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Gnasso C, Pinos D, Schoepf UJ, Vecsey-Nagy M, Aquino GJ, Fink N, Zsarnoczay E, Holtackers RJ, Stock J, Suranyi P, Varga-Szemes A, Emrich T. Impact of reconstruction parameters on the accuracy of myocardial extracellular volume quantification on a first-generation, photon-counting detector CT. Eur Radiol Exp 2024; 8:70. [PMID: 38890175 PMCID: PMC11189359 DOI: 10.1186/s41747-024-00469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The potential role of cardiac computed tomography (CT) has increasingly been demonstrated for the assessment of diffuse myocardial fibrosis through the quantification of extracellular volume (ECV). Photon-counting detector (PCD)-CT technology may deliver more accurate ECV quantification compared to energy-integrating detector CT. We evaluated the impact of reconstruction settings on the accuracy of ECV quantification using PCD-CT, with magnetic resonance imaging (MRI)-based ECV as reference. METHODS In this post hoc analysis, 27 patients (aged 53.1 ± 17.2 years (mean ± standard deviation); 14 women) underwent same-day cardiac PCD-CT and MRI. Late iodine CT scans were reconstructed with different quantum iterative reconstruction levels (QIR 1-4), slice thicknesses (0.4-8 mm), and virtual monoenergetic imaging levels (VMI, 40-90 keV); ECV was quantified for each reconstruction setting. Repeated measures ANOVA and t-test for pairwise comparisons, Bland-Altman plots, and Lin's concordance correlation coefficient (CCC) were used. RESULTS ECV values did not differ significantly among QIR levels (p = 1.000). A significant difference was observed throughout different slice thicknesses, with 0.4 mm yielding the highest agreement with MRI-based ECV (CCC = 0.944); 45-keV VMI reconstructions showed the lowest mean bias (0.6, 95% confidence interval 0.1-1.4) compared to MRI. Using the most optimal reconstruction settings (QIR4. slice thickness 0.4 mm, VMI 45 keV), a 63% reduction in mean bias and a 6% increase in concordance with MRI-based ECV were achieved compared to standard settings (QIR3, slice thickness 1.5 mm; VMI 65 keV). CONCLUSIONS The selection of appropriate reconstruction parameters improved the agreement between PCD-CT and MRI-based ECV. RELEVANCE STATEMENT Tailoring PCD-CT reconstruction parameters optimizes ECV quantification compared to MRI, potentially improving its clinical utility. KEY POINTS • CT is increasingly promising for myocardial tissue characterization, assessing focal and diffuse fibrosis via late iodine enhancement and ECV quantification, respectively. • PCD-CT offers superior performance over conventional CT, potentially improving ECV quantification and its agreement with MRI-based ECV. • Tailoring PCD-CT reconstruction parameters optimizes ECV quantification compared to MRI, potentially improving its clinical utility.
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Affiliation(s)
- Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Üllői Út 78, Budapest, 1082, Hungary
| | - Robert J Holtackers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, 6229 HX, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maa stricht University, Maastricht, 6229 ER, The Netherlands
| | - Jonathan Stock
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Paracelsus Medical University, Prof.-Ernst-Nathan-Strasse 1, Nuremberg, 90419, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany.
- German Centre for Cardiovascular Research, Mainz, 55131, Germany.
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Ha S, Jang Y, Lee BK, Hong Y, Kim BK, Park S, Yoo SK, Chang HJ. Simultaneous Viability Assessment and Invasive Coronary Angiography Using a Therapeutic CT System in Chronic Myocardial Infarction Patients. Yonsei Med J 2024; 65:257-264. [PMID: 38653564 PMCID: PMC11045343 DOI: 10.3349/ymj.2023.0208] [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] [Received: 06/07/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE In a preclinical study using a swine myocardial infarction (MI) model, a delayed enhancement (DE)-multi-detector computed tomography (MDCT) scan was performed using a hybrid system alongside diagnostic invasive coronary angiography (ICA) without the additional use of a contrast agent, and demonstrated an excellent correlation in the infarct area compared with histopathologic specimens. In the present investigation, we evaluated the feasibility and diagnostic accuracy of a myocardial viability assessment by DE-MDCT using a hybrid system comprising ICA and MDCT alongside diagnostic ICA without the additional use of a contrast agent. MATERIALS AND METHODS We prospectively enrolled 13 patients (median age: 67 years) with a previous MI (>6 months) scheduled to undergo ICA. All patients underwent cardiac magnetic resonance (CMR) imaging before diagnostic ICA. MDCT viability scans were performed concurrently with diagnostic ICA without the use of additional contrast. The total myocardial scar volume per patient and average transmurality per myocardial segment measured by DE-MDCT were compared with those from DE-CMR. RESULTS The DE volume measured by MDCT showed an excellent correlation with the volume measured by CMR (r=0.986, p<0.0001). The transmurality per segment by MDCT was well-correlated with CMR (r=0.900, p<0.0001); the diagnostic performance of MDCT in differentiating non-viable from viable myocardium using a 50% transmurality criterion was good with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 87.5%, 99.5%, 87.5%, 99.5%, and 99.1%, respectively. CONCLUSION The feasibility of the DE-MDCT viability assessment acquired simultaneously with conventional ICA was proven in patients with chronic MI using DE-CMR as the reference standard.
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Affiliation(s)
- Seongmin Ha
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeonggul Jang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science Yonsei University, Seoul, Korea
| | - Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Youngtaek Hong
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Ontact Health Co., Ltd., Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seil Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Kook Yoo
- Department of Medical Engineering, Yonsei University College of Medicine, Seoul, Korea.
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Ontact Health Co., Ltd., Seoul, Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Oyama-Manabe N, Oda S, Ohta Y, Takagi H, Kitagawa K, Jinzaki M. Myocardial late enhancement and extracellular volume with single-energy, dual-energy, and photon-counting computed tomography. J Cardiovasc Comput Tomogr 2024; 18:3-10. [PMID: 38218665 DOI: 10.1016/j.jcct.2023.12.006] [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] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
Computed tomography late enhancement (CT-LE) is emerging as a non-invasive technique for cardiac diagnosis with wider accessibility compared to MRI, despite its typically lower contrast-to-noise ratio. Optimizing CT-LE image quality necessitates a thorough methodology addressing contrast administration, timing, and radiation dose, alongside a robust understanding of extracellular volume (ECV) quantification methods. This review summarizes CT-LE protocols, clinical utility, and advances in ECV measurement through both single-energy and dual-energy CT. It also highlights photon-counting detector CT technology as an innovative means to potentially improve image quality and reduce radiation exposure.
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Affiliation(s)
- Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidenobu Takagi
- Department of Advanced Radiological Imaging Collaborative Research, Tohoku University, Sendai, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan.
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Zonana Amkie R, Buddhavarapu A, Patel MD, Zhao B, Adebo DA. Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor. JACC Case Rep 2023; 21:101962. [PMID: 37719289 PMCID: PMC10500330 DOI: 10.1016/j.jaccas.2023.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 09/19/2023]
Abstract
Little is known about tissue characterization of cardiac tumors by dedicated cardiac computed tomography (CT) protocols in pediatric patients. We report using arterial and delayed CT acquisitions to characterize a large left ventricular free wall tumor in a 12-year-old female with congenital mitral insufficiency and an automatic implantable cardioverter defibrillator. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Rafael Zonana Amkie
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Amulya Buddhavarapu
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Mehul D. Patel
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, Cardiovascular and Pulmonary Pathology Service, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Dilachew A. Adebo
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
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De Lio F, Andreis A, De Lio G, Bellettini M, Pidello S, Raineri C, Gallone G, Alunni G, Frea S, Imazio M, Castagno D, De Ferrari GM. Cardiac imaging for the prediction of sudden cardiac arrest in patients with heart failure. Heliyon 2023; 9:e17710. [PMID: 37456051 PMCID: PMC10338975 DOI: 10.1016/j.heliyon.2023.e17710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
The identification of heart failure (HF) patients at risk for arrhythmic sudden cardiac arrest (SCA) is a major challenge in the cardiovascular field. In addition to optimal medical treatment for HF, implantable cardioverter defibrillator (ICD) is currently recommended to prevent SCA in patients with reduced left ventricular ejection fraction (LVEF). The indication for an ICD implantation, in addition to HF etiology, New York Health Association (NYHA) class and life expectancy, mainly depends on LVEF value at echocardiography. However, the actual role of LVEF in the prediction of SCA has recently been debated, while newer multimodality imaging techniques with increased prognostic accuracy have been developed. Speckle tracking imaging allows the quantification of mechanical dispersion, a marker of electrophysiological heterogeneity predisposing to malignant arrhythmias, while advanced cardiac magnetic resonance techniques such as myocardial T1-mapping and extracellular volume fraction assessment allow the evaluation of interstitial diffuse fibrosis. Nuclear imaging is helpful for the appraisal of sympathetic nervous system dysfunction, while newer computed tomography techniques assessing myocardial delayed enhancement allow the identification of focal myocardial scar. This review will focus on the most modern advances in the field of cardiovascular imaging along with its applications for the prediction of SCA in patients with HF. Modern artificial intelligence applications in cardiovascular imaging will also be discussed.
