1
|
Keramati H, de Vecchi A, Rajani R, Niederer SA. Using Gaussian process for velocity reconstruction after coronary stenosis applicable in positron emission particle tracking: An in-silico study. PLoS One 2023; 18:e0295789. [PMID: 38096169 PMCID: PMC10721050 DOI: 10.1371/journal.pone.0295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We investigated the influence of tracer particle quantity and detection time interval on flow reconstruction accuracy. Three models were used to represent different levels of stenosis and anatomical complexity: a narrowed straight tube, an idealized coronary bifurcation with stenosis, and patient-specific coronary arteries with a stenotic left circumflex artery. Computational fluid dynamics (CFD), particle tracking, and the Gaussian process of kriging were employed to simulate and reconstruct the pulsatile flow field. The study examined the error and uncertainty in velocity profile reconstruction after stenosis by comparing particle-derived flow velocity with the CFD solution. Using 600 particles (15 batches of 40 particles) released in the main coronary artery, the time-averaged error in velocity reconstruction ranged from 13.4% (no occlusion) to 161% (70% occlusion) in patient-specific anatomy. The error in maximum cross-sectional velocity at peak flow was consistently below 10% in all cases. PEPT and kriging tended to overestimate area-averaged velocity in higher occlusion cases but accurately predicted maximum cross-sectional velocity, particularly at peak flow. Kriging was shown to be useful to estimate the maximum velocity after the stenosis in the absence of negative near-wall velocity.
Collapse
Affiliation(s)
- Hamed Keramati
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiology Department, Guy’s and St, Thomas’s Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
| |
Collapse
|
2
|
Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
Collapse
Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| |
Collapse
|
3
|
Wang R, Fang Z, Wang H, Schoepf UJ, Emrich T, Giovagnoli D, Biles E, Zhou Z, Du Z, Liu T, Xu L. Quantitative analysis of three-dimensional left ventricular global strain using coronary computed tomography angiography in patients with heart failure: Comparison with 3T cardiac MR. Eur J Radiol 2020; 135:109485. [PMID: 33401113 DOI: 10.1016/j.ejrad.2020.109485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to investigate whether three dimentional (3D)- Coronary CT angiography (CCTA)- feature tracking (FT) can measure global myocardial strain of the left ventricle (LV) in patients with heart failure using cardiac MR (CMR) as reference. METHODS Consecutive patients (n = 44) with variable degrees of heart failure who underwent an ECG-gated CCTA and CMR within 24 h were included. Both modalities were compared for 2D/3D LV global radial strain (2D/3D-GRS), circumferential strain (2D/3D-GCS), longitudinal strain (2D/3D-GLS) and conventional functional parameters. RESULTS Compared to CMR, CCTA-derived 3D-GLS and LVEF showed no significant difference (p > 0.05). Bland-Altman plots showed a small bias (0.3 %) between CCTA-derived 3D-GLS and CMR 3D-GLS. Close correlations were observed between the two modalities regarding LV global strain (3D-GRS, r = 0.89; 3D-GCS, r = 0.86; 3D-GLS, r = 0.79, respectively, p < 0.001 for all). However, CCTA-derived 3D-GRS and 3D-GCS were statistically different compared with CMR. CCTA-derived 3D-GLS had an inverse correlation with CCTA-LVEF(r=-0.75, p < 0.05). Intraobserver agreements for CCTA-derived 3D-global strain were good (ICC = 0.856 for 3D-GLS, ICC = 0.741 for 3D-GCS and ICC = 0.762 for 3D-GRS). 2D global strain showed statistical differences between the two modalities (p<0.05 for all), but close correlations were observed regarding 2D LV global strain (2D-GRS, r = 0.80; 2D-GCS, r = 0.81; 2D-GLS, r = 0.81, respectively, p < 0.001 for all). The average radiation dose-long-product (DLP) of CCTA was 387.86 ± 89.3 mGy*cm. CONCLUSION CCTA-derived 3D-GLS can provide both reliable and interchangeable results for quantitative assessment of myocardial mechanical changes in HF patients compared to CMR with good intra-observer agreement.
