1
|
Rovera C, Moretti C, Bisanti F, De Zan G, Guglielmo M. Myocardial Bridging: Review on the Role of Coronary Computed Tomography Angiography. J Clin Med 2023; 12:5949. [PMID: 37762890 PMCID: PMC10532361 DOI: 10.3390/jcm12185949] [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: 07/20/2023] [Revised: 08/20/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery, most frequently the left anterior descending artery, deviates from its epicardial route by passing through the myocardium. The advent of cardiac computed tomography angiography (CCTA), equipped with its multiplane and three-dimensional functionalities, has notably enhanced the ability to identify MBs. Furthermore, novel post-processing methods have recently emerged to extract functional insights from anatomical evaluations. MB is generally considered a benign entity with very good survival rates; however, there is an increasing volume of evidence that certain MB characteristics may be associated with cardiovascular morbidity. This review is intended to depict the diagnostic and prognostic role of CCTA in the MB context.
Collapse
Affiliation(s)
- Chiara Rovera
- Department of Cardiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy; (C.R.); (C.M.)
| | - Claudio Moretti
- Department of Cardiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy; (C.R.); (C.M.)
| | - Francesca Bisanti
- Department of Radiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy;
| | - Giulia De Zan
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands;
- Department of Translational Medicine, University of Easter Piedmont, Maggiore della Carita’ Hospital, 28100 Novara, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands;
| |
Collapse
|
2
|
Bakker LMML, Xiao N, Lynch S, van de Ven AAF, UpdePac A, Schaap M, Buls N, de Mey J, van de Vosse FN, Taylor CA. Preclinical validation of the advection diffusion flow estimation method using computational patient specific coronary tree phantoms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3746. [PMID: 37459894 DOI: 10.1002/cnm.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/24/2023] [Accepted: 06/11/2023] [Indexed: 09/02/2023]
Abstract
Coronary computed tomography angiography (CCTA) does not allow the quantification of reduced blood flow due to coronary artery disease (CAD). In response, numerical methods based on the CCTA image have been developed to compute coronary blood flow and assess the impact of disease. However to compute blood flow in the coronary arteries, numerical methods require specification of boundary conditions that are difficult to estimate accurately in a patient-specific manner. We describe herein a new noninvasive flow estimation method, called Advection Diffusion Flow Estimation (ADFE), to compute coronary artery flow from CCTA to use as boundary conditions for numerical models of coronary blood flow. ADFE uses image contrast variation along the tree-like structure to estimate flow in each vessel. For validating this method we used patient specific software phantoms on which the transport of contrast was simulated. This controlled validation setting enables a direct comparison between estimated flow and actual flow and a detailed investigation of factors affecting accuracy. A total of 10 CCTA image data sets were processed to extract all necessary information for simulating contrast transport. A spectral element method solver was used for computing the ground truth simulations with high accuracy. On this data set, the ADFE method showed a high correlation coefficient of 0.998 between estimated flow and the ground truth flow together with an average relative error of only 1 % . Comparing the ADFE method with the best method currently available (TAFE) for image-based blood flow estimation, which showed a correlation coefficient of 0.752 and average error of 20 % , it can be concluded that the ADFE method has the potential to significantly improve the quantification of coronary artery blood flow derived from contrast gradients in CCTA images.
Collapse
Affiliation(s)
- L M M L Bakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N Xiao
- HeartFlow, Inc., Mountain View, California, USA
| | - S Lynch
- HeartFlow, Inc., Mountain View, California, USA
| | - A A F van de Ven
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - A UpdePac
- HeartFlow, Inc., Mountain View, California, USA
| | - M Schaap
- HeartFlow, Inc., Mountain View, California, USA
| | - N Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - J de Mey
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - F N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - C A Taylor
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- HeartFlow, Inc., Mountain View, California, USA
| |
Collapse
|
3
|
Kato Y, Noda C, Ambale-Venkatesh B, Ortman JM, Kassai Y, Lima JAC, Liu CY. The mechanisms of arterial signal intensity profile in non-contrast coronary MRA (NC-MRCA): a 3D printed phantom investigation and clinical translations. Int J Cardiovasc Imaging 2023; 39:209-220. [PMID: 36598690 DOI: 10.1007/s10554-022-02700-1] [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: 03/09/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023]
Abstract
Signal intensity (SI) drop has been proposed as an indirect stenosis assessment in non-contrast coronary MRA (NC-MRCA) but it uses unproven assumptions. We aimed to clarify the mechanisms that govern the SI in vitro and develop a stenosis detection method in vivo. Flow phantom tubes with/without stenosis were scanned under two spatial resolutions (0.5/1.0 mm3) on a 3.0 T MRI. Thirty-two coronary arteries from 11 volunteers were prospectively scanned with an EKG- and respiratory-gated 3D NC-MRCA with a resolution of 1.0 mm3, with coronary computed tomography angiography (CTA) as reference. The normalized SI along the centerline of the tubes or the coronary arteries was assessed against the distance from the orifice using a linear regression model. Its coefficient (SI decay slope) and goodness-of-fit (R2) were extracted to assess the effect of flow velocity and stenosis on the SI profile curve. The R2 was utilized for the stenosis detection. Phantom study: A slow flow velocity caused a steep SI decay slope. The SI drop revealed only at the inlet and outlet of stenosis due to the flow turbulence/vortex and yielded low R2, in which shape changed by the resolution. Clinical study: The R2 cutoff to detect ≥ 50% stenosis for the left and right coronary arteries were 0.64 and 0.20 with a sensitivity/specificity of 71.5/71.5 and 66.7/100 (%), respectively. The SI drop did not reflect the actual stenosis position and not suitable for the stenosis localization. The R2 cutoff represents an alternative method to detect stenoses on NC-MRCA at vessel level.Trial registration: ClinicalTrials.gov; NCT03768999, registered on December 7, 2018.
Collapse
Affiliation(s)
- Yoko Kato
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chikara Noda
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jason M Ortman
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoshimori Kassai
- Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chia-Ying Liu
- Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan.
| |
Collapse
|
4
|
Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography. PLoS One 2022; 17:e0271189. [PMID: 35802711 PMCID: PMC9269916 DOI: 10.1371/journal.pone.0271189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA). Methods A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator (‘baseline CT’) and CCTA during continuous intravenous nitrate infusion (‘IV nitrate CT’). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT. Results Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm. Conclusions A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.
Collapse
|
5
|
Shi K, Yang FF, Si N, Zhu CT, Li N, Dong XL, Guo Y, Zhang T. Effect of 320-row CT reconstruction technology on fractional flow reserve derived from coronary CT angiography based on machine learning: single- versus multiple-cardiac periodic images. Quant Imaging Med Surg 2022; 12:3092-3103. [PMID: 35655842 PMCID: PMC9131332 DOI: 10.21037/qims-21-659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/02/2022] [Indexed: 10/13/2023]
Abstract
BACKGROUND Fractional flow reserve derived from computed tomography (CT-FFR) can be used to noninvasively evaluate the functions of coronary arteries and has been widely welcomed in the field of cardiovascular research. However, whether different image reconstruction schemes have an effect on CT-FFR analysis through single- and multiple-cardiac periodic images in the same patient has not been investigated. METHODS This study retrospectively enrolled 122 patients who underwent 320-row computed tomography (CT) examination with both single- and multiple-cardiac periodic reconstruction schemes; a total of 366 coronary arteries were analyzed. The lowest CT-FFR values of each vessel and the poststenosis CT-FFR values of the lesion-specific coronary artery were measured using the two reconstruction techniques. The Wilcoxon signed-rank test was used to compare differences in CT-FFR values between the two reconstruction techniques. Spearman correlation analysis was performed to determine the relationship between CT-FFR values derived using the two methods. Bland-Altman and intraclass correlation coefficient (ICC) analyses were performed to evaluate the consistency of CT-FFR values. RESULTS In all blood vessels, the lowest CT-FFR values showed no significant differences between the two reconstruction techniques in the left anterior descending artery (LAD; P=0.65), left circumflex artery (LCx; P=0.46), or right coronary artery (RCA; P=0.22). In blood vessels with atherosclerotic plaques, the poststenosis CT-FFR values (2 cm distal to the maximum stenosis) exhibited no significant differences between the two reconstruction techniques in the LAD (P=0.78), LCx (P=1.00), or RCA (P=1.00). The mean CT-FFR values of single- and multiple-cardiac periodic images showed excellent correlation and minimal bias in all groups. CONCLUSIONS CT-FFR analysis based on an artificial intelligence deep learning neural network is stable and not affected by the type of 320-row CT reconstruction technology.
Collapse
Affiliation(s)
- Ke Shi
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Feng-Feng Yang
- Department of Radiology, The Second Hospital, Tianjin Medical University, Tianjin, China
| | - Nuo Si
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Chen-Tao Zhu
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Na Li
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xiao-Lin Dong
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yan Guo
- GE Healthcare, Beijing, China
| | - Tong Zhang
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| |
Collapse
|
6
|
von Felten E, Benz DC, Benetos G, Giannopoulos AA, Messerli M, Gräni C, Fuchs TA, Gebhard C, Buechel RR, Kaufmann PA, Pazhenkottil AP. Transluminal attenuation gradient derived from coronary CT angiography to predict ischemia in SPECT myocardial perfusion imaging: Effect of coronary cross-sectional area. J Nucl Cardiol 2022; 29:350-358. [PMID: 32613474 DOI: 10.1007/s12350-020-02242-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-based transluminal attenuation gradient (TAG) was suggested to determine the functional significance of a stenosis. However, evidence that TAG acquired by wide-volume scanners can assess the hemodynamic significance of stenosis assessed by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is lacking. Moreover, coronary cross-sectional area may influence TAG. Hence, we aimed at assessing the diagnostic value of TAG to predict ischemia in SPECT-MPI and the correlation between TAG and the transluminal cross-sectional area gradient (TCG). METHODS Patients undergoing CCTA and SPECT-MPI for suspected coronary artery disease were included. TAG and TCG were calculated measuring the mean vessel attenuation and the cross-sectional area along major coronary vessels at 5-mm intervals. RESULTS A total of 255 coronary arteries of 87 patients were included. TAG and TCG did not discriminate between coronary arteries with or without ischemia as assessed by SPECT-MPI (p = .44 and p = .25, respectively). The area under the curve to predict ischemia was not increased by adding TAG (0.88, 95% CI 0.83-0.92) or TCG (0.87, 95% CI 0.81-0.90) to CCTA alone (0.85, 95% CI 0.80-0.89). There was a significant correlation between TAG and TCG (r = 0.43; p < .001). CONCLUSIONS CCTA-derived TAG and TCG do not offer any value in predicting ischemia assessed by SPECT-MPI. TAG is partly affected by differences in the coronary luminal area.