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Affiliation(s)
- Francesca De Lio
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Giulia De Lio
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Matteo Bellettini
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Stefano Pidello
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Claudia Raineri
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Gianluca Alunni
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Massimo Imazio
- Cardiology Unit, Cardiothoracic Department, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Davide Castagno
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Città della Salute e della Scienza di Torino University Hospital, University of Torino, Turin, Italy
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Tonet E, Boccadoro A, Micillo M, Cocco M, Cossu A, Pompei G, Giganti M, Campo G. Coronary Computed Tomography Angiography: Beyond Obstructive Coronary Artery Disease. Life (Basel) 2023; 13:1086. [PMID: 37240730 PMCID: PMC10223586 DOI: 10.3390/life13051086] [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: 03/09/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Nowadays, coronary computed tomography angiography (CCTA) has a role of paramount importance in the diagnostic algorithm of ischemic heart disease (IHD), both in stable coronary artery disease (CAD) and acute chest pain. Alongside the quantification of obstructive coronary artery disease, the recent technologic developments in CCTA provide additional relevant information that can be considered as "novel markers" for risk stratification in different settings, including ischemic heart disease, atrial fibrillation, and myocardial inflammation. These markers include: (i) epicardial adipose tissue (EAT), associated with plaque development and the occurrence of arrhythmias; (ii) late iodine enhancement (LIE), which allows the identification of myocardial fibrosis; and (iii) plaque characterization, which provides data about plaque vulnerability. In the precision medicine era, these emerging markers should be integrated into CCTA evaluation to allow for the bespoke interventional and pharmacological management of each patient.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Cossu
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Graziella Pompei
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
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Kidoh M, Oda S, Takashio S, Hirakawa K, Kawano Y, Shiraishi S, Hayashi H, Nakaura T, Nagayama Y, Funama Y, Ueda M, Tsujita K, Hirai T. CT Extracellular Volume Fraction versus Myocardium-to-Lumen Signal Ratio for Cardiac Amyloidosis. Radiology 2023; 306:e220542. [PMID: 36255307 DOI: 10.1148/radiol.220542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Large studies on the diagnostic performance of CT-derived myocardial extracellular volume fraction (ECV) for detecting cardiac amyloidosis are lacking. A simple and practical index as a surrogate for CT ECV would be clinically useful. Purpose To compare the diagnostic performances between CT-derived myocardial ECV and myocardium-to-lumen signal ratio for the detection of cardiac amyloidosis in a large patient sample. Materials and Methods This retrospective study included patients who underwent CT ECV analysis because of suspected heart failure or cardiomyopathy between January 2018 and July 2021. CT ECV was quantified using routine pre-transcatheter aortic valve replacement planning cardiac CT, pre-atrial fibrillation ablation planning cardiac CT, or coronary CT angiography with the addition of unenhanced and delayed phase cardiac CT scans. The diagnostic performances of CT ECV and myocardium-to-lumen signal ratio in delayed phase cardiac CT (a simplified index not requiring unenhanced CT and hematocrit) for detecting cardiac amyloidosis were evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results Of 552 patients (mean age, 69 years ± 14 [SD]; 295 men), 41 had cardiac amyloidosis. The sensitivity of CT ECV for amyloidosis was 90% (37 of 41 patients [95% CI: 77, 97]), with a specificity of 92% (472 of 511 patients [95% CI: 90, 95]) and optimal ECV cutoff value of 37% (AUC, 0.97 [95% CI: 0.96, 0.99]). The sensitivity of myocardium-to-lumen signal ratio was 88% (36 of 41 patients [95% CI: 74, 96]), with a specificity of 92% (469 of 511 patients [95% CI: 89, 94]) and optimal myocardium-to-lumen signal ratio cutoff value of 0.87 (AUC, 0.96 [95% CI: 0.94, 0.97]; P = .27 for comparison with ECV). Conclusion CT-derived myocardial extracellular volume fraction and myocardium-to-lumen signal ratio showed comparable and excellent diagnostic performance in detecting cardiac amyloidosis in a large patient sample. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Williams in this issue.
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Affiliation(s)
- Masafumi Kidoh
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seitaro Oda
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seiji Takashio
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kyoko Hirakawa
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yawara Kawano
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shinya Shiraishi
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hidetaka Hayashi
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takeshi Nakaura
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yasunori Nagayama
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yoshinori Funama
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Mitsuharu Ueda
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Tsujita
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Toshinori Hirai
- From the Departments of Diagnostic Radiology (M.K., S.O., S.S., H.H., T.N., Y.N., T.H.), Cardiovascular Medicine (S.T., K.H., K.T.), Hematology, Rheumatology, and Infectious Disease (Y.K.), and Neurology (M.U.), Graduate School of Medical Sciences, and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Møller MB, Schuijf JD, Oyama-Manabe N, Linde JJ, Kühl JT, Lima JAC, Kofoed KF. Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography. J Thorac Imaging 2023; 38:54-68. [PMID: 36044617 DOI: 10.1097/rti.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.
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Affiliation(s)
- Mathias B Møller
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joanne D Schuijf
- Global Research and Development Center, Canon Medical Systems Europe, Zoetermeer, The Netherlands
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Jørgen T Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joao A C Lima
- Departments of Medicine and Radiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
- Department of Radiology, Rigshospitalet, University of Copenhagen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Evaluation of myocardial viability in patients with myocardial ischemia reperfusion injury using the dual-energy CT myocardial blood pool imaging. Eur Radiol 2022; 33:3819-3831. [PMID: 36449059 DOI: 10.1007/s00330-022-09286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To evaluate myocardial viability in patients with myocardial ischemia reperfusion injury (MIRI) via dual-energy computed tomography myocardial blood pool imaging (DECT MBPI). METHODS Between September 2017 and January 2019, we prospectively recruited 59 patients with acute myocardial infarction (AMI) who developed MIRI after revascularization during invasive coronary angiography (ICA). Then, they received DECT MBPI, SPECT, and PET sequentially within 1 week after the onset of MIRI. A total of 1003 myocardial segments of 59 patients were recruited for this study. The iodine reduction areas and delayed enhancement areas were calculated by cardiac iodine map with SPECT rest myocardial perfusion imaging (MPI) + PET myocardial metabolism imaging (MMI) as reference criteria. The paired sample t-test was used to measure the difference of the myocardial iodine value. Cohen's Kappa analysis was used to test the consistency among different observers. ROC analysis was used to calculate the myocardial viability of DECT MBPI. RESULTS ROC showed the AUCs of DECT MBPI iodine value to identify a normal myocardium, an ischemic myocardium, and an infarcted myocardium were 0.957, 0.900, and 0.906 (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an ischemic myocardium were 87.6%, 89.3%, and 97.9% (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an infarcted myocardium were 88.9%, 92.2%, and 98.6% (p < 0.001). The cutoff value for DECT MBPI to differentiate between an ischemic and a normal myocardium was 0.84 mg I/mL. The cutoff value for DECT MBPI to differentiate between an infarct and a normal myocardium was 2.01 mg I/mL. CONCLUSION DECT MBPI can be used to assess myocardial viability in patients with MIRI with high sensitivity and specificity. KEY POINTS • Dual-energy computed tomography myocardial blood pool imaging (DECT MBPI) can evaluate myocardial viability of myocardial ischemia-reperfusion injury (MIRI). • DECT MBPI is a non-invasive and timesaving method for evaluation on myocardial ischemia-reperfusion injury in patients with acute myocardial infarction after coronary intervention.