Collapse
Affiliation(s)
- Rui Wang
- Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China
| | - Zhe Fang
- Cardiology, Daxing Hospital, Capital Medical University, Beijing, 102600, PR China
| | - Hongwei Wang
- Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Dominic Giovagnoli
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Evan Biles
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Zhen Zhou
- Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China
| | - Zhiqiang Du
- Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China
| | - Tong Liu
- 40 Ward of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China.
| | - Lei Xu
- Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China.
| |
Collapse
|
4
|
Baumann S, Renker M, Schoepf UJ, De Cecco CN, Coenen A, De Geer J, Kruk M, Kim YH, Albrecht MH, Duguay TM, Jacobs BE, Bayer RR, Litwin SE, Weiss C, Akin I, Borggrefe M, Yang DH, Kepka C, Persson A, Nieman K, Tesche C. Gender differences in the diagnostic performance of machine learning coronary CT angiography-derived fractional flow reserve -results from the MACHINE registry. Eur J Radiol 2019; 119:108657. [PMID: 31521876 DOI: 10.1016/j.ejrad.2019.108657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study investigated the impact of gender differences on the diagnostic performance of machine-learning based coronary CT angiography (cCTA)-derived fractional flow reserve (CT-FFRML) for the detection of lesion-specific ischemia. METHOD Five centers enrolled 351 patients (73.5% male) with 525 vessels in the MACHINE (Machine leArning Based CT angiograpHy derIved FFR: a Multi-ceNtEr) registry. CT-FFRML and invasive FFR ≤ 0.80 were considered hemodynamically significant, whereas cCTA luminal stenosis ≥50% was considered obstructive. The diagnostic performance to assess lesion-specific ischemia in both men and women was assessed on a per-vessel basis. RESULTS In total, 398 vessels in men and 127 vessels in women were included. Compared to invasive FFR, CT-FFRML reached a sensitivity, specificity, positive predictive value, and negative predictive value of 78% (95%CI 72-84), 79% (95%CI 73-84), 75% (95%CI 69-79), and 82% (95%CI: 76-86) in men vs. 75% (95%CI 58-88), 81 (95%CI 72-89), 61% (95%CI 50-72) and 89% (95%CI 82-94) in women, respectively. CT-FFRML showed no statistically significant difference in the area under the receiver-operating characteristic curve (AUC) in men vs. women (AUC: 0.83 [95%CI 0.79-0.87] vs. 0.83 [95%CI 0.75-0.89], p = 0.89). CT-FFRML was not superior to cCTA alone [AUC: 0.83 (95%CI: 0.75-0.89) vs. 0.74 (95%CI: 0.65-0.81), p = 0.12] in women, but showed a statistically significant improvement in men [0.83 (95%CI: 0.79-0.87) vs. 0.76 (95%CI: 0.71-0.80), p = 0.007]. CONCLUSIONS Machine-learning based CT-FFR performs equally in men and women with superior diagnostic performance over cCTA alone for the detection of lesion-specific ischemia.
Collapse
Affiliation(s)
- Stefan Baumann
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Matthias Renker
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Carlo N De Cecco
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Adriaan Coenen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jakob De Geer
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Mariusz Kruk
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Moritz H Albrecht
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Taylor M Duguay
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Jacobs
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Bayer
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sheldon E Litwin
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christel Weiss
- Medical Faculty Mannheim, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Anders Persson
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Tesche
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
5
|
Wu Q, Zhang X, Xu Y, Wang M, Wang Y, Yang X, Ma Z, Sun Y. A cross-section study of main determinants of arterial stiffness in Hefei area, China. INT ANGIOL 2019; 38:150-156. [PMID: 30938496 DOI: 10.23736/s0392-9590.19.04078-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arterial stiffness has emerged as an independent risk factor for adverse cardiovascular disease events and is the consequence of multiple risk factors. The aim of the present study is to explore the main determinants of arterial stiffness in a Chinese population and to study how the arterial stiffness levels affected by different number of risk factors. METHODS This study included 358 subjects in Hefei area of China. Anthropometric indexes, biochemical indexes, cardiovascular function indexes and lifestyle were achieved. Brachial-ankle pulse wave velocity (baPWV) was used to assess arterial stiffness. Multivariate linear regression model was performed to identify the main determinants of arterial stiffness levels. RESULTS baPWV was correlated with age, sex, hypertension, various blood pressure components (systolic blood pressure [SPB], diastolic blood pressure, pulse pressure, and central arterial pressure), serum lipids, fasting blood-glucose and body mass index, subendocardial viability ratio (SEVR) and ejection duration (ED) in bivariate correlation analysis. Moreover, baPWV was only positively correlated with age, hypertension and SBP and inversely correlated with SEVR and ED in multivariable regression model. These five variables explained about 74.8% variances of baPWV and age was the strongest determinant of arterial stiffness. In addition, the levels of arterial stiffness increased with the augmented number of risk factors when the total number of factors was no more than 4. CONCLUSIONS The main determinants of arterial stiffness were age, hypertension, SBP, SEVR and ED. Furthermore, the number of risk factors had an independent influence on arterial stiffness, it is of great importance to consider the number of risk factors when it comes to cardiovascular risk assessment.
