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Branch KR, Nguyen ML, Kudenchuk PJ, Johnson NJ. Head-to-pelvis CT imaging after sudden cardiac arrest: Current status and future directions. Resuscitation 2023; 191:109916. [PMID: 37506817 DOI: 10.1016/j.resuscitation.2023.109916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Causes for sudden circulatory arrest (SCA) can vary widely making early treatment and triage decisions challenging. Additionally, cardiopulmonary resuscitation (CPR), while a life-saving link in the chain of survival, can be associated with traumatic injuries. Computed tomography (CT) can identify many causes of SCA as well as its sequelae. However, the diagnostic and therapeutic impact of CT in survivors of SCA has not been reviewed to date. This general review outlines the rationale and potential applications of focused head, chest, and abdomen/pelvis CT as well as comprehensive head-to-pelvis CT imaging after SCA. CT has a diagnostic yield approaching 30% to identify causes of SCA while the addition of ECG-gated chest CT provides further information about coronary anatomy and cardiac function. Risks of CT include radiation exposure, contrast-induced kidney injury, and incidental findings. This review's findings suggest that routine head-to-pelvis CT can yield clinically actional findings with the potential to improve clinical outcome after SCA that merits further investigation.
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Affiliation(s)
- Kelley R Branch
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - My-Linh Nguyen
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | | | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Divsion of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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2
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Koh N, Nieman K. Role of cardiac imaging in acute chest pain. Br J Radiol 2023; 96:20220307. [PMID: 36533544 PMCID: PMC9975370 DOI: 10.1259/bjr.20220307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Chest pain is the second most common complaint in the emergency department. The need to diagnose the cause of chest pain in a timely manner and appropriately direct care is crucial. This article discusses the role of imaging in acute chest pain, after first differentiating chest pain into cardiac and non-cardiac causes with upfront clinical and biochemical assessment. The role of non-invasive imaging including point-of-care ultrasound, echocardiography, myocardial perfusion imaging, cardiac MRI, coronary computed tomography angiography and novel cardiac CT applications are discussed. Updates in the literature regarding the role of coronary plaque imaging in acute chest pain are reviewed, as are ongoing challenges and future directions. This includes a discussion on the yield of diagnostic testing in low-risk acute chest pain cohorts vs intermediate-high risk cohorts. The incremental value of further testing in the former is low, which is reflected in contemporary guidelines that discourage the use of costly diagnostic tests in these cohorts. In the latter cohort, emerging evidence has shown specifically the role coronary computed tomography angiography could play in reducing the need for invasive coronary angiography in selective patients where the true probability of acute coronary syndrome is thought to be low. Real-world considerations such as accessibility and affordability are also discussed in the paper because while guidelines offer clinicians the flexibility of evidence-based choice, physician decision must necessarily be made in consideration of real-world constraints.
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Affiliation(s)
- Natalie Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, School of Medicine, Stanford, CA, USA
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3
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Yoshihara S. Acute coronary syndrome on non-electrocardiogram-gated contrast-enhanced computed tomography. World J Radiol 2022; 14:30-46. [PMID: 35317242 PMCID: PMC8891644 DOI: 10.4329/wjr.v14.i2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
It is not rare for acute coronary syndrome (ACS) patients to present with symptoms that are atypical, rather than chest pain. It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms, normal initial biomarkers of myocardial necrosis, and normal or nondiagnostic electrocardiograms (ECGs). Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS, it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients. However, several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT. A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient’s presenting symptoms. In order to avoid inappropriate management for this life-threatening event, clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.