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10
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Akiyama T, Okoshi Y, Takano T, Yoshida T, Tanabe Y, Inomata T. Subendocardial Infarction in Severe Bicuspid Aortic Stenosis Without Coronary Stenosis Confirmed by Contrast-enhanced Computed Tomography and Autopsy. Intern Med 2022; 62:1181-1183. [PMID: 36104194 PMCID: PMC10183289 DOI: 10.2169/internalmedicine.0109-22] [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] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old man with aortic stenosis (AS) showed cardiopulmonary arrest requiring extracorporeal circulation. Although coronary angiography did not show coronary artery stenosis, he had an elevated creatine kinase-myocardial band value of 1,298 U/L. Echocardiography revealed severe AS and global hypokinesia of the thickened myocardium. Contrast-enhanced computed tomography (CT) detected a circumferential subendocardial perfusion defect of the left ventricular myocardium. Eventually, the patient died from brain anoxia. Autopsy revealed circumferential subendocardial infarction of the left ventricular myocardium. This is the first case of circumferential subendocardial defect on CT corresponding to circumferential subendocardial infarction on autopsy in severe AS without coronary stenosis.
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Affiliation(s)
- Takumi Akiyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Yuki Okoshi
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Toshiki Takano
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Tsuyoshi Yoshida
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
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11
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Affiliation(s)
- Prashant Nagpal
- From the Department of Radiology, University of Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53706
| | - David A. Bluemke
- From the Department of Radiology, University of Wisconsin–Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53706
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12
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Conte E, Mushtaq S, Muscogiuri G, Formenti A, Annoni A, Mancini E, Ricci F, Melotti E, Gigante C, Lorenza Z, Guglielmo M, Baggiano A, Maragna R, Giacari CM, Carbucicchio C, Catto V, Pepi M, Andreini D, Pontone G. The Potential Role of Cardiac CT in the Evaluation of Patients With Known or Suspected Cardiomyopathy: From Traditional Indications to Novel Clinical Applications. Front Cardiovasc Med 2021; 8:709124. [PMID: 34595219 PMCID: PMC8476802 DOI: 10.3389/fcvm.2021.709124] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
After 15 years from its advent in the clinical field, coronary computed tomography (CCTA) is now widely considered as the best first-step test in patients with low-to-moderate pre-test probability of coronary artery disease. Technological innovation was of pivotal importance for the extensive clinical and scientific interest in CCTA. Recently, the advent of last generation wide-coverage CT scans paved the way for new clinical applications of this technique beyond coronary arteries anatomy evaluation. More precisely, both biventricular volume and systolic function quantification and myocardial fibrosis identification appeared to be feasible with last generation CT. In the present review we would focus on potential applications of cardiac computed tomography (CCT), beyond CCTA, for a comprehensive assessment patients with newly diagnosed cardiomyopathy, from technical requirements to novel clinical applications.
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Affiliation(s)
- Edoardo Conte
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alberto Formenti
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Annoni
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elisabetta Mancini
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesca Ricci
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Eleonora Melotti
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Gigante
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Zanotto Lorenza
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marco Guglielmo
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Baggiano
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Riccardo Maragna
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Maria Giacari
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Corrado Carbucicchio
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Valentina Catto
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Pepi
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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13
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Kirkbride RR, Rawal B, Mirsadraee S, Galperin-Aizenberg M, Wechalekar K, Ridge CA, Litmanovich DE. Imaging of Cardiac Infections: A Comprehensive Review and Investigation Flowchart for Diagnostic Workup. J Thorac Imaging 2021; 36:W70-W88. [PMID: 32852420 DOI: 10.1097/rti.0000000000000552] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infections of the cardiovascular system may present with nonspecific symptoms, and it is common for patients to undergo multiple investigations to arrive at the diagnosis. Echocardiography is central to the diagnosis of endocarditis and pericarditis. However, cardiac computed tomography (CT) and magnetic resonance imaging also play an additive role in these diagnoses; in fact, magnetic resonance imaging is central to the diagnosis of myocarditis. Functional imaging (fluorine-18 fluorodeoxyglucose-positron emission tomography/CT and radiolabeled white blood cell single-photon emission computed tomography/CT) is useful in the diagnosis in prosthesis-related and disseminated infection. This pictorial review will detail the most commonly encountered cardiovascular bacterial and viral infections, including coronavirus disease-2019, in clinical practice and provide an evidence basis for the selection of each imaging modality in the investigation of native tissues and common prostheses.
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Affiliation(s)
- Rachael R Kirkbride
- Department of Cardiothoracic Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | - Maya Galperin-Aizenberg
- Department of Radiology Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA
| | - Kshama Wechalekar
- Department of Nuclear Medicine and PET, Royal Brompton and Harefield Foundation Trust Hospital, London, UK
| | | | - Diana E Litmanovich
- Department of Cardiothoracic Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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14
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Mpanya D, Ayeni A, More S, Hadebe B, Sathekge M, Tsabedze N. The clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in guiding myocardial revascularisation. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00454-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Enhancement patterns detected by multidetector computed tomography are associated with the long-term prognosis of patients with acute myocardial infarction. Heart Vessels 2021; 36:1784-1793. [PMID: 33997914 DOI: 10.1007/s00380-021-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The present study investigated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) without iodine re-injection immediately after primary percutaneous coronary intervention (PCI) for predicting future cardiovascular events after acute myocardial infarction (AMI). We performed a prospective study in which 263 consecutive patients with first AMI successfully treated with primary PCI were enrolled. Sixty-four-slice MDCT without the re-injection of contrast medium was performed immediately after PCI. Myocardial DE was considered to be transmural when involving myocardial thickness ≥ 75% (Group A; n = 104), subendocardial (< 75%, Group B; n = 108), or normal (Group C; n = 51). A semiquantitative scale score was defined for 17 left ventricular segments to investigate the extent of the DE area assessed. We examined the relationship between the presence or absence of transmural DE and long-term cardiovascular event rates. The median follow-up period was 3.5 years. Kaplan-Meier survival curves showed that patient prognosis was poorer in the group with Group A than that in the group with Group B, which was equivalent to that with Group C. A multivariate analysis identified the presence of transmural DE as the strongest predictor for future cardiovascular events (hazard ratio: 3.7; P = 0.023). Transmural myocardial DE immediately following primary PCI without an iodine re-injection for AMI is a major risk factor for future cardiovascular events.
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16
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Gupta S, Ge Y, Singh A, Gräni C, Kwong RY. Multimodality Imaging Assessment of Myocardial Fibrosis. JACC Cardiovasc Imaging 2021; 14:2457-2469. [PMID: 34023250 DOI: 10.1016/j.jcmg.2021.01.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Myocardial fibrosis, seen in ischemic and nonischemic cardiomyopathies, is associated with adverse cardiac outcomes. Noninvasive imaging plays a key role in early identification and quantification of myocardial fibrosis with the use of an expanding array of techniques including cardiac magnetic resonance, computed tomography, and nuclear imaging. This review discusses currently available noninvasive imaging techniques, provides insights into their strengths and limitations, and examines novel developments that will affect the future of noninvasive imaging of myocardial fibrosis.