Collapse
Affiliation(s)
- Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Georgios Benetos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
7
|
Henriksson L, Woisetschläger M, Alfredsson J, Janzon M, Ebbers T, Engvall J, Persson A. The transluminal attenuation gradient does not add diagnostic accuracy to coronary computed tomography. Acta Radiol 2021; 62:867-874. [PMID: 32722968 DOI: 10.1177/0284185120943042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A method for improving the accuracy of coronary computed tomography angiography (CCTA) is highly sought after as it would help to avoid unnecessary invasive coronary angiographies. Measurement of the transluminal attenuation gradient (TAG) has been proposed as an alternative to other existing methods, i.e. CT perfusion and CT fractional flow reserve (FFR). PURPOSE To evaluate the incremental value of three types of TAG in high-pitch spiral CCTA with invasive FFR measurements as reference. MATERIAL AND METHODS TAG was measured using two semi-automatic methods and one manual method. A receiver operating characteristic (ROC) analysis was made to determine the usefulness of TAG alone as well as TAG combined with CCTA for detection of significant coronary artery stenoses defined by an invasive FFR value ≤0.80. RESULTS A total of 51 coronary vessels in 37 patients were included in this retrospective study. Hemodynamically significant stenoses were found in 13 vessels according to FFR. The ROC analysis TAG alone resulted in areas under the curve (AUCs) of 0.530 and 0.520 for the semi-automatic TAG and 0.557 for the manual TAG. TAG and CCTA combined resulted in AUCs of 0.567, 0.562 for semi-automatic TAG, and 0.569 for the manual TAG. CONCLUSION The results from our study showed no incremental value of TAG measured in single heartbeat CCTA in determining the severity of coronary artery stenosis degrees.
Collapse
Affiliation(s)
- Lilian Henriksson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology, Department of Health, Medicine and Caring Sciences and, Linköping University, Linköping, Sweden
| | - Mischa Woisetschläger
- Department of Radiology, Department of Health, Medicine and Caring Sciences and, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| |
Collapse
|
8
|
Diagnostic performance of corrected FFR CT metrics to predict hemodynamically significant coronary artery stenosis. Eur Radiol 2021; 31:9232-9239. [PMID: 34080038 DOI: 10.1007/s00330-021-08064-9] [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: 03/24/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of the fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFRCT) difference across the lesion (ΔFFRCT lesion) or the vessel (ΔFFRCT vessel) and the gradient of FFRCT for the identification of hemodynamically significant coronary stenosis. METHODS From June 2016 to December 2018, 73 patients suspected of having coronary artery disease who underwent CCTA followed invasive coronary angiography (ICA) within 1 month were retrospectively included. ΔFFRCT lesion, ΔFFRCT vessel, and FFRCT gradient were calculated. Performance characteristics of different corrected FFRCT metrics in detecting ischemic stenosis were analyzed. Impacts of coronary calcification and lesion length on the corrected FFRCT metrics were also analyzed. RESULTS The diagnostic sensitivities, specificities, and accuracies of 94.4%, 88.7%, and 91.0% with ΔFFRCT lesion, 57.1%, 72.3%, and 65.2% with ΔFFRCT vessel, and 50.0%, 85.1%, and 68.5% with FFRCT gradient, respectively, were detected. There was higher specificity, accuracy, and area under the curve (AUC) for ΔFFRCT lesion compared with CCTA (p < 0.05 for all). The specificity and AUC of FFRCT gradient and ΔFFRCT vessel were significantly higher than CCTA (p < 0.05 for all). Coronary calcification showed no impact on corrected FFRCT metrics. ΔFFRCT lesion for lesion length ratio (LLR) < 1/10 was significantly lower than that for LLR 1/10 to 3/10 and LLR > 3/10. CONCLUSIONS ΔFFRCT lesion was significantly correlated with the hemodynamically significant coronary artery stenosis. ΔFFRCT lesion had the potential to be immediately used in real-world practice to discriminate ischemic coronary artery stenosis. KEY POINTS • The difference of FFRCT across the lesion or the vessel and the gradient of FFRCT was related to the hemodynamically significant coronary artery stenosis. • The difference of FFRCT across the lesion showed the best diagnostic performance in detecting the hemodynamically significant coronary artery stenosis. • Coronary calcification showed no impact on corrected FFRCT metrics, while lesion length related to the difference of FFRCT across the lesion.
Collapse
|
9
|
Gürsoy Çoruh A, Peker E, Gülpınar B, Sorgun MH, Elhan AH, Fitoz ÖS. Prediction of degree of carotid stenosis with the transluminal attenuation difference ratio. ACTA ACUST UNITED AC 2021; 26:249-254. [PMID: 32071030 DOI: 10.5152/dir.2019.19259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the diagnostic performance of transluminal attenuation difference (TAD) in predicting the severity of internal carotid artery (ICA) stenosis. METHODS The study cohort consisted of 48 patients with <50% stenosis, 50%-69% stenosis, 70%-99% stenosis, and 51 controls without plaque development in ICA. A total of 143 measurements were performed through right and left internal and common carotid arteries. The TAD ratio was calculated as the difference between the mean attenuation values of the common carotid artery (CCA) and ICA, divided by the MAV of the CCA, multiplied by 100. RESULTS TAD ratio was significantly higher in severe (>70%) stenosis compared with control arteries and low-moderate stenosis. A TAD ratio cutoff of 4.5 predicted 70%-99% stenosis with a sensitivity of 100% and specificity of 93%. The inter- and intraobserver agreements in TAD measurements were almost perfect (ICC, 0.89-0.86). CONCLUSION Assessment of TAD ratio predicts the degree of stenosis in concordance with NASCET system.
Collapse
Affiliation(s)
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mine Hayriye Sorgun
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Suat Fitoz
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
10
|
Kojima T, Nagao M, Yabuuchi H, Yamasaki Y, Shirasaka T, Kawakubo M, Fukushima K, Kato T, Yamamoto A, Nakao R, Sakai A, Watanabe E, Sakai S. New transluminal attenuation gradient derived from dynamic coronary CT angiography: diagnostic ability of ischemia detected by 13N-ammonia PET. Heart Vessels 2020; 36:433-441. [PMID: 33048244 DOI: 10.1007/s00380-020-01712-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
Coronary computed tomography angiography (CCTA) has low specificity for detecting significant functional coronary stenosis. We developed a new transluminal attenuation gradient (TAG)-derived dynamic CCTA with dose modulation, and we investigated its diagnostic performance for myocardial ischemia depicted by 13N-ammonia positron emission tomography (PET). Data from 48 consecutive patients who had undergone both dynamic CCTA and 13N-ammonia PET were retrospectively analyzed. Dynamic CCTA was continuously performed in mid-diastole for five cardiac cycles with prospective electrocardiography gating after a 10-s contrast medium injection. One scan of the dynamic CCTA was performed as a boost scan for conventional CCTA at the peak phase of the ascending aorta. Absolute TAG values at five phases around the boost scan were calculated. The dynamic TAG index (DTI) was defined as the ratio of the maximum absolute TAG to the standard deviation of five TAG values. We categorized the coronary territories as non-ischemia or ischemia based on the 13N-ammonia PET results. A receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff of the DTI for identifying ischemia. The DTI was significantly higher for ischemia compared to non-ischemia (8.8 ± 3.9 vs. 4.6 ± 2.0, p < 0.01). The ROC analysis revealed 5.60 as the optimal DTI cutoff to detect ischemia, with an area under the curve of 0.87, 85.7% sensitivity, and 76.2% specificity. TAG provided no additional diagnostic value for the detection of ischemia. We propose the DTI derived from dynamic CCTA as a novel coronary flow index. The DTI is a valid technique for detecting functional coronary stenosis.
Collapse
Affiliation(s)
- Tsukasa Kojima
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Hidetake Yabuuchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuzo Yamasaki
- Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Shirasaka
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Fukushima
- Department of Nuclear Medicine, Saitama Medical University, Saitama, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Atsushi Yamamoto
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
11
|
Tian XW, Ma AL, Zhou RB, Jiang LJ, Hao Y, Zou XG. Advances in Cardiac Computed Tomography Functional Imaging Technology. Cardiology 2020; 145:615-622. [PMID: 32829331 DOI: 10.1159/000505317] [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: 05/14/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among patients in China, and cardiac computed tomography (CT) is one of the most commonly used examination methods for CVD. Coronary artery CT angiography can be used for the morphologic evaluation of the coronary artery. At present, cardiac CT functional imaging has become an important direction of development of CT. At present, common CT functional imaging technologies include transluminal attenuation gradient, stress dynamic CT myocardial perfusion imaging, and CT-fractional flow reserve. These three imaging modes are introduced and analyzed in this review.