Collapse
Affiliation(s)
- Qingyuan Wu
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Xiaoyu Zhang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Yang Xu
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Mu Wang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Yu Wang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Xiaoyue Yang
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China.,Department of Automation, University of Science and Technology of China, Hefei, China
| | - Zuchang Ma
- Department of Automation, University of Science and Technology of China, Hefei, China -
| | - Yining Sun
- AnHui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| |
Collapse
|
6
|
Rudziński PN, Kruk M, Kępka C, Schoepf UJ, Duguay T, Dzielińska Z, Pręgowski J, Witkowski A, Rużyłło W, Demkow M. The value of Coronary Artery computed Tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected Coronary Artery Disease: CAT-CAD randomized trial. J Cardiovasc Comput Tomogr 2018; 12:472-479. [DOI: 10.1016/j.jcct.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/31/2018] [Accepted: 08/30/2018] [Indexed: 12/26/2022]
|
7
|
Impact of a New Adaptive Statistical Iterative Reconstruction (ASIR)-V Algorithm on Image Quality in Coronary Computed Tomography Angiography. Acad Radiol 2018; 25:1305-1313. [PMID: 29602723 DOI: 10.1016/j.acra.2018.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/28/2018] [Accepted: 02/03/2018] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES A new postprocessing algorithm named adaptive statistical iterative reconstruction (ASIR)-V has been recently introduced. The aim of this article was to analyze the impact of ASIR-V algorithm on signal, noise, and image quality of coronary computed tomography angiography. MATERIALS AND METHODS Fifty consecutive patients underwent clinically indicated coronary computed tomography angiography (Revolution CT; GE Healthcare, Milwaukee, WI). Images were reconstructed using filtered back projection and ASIR-V 0%, and a combination of filtered back projection and ASIR-V 20%-80% and ASIR-V 100%. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) and were compared between the different postprocessing algorithms used. Similarly a four-point Likert image quality score of coronary segments was graded for each dataset and compared. A cutoff value of P < .05 was considered statistically significant. RESULTS Compared to ASIR-V 0%, ASIR-V 100% demonstrated a significant reduction of image noise in all coronaries (P < .01). Compared to ASIR-V 0%, SNR was significantly higher with ASIR-V 60% in LM (P < .01), LAD (P < .05), LCX (P < .05), and RCA (P < .01). Compared to ASIR-V 0%, CNR for ASIR-V ≥60% was significantly improved in LM (P < .01), LAD (P < .05), and RCA (P < .01), whereas LCX demonstrated a significant improvement with ASIR-V ≥80%. ASIR-V 60% had significantly better Likert image quality scores compared to ASIR-V 0% in segment-, vessel-, and patient-based analyses (P < .01). CONCLUSIONS Reconstruction with ASIR-V 60% provides the optimal balance between image noise, SNR, CNR, and image quality.
Collapse
|
8
|
Agasthi P, Kanmanthareddy A, Khalil C, Egbuche O, Yarlagadda V, Sachdeva R, Arsanjani R. Comparison of Computed Tomography derived Fractional Flow Reserve to invasive Fractional Flow Reserve in Diagnosis of Functional Coronary Stenosis: A Meta-Analysis. Sci Rep 2018; 8:11535. [PMID: 30069020 PMCID: PMC6070545 DOI: 10.1038/s41598-018-29910-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
Computed Tomography derived Fractional Flow Reserve (CTFFR) is an emerging non-invasive imaging modality to assess functional significance of coronary stenosis. We performed a meta-analysis to compare the diagnostic performance of CTFFR to invasive Fractional Flow reserve (FFR). Electronic search was performed to identify relevant articles. Pooled Estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) with corresponding 95% confidence intervals (CI) were calculated at the patient level as well as the individual vessel level using hierarchical logistic regression, summary receiver operating characteristic (SROC) curve and area under the curve were estimated. Our search yielded 559 articles and of these 17 studies was included in the analysis. A total of 2,191 vessels in 1294 patients were analyzed. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-patient level were 83% (79-87), 72% (68-76), 3.0 (2.6-3.5), 0.23 (0.18-0.29) and 13 (9-18) respectively. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-vessel level were 85% (83-88), 76% (74-79), 3.6 (3.3-4.0), 0.19 (0.16-0.22) and 19 (15-24). The area under the SROC curve was 0.89 for both per patient level and at the per vessel level. In our meta-analysis, CTFFR demonstrated good diagnostic performance in identifying functionally significant coronary artery stenosis compared to the FFR.