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Affiliation(s)
- Sumit Gupta
- Department of Radiology Brigham and Women's Hospital, Boston, Massachusetts, USA; Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amitoj Singh
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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17
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Scharm SC, Vogel-Claussen J, Schaefer-Prokop C, Dettmer S, Knudsen L, Jonigk D, Fuge J, Apel RM, Welte T, Wacker F, Prasse A, Shin HO. Quantification of dual-energy CT-derived functional parameters as potential imaging markers for progression of idiopathic pulmonary fibrosis. Eur Radiol 2021; 31:6640-6651. [PMID: 33725189 PMCID: PMC8379131 DOI: 10.1007/s00330-021-07798-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/04/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The individual course of disease in idiopathic pulmonary fibrosis (IPF) is highly variable. Assessment of disease activity and prospective estimation of disease progression might have the potential to improve therapy management and indicate the onset of treatment at an earlier stage. The aim of this study was to evaluate whether regional ventilation, lung perfusion, and late enhancement can serve as early imaging markers for disease progression in patients with IPF. METHODS In this retrospective study, contrast-enhanced dual-energy CT scans of 32 patients in inspiration and delayed expiration were performed at two time points with a mean interval of 15.4 months. The pulmonary blood volume (PBV) images obtained in the arterial and delayed perfusion phase served as a surrogate for arterial lung perfusion and parenchymal late enhancement. The virtual non-contrast (VNC) images in inspiration and expiration were non-linearly registered to provide regional ventilation images. Image-derived parameters were correlated with longitudinal changes of lung function (FVC%, DLCO%), mean lung density in CT, and CT-derived lung volume. RESULTS Regional ventilation and late enhancement at baseline preceded future change in lung volume (R - 0.474, p 0.006/R - 0.422, p 0.016, respectively) and mean lung density (R - 0.469, p 0.007/R - 0.402, p 0.022, respectively). Regional ventilation also correlated with a future change in FVC% (R - 0.398, p 0.024). CONCLUSION CT-derived functional parameters of regional ventilation and parenchymal late enhancement are potential early imaging markers for idiopathic pulmonary fibrosis progression. KEY POINTS • Functional CT parameters at baseline (regional ventilation and late enhancement) correlate with future structural changes of the lung as measured with loss of lung volume and increase in lung density in serial CT scans of patients with idiopathic pulmonary fibrosis. • Functional CT parameter measurements in high-attenuation areas (- 600 to - 250 HU) are significantly different from normal-attenuation areas (- 950 to - 600 HU) of the lung. • Mean regional ventilation in functional CT correlates with a future change in forced vital capacity (FVC) in pulmonary function tests.
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Affiliation(s)
- Sarah C Scharm
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Radboud University, Nijmegen, The Netherlands.,Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Lars Knudsen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Rosa-Marie Apel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Antje Prasse
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hoen-Oh Shin
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.
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18
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From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-020-09551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Abstract
PURPOSE OF REVIEW Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population. RECENT FINDINGS The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
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Affiliation(s)
- Kinjan Parikh
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Alana Choy-Shan
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA
| | - Munir Ghesani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA.
- Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.
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20
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Clemente A, Seitun S, Mantini C, Gentile G, Federici D, Barison A, Rossi A, Cuman M, Pizzuto A, Ait-Ali L, Bossone E, Cademartiri F, Chiappino D. Cardiac CT angiography: normal and pathological anatomical features-a narrative review. Cardiovasc Diagn Ther 2020; 10:1918-1945. [PMID: 33381435 DOI: 10.21037/cdt-20-530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.
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Affiliation(s)
- Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Sara Seitun
- IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Gentile
- Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Duccio Federici
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Andrea Barison
- Cardiology Division, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Andrea Rossi
- Arrhythmology Unit, Department of Invasive Cardiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | | | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
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Gräni C, Benz DC, Gupta S, Windecker S, Kwong RY. Sudden Cardiac Death in Ischemic Heart Disease. JACC Cardiovasc Imaging 2020; 13:2223-2238. [DOI: 10.1016/j.jcmg.2019.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022]
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Detailed CAD Phenotyping by Angiography, Dynamic Perfusion and Scar Imaging Sharpens CT Prognostic Power. JACC Cardiovasc Imaging 2020; 13:1735-1738. [DOI: 10.1016/j.jcmg.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 11/21/2022]
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Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, Bonow RO, Eshtehardi P, Bois JP. State of the Art: Imaging for Myocardial Viability: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2020; 13:e000053. [PMID: 32833510 DOI: 10.1161/hci.0000000000000053] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A substantial proportion of patients with acute myocardial infarction develop clinical heart failure, which remains a common and major healthcare burden. It has been shown that in patients with chronic coronary artery disease, ischemic episodes lead to a global pattern of cardiomyocyte remodeling and dedifferentiation, hallmarked by myolysis, glycogen accumulation, and alteration of structural proteins. These changes, in conjunction with an impaired global coronary reserve, may eventually become irreversible and result in ischemic cardiomyopathy. Moreover, noninvasive imaging of myocardial scar and hibernation can inform the risk of sudden cardiac death. Therefore, it would be intuitive that imaging of myocardial viability is an essential tool for the proper use of invasive treatment strategies and patient prognostication. However, this notion has been challenged by large-scale clinical trials demonstrating that, in the modern era of improved guideline-directed medical therapies, imaging of myocardial viability failed to deliver effective guidance of coronary bypass surgery to a reduction of adverse cardiac outcomes. In addition, current available imaging technologies in this regard are numerous, and they target diverse surrogates of structural or tissue substrates of myocardial viability. In this document, we examine these issues in the current clinical context, collect current evidence of imaging technology by modality, and inform future directions.
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Ko SM, Kim TH, Chun EJ, Kim JY, Hwang SH. Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean J Radiol 2019; 20:333-351. [PMID: 30799565 PMCID: PMC6389818 DOI: 10.3348/kjr.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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Quantitative low-dose rest and stress CT myocardial perfusion imaging with a whole-heart coverage scanner improves functional assessment of coronary artery disease. IJC HEART & VASCULATURE 2019; 24:100381. [PMID: 31763433 PMCID: PMC6859740 DOI: 10.1016/j.ijcha.2019.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 12/02/2022]
Abstract
Objective We evaluated the diagnostic accuracy of myocardial blood flow (MBF) and perfusion reserve (MPR) measured from low-dose dynamic contrast-enhanced (DCE) imaging with a whole-heart coverage CT scanner for detecting functionally significant coronary artery disease (CAD). Methods Twenty one patients with suspected or known CAD had rest and dipyridamole stress MBF measurements with CT and SPECT myocardial perfusion imaging (MPI), and lumen narrowing assessment with coronary angiography (catheter and/or CT based) within 6 weeks. SPECT MBF measurements and coronary angiography were used together as reference to determine the functional significance of coronary artery stenosis. In each CT MPI study, DCE images of the whole heart were acquired with breath-hold using a low-dose acquisition protocol to generate MBF maps. Binomial logistic regression analysis was used to determine the diagnostic accuracy of CT-measured MBF and MPR (ratio of stress to rest MBF) for assessing functionally significant coronary stenosis. Results Mean stress MBF and MPR in ischemic segments were lower than those in non-ischemic segments (1.37 ± 0.34 vs. 2.14 ± 0.64 ml/min/g; 1.56 ± 0.41 vs. 2.53 ± 0.70; p < 0.05 for all). The receiver operating characteristic curve analysis revealed that MPR (AUC 0.916, 95%CI: 0.885–0.947) had a superior power than stress MBF (AUC 0.869, 95%CI: 0.830–0.909) for differentiating non-ischemic and ischemic myocardial segments (p = 0.045). On a per-vessel and per-segment analysis, concomitant use of MPR and stress MBF thresholds further improved the diagnostic accuracy compared to MPR or stress MBF alone for detecting obstructive coronary lesions (per-vessel: 93.4% vs. 83.6% and 88.5%, respectively; per-segment: 90.0% vs. 83.7% and 83.1%, respectively). The estimated effective dose of a rest and stress CT MPI study was 3.04 and 3.19 mSv respectively. Conclusion Quantitative rest and stress myocardial perfusion measurement with a large-coverage CT scanner improves the diagnostic accuracy for detecting functionally significant coronary stenosis.