Collapse
Affiliation(s)
- Xu-Wei Tian
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ai-Lin Ma
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ren-Bing Zhou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Liu-Jiang Jiang
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Yue Hao
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Xiao-Guang Zou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China,
| |
Collapse
|
12
|
Kim MS, Kang EJ, Kim HJ, Kim MH, Lee KN. The Effects of a Vasodilator on Transluminal Attenuation Gradient at Coronary Computed Tomography Angiography. Korean J Radiol 2020; 21:1285-1293. [PMID: 32767863 PMCID: PMC7689139 DOI: 10.3348/kjr.2019.0908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effects of vasodilators on contrast enhancement and transluminal attenuation gradient (TAG) of coronary arteries at coronary computed tomography angiography (CCTA). Materials and Methods We retrospectively reviewed CCTA scans of patients who underwent double-acquisition CCTA; CCTA without a vasodilator, and CCTA during a intravenous (IV) infusion of nitrate. Among them, we enrolled 19 patients who had no significant atherosclerotic lesions or coronary spasms. In the control group, 28 patients were enrolled who showed normal coronary arteries on CCTA, which was acquired by a conventional method (sublingual vasodilator). We measured the TAG and Hounsfield units for each of the three major epicardial coronary arteries (reported as ‘ProxHU’) and then compared the results between the nitrate administration methods (CT without vasodilator [CTpre], CT with IV vasodilator [CTiv], and CT with sublingual vasodilator [CTsub]). Results The mean TAG showed a significant difference between the coronary arteries (right coronary artery [RCA] > left anterior descending artery [LAD] > left circumflex artery [LCX], p < 0.05), while there was no difference in ProxHU of each coronary artery in all three types of nitrate administration methods (p > 0.05). The TAG of CTpre group showed steeper slope than those of vasodilator groups (CTiv and CTsub) on LAD and LCX ([LAD: CTpre = −22.1 ± 6.66, CTiv = −16.76 ± 5.78, and CTsub = −16.47 ± 5.78, p = 0.005], [LCX: CTpre = −31.26 ± 17.43, CTiv = −23.74 ± 14.06, and CTsub = −20.94 ± 12.15, p = 0.051]), while that of RCA showed no significant differences (p = 0.600). When comparing proxHU, CTiv showed higher proxHU than that of CTpre or CTsub, especially on LCX (CTpre = 426.7 ± 68.3, CTiv = 467.9 ± 84.9, and CTsub = 404.9 ± 63.3, p = 0.013). ProxHU showed a negative correlation with TAG on all three of methods (r = −0.280, p < 0.001). Conclusion TAG in CCTA was significantly affected by vasodilator administration. Both TAG and ProxHU of coronary arteries tend to increase with vasodilator administration on CCTA.
Collapse
Affiliation(s)
- Moon Sung Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Eun Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea.
| | - Hyun Jin Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Moo Hyun Kim
- Department of Cardiology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki Nam Lee
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
13
|
Kang EJ. Clinical Applications of Wide-Detector CT Scanners for Cardiothoracic Imaging: An Update. Korean J Radiol 2020; 20:1583-1596. [PMID: 31854147 PMCID: PMC6923215 DOI: 10.3348/kjr.2019.0327] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
Technical developments in multidetector computed tomography (CT) have increased the number of detector rows on the z-axis, and 16-cm wide-area-coverage CT scanners have enabled volumetric scanning of the entire heart. Beyond coronary arterial imaging, such innovations offer several advantages during clinical imaging in the cardiothoracic area. The wide-detector CT scanner markedly reduces the image acquisition time to less than 1 second for coronary CT angiography, thereby decreasing the volume of contrast material and radiation dose required for the examination. It also eliminates stair-step artifacts, allowing robust improvements in myocardial function and perfusion imaging. Additionally, new imaging techniques for the cardiothoracic area, including subtraction imaging and free-breathing scans, have been developed and further improved by using the wide-detector CT scanner. This article investigates the technical developments in wide-detector CT scanners, summarizes their clinical applications in the cardiothoracic area, and provides a review of the recent literature.
Collapse
Affiliation(s)
- Eun Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea.
| |
Collapse
|
14
|
Does vessel length impact transluminal attenuation gradient in 320-slice coronary CT angiography? Correlation with invasive angiography. Eur Radiol 2019; 29:6837-6845. [DOI: 10.1007/s00330-019-06311-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022]
|
15
|
Decrease in LDL-C is associated with decrease in all components of noncalcified plaque on coronary CTA. Atherosclerosis 2019; 285:128-134. [DOI: 10.1016/j.atherosclerosis.2019.04.201] [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: 12/01/2018] [Revised: 03/16/2019] [Accepted: 04/03/2019] [Indexed: 01/19/2023]
|
16
|
Benz DC, Gräni C, Ferro P, Neumeier L, Messerli M, Possner M, Clerc OF, Gebhard C, Gaemperli O, Pazhenkottil AP, Kaufmann PA, Buechel RR. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J Nucl Cardiol 2019; 26:561-568. [PMID: 28685251 DOI: 10.1007/s12350-017-0980-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI). METHODS AND RESULTS This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively. CONCLUSIONS CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. However, its high negative predictive value to rule out functional relevance of a given lesion may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.
Collapse
Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Luis Neumeier
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| |
Collapse
|
17
|
Yerly J, Becce F, van Heeswijk RB, Verdun FR, Gubian D, Meuli R, Stuber M. In vitro optimization and comparison of CT angiography versus radial cardiovascular magnetic resonance for the quantification of cross-sectional areas and coronary endothelial function. J Cardiovasc Magn Reson 2019; 21:11. [PMID: 30728035 PMCID: PMC6366062 DOI: 10.1186/s12968-019-0521-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Our objectives were first to determine the optimal coronary computed tomography angiography (CTA) protocol for the quantification and detection of simulated coronary artery cross-sectional area (CSA) differences in vitro, and secondly to quantitatively compare the performance of the optimized CTA protocol with a previously validated radial coronary cardiovascular magnetic resonance (CMR) technique. METHODS 256-multidetector CTA and radial coronary CMR were used to obtain images of a custom in vitro resolution phantom simulating a range of physiological responses of coronary arteries to stress. CSAs were automatically quantified and compared with known nominal values to determine the accuracy, precision, signal-to-noise ratio (SNR), and circularity of CSA measurements, as well as the limit of detection (LOD) of CSA differences. Various iodine concentrations, radiation dose levels, tube potentials, and iterative image reconstruction algorithms (ASiR-V) were investigated to determine the optimal CTA protocol. The performance of the optimized CTA protocol was then compared with a radial coronary CMR method previously developed for endothelial function assessment under both static and moving conditions. RESULTS The iodine concentration, dose level, tube potential, and reconstruction algorithm all had significant effects (all p < 0.001) on the accuracy, precision, LOD, SNR, and circularity of CSA measurements with CTA. The best precision, LOD, SNR, and circularity with CTA were achieved with 6% iodine, 20 mGy, 100 kVp, and 90% ASiR-V. Compared with the optimized CTA protocol under static conditions, radial coronary CMR was less accurate (- 0.91 ± 0.13 mm2 vs. -0.35 ± 0.04 mm2, p < 0.001), but more precise (0.08 ± 0.02 mm2 vs. 0.21 ± 0.02 mm2, p < 0.001), and enabled the detection of significantly smaller CSA differences (0.16 ± 0.06 mm2 vs. 0.52 ± 0.04 mm2; p < 0.001; corresponding to CSA percentage differences of 2.3 ± 0.8% vs. 7.4 ± 0.6% for a 3-mm baseline diameter). The same results held true under moving conditions as CSA measurements with CMR were less affected by motion. CONCLUSIONS Radial coronary CMR was more precise and outperformed CTA for the specific task of detecting small CSA differences in vitro, and was able to reliably identify CSA changes an order of magnitude smaller than those reported for healthy physiological vasomotor responses of proximal coronary arteries. However, CTA yielded more accurate CSA measurements, which may prove useful in other clinical scenarios, such as coronary artery stenosis assessment.
Collapse
Affiliation(s)
- Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
| | - Ruud B. van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Francis R. Verdun
- Institute of Radiation Physics, Lausanne University Hospital (CHUV and UNIL), Lausanne, Switzerland
| | - Danilo Gubian
- Direction des Constructions, Ingénierie, Technique et Sécurité (CIT-S), Lausanne University Hospital (CHUV and UNIL), Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV and UNIL), Rue du Bugnon 46, Lausanne, 1011 VD Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| |
Collapse
|
18
|
CT morphological index provides incremental value to machine learning based CT-FFR for predicting hemodynamically significant coronary stenosis. Int J Cardiol 2019; 265:256-261. [PMID: 29885695 DOI: 10.1016/j.ijcard.2018.01.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/06/2023]
Abstract
AIMS To study the diagnostic performance of the ratio of Duke jeopardy score (DJS) to the minimal lumen diameter (MLD) at coronary computed tomographic angiography (CCTA) and machine learning based CT-FFR for differentiating functionally significant from insignificant lesions, with reference to fractional flow reserve (FFR). METHODS AND RESULTS Patients who underwent both coronary CTA and FFR measurement at invasive coronary angiography (ICA) within 2 weeks were retrospectively included in our study. CT-FFR, DJS/MLDCT ratio, along with other parameters, including minimal luminal area (MLA), MLD, lesion length (LL), diameter stenosis, area stenosis, plaque burden, and remodeling index of lesions, were recorded. Lesions with FFR ≤0.8 were considered to be functionally significant. One hundred and twenty-nine patients with 166 lesions were ultimately included for analysis. The LL, diameter stenosis, area stenosis, plaque burden, DJS and DJS/MLDCT ratio were all significantly longer or larger in the group of FFR ≤ 0.8 (p < 0.001 for all), while smaller MLA, MLD and CT-FFR value were also noted (p < 0.001 for all). CT-FFR and DJS/MLDCT ratio showed the largest AUC among all single parameters (AUC = 0.85 and AUC = 0.83, respectively; p < 0.001 for both) for diagnosing functionally significant stenosis. Combining CT-FFR and DJS/MLDCT ratio provided incremental value for discrimination between flow-limiting and non-flow-limiting coronary lesions and yielded the best diagnostic performance (accuracy of 83.7%). CONCLUSIONS The combination of ML-based CT-FFR and DJS/MLDCT allows accurate non-invasive discrimination between flow-limiting and non-flow-limiting coronary lesions.
Collapse
|
19
|
Affiliation(s)
- K Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas.
| | - Nils P Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Kirkeeide
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| |
Collapse
|
20
|
Doris MK, Otaki Y, Arnson Y, Tamarappoo B, Goeller M, Gransar H, Wang F, Hayes S, Friedman J, Thomson L, Slomka P, Dey D, Berman D. Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden. J Cardiovasc Comput Tomogr 2018; 12:379-384. [DOI: 10.1016/j.jcct.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 10/17/2022]
|
21
|
Hell MM, Motwani M, Otaki Y, Cadet S, Gransar H, Miranda-Peats R, Valk J, Slomka PJ, Cheng VY, Rozanski A, Tamarappoo BK, Hayes S, Achenbach S, Berman DS, Dey D. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging 2018; 18:1331-1339. [PMID: 28950315 DOI: 10.1093/ehjci/jex183] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up. Methods and results Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score. Conclusion Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.
