. [PMID: 32980432 DOI: 10.1016/j.ijcard.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Rheumatic heart disease (RHD) is prevalent in sub-Saharan Africa, where the capacity for diagnosis and evaluation of disease severity and complications is not always optimal. While the medical history and physical examination are important in the assessment of patients suspected to have RHD, cardiovascular imaging techniques are useful for confirmation of the diagnosis. Echocardiography is the workhorse modality for initial evaluation and diagnosis of RHD. Cardiovascular magnetic resonance is complementary and may provide additive information, including tissue characteristics, where echocardiography is inadequate or non-diagnostic. There is emerging evidence on the role of computed tomography, particularly following valve replacement surgery, in the monitoring and management of RHD. This article summarises the techniques used in imaging RHD patients, considers the evidence base for their utility, discusses their limitations and recognises the clinical contexts in which indications and imaging with various modalities are expanding.
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Affiliation(s)
- Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for the Study of Emerging and Ee-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant studies (IMPM), Ministry of Scientific Research and Innovation, Cameroon
| | - Daniel Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Blanche J Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sebastian Skatulla
- Division of Structural Engineering and Mechanics, Department of Civil Engineering, University of Cape Town, South Africa; Department of Civil Engineering, Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa.
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Lipiski M, Eberhard M, Fleischmann T, Halvachizadeh S, Kolb B, Maisano F, Sauer M, Falk V, Emmert MY, Alkadhi H, Cesarovic N. Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research. Sci Rep 2020; 10:6020. [PMID: 32265478 PMCID: PMC7138799 DOI: 10.1038/s41598-020-63044-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/24/2020] [Indexed: 12/25/2022] Open
Abstract
The pig (Sus Scrofa Domestica) is an accepted model for preclinical evaluation of prosthetic heart valves and trans-catheter implantation techniques. Understanding porcine cardiac dimensions through three-dimensional computed tomography (CT), increases preclinical study success, leading to higher cost efficiency and to the observance of the obligation to the 3 R principles. Cardiac CT images of twenty-four Swiss large white pigs were segmented; aortic root, mitral valve, pulmonary trunk, tricuspid valve, as well as the aorto-mitral angle and left atrial height were analyzed. Correlation coefficient (r) was calculated in relation to body weight. In Swiss large white pigs, valvular dimensions, length of the pulmonary artery and ascending aorta as well as left atrial height correlate with body weight. Coronary ostia heights and aorto-mitral angle size can be neglected in animal size selection; no changes were found for either of the two parameters with increasing body weight.
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Affiliation(s)
- Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Matthias Eberhard
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Beate Kolb
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Mareike Sauer
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Hatem Alkadhi
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Kim JY, Suh YJ, Han K, Kim YJ, Choi BW. Diagnostic Value of Advanced Imaging Modalities for the Detection and Differentiation of Prosthetic Valve Obstruction. JACC Cardiovasc Imaging 2019; 12:2182-2192. [DOI: 10.1016/j.jcmg.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 01/18/2023]
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Non-destructive two-photon excited fluorescence imaging identifies early nodules in calcific aortic-valve disease. Nat Biomed Eng 2017; 1:914-924. [PMID: 29456878 DOI: 10.1038/s41551-017-0152-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Calcifications occur during the development of healthy bone, and at the onset of calcific aortic-valve disease (CAVD) and many other pathologies. Although the mechanisms regulating early calcium deposition are not fully understood, they may provide targets for new treatments and for early interventions. Here, we show that two-photon excited fluorescence (TPEF) can provide quantitative and sensitive readouts of calcific nodule formation, in particular in the context of CAVD. Specifically, by means of the decomposition of TPEF spectral images from excised human CAVD valves and from rat bone prior to and following demineralization, as well as from calcific nodules formed within engineered gels, we identified an endogenous fluorophore that correlates with the level of mineralization in the samples. We then developed a ratiometric imaging approach that provides a quantitative readout of the presence of mineral deposits in early calcifications. TPEF should enable non-destructive, high-resolution imaging of three-dimensional tissue specimens for the assessment of the presence of calcification.
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Nafakhi H, Al-Nafakh HA, Al-Mosawi AA. Aortic Root Calcification: A Possible Imaging Biomarker of Coronary Atherosclerosis. Pulse (Basel) 2016; 3:167-71. [PMID: 27195236 DOI: 10.1159/000442762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
It has been reported that coronary atherosclerosis risk assessment using coronary artery calcium and thoracic aorta calcium quantification may improve risk stratification as it can lead to the reclassification of persons at increased risk. The aortic root has been characterized by its close anatomical proximity to the ostial origins of the right and left coronary arteries, and it can be evaluated using multi-detector computed tomography without additional radiation exposure and the use of contrast. The correlations between aortic root calcification and coronary atherosclerotic markers as well as cardiac risk factors have been analyzed.
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Affiliation(s)
- Hussein Nafakhi
- Internal Medicine Department, AL-Sader Teaching Hospital, Medicine College, Kufa University, Najaf, Iraq
| | - Hasan A Al-Nafakh
- Radiology Department, Medicine College, Kufa University, Najaf, Iraq
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