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Mukai-Yatagai N, Ohta Y, Amisaki R, Sasaki N, Akasaka T, Watanabe T, Kishimoto J, Kato M, Ogawa T, Yamamoto K. Myocardial delayed enhancement on dual-energy computed tomography: The prevalence and related factors in patients with suspicion of coronary artery disease. J Cardiol 2019; 75:302-308. [PMID: 31500962 DOI: 10.1016/j.jjcc.2019.08.004] [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: 03/01/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We aimed to assess the prevalence of myocardial delayed enhancement (MDE) in patients with suspected obstructive coronary artery disease (CAD), and to investigate factors related to the presence or absence of MDE. METHODS We retrospectively evaluated 191 consecutive patients who underwent coronary computed tomography angiography (CCTA) with MDE imaging for clinical suspicion of CAD from December 2014 to December 2016. The presence of MDE on iodine-density images using dual-energy CT was assessed by two independent readers. Multivariable logistic regression analyses were used to determine factors associated with the presence of MDE. RESULTS MDE was detected in 58 (30%) patients. Male gender, hypertension, prior heart failure (HF) hospitalization, and CCTA-detected CAD were independent factors related to the presence of MDE. When CCTA-detected CAD was excluded to narrow down the analysis to factors obtainable before CCTA, interventricular septum thickness (IVST) ≥12 mm was added as another independent factor. The combination of the following four factors: female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm demonstrated high specificity (98.3%) and positive predictive value (96.2%) for predicting the absence of MDE. CONCLUSIONS Male gender, hypertension, prior HF hospitalization, and CAD were independently associated with the presence of MDE in patients with suspected CAD. The combination of female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm is likely to be a helpful predictor in discriminating patients without MDE before CCTA.
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Affiliation(s)
- Natsuko Mukai-Yatagai
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yasutoshi Ohta
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryosuke Amisaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Naoko Sasaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihiko Akasaka
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tomomi Watanabe
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Junichi Kishimoto
- Department of Clinical Radiology, Tottori University Hospital, Yonago, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihide Ogawa
- Division of Radiology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
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Nieman K, Balla S. Dynamic CT myocardial perfusion imaging. J Cardiovasc Comput Tomogr 2019; 14:303-306. [PMID: 31540820 DOI: 10.1016/j.jcct.2019.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/09/2019] [Accepted: 09/07/2019] [Indexed: 12/30/2022]
Abstract
Cardiac CT offers several approaches to establish the hemodynamic severity of coronary artery obstructions. Dynamic myocardial perfusion CT (MPICT) is based on serial CT imaging to measure the inflow of contrast medium into the myocardium and calculate absolute measures of myocardial perfusion. This review describes the MPICT acquisition protocol, post-image acquisition processing and calculation of quantitative parameters, the diagnostic performance of MPICT and the potential incremental value of this technique in comparison to alternative approaches. Further technical innovation using different scanner platforms and establishment of reproducible diagnostic thresholds to differentiate significant coronary artery disease will be crucial in the path to broader clinical implementation.
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Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Sujana Balla
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA
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Taron J, Foldyna B, Eslami P, Hoffmann U, Nikolaou K, Bamberg F. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. ROFO-FORTSCHR RONTG 2019; 191:817-826. [PMID: 31250415 PMCID: PMC6839890 DOI: 10.1055/a-0924-5883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rapid improvement of scanner and postprocessing technology as well as the introduction of minimally invasive procedures requiring preoperative imaging have led to the broad utilization of cardiac computed tomography (CT) beyond coronary CT angiography (CTA). METHOD This review article presents an overview of recent literature on cardiac CT. The goal is to summarize the current guidelines on performing cardiac CT and to list established as well as emerging techniques with a special focus on extracoronary applications. RESULTS AND CONCLUSION Most recent guidelines for the appropriate use of cardiac CT include the evaluation of coronary artery disease, cardiac morphology, intra- and extracardiac structures, and functional and structural assessment of the myocardium under certain conditions. Besides coronary CTA, novel applications such as the calculation of a CT-derived fractional flow reserve (CT-FFR), assessment of myocardial function and perfusion imaging, as well as pre-interventional planning in valvular heart disease or prior pulmonary vein ablation in atrial fibrillation are becoming increasingly important. Especially these extracoronary applications are of growing interest in the field of cardiac CT and are expected to be gradually implemented in the daily clinical routine. KEY POINTS · Coronary artery imaging remains the main indication for cardiac CT. · Novel computational fluid dynamics allow the calculation of a CT-derived fractional flow reserve in patients with known or suspected coronary artery disease. · Cardiac CT delivers information on left ventricular volume as well as myocardial function and perfusion. · CT is the cardinal element for pre-interventional planning in transcatheter valve implantation and pulmonary vein isolation. CITATION FORMAT · Taron J, Foldyna B, Eslami P et al. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. Fortschr Röntgenstr 2019; 191: 817 - 826.
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Affiliation(s)
- Jana Taron
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Borek Foldyna
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Parastou Eslami
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Computed Tomography in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kobayashi K, Wakasa S, Sato K, Kanai S, Date H, Kimura S, Oyama-Manabe N, Matsui Y. Quantitative analysis of regional endocardial geometry dynamics from 4D cardiac CT images: endocardial tracking based on the iterative closest point with an integrated scale estimation. ACTA ACUST UNITED AC 2019; 64:055009. [DOI: 10.1088/1361-6560/ab009a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ko SM, Hwang SH, Lee HJ. Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases. J Cardiovasc Imaging 2019; 27:73-92. [PMID: 30993942 PMCID: PMC6470070 DOI: 10.4250/jcvi.2019.27.e17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
Multimodality imaging is indicated for the evaluation of left ventricular (LV) myocardial diseases. Cardiac magnetic resonance (CMR) allows morphological and functional assessment of the LV along with soft tissue characterization. Technological advances in cardiac computed tomography (CT) have led to the development of techniques for diagnostic acquisition in LV myocardial disease. Cardiac CT facilitates the characterization of LV myocardial disease based on anatomy, function, and enhancement pattern. LV regional and global functional parameters are evaluated using multi-phasic cine CT images. CT myocardial perfusion facilitates the identification of hemodynamically significant coronary artery stenosis. Cardiac CT with delayed enhancement is used to detect myocardial scarring or fibrosis in myocardial infarction and non-ischemic cardiomyopathy, and for the measurement of extracellular volume fraction in non-ischemic cardiomyopathy. In this review, we review imaging techniques and key imaging features of cardiac CT used for the evaluation of myocardial diseases, along with CMR findings.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Hye Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction. Int J Cardiovasc Imaging 2018; 35:917-926. [DOI: 10.1007/s10554-018-1513-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/11/2018] [Indexed: 01/02/2023]
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Association of regional myocardial conduction velocity with the distribution of hypoattenuation on contrast-enhanced perfusion computed tomography in patients with postinfarct ventricular tachycardia. Heart Rhythm 2018; 16:588-594. [PMID: 30935494 DOI: 10.1016/j.hrthm.2018.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging has been shown to be beneficial for identification of the ventricular tachycardia (VT) substrate before catheter ablation. Contrast-enhanced perfusion multidetector computed tomography (CEP-MDCT) is more generalizable to clinical practice, and wall thickness and regional hypoenhancement on CEP-MDCT can identify potential substrate sites, albeit with decreased specificity. OBJECTIVE The purpose of this study was to evaluate the association between wall thickness and attenuation on CEP-MDCT with local conduction velocity (CV) and electrogram abnormalities in patients with postinfarct VT. METHODS Fourteen patients with postinfarct VT underwent preprocedural CEP-MDCT followed by endocardial electroanatomic mapping (EAM) and ablation. Myocardial attenuation and wall thickness were calculated from 3-dimensional MDCT images using ADAS-VT software (Galgo Medical). EAM was registered with 3-dimensional MDCT images using the CartoMERGE module of CARTO3 software (Biosense Webster). Local CV was calculated by averaging the velocity between each point and 5 adjacent points with concordant wavefront direction. RESULTS A total of 3689 points were included. In multivariable regression analysis clustered by patient, local CV was positively associated with myocardial attenuation, bipolar voltage, unipolar voltage, and wall thickness. Each 10-HU drop in full-thickness attenuation correlated to 2.6% decrease in CV (P <.001) and 5.5% decrease in bipolar voltage amplitude (P <.001), after adjusting for wall thickness. CONCLUSION Myocardial attenuation distribution on CEP-MDCT is associated with regional CV and electrogram amplitude. Regions with low CV identified with low attenuation on CEP-MDCT may serve as important VT substrates in postinfarct patients.