Collapse
Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Manish Motwani
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Yuka Otaki
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sebastien Cadet
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Heidi Gransar
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Romalisa Miranda-Peats
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Jacob Valk
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Victor Y Cheng
- Oklahoma Heart Institute, 1265 S. Utica Avenue Suite 300, Tulsa, OK 74104, USA
| | - Alan Rozanski
- Mount Sinai St Lukes Hospital Cardiology, Division of Cardiology, 1111 Amsterdam Ave FL 3, New York, NY 10025, USA
| | - Balaji K Tamarappoo
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sean Hayes
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Daniel S Berman
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA
| |
Collapse
|
22
|
Tamarappoo B, Otaki Y, Doris M, Arnson Y, Gransar H, Hayes S, Friedman J, Thomson L, Wang F, Rozanski A, Slomka P, Dey D, Berman D. Improvement in LDL is associated with decrease in non-calcified plaque volume on coronary CTA as measured by automated quantitative software. J Cardiovasc Comput Tomogr 2018; 12:385-390. [PMID: 29793847 DOI: 10.1016/j.jcct.2018.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomography coronary angiography (CTA) can be used for assessment of plaque characteristics; however, quantitative assessment of changes in plaque composition in response to LDL lowering has not been performed with CTA. We sought to assess the association between LDL reduction and changes in plaque composition with quantitative CTA. METHODS Quantification of total, calcified, non-calcified and low-density non-calcified plaque volumes (TPV, CPV, NCPV and LD-NCPV) was performed using semi-automated software in 234 vessels from 116 consecutive patients (89 men, 60 ± 10 years) with baseline LDL>70 mg/dl. Significant reduction in LDL was defined as a decrease by >10% of baseline LDL. Changes (Δ) in plaque volumes between the second and baseline study were compared between patients with LDL reduction (n = 63) and those with no decrease in LDL (n = 53). RESULTS Median LDL at baseline was 98 mg/dl [interquartile range (IQR) 83-119 mg/dl] and median ΔLDL was -14 mg/dl (IQR -38 to 3 mg/dl). Mean interval between sequential CTA was 3.5 ± 1.6 years. TPV, NCPV, and LD-NCPV decreased in patients with a reduction in LDL compared to baseline; whereas, patients without reduction in LDL experienced an increase in TPV, NCPV and LD-NCPV. After adjusting for age, statin use, diabetes, baseline LDL and baseline TPV, reduction in LDL was associated with a decrease in TPV (P = 0.005), NCPV (P = 0.002) and LD-NCPV (P = 0.011) compared to patients without a reduction in LDL. CONCLUSION Reduction in LDL was associated with beneficial changes in the amount and composition of noncalcified plaque as measured using semi-automated quantitative software by CTA.
Collapse
Affiliation(s)
- Balaji Tamarappoo
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine and Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA; Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
| | - Yuka Otaki
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mhairi Doris
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yoav Arnson
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Hayes
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John Friedman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Louise Thomson
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Frances Wang
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA; Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA; Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine and Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA; Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
23
|
Fujimoto S, Giannopoulos AA, Kumamaru KK, Matsumori R, Tang A, Kato E, Kawaguchi Y, Takamura K, Miyauchi K, Daida H, Rybicki FJ, Mitsouras D. The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally? Br J Radiol 2018; 91:20180043. [PMID: 29589976 DOI: 10.1259/bjr.20180043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Results of the use of the transluminal attenuation gradient (TAG) at coronary CT angiography (CCTA) to predict hemodynamically significant disease vary widely. This study tested whether diagnostic performance of TAG to predict fractional flow reserve (FFR) ≤ 0.8 is improved when applied separately to subsets of coronary arteries that carry similar physiological flow. METHODS 28 patients with 64 × 0.5 mm CCTA and invasive FFR in ≥1 major coronary artery were retrospectively evaluated. Two readers assessed TAG in each artery. The receiver operating characteristic (ROC) area under the curve (AUC) was used to assess the diagnostic performance of TAG to detect hemodynamically significant disease following a clinical use rule [negative: FFR > 0.8 or ≤ 25% diameter stenosis (DS) at invasive catheter angiography; positive: FFR ≤ 0.8 or ≥ 90% DS at invasive catheter angiography]. ROC AUC was compared for all arteries pooled together, vs separately for arteries carrying similar physiological flow (Group 1: all left anterior descending plus right-dominant left circumflex; Group 2: right-dominant RCA plus left/co-dominant left circumflex). RESULTS Of the 84 arteries, 30 had FFR measurements, 30 had ≤25% DS and 13 had ≥90% DS. 11 arteries with 26-89% DS and no FFR measurement were excluded. TAG interobserver reproducibility was excellent (Pearson r = 0.954, Bland-Altman bias: 0.224 Hounsfield unit cm-1). ROC AUC to detect hemodynamically significant disease was higher when considering arteries separately (Group 1 AUC = 0.841, p = 0.039; Group 2 AUC = 0.840, p = 0.188), than when pooling all arteries together (AUC = 0.661). CONCLUSION Incorporating information on the physiology of coronary flow via the particular vessel interrogated and coronary dominance may improve the accuracy of TAG, a simple measurement that can be quickly performed at the time of CCTA interpretation to detect hemodynamically significant stenosis in individual coronary arteries. Advances in knowledge: The interpretation of TAG may benefit by incorporating information regarding which coronary artery is being interrogated.
Collapse
Affiliation(s)
- Shinichiro Fujimoto
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Andreas A Giannopoulos
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,3 Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich , Zurich , Switzerland
| | - Kanako K Kumamaru
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,4 Department of Radiology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Rie Matsumori
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Anji Tang
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Etsuro Kato
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Yuko Kawaguchi
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Kazuhisa Takamura
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Katsumi Miyauchi
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Hiroyuki Daida
- 1 Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Frank J Rybicki
- 5 The Ottawa Hospital Research Institute , Ottawa, ON , Canada.,6 Department of Radiology, The University of Ottawa , Ottawa, ON , Canada
| | - Dimitris Mitsouras
- 2 Department of Radiology, Applied Imaging Science Laboratory, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA.,5 The Ottawa Hospital Research Institute , Ottawa, ON , Canada.,7 Department of Biochemistry, Microbiology and Immunology, The University of Ottawa , Ottawa, ON , Canada
| |
Collapse
|
24
|
Kishi S, Giannopoulos AA, Tang A, Kato N, Chatzizisis YS, Dennie C, Horiuchi Y, Tanabe K, Lima JAC, Rybicki FJ, Mitsouras D. Fractional Flow Reserve Estimated at Coronary CT Angiography in Intermediate Lesions: Comparison of Diagnostic Accuracy of Different Methods to Determine Coronary Flow Distribution. Radiology 2018; 287:76-84. [PMID: 29156145 PMCID: PMC5896162 DOI: 10.1148/radiol.2017162620] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To compare the diagnostic accuracy of different computed tomographic (CT) fractional flow reserve (FFR) algorithms for vessels with intermediate stenosis. Materials and Methods This cross-sectional HIPAA-compliant and human research committee-approved study applied a four-step CT FFR algorithm in 61 patients (mean age, 69 years ± 10; age range, 29-89 years) with a lesion of intermediate-diameter stenosis (25%-69%) at CT angiography who underwent FFR measurement within 90 days. The per-lesion diagnostic performance of CT FFR was tested for three different approaches to estimate blood flow distribution for CT FFR calculation. The first two, the Murray law and the Huo-Kassab rule, used coronary anatomy; the third used contrast material opacification gradients. CT FFR algorithms and CT angiography percentage diameter stenosis (DS) measurements were compared by using the area under the receiver operating characteristic curve (AUC) to detect FFRs of 0.8 or lower. Results Twenty-five lesions (41%) had FFRs of 0.8 or lower. The AUC of CT FFR determination by using contrast material gradients (AUC = 0.953) was significantly higher than that of the Huo-Kassab (AUC = 0.882, P = .043) and Murray law models (AUC = 0.871, P = .033). All three AUCs were higher than that for 50% or greater DS at CT angiography (AUC = 0.596, P < .001). Correlation of CT FFR with FFR was highest for gradients (Spearman ρ = 0.80), followed by the Huo-Kassab rule (ρ = 0.68) and Murray law (ρ = 0.67) models. All CT FFR algorithms had small biases, ranging from -0.015 (Murray) to -0.049 (Huo-Kassab). Limits of agreement were narrowest for gradients (-0.182, 0.147), followed by the Huo-Kassab rule (-0.246, 0.149) and the Murray law (-0.285, 0.256) models. Conclusion Clinicians can perform CT FFR by using a four-step approach on site to accurately detect hemodynamically significant intermediate-stenosis lesions. Estimating blood flow distribution by using coronary contrast opacification variations may improve CT FFR accuracy. © RSNA, 2017 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Satoru Kishi
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Andreas A. Giannopoulos
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Anji Tang
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Nahoko Kato
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Yiannis S. Chatzizisis
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Carole Dennie
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Yu Horiuchi
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Kengo Tanabe
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - João A. C. Lima
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Frank J. Rybicki
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| | - Dimitris Mitsouras
- From the Division of Diabetes, Mitsui Memorial Hospital, Tokyo, Japan
(S.K.); Applied Imaging Science Laboratory, Department of Radiology, Brigham and
Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
(A.A.G., A.T., D.M.); Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(N.K., Y.H., K.T.); Department of Cardiology, University of Nebraska Medical Center,
Omaha, Neb (Y.S.C.); Department of Radiology, the University of Ottawa Faculty of
Medicine, and the Ottawa Hospital Research Institute, Ottawa, Canada (C.D., F.J.R.,
D.M.); and Department of Cardiovascular Imaging, Johns Hopkins Medicine, Baltimore,
Md (J.A.C.L.)