Collapse
Affiliation(s)
- Pradyumna Agasthi
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Arun Kanmanthareddy
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charl Khalil
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Obiora Egbuche
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Vivek Yarlagadda
- Department of Internal Medicine, Atlanticare Regional Medical Center, Atlantic City, New Jersey, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
9
|
Singh G, Al’Aref SJ, Van Assen M, Kim TS, van Rosendael A, Kolli KK, Dwivedi A, Maliakal G, Pandey M, Wang J, Do V, Gummalla M, De Cecco CN, Min JK. Machine learning in cardiac CT: Basic concepts and contemporary data. J Cardiovasc Comput Tomogr 2018; 12:192-201. [DOI: 10.1016/j.jcct.2018.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/16/2023]
|
10
|
Beller E, Meinel FG, Schoeppe F, Kunz WG, Thierfelder KM, Hausleiter J, Bamberg F, Schoepf UJ, Hoffmann VS. Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2018; 12:320-328. [PMID: 29685675 DOI: 10.1016/j.jcct.2018.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/31/2018] [Accepted: 04/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Coronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup. METHODS We searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression. RESULTS A total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063). CONCLUSION The presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up.
Collapse
Affiliation(s)
- Ebba Beller
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany
| | - Felix G Meinel
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany.
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Kolja M Thierfelder
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians University, Munich, Germany
| | - Fabian Bamberg
- Department of Radiology, University of Tübingen, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Verena S Hoffmann
- Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany; Department of Infectious Diseases & Tropical Medicine, Ludwig-Maximilians University, Germany
| |
Collapse
|
11
|
Arendt CT, Tischendorf P, Wichmann JL, Messerli M, Jörg L, Ehl N, Gohmann RF, Wildermuth S, Vogl TJ, Bauer RW. Using coronary CT angiography for guiding invasive coronary angiography: potential role to reduce intraprocedural radiation exposure. Eur Radiol 2018; 28:2756-2762. [PMID: 29417250 DOI: 10.1007/s00330-018-5317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/29/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated the potential reduction of patient exposure during invasive coronary angiography (ICA) if the procedure had only been directed to the vessel with at least one ≥ 50% stenosis as described in the CT report. METHODS Dose reports of 61 patients referred to ICA because of at least one ≥ 50% stenosis on coronary CT angiography (CCTA) were included. Dose-area product (DAP) was documented separately for left (LCA) and right coronary arteries (RCA) by summing up the single DAP for each angiographic projection. The study population was subdivided as follows: coronary intervention of LCA (group 1) or RCA (group 2) only, or of both vessels (group 3), or further bypass grafting (group 4), or no further intervention (group 5). RESULTS 57.4% of the study population could have benefitted from reduced exposure if catheterization had been directly guided to the vessel of interest as described on CCTA. Mean relative DAP reductions were as follows: group 1 (n = 18), 11.2%; group 2 (n = 2), 40.3%; group 3 (n = 10), 0%; group 4 (n = 3), 0%; group 5 (n = 28), 28.8%. CONCLUSIONS Directing ICA to the vessel with stenosis as described on CCTA would reduce intraprocedural patient exposure substantially, especially for patients with single-vessel stenosis. KEY POINTS • Patients with CAD can benefit from decreased radiation exposure during coronary angiography. • ICA should be directed solely to significant stenoses as described on CCTA. • Severely calcified plaques remain a limitation of CCTA leading to unnecessary ICA referrals.
Collapse
Affiliation(s)
- Christophe T Arendt
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Patricia Tischendorf
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julian L Wichmann
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Michael Messerli
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.,Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zürich, Switzerland
| | - Lucas Jörg
- Clinic for Cardiology, Medical Department I, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Niklas Ehl
- Clinic for Cardiology, Medical Department I, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Robin F Gohmann
- Clinic for Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Simon Wildermuth
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ralf W Bauer
- RNS Gemeinschaftspraxis GbR, Private Radiology and Radiation Therapy Group, Alte Schmelze 20, 65201, Wiesbaden, Germany.
| |
Collapse
|
12
|
Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute. J Thorac Imaging 2018; 33:225-231. [PMID: 29346192 DOI: 10.1097/rti.0000000000000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm. MATERIALS AND METHODS One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant. RESULTS cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01). CONCLUSION MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.