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Eck BL, Muzic RF, Levi J, Wu H, Fahmi R, Li Y, Fares A, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. The role of acquisition and quantification methods in myocardial blood flow estimability for myocardial perfusion imaging CT. Phys Med Biol 2018; 63:185011. [PMID: 30113311 PMCID: PMC6264889 DOI: 10.1088/1361-6560/aadab6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, we clarified the role of acquisition parameters and quantification methods in myocardial blood flow (MBF) estimability for myocardial perfusion imaging using CT (MPI-CT). We used a physiologic model with a CT simulator to generate time-attenuation curves across a range of imaging conditions, i.e. tube current-time product, imaging duration, and temporal sampling, and physiologic conditions, i.e. MBF and arterial input function width. We assessed MBF estimability by precision (interquartile range of MBF estimates) and bias (difference between median MBF estimate and reference MBF) for multiple quantification methods. Methods included: six existing model-based deconvolution models, such as the plug-flow tissue uptake model (PTU), Fermi function model, and single-compartment model (SCM); two proposed robust physiologic models (RPM1, RPM2); model-independent singular value decomposition with Tikhonov regularization determined by the L-curve criterion (LSVD); and maximum upslope (MUP). Simulations show that MBF estimability is most affected by changes in imaging duration for model-based methods and by changes in tube current-time product and sampling interval for model-independent methods. Models with three parameters, i.e. RPM1, RPM2, and SCM, gave least biased and most precise MBF estimates. The average relative bias (precision) for RPM1, RPM2, and SCM was ⩽11% (⩽10%) and the models produced high-quality MBF maps in CT simulated phantom data as well as in a porcine model of coronary artery stenosis. In terms of precision, the methods ranked best-to-worst are: RPM1 > RPM2 > Fermi > SCM > LSVD > MUP [Formula: see text] other methods. In terms of bias, the models ranked best-to-worst are: SCM > RPM2 > RPM1 > PTU > LSVD [Formula: see text] other methods. Models with four or more parameters, particularly five-parameter models, had very poor precision (as much as 310% uncertainty) and/or significant bias (as much as 493%) and were sensitive to parameter initialization, thus suggesting the presence of multiple local minima. For improved estimates of MBF from MPI-CT, it is recommended to use reduced models that incorporate prior knowledge of physiology and contrast agent uptake, such as the proposed RPM1 and RPM2 models.
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Affiliation(s)
- Brendan L Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
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Sramko M, Hoogendoorn JC, Glashan CA, Zeppenfeld K. Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease. Europace 2018; 21:383-403. [DOI: 10.1093/europace/euy150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marek Sramko
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jarieke C Hoogendoorn
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Claire A Glashan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
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Ohta Y, Kitao S, Yunaga H, Fujii S, Mukai N, Yamamoto K, Ogawa T. Myocardial Delayed Enhancement CT for the Evaluation of Heart Failure: Comparison to MRI. Radiology 2018; 288:682-691. [PMID: 29989514 DOI: 10.1148/radiol.2018172523] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the diagnostic performance of dual-energy CT with myocardial delayed enhancement (MDE) in the detection and classification of myocardial scar in patients with heart failure, with late gadolinium enhancement (LGE) MRI as the standard of reference. Materials and Methods MDE CT and LGE MRI were performed in 44 patients with heart failure (30 men; mean patient age, 66 years ± 14) between 2013 and 2016, and images were retrospectively analyzed. The presence and patterns of MDE on iodine-density and virtual monochromatic (VM) images were assessed by two independent readers. Contrast-to-noise ratio (CNR) and percentage signal intensity increase relative to normal myocardium were measured. Diagnostic performance and area under the receiver operating characteristic curve for MDE CT and kappa values for reader agreement were determined. Results Thirty-five of the 44 patients (80%) demonstrated a focal area of LGE, with a nonischemic pattern in 22 of the 44 patients (50%) and an ischemic pattern in 13 (30%). Iodine-density images demonstrated the highest CNR and percentage signal intensity increase on CT images (P < .05), resulting in the highest diagnostic performance in the detection of any MDE CT abnormality (92% sensitivity [195 of 213 segments] and 98% specificity [481 of 491 segments]). The areas under the receiver operating characteristic curve for iodine-density images and 40-keV VM images in the detection of MDE were 0.97 and 0.95, respectively (P < .001). Kappa values for reader agreement were 0.82 for iodine-density images and 0.72 for 40-keV VM images. Conclusion Myocardial delayed enhancement CT enables accurate detection and localization of scar in patients with heart failure when compared with late gadolinium enhancement MRI, the reference standard.
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Affiliation(s)
- Yasutoshi Ohta
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Shinichiro Kitao
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Hiroto Yunaga
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Shinya Fujii
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Natsuko Mukai
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Kazuhiro Yamamoto
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Toshihide Ogawa
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
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Misra S, Zahid S, Prakosa A, Saju N, Tandri H, Berger RD, Marine JE, Calkins H, Zipunnikov V, Trayanova N, Zimmerman SL, Nazarian S. Field of view of mapping catheters quantified by electrogram associations with radius of myocardial attenuation on contrast-enhanced cardiac computed tomography. Heart Rhythm 2018; 15:1617-1625. [PMID: 29870783 DOI: 10.1016/j.hrthm.2018.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contrast-enhanced cardiac computed tomography (CE-CT) provides useful substrate characterization in patients with ventricular tachycardia (VT). OBJECTIVE The purpose of this study was to describe the association between endocardial electrogram measurements and myocardial characteristics on CE-CT, in particular the field of view of electrogram features. METHODS Fifteen patients with postinfarct VT who underwent catheter ablation with preprocedural CE-CT were included. Electroanatomic maps were registered to CE-CT, and myocardial attenuation surrounding each endocardial point was measured at a radius of 5, 10, and 15 mm. The association between endocardial voltage and attenuation was assessed using a multilevel random effects linear regression model, clustered by patient, with best model fit defined by highest log likelihood. RESULTS A total of 4698 points were included. There was a significant association of bipolar and unipolar voltage with myocardial attenuation at all radii. For unipolar voltage, the best model fit was at an analysis radius of 15 mm regardless of the mapping catheter used. For bipolar voltage, the best model fit was at an analysis radius of 15 mm for points acquired with a conventional ablation catheter. In contrast, the best model fit for points acquired with a multipolar mapping catheter was at an analysis radius of 5 mm. CONCLUSION Myocardial attenuation on CE-CT indicates a smaller myocardial field of view of bipolar electrograms using multipolar catheters with smaller electrodes in comparison to standard ablation catheters despite similar interelectrode spacing. Smaller electrodes may provide improved spatial resolution for the definition of myocardial substrate for VT ablation.