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Affiliation(s)
- Shu Yoshihara
- Department of Diagnostic Radiology, Iwata City Hospital, Iwata 438-8550, Japan
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Son MJ, Lee D, Yoo SM, White CS. Diagnostic Accuracy of Coronary Artery Occlusion and Myocardial Perfusion Defect on Non-Gated Enhanced Chest CT in Predicting Acute Myocardial Infarction. Tomography 2021; 7:504-512. [PMID: 34698293 PMCID: PMC8544712 DOI: 10.3390/tomography7040043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic accuracy of coronary artery occlusion (CAO) and myocardial perfusion defect (MPD) identified on non-gated enhanced chest CT in patients with acute myocardial infarction (AMI). We retrospectively assessed 99 patients with AMI (group 1, n = 33) and without AMI (group 2, n = 66) who underwent non-gated chest CT. We analyzed the presence of MPD and CAO on non-gated chest CT. MPD on the CT was categorized using a three-point scale (0 = no definite MPD; 1 = probable artifact or questionable MPD; 2 = probable MPD). Presence of CAO was defined as an abrupt change of contrast enhancement in a coronary artery segment with no or minimal coronary motion on the CT. There were 42.4% and 12.1% patients with probable MPD (p = 0.002), and 18.2% and 0% patients with CAO (p = 0.001) in groups 1 and 2, respectively. Probable MPD alone and simultaneous presence of CAO and probable MPD to predict AMI resulted in sensitivity, specificity, negative predictive value, and positive predictive valve of 42.4%, 87.9%, 75.3%, and 63.6%, respectively, and 12.1%, 100%, 69.5%, and 100%, respectively. In conclusion, probable MPD alone on non-gated chest CT demonstrated a relatively low sensitivity, high specificity, and modest positive predictive value for the prediction of AMI on non-gated enhanced chest CT. Although it is rare, simultaneous presence of CAO and probable MPD had a high positive predictive value to predict AMI on non-gated enhanced chest CT.
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Affiliation(s)
- Min Ji Son
- Department of Radiology, CHA University Bundang Medical Center, Seongnam 13497, Korea; (M.J.S.); (D.L.)
| | - Dongjun Lee
- Department of Radiology, CHA University Bundang Medical Center, Seongnam 13497, Korea; (M.J.S.); (D.L.)
| | - Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Seongnam 13497, Korea; (M.J.S.); (D.L.)
| | - Charles S. White
- Department of Radiology, University of Maryland, Baltimore, MD 20742, USA;
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Xu Z, Tao B, Liu C, Han D, Zhang J, Liu J, Li S, Li W, Wang J, Liang J, Cao F. Three-dimensional quantitative assessment of myocardial infarction via multimodality fusion imaging: methodology, validation, and preliminary clinical application. Quant Imaging Med Surg 2021; 11:3175-3189. [PMID: 34249644 PMCID: PMC8250027 DOI: 10.21037/qims-20-702] [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] [Received: 05/27/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The precise assessment of myocardial infarction (MI) is crucial both for therapeutic interventions in old MI and the development of new and effective techniques to repair injured myocardium. A novel method was developed to assess left ventricular (LV) quantitatively infarction through three-dimensional (3D) multimodality fusion based on computed tomography angiography (CTA) and technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) images. This study sought to develop a 3D quantitative method for MI for pre-clinical study and clinical application. METHODS Three months after the MI models were established in 20 minipigs, CTA and SPECT images were acquired separately, which were then aligned automatically with the constraints of the shape and the whole heart and LV myocardium position. Infarct ratios were quantified based on the 3D fusion images. The quantitative assessment was then experimentally validated via an ex vivo histology analysis using triphenyl-tetrazolium-chloride staining and subsequently applied to post-MI patients (n=8). RESULTS The location of an infarct identified by the SPECT was consistent with that identified by an ex vivo heart in a 3D space. Infarct size determined by CTA-SPECT was correlated with infarct size assessed by triphenyl-tetrazolium-chloride pathology {27.6% [interquartile range (IQR) 17.1-34.7%] vs. 24.1% (IQR 14.7-32.5%), r2=0.99, P<0.01}. In clinical cases, the CTA-SPECT 3D fusion quantitative results were significantly correlated with the quantitative perfusion SPECT results (r=0.976, P<0.01). CONCLUSIONS The proposed 3D fusion quantitative assessment method provides reliable and intuitive evaluations of infarction. This novel quantification technique enables whole heart quantification for the pre-operation evaluation and post-diagnosis management of old MI patients. It could also be applied to the design of 3D-printed cardiac patches.