Collapse
|
13
|
Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol. Eur Radiol 2017; 28:2134-2142. [PMID: 29181587 DOI: 10.1007/s00330-017-5150-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/07/2017] [Accepted: 10/18/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy between low-kilovolt peak (kVp) (≤ 100) and high-kVp (> 100) third-generation dual-source coronary CT angiography (CCTA) using a kVp-tailored contrast media injection protocol. METHODS One hundred twenty patients (mean age = 62.6 years, BMI = 29.0 kg/m2) who underwent catheter angiography and CCTA with automated kVp selection were separated into two cohorts (each n = 60, mean kVp = 84 and 117). Contrast media dose was tailored to the kVp level: 70 = 40 ml, 80 = 50 ml, 90 = 60 ml, 100 = 70 ml, 110 = 80 ml, and 120 = 90 ml. Contrast-to-noise ratio (CNR) was measured. Two observers evaluated image quality and the presence of significant coronary stenosis (> 50% luminal narrowing). RESULTS Diagnostic accuracy (sensitivity/specificity) with ≤ 100 vs. > 100 kVp CCTA was comparable: per patient = 93.9/92.6% vs. 90.9/92.6%, per vessel = 91.5/97.8% vs. 94.0/96.8%, and per segment = 90.0/96.7% vs. 90.7/95.2% (all P > 0.64). CNR was similar (P > 0.18) in the low-kVp vs. high-kVp group (12.0 vs. 11.1), as ws subjective image quality (P = 0.38). Contrast media requirements were reduced by 38.1% in the low- vs. high-kVp cohort (53.6 vs. 86.6 ml, P < 0.001) and radiation dose by 59.6% (4.3 vs. 10.6 mSv, P < 0.001). CONCLUSIONS Automated tube voltage selection with a tailored contrast media injection protocol allows CCTA to be performed at ≤ 100 kVp with substantial dose reductions and equivalent diagnostic accuracy for coronary stenosis detection compared to acquisitions at > 100 kVp. KEY POINTS • Low-kVp coronary CT angiography (CCTA) enables reduced contrast and radiation dose. • Diagnostic accuracy is comparable between ≤ 100 and > 100 kVp CCTA. • Image quality is similar for low- and high-kVp CCTA. • Low-kVp image acquisition is facilitated by automated tube voltage selection. • Tailoring contrast injection protocols to the automatically selected kVp-level is feasible.
Collapse
|
14
|
Tesche C, De Cecco CN, Albrecht MH, Duguay TM, Bayer RR, Litwin SE, Steinberg DH, Schoepf UJ. Coronary CT Angiography–derived Fractional Flow Reserve. Radiology 2017; 285:17-33. [DOI: 10.1148/radiol.2017162641] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christian Tesche
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Carlo N. De Cecco
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Moritz H. Albrecht
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Taylor M. Duguay
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Richard R. Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Sheldon E. Litwin
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Daniel H. Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - U. Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| |
Collapse
|
15
|
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique. AJR Am J Roentgenol 2017; 209:370-379. [DOI: 10.2214/ajr.17.17850] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
|
17
|
Citro R, Pontone G, Pace L, Zito C, Silverio A, Bossone E, Piscione F. Contemporary Imaging in Takotsubo Syndrome. Heart Fail Clin 2017; 12:559-75. [PMID: 27638026 DOI: 10.1016/j.hfc.2016.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transthoracic echocardiography is the first-line imaging modality for evaluating patients with Takotsubo syndrome (TTS). Beyond diagnosis, TTE enables detection of peculiar complications and is useful for risk stratification and management of patients with cardiogenic shock. Cardiac magnetic resonance can be used to detect myocardial edema typically associated with TTS and is helpful in the differential diagnosis with other disease states. Coronary computed tomography angiography can be performed as an alternative to coronary angiography to confirm coronary artery patency. Molecular imaging is a promising approach for identifying patients at increased risk of recurrence.