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Affiliation(s)
- Satish Misra
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sohail Zahid
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nissi Saju
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harikrishna Tandri
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald D Berger
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Marine
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Epidemiology, Johns Hopkins University School of Public Heatlh, Baltimore, Maryland
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan L Zimmerman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Department of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Chang S, Han K, Youn JC, Im DJ, Kim JY, Suh YJ, Hong YJ, Hur J, Kim YJ, Choi BW, Lee HJ. Utility of Dual-Energy CT-based Monochromatic Imaging in the Assessment of Myocardial Delayed Enhancement in Patients with Cardiomyopathy. Radiology 2017; 287:442-451. [PMID: 29272215 DOI: 10.1148/radiol.2017162945] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To investigate the diagnostic utility of dual-energy computed tomography (CT)-based monochromatic imaging for myocardial delayed enhancement (MDE) assessment in patients with cardiomyopathy. Materials and Methods The institutional review board approved this prospective study, and informed consent was obtained from all participants who were enrolled in the study. Forty patients (27 men and 13 women; mean age, 56 years ± 15 [standard deviation]; age range, 22-81 years) with cardiomyopathy underwent cardiac magnetic resonance (MR) imaging and dual-energy CT. Conventional (120-kV) and monochromatic (60-, 70-, and 80-keV) images were reconstructed from the dual-energy CT acquisition. Subjective quality score, contrast-to-noise ratio (CNR), and beam-hardening artifacts were compared pairwise with the Friedman test at post hoc analysis. With cardiac MR imaging as the reference standard, diagnostic performance of dual-energy CT in MDE detection and its predictive ability for pattern classification were compared pairwise by using logistic regression analysis with the generalized estimating equation in a per-segment analysis. The Bland-Altman method was used to find agreement between cardiac MR imaging and CT in MDE quantification. Results Among the monochromatic images, 70-keV CT images resulted in higher subjective quality (mean score, 3.38 ± 0.54 vs 3.15 ± 0.43; P = .0067), higher CNR (mean, 4.26 ± 1.38 vs 3.93 ± 1.33; P = .0047), and a lower value for beam-hardening artifacts (mean, 3.47 ± 1.56 vs 4.15 ± 1.67; P < .0001) when compared with conventional CT. When compared with conventional CT, 70-keV CT showed improved diagnostic performance for MDE detection (sensitivity, 94.6% vs 90.4% [P = .0032]; specificity, 96.0% vs 94.0% [P = .0031]; and accuracy, 95.6% vs 92.7% [P < .0001]) and improved predictive ability for pattern classification (subendocardial, 91.5% vs 84.3% [P = .0111]; epicardial, 94.3% vs 73.5% [P = .0001]; transmural, 93.0% vs 77.7% [P = .0018]; mesocardial, 85.4% vs 69.2% [P = .0047]; and patchy. 84.4% vs 78.4% [P = .1514]). For MDE quantification, 70-keV CT showed a small bias 0.1534% (95% limits of agreement: -4.7013, 5.0080). Conclusion Dual-energy CT-based 70-keV monochromatic images improve MDE assessment in patients with cardiomyopathy via improved image quality and CNR and reduced beam-hardening artifacts when compared with conventional CT images. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Suyon Chang
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Kyunghwa Han
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Jong-Chan Youn
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Dong Jin Im
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Jin Young Kim
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Young Joo Suh
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Yoo Jin Hong
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Jin Hur
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Young Jin Kim
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Byoung Wook Choi
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
| | - Hye-Jeong Lee
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (S.C., D.J.I., J.Y.K., Y.J.S., Y.J.H., J.H., Y.J.K., B.W.C., H.J.L.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.); and Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.C.Y.)
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Rodriguez-Granillo GA, Campisi R, Deviggiano A, de Munain MNL, Zan MD, Capunay C, Carrascosa P. Detection of Myocardial Infarction Using Delayed Enhancement Dual-Energy CT in Stable Patients. AJR Am J Roentgenol 2017; 209:1023-1032. [DOI: 10.2214/ajr.17.18118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - Roxana Campisi
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
| | - Maria N. Lopez de Munain
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
| | - Macarena De Zan
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina
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40
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Kishimoto J, Ohta Y, Kitao S, Watanabe T, Ogawa T. Image quality improvements using adaptive statistical iterative reconstruction for evaluating chronic myocardial infarction using iodine density images with spectral CT. Int J Cardiovasc Imaging 2017; 34:633-639. [DOI: 10.1007/s10554-017-1258-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
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Myocardial delayed-enhancement CT: initial experience in children and young adults. Pediatr Radiol 2017; 47:1452-1462. [PMID: 28534155 DOI: 10.1007/s00247-017-3889-7] [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: 02/27/2017] [Revised: 04/01/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. OBJECTIVE To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. MATERIALS AND METHODS Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. RESULTS Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). CONCLUSION Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality.
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Florea V, Rieger AC, DiFede DL, El-Khorazaty J, Natsumeda M, Banerjee MN, Tompkins BA, Khan A, Schulman IH, Landin AM, Mushtaq M, Golpanian S, Lowery MH, Byrnes JJ, Hendel RC, Cohen MG, Valasaki K, Pujol MV, Ghersin E, Miki R, Delgado C, Abuzeid F, Vidro-Casiano M, Saltzman RG, DaFonseca D, Caceres LV, Ramdas KN, Mendizabal A, Heldman AW, Mitrani RD, Hare JM. Dose Comparison Study of Allogeneic Mesenchymal Stem Cells in Patients With Ischemic Cardiomyopathy (The TRIDENT Study). Circ Res 2017; 121:1279-1290. [PMID: 28923793 DOI: 10.1161/circresaha.117.311827] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Cell dose and concentration play crucial roles in phenotypic responses to cell-based therapy for heart failure. OBJECTIVE To compare the safety and efficacy of 2 doses of allogeneic bone marrow-derived human mesenchymal stem cells identically delivered in patients with ischemic cardiomyopathy. METHODS AND RESULTS Thirty patients with ischemic cardiomyopathy received in a blinded manner either 20 million (n=15) or 100 million (n=15) allogeneic human mesenchymal stem cells via transendocardial injection (0.5 cc per injection × 10 injections per patient). Patients were followed for 12 months for safety and efficacy end points. There were no treatment-emergent serious adverse events at 30 days or treatment-related serious adverse events at 12 months. The Major Adverse Cardiac Event rate was 20.0% (95% confidence interval [CI], 6.9% to 50.0%) in 20 million and 13.3% (95% CI, 3.5% to 43.6%) in 100 million (P=0.58). Worsening heart failure rehospitalization was 20.0% (95% CI, 6.9% to 50.0%) in 20 million and 7.1% (95% CI, 1.0% to 40.9%) in 100 million (P=0.27). Whereas scar size reduced to a similar degree in both groups: 20 million by -6.4 g (interquartile range, -13.5 to -3.4 g; P=0.001) and 100 million by -6.1 g (interquartile range, -8.1 to -4.6 g; P=0.0002), the ejection fraction improved only with 100 million by 3.7 U (interquartile range, 1.1 to 6.1; P=0.04). New York Heart Association class improved at 12 months in 35.7% (95% CI, 12.7% to 64.9%) in 20 million and 42.9% (95% CI, 17.7% to 71.1%) in 100 million. Importantly, proBNP (pro-brain natriuretic peptide) increased at 12 months in 20 million by 0.32 log pg/mL (95% CI, 0.02 to 0.62; P=0.039), but not in 100 million (-0.07 log pg/mL; 95% CI, -0.36 to 0.23; P=0.65; between group P=0.07). CONCLUSIONS Although both cell doses reduced scar size, only the 100 million dose increased ejection fraction. This study highlights the crucial role of cell dose in the responses to cell therapy. Determining optimal dose and delivery is essential to advance the field, decipher mechanism(s) of action and enhance planning of pivotal Phase III trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02013674.
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Affiliation(s)
- Victoria Florea
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Angela C Rieger
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Darcy L DiFede
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Jill El-Khorazaty
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Makoto Natsumeda
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Monisha N Banerjee
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Bryon A Tompkins
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Aisha Khan
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ivonne H Schulman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ana Marie Landin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Muzammil Mushtaq
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Samuel Golpanian
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Maureen H Lowery
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - John J Byrnes
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Robert C Hendel
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mauricio G Cohen
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Krystalenia Valasaki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Marietsy V Pujol
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Eduard Ghersin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Roberto Miki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Cindy Delgado
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Fouad Abuzeid
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mayra Vidro-Casiano
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Russell G Saltzman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Daniel DaFonseca
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Lina V Caceres
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Kevin N Ramdas
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Adam Mendizabal
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Alan W Heldman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Raul D Mitrani
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Joshua M Hare
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.).