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Affiliation(s)
- Zhenzhen Xu
- School of Life Science and Technology, Xidian University, Xi’an, China
| | - Bo Tao
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Chuanbin Liu
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jibin Zhang
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Junsong Liu
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weijie Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Jimin Liang
- School of Electronic Engineering, Xidian University, Xi’an, China
| | - Feng Cao
- Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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6
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Vallejo E, Buelna-Cano C. Clinical utility of two-phase computed tomography angiography for the detection of myocardial perfusion defects related to acute coronary syndrome in patients with acute chest pain: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab139. [PMID: 34268474 PMCID: PMC8276621 DOI: 10.1093/ehjcr/ytab139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/02/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022]
Abstract
Background Evaluation of acute chest pain (ACP) in the emergency department is a major health issue and differential diagnosis remains challenging for the physician, particularly in patients with atypical symptoms and inconclusive changes in electrocardiogram (ECG) or biomarkers levels. Case summary We present the potential value of the two-phase computed tomography angiography (TP-CTA) imaging protocol done in six different patients evaluated with ACP and underwent non-gated or gated computed tomography angiography (CTA) to exclude pulmonary embolism (PE), acute aortic syndrome (AAS), or acute coronary syndrome (ACS). All patients had new-onset chest pain and atypical clinical presentation with non-diagnostic ECG and initially negative or near-normal cardiac biomarkers. Discussion The evaluation of myocardial computed tomography perfusion (MCTP) using TP-CTA imaging protocol might open a new diagnostic approach to evaluate MCTP in patients with ACP related to PE, AAS, or ACS.
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Affiliation(s)
- Enrique Vallejo
- Cardiovascular Imaging at American British Cowdray Hospital, Centro Medico ABC, Calle Sur 136, No 116, Torre Sur 4o Piso, Interior 2, Colonia Las Americas, Delegación Alvaro Obregon, C.P. 01120, Mexico City, Mexico
| | - Christian Buelna-Cano
- Cardiovascular Imaging at American British Cowdray Hospital, Centro Medico ABC, Calle Sur 136, No 116, Torre Sur 4o Piso, Interior 2, Colonia Las Americas, Delegación Alvaro Obregon, C.P. 01120, Mexico City, Mexico
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7
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Yang MX, Xu HY, Zhang L, Chen L, Xu R, Fu H, Liu H, Li XS, Fu C, Liu KL, Li H, Zhou XY, Guo YK, Yang ZG. Myocardial perfusion assessment in the infarct core and penumbra zones in an in-vivo porcine model of the acute, sub-acute, and chronic infarction. Eur Radiol 2020; 31:2798-2808. [PMID: 33156386 DOI: 10.1007/s00330-020-07220-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 07/12/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To assess the longitudinal changes of microvascular function in different myocardial regions after myocardial infarction (MI) using myocardial blood flow derived by dynamic CT perfusion (CTP-MBF), and compare CTP-MBF with the results of cardiac magnetic resonance (CMR) and histopathology. METHODS The CTP scanning was performed in a MI porcine model 1 day (n = 15), 7 days (n = 10), and 3 months (n = 5) following induction surgery. CTP-MBF was measured in the infarcted myocardium, penumbra, and remote myocardium, respectively. CMR perfusion and histopathology were performed for validation. RESULTS From baseline to follow-up scans, CTP-MBF presented a stepwise increase in the infarcted myocardium (68.51 ± 11.04 vs. 86.73 ± 13.32 vs. 109.53 ± 26.64 ml/100 ml/min, p = 0.001) and the penumbra (104.92 ± 29.29 vs. 120.32 ± 24.74 vs. 183.01 ± 57.98 ml/100 ml/min, p = 0.008), but not in the remote myocardium (150.05 ± 35.70 vs. 166.66 ± 38.17 vs. 195.36 ± 49.64 ml/100 ml/min, p = 0.120). The CTP-MBF correlated with max slope (r = 0.584, p < 0.001), max signal intensity (r = 0.357, p < 0.001), and time to max (r = - 0.378, p < 0.001) by CMR perfusion. Moreover, CTP-MBF defined the infarcted myocardium on triphenyl tetrazolium chloride staining (AUC: 0.810, p < 0.001) and correlated with microvascular density on CD31 staining (r = 0.561, p = 0.002). CONCLUSION CTP-MBF could quantify the longitudinal changes of microvascular function in different regions of the post-MI myocardium, which demonstrates good agreement with contemporary CMR and histopathological findings. KEY POINTS • The CT perfusion-based myocardial blood flow (CTP-MBF) could quantify the microvascular impairment in different myocardial regions after myocardial infarction (MI) and track its recovery over time. • The assessment of CTP-MBF is in good agreement with contemporary cardiac MRI and histopathological findings, which potentially facilitates a rapid approach for pathophysiological insights following MI.