| |
Collapse
|
25
|
Wen D, Li J, Zhao H, Li J, Zheng M. Diagnostic performance of two corrected transluminal attenuation gradient metrics in coronary CT angiography for the evaluation of significant in-stent restenosis by dual-source CT: a validation study with invasive coronary angiography. Clin Radiol 2018; 73:592.e1-592.e8. [PMID: 29454588 DOI: 10.1016/j.crad.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
AIM To determine the diagnostic potential of transluminal attenuation gradients (TAG) with exclusion of stented coronary segments (TAG-ExS) and TAG-corrected contrast opacification (CCO) excluding stented coronary segments (TAG-CCO-ExS) for the assessment of in-stent restenosis (ISR). MATERIALS AND METHODS TAG-ExS and TAG-CCO-ExS were calculated in 93 coronary arteries with 190 stents. The diagnostic performances and the incremental values of the two metrics to coronary computed tomography angiography (CCTA) were analysed and compared. RESULTS For all stents and stents >3 mm in diameter, TAG-ExS and TAG-CCO-ExS were significantly lower in ≥50% than that in <50% of ISR (both p<0.05). For stent diameters ≤3 mm, significantly lower TAG-CCO-ExS (p=0.000), but not TAG-ExS (p=0.059), was found in ≥50% than in <50% of ISR. Addition of TAG-ExS or TAG-CCO-ExS to CCTA, did not improve the diagnostic accuracy of CCTA significantly (all p>0.05). Only TAG-CCO-ExS had a significant impact on CCTA for the reclassifications of ISR (p=0.046) in stent diameters ≤3 mm. CONCLUSIONS TAG-ExS and TAG-CCO-ExS did not provide incremental diagnostic value over CCTA in assessing ISR. TAG-CCO-ExS slightly enhanced the reclassifications of ISR for stents ≤3 mm in diameter.
Collapse
Affiliation(s)
- D Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - H Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - M Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China.
| |
Collapse
|
26
|
Giannopoulos AA, Tang A, Ge Y, Cheezum MK, Steigner ML, Fujimoto S, Kumamaru KK, Chiappino D, Della Latta D, Berti S, Chiappino S, Rybicki FJ, Melchionna S, Mitsouras D. Diagnostic performance of a Lattice Boltzmann-based method for CT-based fractional flow reserve. EUROINTERVENTION 2018. [DOI: 10.4244/eij-d-17-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Hodgdon T, Danrad R, Patel MJ, Smith SE, Richardson ML, Ballard DH, Ali S, Trace AP, DeBenedectis CM, Zygmont ME, Lenchik L, Decker SJ. Logistics of Three-dimensional Printing: Primer for Radiologists. Acad Radiol 2018; 25:40-51. [PMID: 29030283 DOI: 10.1016/j.acra.2017.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.
Collapse
|
28
|
Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography. Heart Vessels 2017; 33:462-469. [PMID: 29134268 DOI: 10.1007/s00380-017-1081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
The clinical significance of the transluminal attenuation gradient (TAG) has not been established. We evaluated the incremental diagnostic value of TAG by 320-row area detector computed tomography (320-ADCT). Subjects were 65 patients who underwent one-rotation scanning by 320-ADCT and invasive coronary angiography (ICA) within 3 months. TAG values were obtained for the major epicardial vessels 2 mm or more each in RCA, LAD and LCX using automatic analysis software. Moreover, TAG values that excluded calcified lesions in calculation of the regression line were also evaluated (excluded-TAG). In LAD, 21 intermediate lesions underwent functional flow reserve (FFR), and the incremental diagnostic value for functional stenosis was evaluated. The TAG values in the normal vessels were - 8.3 ± 5.0 (HU/cm) for the RCA (n = 32), - 23.3 ± 4.3 for the LAD (n = 9) and - 20.6 ± 10.0 for the LCX (n = 32). The RCA value was significantly higher (p < 0.001). The TAG values with stenosis degrees of ≤ 25%, 26-75%, ≥ 76% on ICA were - 8.3 ± 5.0 (n = 32) vs - 10.3 ± 7.2 (n = 25) vs - 10.0 ± 5.4 (n = 4) in the RCA, - 23.3 ± 4.3 (n = 9) vs - 21.0 ± 11.5 (n = 35) vs - 23.5 ± 15.3 (n = 10) in the LAD and - 21.1 ± 15.1 (n = 32) vs - 21.1 ± 15.1 (n = 16) vs - 17.7 ± 15.7 (n = 6) in the LCX, with no significant difference among the three groups. The excluded-TAG values also showed no significant difference. The area under the curve in the diagnosis of FFR < 0.8 in 21 LAD cases was 0.542 for CT only, 0.694 for CT + TAG, and 0.694 for CT + excluded-TAG. In single time-phase scanning by 320-ADCT, TAG does not offer an incremental diagnostic value.
Collapse
|
29
|
Editorial. The Closer We Get, The Further Apart We Become. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Grande Gutierrez N, Shirinsky O, Gagarina N, Lyskina G, Fukazawa R, Ogawa S, Burns JC, Marsden AL, Kahn AM. Assessment of Coronary Artery Aneurysms Caused by Kawasaki Disease Using Transluminal Attenuation Gradient Analysis of Computerized Tomography Angiograms. Am J Cardiol 2017; 120:556-562. [PMID: 28666576 DOI: 10.1016/j.amjcard.2017.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/20/2022]
Abstract
Patients with coronary artery aneurysms (CAAs) resulting from Kawasaki disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend CAA diameter ≥8 mm as the criterion for initiating systemic anticoagulation. Transluminal attenuation gradient (TAG) analysis has been proposed as a noninvasive method for evaluating functional significance of coronary stenoses using computerized tomography angiography (CTA), but has not previously been used in CAA. We hypothesized that abnormal hemodynamics in CAA caused by KD could be quantified using TAG analysis. We studied 23 patients with a history of KD who had undergone clinically indicated CTA. We quantified TAG in the major coronary arteries and aneurysm geometry was characterized using maximum diameter, aneurysm shape index, and sphericity index. A total of 55 coronary arteries were analyzed, 25 of which had at least 1 aneurysmal region. TAG in aneurysmal arteries was significantly lower than in normal arteries (-23.5 ± 10.7 vs -10.5 ± 9.0, p = 0.00002). Aneurysm diameter, aneurysm shape index, and sphericity index were weakly correlated with TAG (r2 = 0.01, p = 0.6; r2 = 0.15, p = 0.06; r2 = 0.16, p = 0.04). This is the first application of TAG analysis to CAA caused by KD, and demonstrates significantly different TAG values in aneurysmal versus normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide hemodynamic information not available from anatomy alone. TAG represents a possible extension to standard CTA for KD patients who may improve thrombotic risk stratification and aid in clinical decision making.
Collapse
|
31
|
Automated Quantitative Plaque Analysis for Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion in Computed Tomography Angiography. J Thorac Imaging 2017; 31:367-372. [PMID: 27262145 DOI: 10.1097/rti.0000000000000223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the utility of automated plaque analysis in differentiating chronic total occlusion (CTO) from subtotal occlusion (SO) in patients with ambiguous coronary lesions on coronary computed tomography angiography (CTA). MATERIALS AND METHODS A total of 63 patients with 63 ambiguous coronary lesions on CTA were included. The lesion length (LL), diameter stenosis, plaque volume and composition, remodeling index, and contrast density difference (CDD) (reflecting intraluminal contrast kinetics over the lesion) were assessed using an automatic software tool. All patients underwent invasive coronary angiography. RESULTS Coronary angiography confirmed 28 CTOs and 35 SOs. CTOs showed significantly longer LL (6.4±12.3 vs. 1.0±2.2 mm, P=0.03) and higher CDD (74%±31% vs. 55%±32%, P=0.02) compared with SO. The optimal thresholds for prediction of CTO for CDD and LL were ≥43% and ≥1 mm, respectively (max. sensitivity: 82% for CDD, max. specificity: 77% for LL). The guidewire manipulation time correlated with LL (r=0.529, P=0.004) and CDD (r=0.435, P=0.021) in lesions attempted by percutaneous coronary intervention. CONCLUSIONS Automated computed tomography plaque analysis may be applied as a noninvasive tool to differentiate CTO from SO.
Collapse
|
32
|
Benz DC, Mikulicic F, Gräni C, Moret D, Possner M, Clerc OF, Studer Bruengger AA, Gaemperli O, Buechel RR, Pazhenkottil AP, Kaufmann PA. Long-term outcome prediction by functional parameters derived from coronary computed tomography angiography. Int J Cardiol 2017; 243:533-537. [PMID: 28592383 DOI: 10.1016/j.ijcard.2017.05.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Estimation of hemodynamic relevance of a coronary stenosis from coronary computed angiography (CCTA) has raised substantial interest. Recently, the corrected coronary opacification (CCO) decrease and the transluminal attenuation gradient (TAG) have been suggested as faster alternatives to the FFRCT. The aim of the study was to evaluate whether the diagnostic accuracy of CCO decrease and TAG translates into an added prognostic value in patients evaluated for coronary artery disease (CAD). METHODS This retrospective study consists of 162 consecutive patients referred for evaluation of known or suspected CAD by CCTA. CCO decrease was defined as difference of mean luminal coronary attenuation normalized to aorta attenuation proximal-distal of a stenosis. To calculate TAG, mean attenuation was measured at 5-mm intervals from the ostium to a distal segment with a minimal cross-sectional area of 2.0mm2. Death, myocardial infarction, unstable angina requiring hospitalization, and coronary revascularization were defined as major adverse cardiac events (MACE). Multivariate analysis included covariates age, sex, ≥3 cardiovascular risk factors and stenosis severity. RESULTS Follow-up was completed in 154 patients, CAD was found in 72. During median follow-up of 6.1years (interquartile range, 5.8-6.9years), 55 patients experienced a MACE. Among CAD patients, the presence of an abnormal CCO decrease (p<0.05) but not TAG (p=0.894) was associated with a worse MACE-free survival. In multivariate analysis, CCO decrease was an independent predictor of MACE (HR, 2.27; 95% CI, 1.14-4.52; p=0.02) while TAG was not predictive (p=0.895). CONCLUSION In CAD patients, CCO decrease adds long-term prognostic value over clinical characteristics and stenosis severity while TAG does not.