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Ha SJ, Jang Y, Lee BK, Cho IJ, Shim CY, Hong GR, Chung N, Chang HJ. Assessment of myocardial viability based on dual-energy computed tomography in patients with chronic myocardial infarction: comparison with magnetic resonance imaging. Clin Imaging 2017; 46:8-13. [PMID: 28672224 DOI: 10.1016/j.clinimag.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/12/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of dual-energy computed tomography (DECT) for the assessment of myocardial viability compared with magnetic resonance imaging (MRI) in patients with chronic myocardial infarction (CMI). METHODS AND MATERIAL Twenty-six patients were prospectively enrolled, who underwent DECT and MRI at delayed phase. The infarct volumes for DECT and MRI were measured. RESULTS In per-segment and per-vessel analysis, DECT showed excellent diagnostic performance compared with MRI (diagnostic accuracy: 86.2%, 81.2% respectively). In volume analysis, DECT correlated well with MRI (r=0.966, p<0.0001). CONCLUSIONS DECT has excellent diagnostic performance for detecting CMI.
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Affiliation(s)
- Sang Jin Ha
- Division of Cardiology, Departmet of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Yeonggul Jang
- Brain Korea 21 Project for Medical Science Yonsei University, Republic of Korea; Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Hyuk-Jae Chang
- Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea.
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Impact of knowledge-based iterative model reconstruction on myocardial late iodine enhancement in computed tomography and comparison with cardiac magnetic resonance. Int J Cardiovasc Imaging 2017; 33:1609-1618. [DOI: 10.1007/s10554-017-1137-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/08/2017] [Indexed: 01/08/2023]
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Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study. Eur Radiol 2017; 27:4054-4063. [PMID: 28382537 DOI: 10.1007/s00330-017-4824-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/03/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of delayed contrast-enhanced computed tomography (DE-CT) for cardiac sarcoidosis (CS) in patients with or without implantable devices, including a quantitative comparison with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). METHODS Twenty-four patients (mean age, 64 ± 9 years; 17 women) with known or suspected CS underwent retrospective electrocardiogram-gated DE-CT at 80 kV with knowledge-based iterative model reconstruction. Fourteen patients without implantable devices also underwent LGE-CMR, while ten with pacemakers or implantable cardioverter-defibrillators did not. The presence of hyperenhanced myocardium was assessed visually and quantitatively using a 5-standard deviation threshold above the mean of remote myocardium. RESULTS Inter-observer agreement for visual detection of hyperenhanced segments on DE-CT was excellent in patients with implantable devices and in those without (κ = 0.91 and κ = 0.94, respectively). Comparisons of the percent area of hyperenhanced myocardium between DE-CT and LGE-CMR on both per-patient and per-segment analyses showed good correlations (r = 0.96 and r = 0.83, respectively; p < 0.001). The sensitivity and specificity of DE-CT for the diagnosis of CS were 94% and 33%. CONCLUSIONS The extent of hyperenhanced lesion with DE-CT showed good agreement with LGE-CMR results. DE-CT showed high sensitivity for detecting CS and may be useful particularly in patients with contraindications to CMR. KEY POINTS • Delayed contrast-enhanced CT (DE-CT) can be applied to patients with implantable devices. • DE-CT can detect cardiac sarcoidosis (CS) lesions similarly to cardiac MRI. • DE-CT shows high sensitivity for detecting CS. • DE-CT may be useful particularly in patients with contraindications to cardiac MRI.
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Rodriguez-Granillo GA. Delayed enhancement cardiac computed tomography for the assessment of myocardial infarction: from bench to bedside. Cardiovasc Diagn Ther 2017; 7:159-170. [PMID: 28540211 DOI: 10.21037/cdt.2017.03.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A large number of studies support the increasingly relevant prognostic value of the presence and extent of delayed enhancement (DE), a surrogate marker of fibrosis, in diverse etiologies. Gadolinium and iodinated based contrast agents share similar kinetics, thus leading to comparable myocardial characterization with cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) at both first-pass perfusion and DE imaging. We review the available evidence of DE imaging for the assessment of myocardial infarction (MI) using cardiac CT (CTDE), from animal to clinical studies, and from 16-slice CT to dual-energy CT systems (DECT). Although both CMR and gadolinium agents have been originally deemed innocuous, a number of concerns (though inconclusive and very rare) have been recently issued regarding safety issues, including DNA double-strand breaks related to CMR, and gadolinium-associated nephrogenic systemic fibrosis and deposition in the skin and certain brain structures. These concerns have to be considered in the context of non-negligible rates of claustrophobia, increasing rates of patients with implantable cardiac devices, and a number of logistic drawbacks compared with CTDE, such as higher costs, longer scanning times, and difficulties to scan patients with impaired breath-holding capabilities. Overall, these issues might encourage the role of CTDE as an alternative for DE-CMR in selected populations.
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Dual-contrast agent photon-counting computed tomography of the heart: initial experience. Int J Cardiovasc Imaging 2017; 33:1253-1261. [DOI: 10.1007/s10554-017-1104-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/25/2017] [Indexed: 11/25/2022]
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Stănescu A, Opincariu D, Rat N, Morariu M, Condrea S, Benedek I, Benedek T. Hybrid Imaging in the Assessment of Myocardial Ischemia and Viability. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Myocardial ischemia results from a reduction in blood flow as a consequence of a coronary stenosis, which produces ischemia in the myocardial territories irrigated by the stenotic artery. Myocardial viability is a concept that derived from several studies in which it was observed that, even if revascularization occurred, an irreversible left ventricular contractile dysfunction remained. The terms “stunned” and “hibernating” myocardium have been traditionally associated with the viable myocardium, and many controversies still exist on the most appropriate method to assess the presence and extent of viable myocardium. During the last decades, many efforts have been made to identify the best method to determine the viability of the myocardial tissue. Due to the fact that none of the stand-alone imaging methods provide sufficient data about myocardial viability, new methods for the investigation of myocardial viability became necessary. Thus, the concept of hybrid imaging was developed, consisting in the association of different imaging techniques, finally resulting in a single image that offers all the details provided by the two isolated methods of diagnosis, therefore being more precise in regards to the identification of viable myocardium territory. This review aims to appraise the recent studies related to myocardial viability investigated with hybrid imaging.
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Affiliation(s)
- Alexandra Stănescu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Diana Opincariu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Nora Rat
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Mirabela Morariu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Sebastian Condrea
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Imre Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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Lee HJ, Im DJ, Youn JC, Chang S, Suh YJ, Hong YJ, Kim YJ, Hur J, Choi BW. Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: a prospective comparison with delayed enhancement cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2016; 33:577-584. [PMID: 27873128 DOI: 10.1007/s10554-016-1024-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/14/2016] [Indexed: 01/15/2023]
Abstract
To evaluate the feasibility of cardiac CT for the evaluation of myocardial delayed enhancement (MDE) in the assessment of patients with cardiomyopathy, compared to cardiac MRI. A total of 37 patients (mean age 54.9 ± 15.7 years, 24 men) who underwent cardiac MRI to evaluate cardiomyopathy were enrolled. Dual-energy ECG-gated cardiac CT was acquired 12 min after contrast injection. Two observers evaluated cardiac MRI and cardiac CT at different kV settings (100, 120 and 140 kV) independently for MDE pattern-classification (patchy, transmural, subendocardial, epicardial and mesocardial), differentiation between ischemic and non-ischemic cardiomyopathy and MDE quantification (percentage MDE). Kappa statics and the intraclass correlation coefficient were used for statistical analysis. Among different kV settings, 100-kV CT showed excellent agreements compared to cardiac MRI for MDE detection (κ = 0.886 and 0.873, respectively), MDE pattern-classification (κ = 0.888 and 0.881, respectively) and differentiation between ischemic and non-ischemic cardiomyopathy (κ = 1.000 and 0.893, respectively) for both Observer 1 and Observer 2. The Bland-Altman plot between MRI and 100-kV CT for the percentage MDE showed a very small bias (-0.15%) with 95% limits of agreement of -7.02 and 6.72. Cardiac CT using 100 kV might be an alternative method to cardiac MRI in the assessment of cardiomyopathy, particularly in patients with contraindications to cardiac MRI.
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Affiliation(s)
- Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jong-Chan Youn
- Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Suyon Chang
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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