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Affiliation(s)
- Meng-Xi Yang
- Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Lin Chen
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Hui Liu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Xue-Sheng Li
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China
| | - Chuan Fu
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ke-Ling Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yue Zhou
- MR Collaboration, Siemens Healthcare Ltd, Shanghai, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China. .,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
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8
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Beache GM, Mohammed TLH, Hurwitz Koweek LM, Ghoshhajra BB, Brown RKJ, Davis AM, Heitner J, Hsu JY, Johri AM, Khosa F, Kligerman SJ, Litmanovich D, Maroules CD, Meyersohn N, Tomaszewski CA, Villines TC, Wann S, Abbara S. ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. J Am Coll Radiol 2020; 17:S346-S354. [PMID: 33153548 DOI: 10.1016/j.jacr.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky.
| | | | | | | | | | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois; American College of Physicians
| | - John Heitner
- New York Presbyterian Methodist Hospital, Brooklyn, New York; Society for Cardiovascular Magnetic Resonance
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Amer M Johri
- Queen's University, Kingston, Ontario; Canada, Cardiology expert
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear cardiology expert
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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9
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Batlle JC, Kirsch J, Bolen MA, Bandettini WP, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johnson TV, Khosa F, Krishnamurthy R, Rajiah P, Singh SP, Tomaszewski CA, Villines TC, Wann S, Young PM, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome. J Am Coll Radiol 2020; 17:S55-S69. [PMID: 32370978 DOI: 10.1016/j.jacr.2020.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida.
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | | | - W Patricia Bandettini
- National Institutes of Health, Bethesda, Maryland; Society for Cardiovascular Magnetic Resonance
| | | | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Cardiology Expert
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear Cardiology Expert
| | | | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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10
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Singh A, Mor-Avi V, Patel AR. The role of computed tomography myocardial perfusion imaging in clinical practice. J Cardiovasc Comput Tomogr 2020; 14:185-194. [DOI: 10.1016/j.jcct.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
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11
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Ryu AJ, Lee KE, Kwon SS, Shin ES, Shim EB. In silico evaluation of the acute occlusion effect of coronary artery on cardiac electrophysiology and the body surface potential map. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2018; 23:71-79. [PMID: 30627012 PMCID: PMC6315095 DOI: 10.4196/kjpp.2019.23.1.71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 11/15/2022]
Abstract
Body surface potential map, an electric potential distribution on the body torso surface, enables us to infer the electrical activities of the heart. Therefore, observing electric potential projected to the torso surface can be highly useful for diagnosing heart diseases such as coronary occlusion. The BSPM for the heart of a patient show a higher level of sensitivity than 12-lead ECG. Relevant research has been mostly based on clinical statistics obtained from patients, and, therefore, a simulation for a variety of pathological phenomena of the heart is required. In this study, by using computer simulation, a body surface potential map was implemented according to various occlusion locations (distal, mid, proximal occlusion) in the left anterior descending coronary artery. Electrophysiological characteristics of the body surface during the ST segment period were observed and analyzed based on an ST isointegral map. We developed an integrated system that takes into account the cellular to organ levels, and performed simulation regarding the electrophysiological phenomena of the heart that occur during the first 5 minutes (stage 1) and 10 minutes (stage 2) after commencement of coronary occlusion. Subsequently, we calculated the bipolar angle and amplitude of the ST isointegral map, and observed the correlation between the relevant characteristics and the location of coronary occlusion. In the result, in the ventricle model during the stage 1, a wider area of ischemia led to counterclockwise rotation of the bipolar angle; and, during the stage 2, the amplitude increased when the ischemia area exceeded a certain size.