Collapse
Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Dominic Moret
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| |
Collapse
|
33
|
Yu M, Zhang Y, Li Y, Li M, Li W, Zhang J. Assessment of Myocardial Bridge by Cardiac CT: Intracoronary Transluminal Attenuation Gradient Derived from Diastolic Phase Predicts Systolic Compression. Korean J Radiol 2017; 18:655-663. [PMID: 28670160 PMCID: PMC5447641 DOI: 10.3348/kjr.2017.18.4.655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To study the predictive value of transluminal attenuation gradient (TAG) derived from diastolic phase of coronary computed tomography angiography (CCTA) for identifying systolic compression of myocardial bridge (MB). Materials and Methods Consecutive patients diagnosed with MB based on CCTA findings and without obstructive coronary artery disease were retrospectively enrolled. In total, 143 patients with 144 MBs were included in the study. Patients were classified into three groups: without systolic compression, with systolic compression < 50%, and with systolic compression ≥ 50%. TAG was defined as the linear regression coefficient between intraluminal attenuation in Hounsfield units (HU) and length from the vessel ostium. Other indices such as the length and depth of the MB were also recorded. Results TAG was the lowest in MB patients with systolic compression ≥ 50% (-19.9 ± 8.7 HU/10 mm). Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for identifying systolic compression ≥ 50%. The result indicated an optimal cutoff value of TAG as -18.8 HU/10 mm (area under curve = 0.778, p < 0.001), which yielded higher sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy (54.1, 80.5, 72.8, and 75.0%, respectively). In addition, the TAG of MB with diastolic compression was significantly lower than the TAG of MB without diastolic compression (-21.4 ± 4.8 HU/10 mm vs. -12.7 ± 8 HU/10 mm, p < 0.001). Conclusion TAG was a better predictor of MB with systolic compression ≥ 50%, compared to the length or depth of the MB. The TAG of MB with persistent diastolic compression was significantly lower than the TAG without diastolic compression.
Collapse
Affiliation(s)
- Mengmeng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yang Zhang
- Department of Pharmaceutical Science, School of Pharmacy, The Second Military Medical University, Shanghai 200433, China.,Department of Scientific Research, TongRen Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200050, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Minghua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wenbin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| |
Collapse
|
34
|
Detection of Hemodynamically Significant Coronary Artery Stenosis With CT Enhancement Ratio: A Validation Study in a Porcine Model. AJR Am J Roentgenol 2017; 209:103-109. [PMID: 28504545 DOI: 10.2214/ajr.16.16698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although numerous techniques that are based on CT number analysis have been proposed, the assessment of hemodynamically significant coronary artery stenosis remains a great challenge. The purpose of this study is to validate use of the CT enhancement ratio in the detection of hemodynamically significant coronary artery stenosis in a porcine model. MATERIALS AND METHODS Experiments involving eight closed-chest swine were performed. A balloon catheter was placed into the left anterior descending coronary artery to simulate different degrees of luminal stenosis. The myocardial blood flow (MBF) ratio was measured using the colored microsphere technique. The fractional flow reserve was measured using an invasive pressure wire. CT scans were performed during the first-pass phase, while the pigs were undergoing adenosine stress tests. The CT enhancement ratio and the CT attenuation ratio were calculated using data from the CT images obtained. RESULTS Results suggested that the CT enhancement ratio had a strong correlation (y = 0.07245 + 0.09963x; r2 = 0.898; p < 0.001) with the MBF ratio measured using the microsphere technique, whereas only moderate correlation (y = -1.5508 + 2.2684x; r2 = 0.498; p < 0.001) was noted between the CT attenuation ratio and the MBF ratio measured using the microsphere technique. In ROC curve analysis, the AUC values of the CT enhancement ratio and the CT attenuation ratio were 0.927 and 0.829, respectively, with regard to the detection of significant ischemia during adenosine stress tests, as defined by the fractional flow reserve. CONCLUSION The CT enhancement ratio provides a reliable prediction of the MBF ratio measured using the microsphere technique, indicating that this metric has good diagnostic performance in the detection of hemodynamically significant coronary artery stenosis. The CT enhancement ratio may have potential for use as an imaging biomarker for the relative quantitative assessment of myocardial perfusion.
Collapse
|
35
|
Diaz-Zamudio M, Fuchs TA, Slomka P, Otaki Y, Arsanjani R, Gransar H, Germano G, Berman DS, Kaufmann PA, Dey D. Quantitative plaque features from coronary computed tomography angiography to identify regional ischemia by myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2017; 18:499-507. [PMID: 28025263 PMCID: PMC5837445 DOI: 10.1093/ehjci/jew274] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed to investigate whether quantitative plaque features measured from coronary CT angiography (CCTA) predict ischemia by myocardial perfusion SPECT imaging (MPI). METHODS AND RESULTS Hundred and eighty-four consecutive patients (63% males) with suspected-coronary artery disease, undergoing hybrid CCTA, and attenuation corrected solid state 99mTc stress/rest MPI and single vessel ischemia were considered. Quantitative analysis of CCTA derived non-calcified plaque (NCP), low-density NCP [< 30 Hounsfield Units (HU)] (LDNCP), calcified and total plaque burdens (%, normalized to vessel volume), maximum diameter stenosis and contrast density difference (CD, maximum difference in HU/lumen area within lesion). Normal thresholds for plaque features were defined as 95th percentile thresholds, from 40% of vessels with non-ischemic MPI regions. These vessels were excluded from further analysis. Regional ischemia (≥ 2%) was quantified from MPI. All plaque features were higher in arteries corresponding to ischemia (P < 0.003 for all). In multi-variable analysis, abnormal NCP burden [odds ratio (OR) 2.6], LDNCP burden (OR 3.9), and CD (OR 2.7) were significantly associated with ischemia, whereas stenosis ≥ 50% was not (P = 0.14). In a subset of vessels with ≥ 50% stenosis, LDNCP burden (OR 4.3, P = 0.008) and CD (OR 3.7, P = 0.029) were associated with ischemia. In subsets of vessels with stenosis 30-69% and ≥ 70%, abnormal LDNCP burden (OR 6.4, P = 0.006) and CD (OR 7.3, P = 0.02) were associated with ischemia. CONCLUSIONS Quantitative plaque features obtained from CCTA, LDNCP, and CD, are associated with ischemia by MPI independent of stenosis. LDNCP burden and CD are associated with ischemia in stenosis 30-69% and ≥ 70%, respectively.
Collapse
Affiliation(s)
- Mariana Diaz-Zamudio
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tobias A. Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Piotr Slomka
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Reza Arsanjani
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guido Germano
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S. Berman
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Philipp A. Kaufmann
- Departments of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
36
|
Cademartiri F, Seitun S, Clemente A, La Grutta L, Toia P, Runza G, Midiri M, Maffei E. Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography. Cardiovasc Diagn Ther 2017; 7:129-150. [PMID: 28540209 DOI: 10.21037/cdt.2017.03.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
During the last decade coronary computed tomography angiography (CTA) has become the preeminent non-invasive imaging modality to detect coronary artery disease (CAD) with high accuracy. However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dual-energy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.
Collapse
Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute, Université de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Sara Seitun
- Department of Radiology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
| | | | - Patrizia Toia
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giuseppe Runza
- Department of Radiology, P.O. Umberto I, Azienda Sanitaria Provinciale 8, Siracusa, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute, Université de Montreal, Montreal, Canada
| |
Collapse
|
37
|
Okubo R, Nakanishi R, Toda M, Saito D, Watanabe I, Yabe T, Amano H, Hirai T, Ikeda T. Pericoronary adipose tissue ratio is a stronger associated factor of plaque vulnerability than epicardial adipose tissue on coronary computed tomography angiography. Heart Vessels 2017; 32:813-822. [PMID: 28229226 DOI: 10.1007/s00380-017-0943-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
This study was designed to clarify the influence of pericoronary adipose tissue (PAT) on plaque vulnerability using coronary computed tomography angiography (CCTA). A total of 103 consecutive patients who underwent CCTA and subsequent percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS) for coronary artery disease were enrolled. The PAT ratio was calculated as the sum of the perpendicular thickness of the visceral layer between the coronary artery and the pericardium, or the coronary artery and the surface of the heart at the PCI site, divided by the PAT thickness without a plaque in the same vessel. PAT ratios were divided into low, mid and high tertile groups. Epicardial adipose tissue (EAT) thickness was measured at the eight points surrounding the heart. Multivariate logistic analysis was performed to determine whether the PAT ratio is predictive of vulnerable plaques (positive remodeling, low attenuation and/or spotty calcification) on CCTA or echo-attenuated plaque on IVUS. The Hounsfield unit of obstructive plaques >50% was lower in the high PAT group than in the mid and low PAT groups (47.5 ± 28.8 vs. 53.1 ± 29.7 vs. 64.7 ± 27.0, p = 0.04). In multivariate logistic analysis, a high PAT ratio was an independent, associated factor of vulnerable plaques on CCTA (OR: 3.55, 95% CI: 1.20-10.49), whereas mean EAT thickness was not (OR: 1.22, 95% CI: 0.82-1.83). We observed a similar result in predicting echo-attenuated plaque on IVUS. PAT ratio on CCTA was an associated factor of vulnerable plaques, while EAT was not. These results support the important concept of local effects of cardiac adipose tissue on plaque vulnerability.