Collapse
Affiliation(s)
- Rodolfo Citro
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy.
| | - Gianluca Pontone
- Centro Cardiolgico Monzino, IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, Schola Medica Salernitana, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Concetta Zito
- Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
| | - Angelo Silverio
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Eduardo Bossone
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Federico Piscione
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy; Department of Medicine and Surgery, Schola Medica Salernitana, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| |
Collapse
|
18
|
Cariou A, Nolan JP, Sunde K. Intensive care medicine in 2050: managing cardiac arrest. Intensive Care Med 2017; 43:1041-1043. [PMID: 28070605 DOI: 10.1007/s00134-016-4658-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alain Cariou
- Medical ICU, Cochin Hospital (AP-HP), 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Paris-Cardiovascular-Research-Centre, INSERM U970 (Sudden Death Expertise Centre), Paris, France. .,Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France.
| | - Jerry P Nolan
- School of Clinical Sciences, University of Bristol, Bristol, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
19
|
Baumann S, Renker M, Hetjens S, Fuller SR, Becher T, Loßnitzer D, Lehmann R, Akin I, Borggrefe M, Lang S, Wichmann JL, Schoepf UJ. Comparison of Coronary Computed Tomography Angiography-Derived vs Invasive Fractional Flow Reserve Assessment: Meta-Analysis with Subgroup Evaluation of Intermediate Stenosis. Acad Radiol 2016; 23:1402-1411. [PMID: 27639627 DOI: 10.1016/j.acra.2016.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES Invasive coronary angiography (ICA) with fractional flow reserve (FFR) assessment is the reference standard for the detection of hemodynamically relevant coronary lesions. We have investigated whether coronary computed tomography angiography (cCTA)-derived FFR (fractional flow reserve from coronary computed tomographic angiography [CT-FFR]) measurement improves diagnostic accuracy over cCTA. METHODS AND RESULTS A literature search was performed for studies comparing invasive FFR, cCTA, and CT-FFR. The analysis included three prospective multicenter trials and two retrospective single-center studies; a total of 765 patients and 1306 vessels were included in the meta-analysis. Compared to invasive FFR on a per-lesion basis, CT-FFR reached a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 83.7% (95% confidence interval [CI]: 78.1-89.3), 74.7% (95% CI: 52.2-97.1), 64.8% (95% CI: 52.1-77.5), and 90.1% (95% CI: 80.8-99.3) compared to 84.6% (95% CI: 78.1-91.1), 49.7% (95% CI: 31.1-68.4), 39.0% (95% CI: 28.0-50.1), and 87.3% (95% CI: 72.5-100.0) for cCTA alone. In 634 vessels with intermediate stenosis (30%-70%), sensitivity, specificity, positive predictive value, and negative predictive value were 81.4% (95% CI: 70.4-92.9), 71.7% (95% CI: 54.5-89.0), 59.4% (95% CI: 35.5-83.4), and 89.9% (95% CI: 85.0-94.7) compared to 90.2% (95% CI: 80.6-99.9), 35.4% (95% CI: 23.5-47.3), 50.7% (95% CI: 30.6-70.8), and 82.5% (95% CI: 64.5-100.0) for cCTA alone. The summary area under the receiver operating characteristic curve of CT-FFR was superior to cCTA alone on a per-vessel (0.90 [95% CI: 0.82-0.98] vs 0.74 [95% CI: 0.63-0.86]; P = .0047) and for intermediate stenoses (0.76 [95% CI: 0.65-0.88] vs 0.57 [95% CI: 0.49-0.66]; P = .0027). CONCLUSION CT-FFR significantly improves specificity without noticeably altering the sensitivity of cCTA with invasive FFR as a reference standard for the detection of hemodynamically relevant stenosis.
Collapse
Affiliation(s)
- Stefan Baumann
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Matthias Renker
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biometry, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephen R Fuller
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA
| | - Tobias Becher
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Dirk Loßnitzer
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ralf Lehmann
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Siegfried Lang
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Julian L Wichmann
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA.
| |
Collapse
|
20
|
Caruso D, Eid M, Schoepf UJ, Jin KN, Varga-Szemes A, Tesche C, Mangold S, Spandorfer A, Laghi A, De Cecco CN. Dynamic CT myocardial perfusion imaging. Eur J Radiol 2016; 85:1893-1899. [PMID: 27510361 DOI: 10.1016/j.ejrad.2016.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.
Collapse
Affiliation(s)
- Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Marwen Eid
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kwang Nam Jin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Adam Spandorfer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
21
|
Cardiovascular Imaging: The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:557-70. [PMID: 25985464 DOI: 10.1097/rli.0000000000000164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.