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Affiliation(s)
| | - Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24341, Korea
| | | | - Eun-Seok Shin
- Department of Cardiology, University of Ulsan College of Medicine, Ulsan 44033, Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24341, Korea
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12
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van Hamersvelt RW, Zreik M, Voskuil M, Viergever MA, Išgum I, Leiner T. Deep learning analysis of left ventricular myocardium in CT angiographic intermediate-degree coronary stenosis improves the diagnostic accuracy for identification of functionally significant stenosis. Eur Radiol 2018; 29:2350-2359. [PMID: 30421020 PMCID: PMC6443613 DOI: 10.1007/s00330-018-5822-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/23/2018] [Accepted: 10/02/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate the added value of deep learning (DL) analysis of the left ventricular myocardium (LVM) in resting coronary CT angiography (CCTA) over determination of coronary degree of stenosis (DS), for identification of patients with functionally significant coronary artery stenosis. METHODS Patients who underwent CCTA prior to an invasive fractional flow reserve (FFR) measurement were retrospectively selected. Highest DS from CCTA was used to classify patients as having non-significant (≤ 24% DS), intermediate (25-69% DS), or significant stenosis (≥ 70% DS). Patients with intermediate stenosis were referred for fully automatic DL analysis of the LVM. The DL algorithm characterized the LVM, and likely encoded information regarding shape, texture, contrast enhancement, and more. Based on these encodings, features were extracted and patients classified as having a non-significant or significant stenosis. Diagnostic performance of the combined method was evaluated and compared to DS evaluation only. Functionally significant stenosis was defined as FFR ≤ 0.8 or presence of angiographic high-grade stenosis (≥ 90% DS). RESULTS The final study population consisted of 126 patients (77% male, 59 ± 9 years). Eighty-one patients (64%) had a functionally significant stenosis. The proposed method resulted in improved discrimination (AUC = 0.76) compared to classification based on DS only (AUC = 0.68). Sensitivity and specificity were 92.6% and 31.1% for DS only (≥ 50% indicating functionally significant stenosis), and 84.6% and 48.4% for the proposed method. CONCLUSION The combination of DS with DL analysis of the LVM in intermediate-degree coronary stenosis may result in improved diagnostic performance for identification of patients with functionally significant coronary artery stenosis. KEY POINTS • Assessment of degree of coronary stenosis on CCTA has consistently high sensitivity and negative predictive value, but has limited specificity for identifying the functional significance of a stenosis. • Deep learning algorithms are able to learn complex patterns and relationships directly from the images without prior specification of which image features represent presence of disease, and thereby may be more sensitive to subtle changes in the LVM caused by functionally significant stenosis. • Addition of deep learning analysis of the left ventricular myocardium to the evaluation of degree of coronary artery stenosis improves diagnostic performance and increases specificity of resting CCTA. This could potentially decrease the number of patients undergoing invasive coronary angiography.
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Affiliation(s)
- Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Majd Zreik
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
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13
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Han D, Lee JH, Rizvi A, Gransar H, Baskaran L, Schulman-Marcus J, Ó Hartaigh B, Lin FY, Min JK. Incremental role of resting myocardial computed tomography perfusion for predicting physiologically significant coronary artery disease: A machine learning approach. J Nucl Cardiol 2018; 25:223-233. [PMID: 28303473 DOI: 10.1007/s12350-017-0834-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evaluation of resting myocardial computed tomography perfusion (CTP) by coronary CT angiography (CCTA) might serve as a useful addition for determining coronary artery disease. We aimed to evaluate the incremental benefit of resting CTP over coronary stenosis for predicting ischemia using a computational algorithm trained by machine learning methods. METHODS 252 patients underwent CCTA and invasive fractional flow reserve (FFR). CT stenosis was classified as 0%, 1-30%, 31-49%, 50-70%, and >70% maximal stenosis. Significant ischemia was defined as invasive FFR < 0.80. Resting CTP analysis was performed using a gradient boosting classifier for supervised machine learning. RESULTS On a per-patient basis, accuracy, sensitivity, specificity, positive predictive, and negative predictive values according to resting CTP when added to CT stenosis (>70%) for predicting ischemia were 68.3%, 52.7%, 84.6%, 78.2%, and 63.0%, respectively. Compared with CT stenosis [area under the receiver operating characteristic curve (AUC): 0.68, 95% confidence interval (CI) 0.62-0.74], the addition of resting CTP appeared to improve discrimination (AUC: 0.75, 95% CI 0.69-0.81, P value .001) and reclassification (net reclassification improvement: 0.52, P value < .001) of ischemia. CONCLUSIONS The addition of resting CTP analysis acquired from machine learning techniques may improve the predictive utility of significant ischemia over coronary stenosis.