Collapse
Affiliation(s)
- Ryo Okubo
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Mikihito Toda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Daiga Saito
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Ippei Watanabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takayuki Yabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tatsushi Hirai
- Gunma Cardiovascular Hospital, 1230 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| |
Collapse
|
38
|
Peng K, Xu N, Zhang L, Xiao F, Indima N, Zhang J, Shen Y, Peng W, Tang G. Transluminal attenuation gradient and corrected models in coronary CT angiography for determining stenosis severity: a primary study using dual-source CT. Clin Radiol 2017; 72:508-516. [PMID: 28190514 DOI: 10.1016/j.crad.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/30/2016] [Accepted: 01/06/2017] [Indexed: 11/18/2022]
Abstract
AIM To compare the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (TAG-CCO), and TAG with exclusion of calcified coronary segments (TAG-ExC) in determining the stenosis severity of coronary arteries using coronary angiography (CAG) as the reference standard. MATERIALS AND METHODS One hundred and fifteen patients who underwent computed tomography coronary angiography (CTCA) and confirmed by coronary angiography (CAG) were included in the retrospective analysis. TAG, TAG-CCO, and TAG-ExC were calculated in 311 major epicardial coronary arteries. Changes in different TAG models were compared with corresponding stenosis severities ascertained by CAG. The diagnostic performances of TAG, TAG-CCO, TAG-ExC, and the TAG/CTCA, TAG-CCO/CTCA, and TAG-ExC/CTCA combinations over CTCA alone in evaluating stenosis severity were then analysed and compared. Furthermore, the incremental value of the TAG and the corrected models in the reclassification of CTCA-evaluated stenosis severity were calculated. RESULTS TAG, TAG-CCO, and TAG-ExC decreased gradually with increased stenosis severity (p<0.001 for all TAG models). TAG and TAG-ExC improved the diagnostic performance over CTCA in total vessel evaluation (c statistic= 0.926 versus 0.907, p=0.018; c statistic= 0.922 versus 0.907, p=0.030, respectively), but TAG-CCO did not. Meanwhile, adding TAG to CTCA enabled a significant reclassification in calcified vessels (n=95; net reclassification improvement = 0.143, p=0.038). CONCLUSIONS TAG and TAG-ExC improved the diagnostic performance of CTCA in all vessels. Adding TAG to CTCA significantly reclassified the calcified vessels. The additional value of TAG-CCO over CTCA alone in determining the stenosis severity is limited.
Collapse
Affiliation(s)
- K Peng
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - N Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China; Department of Radiology, Shanghai East Hospital, Tongji University of Medicine, Shanghai, 200120, China
| | - L Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - F Xiao
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - N Indima
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - J Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Y Shen
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - W Peng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - G Tang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| |
Collapse
|
39
|
Kim HJ, Kim SM, Choi JH, Choe YH. Influence of scan technique on intracoronary transluminal attenuation gradient in coronary CT angiography using 128-slice dual source CT: multi-beat versus one-beat scan. Int J Cardiovasc Imaging 2017; 33:937-946. [PMID: 28150085 DOI: 10.1007/s10554-017-1078-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/19/2017] [Indexed: 01/25/2023]
Abstract
The purpose of our study was to investigate the impact of temporal uniformity and adjustment by the contrast opacification enhancement in the aorta on the performance of transluminal attenuation gradient (TAG) for obstructive coronary artery disease. A total of 274 coronary arteries from 94 patients who underwent both multi- and single-beat scan using 128-slice scanner at the same time were enrolled. TAG and corrected coronary opacification (CCO) of both scan technique were compared against obstructive coronary arteries defined by diameter stenosis ≥50%. In per-vessel analysis, both TAG and CCO were slight but significantly different between multi- and single-beat scan in overall (-13.3 vs. -14.3 HU/10 mm; 0.31 vs. 0.38; p < 0.05, all). However, the difference was evident only in right coronary artery (p < 0.05) but not in left coronary arteries (p = NS). Correlation coefficient value are more than 0.8 for all coronary arteries (0.84) and each of the three vessels (RCA: 0.87, LAD: 0.84, LCX: 0.81) in TAG in single-beat versus multi-beat scans (p < 0.0001). Radiation exposure was significantly lower in single-beat scan compared to multi-beat scan (0.9 vs. 3.7 mSv, p < 0.001). TAGs of multi- and single beat scans well correlated each other in all coronary arteries and were not affected by temporal non-uniformity.
Collapse
Affiliation(s)
- Hae Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jin-Ho Choi
- Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
40
|
Dowsley TF, Chepelev L, McArdle B, Alam M, Dwivedi G, Chow BJ. Improved diagnostic accuracy when combining computed tomography angiography and corrected coronary opacification in patients with coronary stents. Acta Cardiol 2017; 72:53-60. [PMID: 28597738 DOI: 10.1080/00015385.2017.1281525] [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: 10/19/2022]
Abstract
Background The accuracy of coronary computed tomography angiography (CCTA) is sub-optimal in patients with coronary stents. Methods that can increase its diagnostic accuracy are desirable. Objective A proof-of-concept study was undertaken to determine if corrected coronary opacification (CCO) differences can improve the accuracy of CCTA in stented coronary arteries. Methods PCI patients who underwent both CCTA and invasive coronary angiography (ICA) within 3 months were analyzed. Coronary luminal attenuation values (normalized to the aorta) were measured proximally and distally to coronary stents. CCO differences were evaluated for ability to predict (i) stenosis on invasive angiography, (ii) abnormal resting coronary flow as measured by the corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC), and (iii) the combination of abnormal resting flow and significant stenosis on invasive angiography. Results Twenty-nine stented coronary arteries (n = 25, mean age =61.4 years, men =80.0%) were assessed. In stented coronary vessels, CCO identified stenosis (≥ 70%) with an area under the curve of 0.767 (P = 0.021). CCO predicted abnormal resting coronary flow with high accuracy (AUC =0.867, P = 0.002). Combined CCTA/CCO identified both abnormal cTFC and stenosis ≥70% on ICA (functionally significant stenosis) with diagnostic accuracy of 92.3%. In contrast, CCTA visual assessment alone had lower diagnostic accuracy of 66.7% for identifying functionally significant stenosis. Conclusion CCO differences are predictive of abnormal resting flow and consequently, in-stent restenosis. Incorporation of this technique may improve the specificity of CCTA in PCI patients.
Collapse
Affiliation(s)
- Taylor F. Dowsley
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Leonid Chepelev
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Brian McArdle
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Mohammed Alam
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Girish Dwivedi
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Benjamin J.W. Chow
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
- University of Ottawa, Canada Department of Radiology, Canada
| |
Collapse
|
41
|
Lu J, Yu J, Shi H. Feasibility Study of Computational Fluid Dynamics Simulation of Coronary Computed Tomography Angiography Based on Dual-Source Computed Tomography. J Clin Med Res 2016; 9:40-45. [PMID: 27924174 PMCID: PMC5127214 DOI: 10.14740/jocmr2623w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 12/03/2022] Open
Abstract
Background Adding functional features to morphological features offers a new method for non-invasive assessment of myocardial perfusion. This study aimed to explore technical routes of assessing the left coronary artery pressure gradient, wall shear stress distribution and blood flow velocity distribution, combining three-dimensional coronary model which was based on high resolution dual-source computed tomography (CT) with computational fluid dynamics (CFD) simulation. Methods Three cases of no obvious stenosis, mild stenosis and severe stenosis in left anterior descending (LAD) were enrolled. Images acquired on dual-source CT were input into software Mimics, ICEMCFD and FLUENT to simulate pressure gradient, wall shear stress distribution and blood flow velocity distribution. Measuring coronary enhancement ratio of coronary artery was to compare with pressure gradient. Results Results conformed to theoretical values and showed difference between normal and abnormal samples. Conclusions The study verified essential parameters and basic techniques in blood flow numerical simulation preliminarily. It was proved feasible.
Collapse
Affiliation(s)
- Jing Lu
- Nuclear Medicine Department, ZhongShan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, China
| | - Jie Yu
- Department of Radiology, Wuhan Union Hospital, No. 1277, Jiefang Road, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Wuhan Union Hospital, No. 1277, Jiefang Road, Wuhan, China
| |
Collapse
|
42
|
Funama Y, Utsunomiya D, Oda S, Shimonobo T, Nakaura T, Mukunoki T, Kidoh M, Yuki H, Yamashita Y. Transluminal attenuation-gradient coronary CT angiography on a 320-MDCT volume scanner: Effect of scan timing, coronary artery stenosis, and cardiac output using a contrast medium flow phantom. Phys Med 2016; 32:1415-1421. [DOI: 10.1016/j.ejmp.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
|
43
|
The value of noninvasive computed tomography derived fractional flow reserve in our current approach to the evaluation of coronary artery stenosis. Curr Opin Cardiol 2016; 31:970-976. [PMID: 27652813 DOI: 10.1097/hco.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Contemporary diagnosis and management of stable chest pain symptoms possibly due to coronary ischemia is a frequent clinical challenge that involves a variety of test options, based upon either coronary angiographic (anatomic) or functional imaging. This review will discuss the evolution of coronary computed tomography derived fractional flow reserve (FFRCT) from basic science to a currently clinically approved diagnostic test. RECENT FINDINGS In recent years, FFR measured invasively in the coronary catheterization lab has demonstrated clinical outcome benefit for coronary revascularization decisions. Both coronary angiographic (anatomic) and functional myocardial imaging have been limited by an inability to reliably estimate physiologic significance determined by FFR. However, advances in computational fluid dynamics have led to interest in FFR estimated by coronary angiograms obtained noninvasively through coronary CT angiography. SUMMARY The current use of FFRCT has been mostly limited to research applications due to lack of availability and cost, as well as limited outcomes and cost-effectiveness data. Nevertheless, interest remains in the potential role of FFRCT for coronary revascularization treatment decisions, and thus, ongoing and future studies will continue to investigate this technology.
Collapse
|
44
|
Mitsouras D, Liacouras P, Imanzadeh A, Giannopoulos AA, Cai T, Kumamaru KK, George E, Wake N, Caterson EJ, Pomahac B, Ho VB, Grant GT, Rybicki FJ. Medical 3D Printing for the Radiologist. Radiographics 2016; 35:1965-88. [PMID: 26562233 DOI: 10.1148/rg.2015140320] [Citation(s) in RCA: 358] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While use of advanced visualization in radiology is instrumental in diagnosis and communication with referring clinicians, there is an unmet need to render Digital Imaging and Communications in Medicine (DICOM) images as three-dimensional (3D) printed models capable of providing both tactile feedback and tangible depth information about anatomic and pathologic states. Three-dimensional printed models, already entrenched in the nonmedical sciences, are rapidly being embraced in medicine as well as in the lay community. Incorporating 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines. The overall costs of a 3D printing laboratory must be balanced by the clinical benefits. It is expected that the number of 3D-printed models generated from DICOM images for planning interventions and fabricating implants will grow exponentially. Radiologists should at a minimum be familiar with 3D printing as it relates to their field, including types of 3D printing technologies and materials used to create 3D-printed anatomic models, published applications of models to date, and clinical benefits in radiology. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Dimitris Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Peter Liacouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Amir Imanzadeh
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Andreas A Giannopoulos
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Tianrun Cai
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Kanako K Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Elizabeth George
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Nicole Wake
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Edward J Caterson
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Bohdan Pomahac
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Vincent B Ho
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Gerald T Grant
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Frank J Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| |
Collapse
|
45
|
Gonçalves PDA, Rodríguez-Granillo GA, Spitzer E, Suwannasom P, Loewe C, Nieman K, Garcia-Garcia HM. Functional Evaluation of Coronary Disease by CT Angiography. JACC Cardiovasc Imaging 2016; 8:1322-35. [PMID: 26563862 DOI: 10.1016/j.jcmg.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022]
Abstract
In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.