Collapse
|
22
|
Approaches to ultra-low radiation dose coronary artery calcium scoring based on 3rd generation dual-source CT: A phantom study. Eur J Radiol 2016; 85:39-47. [DOI: 10.1016/j.ejrad.2015.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/26/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022]
|
23
|
De Cecco CN, Schoepf UJ. Future of cardiac computed tomography. World J Radiol 2015; 7:421-423. [PMID: 26753058 PMCID: PMC4697116 DOI: 10.4329/wjr.v7.i12.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/06/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) has become an integral tool in the noninvasive diagnostic workup of patients with suspected coronary artery disease in both elective and emergency settings. Today, it represents a mature technique providing accurate, non-invasive morphological assessment of the coronary arteries and atherosclerotic plaque burden. Iterative reconstruction algorithms, low kV imaging, and single-heart beat acquisitions hold promise to further reduce dose requirements and improve the safety and robustness of the technique in several circumstances including imaging of heavily calcified vessels, patients with morbid obesity or irregular heart rates, and assessment in the emergency setting. However, it has become clear over recent years that cardiac radiologists need to take further steps towards the development and integration of functional imaging with morphological CCTA assessment to truly provide a comprehensive evaluation of the heart. Computed tomography myocardial perfusion imaging, including both dynamic and static dual-energy approaches, has demonstrated the ability to directly assess and quantify myocardial ischemia with simultaneous CCTA acquisition with a reasonable contrast medium volume and radiation dose delivered to the patient. In order to promote CCTA in the clinical and research environments, radiologists should prepare to embrace the change from morphological to functional imaging, furnishing all the necessary resources and information to referring clinicians.
Collapse
|
24
|
Comparison of quantitative stenosis characteristics at routine coronary computed tomography angiography with invasive fractional flow reserve for assessing lesion-specific ischemia. J Cardiovasc Comput Tomogr 2015; 9:546-52. [DOI: 10.1016/j.jcct.2015.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 07/07/2015] [Accepted: 08/06/2015] [Indexed: 12/13/2022]
|
25
|
Zhang LJ, Wang Y, Schoepf UJ, Meinel FG, Bayer RR, Qi L, Cao J, Zhou CS, Zhao YE, Li X, Gong JB, Jin Z, Lu GM. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography. Eur Radiol 2015; 26:797-806. [PMID: 26382844 DOI: 10.1007/s00330-015-3868-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/05/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard. MATERIALS AND METHODS Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality. RESULTS At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv. CONCLUSION Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population. KEY POINTS Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.
Collapse
Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.,Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Felix G Meinel
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Li Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jian Cao
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jian Bin Gong
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
| |
Collapse
|
26
|
Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease. AJR Am J Roentgenol 2015; 205:W67-72. [DOI: 10.2214/ajr.14.14087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
27
|
Wang R, Renker M, Schoepf UJ, Wichmann JL, Fuller SR, Rier JD, Bayer RR, Steinberg DH, De Cecco CN, Baumann S. Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve. Eur J Radiol 2015; 84:1509-1515. [PMID: 26022519 DOI: 10.1016/j.ejrad.2015.05.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of CCTA-derived stenosis predictors including CT-FFR for the detection of ischemia-inducing stenosis compared to invasive FFR. MATERIALS AND METHODS Stenosis parameters were assessed using dual-source CT (DSCT). All patients underwent both CCTA and invasive FFR within 3 months and were retrospectively analyzed. Observers visually assessed all CCTA studies and performed multiple lesion measurements. Lesion length/minimal luminal diameter(4) (LL/MLD(4)), transluminal attenuation gradient (TAG), corrected coronary attenuation (CCO) and CT-FFR were calculated. RESULTS The cohort included 32 patients (58±12 years, 66%male). Among 32 coronary lesions, 8 (25%) were considered hemodynamically significant with an FFR <0.80. Compared to invasive FFR, the per-vessel sensitivity and specificity of CCTA, CT-FFR, LL/MLD(4), CCO and TAG for detecting hemodynamically significant lesions were 100% and 54%, 100% and 91%, 85% and 92%, 66% and 88%, 37% and 58%, respectively. Receiver operating characteristics analysis resulted in an area under the curve of 0.91 for CT-FFR (p=0.0005), 0.88 for LL/MLD(4) (p<0.0001), 0.85 for CCO (p<0.0001). TAG with an AUC of 0.67 (p=0.152) was unable to discriminate between vessels with or without hemodynamically significant lesions. CONCLUSION CT-FFR, LL/MLD(4) and CCO provide enhanced diagnostic performance over CCTA analysis alone for discrimination of hemodynamically significant coronary stenosis.