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Affiliation(s)
- Donghee Han
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Lohendran Baskaran
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Joshua Schulman-Marcus
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Albany Medical College, Albany, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA.
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Yu J, Wang L, Peng Y, Xiong M, Cai X, Luo J, Zhang M. Dynamic Monitoring of Erythrocyte Distribution Width (RDW) and Platelet Distribution Width (PDW) in Treatment of Acute Myocardial Infarction. Med Sci Monit 2017; 23:5899-5906. [PMID: 29233957 PMCID: PMC5737569 DOI: 10.12659/msm.904916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background This study investigated the role of erythrocyte distribution width (RDW) and platelet distribution width (PDW) in evaluating the treatment efficacy for acute myocardial infarction (AMI). Material/Methods A total of 120 AMI patients receiving conventional myocardial infarction treatment were included. The patients were divided into an effective group and an ineffective group based on treatment efficacy. The RDW and PDW were measured before and after treatment. We used the independent samples t test, chi-square test, logistic regression, and ROC curves for analysis. Results The change and change rate of RDW and PDW were significantly improved (p<0.01) and the positive change rate of RDW, PDW, and RDW + PDW were significantly lower in the effective group compared with those in the ineffective group (p<0.01). The change and change rate of RDW and PDW are independent factors for treatment efficacy evaluation (p<0.05). ROC curve analysis showed that the changes and change rate of RDW and PDW were all significant in evaluating treatment efficacy (p<0.05). Conclusions The change and change rate of RDW and PDW or their combination can be used to evaluate treatment efficacy; however, the absolute value of RDW and PDW are not as significant.
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Affiliation(s)
- Jian Yu
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Li Wang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Yuchong Peng
- Department of General Surgery, The Ninth People's Hospital of Chongqing, Chongqing, China (mainland)
| | - Mingjie Xiong
- Health Management Center, Southwest University Hospital, Chongqing, China (mainland)
| | - Xiaozhong Cai
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Juan Luo
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Minghao Zhang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
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Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease. Crit Pathw Cardiol 2017; 15:138-144. [PMID: 27846005 DOI: 10.1097/hpc.0000000000000091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital. The ED variables were assessed with logistic regression for their association with eventual ACS diagnosis at hospital discharge. ACS was diagnosed in 74 (26%) of the patients. RESULTS Non-ACS patients had a 2-day median length of stay and $6875 median inpatient (post ED) hospital charges (not including physician fees), totaling 566 hospital bed days and $1,871,250 for the 211 (74%) non-ACS patients. A novel risk score, including (1) history of prior revascularization, (2) comorbid chronic kidney disease, (3) onset of chest discomfort at rest, (4) dynamic electrocardiogram changes in the ED, (5) elevated troponin I (>0.05 ng/mL) in the ED, and (6) associated illness at presentation, discriminated ACS and non-ACS with a c statistic of 0.767; the c statistic for a modified thrombolysis in myocardial infarction risk score was 0.712. CONCLUSIONS Application of these risk scores may reduce the number of potentially avoidable admissions and their associated hazards and costs.
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16
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Kofoed KF, Sørgaard MH, Linde JJ. Functional Information in Coronary Artery Disease: The Case of Computed Tomography Myocardial Perfusion. Curr Cardiol Rep 2017; 19:126. [PMID: 29071430 DOI: 10.1007/s11886-017-0937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW To review methodological and logistical aspects of CT myocardial perfusion, current clinical evidence and possible future directions, with specific focus on use in patients with coronary artery disease (CAD). RECENT FINDINGS CT myocardial perfusion imaging may be performed as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already clinically available perfusion imaging methods. Combining CCTA and CT myocardial perfusion imaging increases the diagnostic accuracy to identify patients with CAD associated with ischemia. In patients suspected of CAD, CCTA frequently detects coronary atherosclerotic lesions, in which revascularization could be clinically beneficial. CT myocardial perfusion imaging may be helpful to identify coronary lesions associated with myocardial ischemia, and thus potentially suitable for coronary intervention.