Collapse
Affiliation(s)
| | - Gastón A Rodríguez-Granillo
- Department of Cardiovascular Imaging, Diagnostico Maipu, and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Koen Nieman
- Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hector M Garcia-Garcia
- Cardialysis B.V., Rotterdam, the Netherlands; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
46
|
Non-invasive imaging of myocardial bridge by coronary computed tomography angiography: the value of transluminal attenuation gradient to predict significant dynamic compression. Eur Radiol 2016; 27:1971-1979. [PMID: 27565800 DOI: 10.1007/s00330-016-4544-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 06/26/2016] [Accepted: 08/08/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To study the diagnostic value of transluminal attenuation gradient (TAG) measured by coronary computed tomography angiography (CCTA) for identifying relevant dynamic compression of myocardial bridge (MB). METHODS Patients with confirmed MB who underwent both CCTA and ICA within one month were retrospectively included. TAG was defined as the linear regression coefficient between luminal attenuation and distance. The TAG of MB vessel, length and depth of MB were measured and correlated with the presence and degree of dynamic compression observed at ICA. Systolic compression ≧50 % was considered significant. RESULTS 302 patients with confirmed MB lesions were included. TAG was lowest (-17.4 ± 6.7 HU/10 mm) in patients with significant dynamic compression and highest in patients without MB compression (-9.5 ± 4.3 HU/10 mm, p < 0.001). Linear correlation revealed relation between the percentage of systolic compression and TAG (Pearson correlation, r = -0.52, p < 0.001) and no significant relation between the percentage of systolic compression and MB depth or length. ROC curve analysis determined the best cut-off value of TAG as -14.8HU/10 mm (area under curve = 0.813, 95 % confidence interval = 0.764-0.855, p < 0.001), which yielded high diagnostic accuracy (82.1 %, 248/302). CONCLUSIONS The degree of ICA-assessed systolic compression of MB significantly correlates with TAG but not MB depth or length. KEY POINTS • TAG is associated with the extent of dynamic compression of MB. • TAG is superior to depth and length for identifying dynamic compression. • Cut-off value of TAG as -14.8HU/10 mm yielded high predictive value.
Collapse
|
47
|
Sevag Packard RR, Karlsberg RP. Integrating FFRCT Into Routine Clinical Practice: A Solid PLATFORM or Slippery Slope? J Am Coll Cardiol 2016; 68:446-449. [PMID: 27470450 PMCID: PMC5378152 DOI: 10.1016/j.jacc.2016.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California; Department of Molecular, Cellular, and Integrative Physiology, University of California, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California; Cardiovascular Research Foundation of Southern California, Los Angeles, California
| | - Ronald P Karlsberg
- David Geffen School of Medicine at UCLA, Los Angeles, California; Cardiovascular Research Foundation of Southern California, Los Angeles, California; Cedars Sinai Heart Institute, Los Angeles, California.
| |
Collapse
|
48
|
Park EA, Lee W, Park SJ, Kim YK, Hwang HY. Influence of Coronary Artery Diameter on Intracoronary Transluminal Attenuation Gradient During CT Angiography. JACC Cardiovasc Imaging 2016; 9:1074-1083. [PMID: 27372017 DOI: 10.1016/j.jcmg.2015.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The goal of this study was to assess the effect of coronary artery diameter on luminal attenuation and the correlation between the transluminal attenuation gradient (TAG) and transluminal diameter gradient (TDG) on computed tomography (CT) coronary angiography. BACKGROUND Recent studies have reported promising results of TAG in detecting significant stenosis. However, because of the intrinsic nature of CT reconstruction algorithms, luminal attenuation may be affected by vessel diameter. METHODS In this 3-part study, phantom simulating vessels of various diameters immersed in different contrast mixtures were scanned, and intraluminal attenuations were measured. In addition, dynamic volume CT scanning was performed in 3 mongrel dogs (untreated, a stenosis model, and an occlusion model) using 320-row area detector computed tomography and intraluminal attenuations, and TAGs were calculated at each temporal scan and compared. In a separate clinical study, TAGs and TDGs of 152 coronary arteries from 62 patients who underwent 320-row area detector computed tomography coronary angiography and invasive angiography were measured and compared. RESULTS Intraluminal attenuation of phantom vessels gradually decreased along with a decrease in diameter. Animal studies revealed that the peak attenuation of distal smaller coronary arteries did not reach that of proximal larger coronary arteries: 55.2% to 78.1% peak attenuation of proximal coronary arteries. No differences in TAG were found between stenotic and normal left circumflex arteries at temporal scans (all, p > 0.05). The clinical study demonstrated significant correlation between TAG and TDG (r = 0.580; p < 0.0001). CONCLUSIONS Intraluminal attenuation was shown to decrease with diminution of vessel diameters. In addition, TAG exhibited a significant correlation with TDG, implying that TAG may be a secondary result because of differences in diameters.
Collapse
Affiliation(s)
- Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Sang Joon Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
49
|
Nakanishi R, Budoff MJ. Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: technology and clinical update. Vasc Health Risk Manag 2016; 12:269-78. [PMID: 27382296 PMCID: PMC4922813 DOI: 10.2147/vhrm.s79632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
After a decade of clinical use of coronary computed tomographic angiography (CCTA) to evaluate the anatomic severity of coronary artery disease, new methods of deriving functional information from CCTA have been developed. These methods utilize the anatomic information provided by CCTA in conjunction with computational fluid dynamics to calculate fractional flow reserve (FFR) values from CCTA image data sets. Computed tomography-derived FFR (CT-FFR) enables the identification of lesion-specific drop noninvasively. A three-dimensional CT-FFR modeling technique, which provides FFR values throughout the coronary tree (HeartFlow FFRCT analysis), has been validated against measured FFR and is now approved by the US Food and Drug Administration for clinical use. This technique requires off-site supercomputer analysis. More recently, a one-dimensional computational analysis technique (Siemens cFFR), which can be performed on on-site workstations, has been developed and is currently under investigation. This article reviews CT-FFR technology and clinical evidence for its use in stable patients with suspected coronary artery disease.
Collapse
Affiliation(s)
- Rine Nakanishi
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mathew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
50
|
Gao X, Kitslaar PH, Budde RPJ, Tu S, de Graaf MA, Xu L, Xu B, Scholte AJHA, Dijkstra J, Reiber JHC. Automatic detection of aorto-femoral vessel trajectory from whole-body computed tomography angiography data sets. Int J Cardiovasc Imaging 2016; 32:1311-22. [PMID: 27209285 DOI: 10.1007/s10554-016-0901-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/22/2016] [Indexed: 12/19/2022]
Abstract
Extraction of the aorto-femoral vessel trajectory is important to utilize computed tomography angiography (CTA) in an integrated workflow of the image-guided work-up prior to trans-catheter aortic valve replacement (TAVR). The aim of this study was to develop a new, fully-automated technique for the extraction of the entire arterial access route from the femoral artery to the aortic root. An automatic vessel tracking algorithm was first used to find the centerline that connected the femoral accessing points and the aortic root. Subsequently, a deformable 3D-model fitting method was used to delineate the lumen boundary of the vascular trajectory in the whole-body CTA dataset. A validation was carried out by comparing the automatically obtained results with semi-automatically obtained results from two experienced observers. The whole framework was validated on whole body CTA datasets of 36 patients. The average Dice similarity indexes between the segmentations of the automatic method and observer 1 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta were 0.977 ± 0.030, 0.980 ± 0.019, 0.982 ± 0.016; the average Dice similarity indexes between the segmentations of the automatic method and observer 2 were 0.950 ± 0.040, 0.954 ± 0.031 and 0.965 ± 0.019, respectively. The inter-observer variability resulted in a Dice similarity index of 0.954 ± 0.038, 0.952 ± 0.031 and 0.969 ± 0.018 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta. The average minimal luminal diameters (MLDs) of the ilio-femoral artery were 6.03 ± 1.48, 5.70 ± 1.43 and 5.52 ± 1.32 mm for the automatic method, observer 1 and observer 2 respectively. The MLDs of the aorta were 13.43 ± 2.54, 12.40 ± 2.93 and 12.08 ± 2.40 mm for the automatic method, observer 1 and observer 2 respectively. The automatic measurement overestimated the MLD slightly in the ilio-femoral artery at the average by 0.323 mm (SD = 0.49 mm, p < 0.001) compared to observer 1 and by 0.51 mm (SD = 0.71 mm, p < 0.001) compared to observer 2. The proposed segmentation approach can automatically provide reliable measurements of the entire arterial accessing route that can be used to support TAVR procedures. To the best of our knowledges, this approach is the first fully automatic segmentation method of the whole aorto-femoral vessel trajectory in CTA images.
Collapse
Affiliation(s)
- Xinpei Gao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands.
- Medis medical imaging systems b.v., Leiden, The Netherlands.
| | - Ricardo P J Budde
- Department of Radiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Xu
- Catheterization Laboratory, National Center for Cardiovascular Diseases of China and Fu Wai Hospital, Beijing, China
| | - Bo Xu
- Catheterization Laboratory, National Center for Cardiovascular Diseases of China and Fu Wai Hospital, Beijing, China
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
- Medis medical imaging systems b.v., Leiden, The Netherlands
| |
Collapse
|