Collapse
Affiliation(s)
- Rui Wang
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Matthias Renker
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA.
| | - Julian L Wichmann
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Stephen R Fuller
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA
| | - Jeremy D Rier
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA
| | - Richard R Bayer
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA
| | - Daniel H Steinberg
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA
| | - Carlo N De Cecco
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Departments of Radiological Sciences, Oncology, and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Viale Regina Elena, 324-00161 Roma, Italy
| | - Stefan Baumann
- Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| |
Collapse
|
28
|
Alexanderson-Rosas E, Guinto-Nishimura GY, Cruz-Mendoza JR, Oropeza-Aguilar M, De La Fuente-Mancera JC, Barrero-Mier AF, Monroy-Gonzalez A, Juarez-Orozco LE, Cano-Zarate R, Meave-Gonzalez A. Current and future trends in multimodality imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:715-31. [PMID: 25912725 DOI: 10.1586/14779072.2015.1039991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.
Collapse
Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Meinel FG, Bayer II RR, Zwerner PL, De Cecco CN, Schoepf UJ, Bamberg F. Coronary Computed Tomographic Angiography in Clinical Practice. Radiol Clin North Am 2015; 53:287-96. [DOI: 10.1016/j.rcl.2014.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
31
|
Cannaò PM, Schoepf UJ, Muscogiuri G, Wichmann JL, Fuller SR, Secchi F, Varga-Szemes A, De Cecco CN. Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. Eur J Radiol 2015; 84:2401-10. [PMID: 25779223 DOI: 10.1016/j.ejrad.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.
Collapse
Affiliation(s)
- Paola M Cannaò
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Scuola di Specializzazione di Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Giuseppe Muscogiuri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Julian L Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen R Fuller
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
| |
Collapse
|
32
|
Beyond stenosis detection: computed tomography approaches for determining the functional relevance of coronary artery disease. Radiol Clin North Am 2014; 53:317-34. [PMID: 25726997 DOI: 10.1016/j.rcl.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary computed tomography angiography (CCTA) is an established imaging technique for the noninvasive assessment of coronary arteries. However, CCTA remains a morphologic technique with the same limitations as invasive coronary angiography in evaluating the hemodynamic significance of coronary stenosis. Different computed tomography (CT) techniques for the functional analysis of coronary lesions have recently emerged, including static and dynamic CT myocardial perfusion imaging and CT-based fractional flow reserve and transluminal attenuation gradient methods. These techniques hold promise for achieving a comprehensive appraisal of anatomic and functional aspects of coronary heart disease with a single modality.
Collapse
|
33
|
Baumann S, Wang R, Schoepf UJ, Steinberg DH, Spearman JV, Bayer RR, Hamm CW, Renker M. Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements – initial experience with a novel physician-driven algorithm. Eur Radiol 2014; 25:1201-7. [DOI: 10.1007/s00330-014-3482-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/24/2014] [Accepted: 10/30/2014] [Indexed: 12/31/2022]
|
34
|
Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve. Am J Cardiol 2014; 114:1303-8. [PMID: 25205628 DOI: 10.1016/j.amjcard.2014.07.064] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/20/2022]
Abstract
Noninvasive fractional flow reserve (FFR) from coronary computed tomography angiography (cCTA) correlates well with invasive FFR and substantially improves the detection of obstructive coronary artery disease. However, with current algorithms, computed tomography (CT)-based FFR is derived off-site in an involved time-consuming manner. We sought to investigate the diagnostic performance of a novel CT-based FFR algorithm, developed for time-efficient in-hospital evaluation of hemodynamically indeterminate coronary lesions. In a blinded fashion, CT-based FFR was assessed in 67 coronary lesions of 53 patients. Pressure guidewire-based FFR <0.80 served as the reference standard to define hemodynamically significant stenosis and assess the diagnostic performance of CT-based FFR compared with standard evaluation of cCTA (luminal diameter stenosis of ≥50%). We recorded the time needed for derivation of CT-based FFR. On a per-lesion and per-patient basis, CT-based FFR resulted in a sensitivity of 85% and 94%, a specificity of 85% and 84%, a positive predictive value of 71% and 71%, and a negative predictive value of 93% and 97%, respectively. The area under the receiver operating characteristic curve on a per-lesion basis was significantly greater for CT-based FFR compared with standard evaluation of cCTA (0.92 vs 0.72, p = 0.0049). A similar trend, albeit not statistically significant, was observed on per-patient analysis (0.91 vs 0.78, p = 0.078). Mean total time for CT-based FFR was 37.5 ± 13.8 minutes. In conclusion, the CT-based FFR algorithm evaluated here outperforms standard evaluation of cCTA for the detection of hemodynamically significant stenoses while allowing on-site application within clinically viable time frames.
Collapse
|