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Affiliation(s)
- Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology 2014, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias H Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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17
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Myocardial CT Perfusion: A Review of Current Modalities, Technology, and Clinical Performance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Non-gated high-pitch computed tomography aortic angiography: Myocardial perfusion defects in patients with suspected aortic dissection. J Cardiovasc Comput Tomogr 2017; 11:208-212. [DOI: 10.1016/j.jcct.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/20/2017] [Accepted: 04/11/2017] [Indexed: 11/22/2022]
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19
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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.
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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.
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20
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Smulders MW, Kietselaer BL, Schalla S, Bucerius J, Jaarsma C, van Dieijen-Visser MP, Mingels AM, Rocca HPBL, Post M, Das M, Crijns HJ, Wildberger JE, Bekkers SC. Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging? Am Heart J 2016; 177:102-11. [PMID: 27297855 DOI: 10.1016/j.ahj.2016.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
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Abstract
PURPOSE OF REVIEW Computed tomography (CT) coronary angiography is a well-validated non-invasive technique for accurate and expedient diagnosis of coronary artery disease (CAD). However, a limitation of coronary CT angiography (CCTA) is its limited capability to identify physiologically significant stenoses, which may eventuate the need for further functional testing. Stress CT myocardial perfusion imaging (CT-MPI) is an emerging technique that has the ability to identify flow-limiting stenoses. RECENT FINDINGS The combination of CCTA coronary and CT-MPI has transformed the modality from a tool to assess anatomy and morphology to a modality capable of simultaneous assessment of coronary stenoses and their physiologic significance. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CT-MPI in comparison to a number of reference standard modalities for CAD diagnosis, including single-photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve testing. SUMMARY While there is still a need for consensus regarding acquisition techniques as well as analysis and interpretation of CT-MPI, with further validation, it is likely to become a powerful adjunctive tool to CCTA in the management of patients with suspected coronary disease.
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22
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Maffei E, Seitun S, Guaricci AI, Cademartiri F. Chest pain: coronary CT in the ER. Br J Radiol 2016; 89:20150954. [PMID: 26866681 PMCID: PMC4985473 DOI: 10.1259/bjr.20150954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 01/16/2023] Open
Abstract
Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.
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Affiliation(s)
- Erica Maffei
- Centre de Recherché/Department of Radiology, Montréal Heart Institute/Universitè de Montréal, Montréal, Quebec, Canada
| | - Sara Seitun
- Department of Radiology, IRCCS San Martino University Hospital—IST, Genoa, Italy
| | | | - Filippo Cademartiri
- Centre de Recherché/Department of Radiology, Montréal Heart Institute/Universitè de Montréal, Montréal, Quebec, Canada
- Department of Radiology, Erasmus Medical Center University, Rotterdam, Netherlands
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Berko NS, Clark ET, Levsky JM. Acute left circumflex coronary artery occlusion detected on nongated CT. Clin Imaging 2015; 39:897-900. [PMID: 26070244 DOI: 10.1016/j.clinimag.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
We describe a patient with chest pain and a nondiagnostic electrocardiogram in whom computed tomographic (CT) aortography demonstrated myocardial hypoperfusion in the distribution of the circumflex artery as well as an abrupt cutoff of contrast in the left circumflex artery. Subsequent cardiac catheterization confirmed occlusion of the circumflex artery and led to revascularization. The diagnosis of acute myocardial infarction on CT can dramatically alter the clinical management of a patient, especially in cases in which other tests are equivocal.
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Affiliation(s)
- Netanel S Berko
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490.
| | - Elana T Clark
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490
| | - Jeffrey M Levsky
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490
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Maroules CD, Cury RC, Ghoshhajra BB, Hoffmann U, Litt HI, Blankstein R, Abbara S. Strategy for Building a Successful Coronary CT Angiography Program in the Emergency Department. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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