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Zhang X, Cao Z, Xu J, Guan X, He H, Duan L, Ji L, Liu G, Guo Q, You Y, Zheng M, Wei M. Peri-coronary fat attenuation index combined with high-risk plaque characteristics quantified from coronary computed tomography angiography for risk stratification in new-onset chest pain individuals without acute myocardial infarction. PLoS One 2024; 19:e0304137. [PMID: 38805487 PMCID: PMC11132441 DOI: 10.1371/journal.pone.0304137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
This study aims to evaluate the role of the peri-coronary Fat Attenuation Index (FAI) and High-Risk Plaque Characteristics (HRPC) in the assessment of coronary heart disease risk. By conducting coronary CT angiography and coronary angiography on 217 patients with newly developed chest pain (excluding acute myocardial infarction), their degree of vascular stenosis, FAI, and the presence and quantity of HRPC were assessed. The study results demonstrate a correlation between FAI and HRPC, and the combined use of FAI and HRPC can more accurately predict the risk of major adverse cardiovascular events (MACE). Additionally, the study found that patients with high FAI were more prone to exhibit high-risk plaque characteristics, severe stenosis, and multiple vessel disease. After adjustment, the combination of FAI and HRPC improved the ability to identify and reclassify MACE. Furthermore, the study identified high FAI as an independent predictor of MACE in patients undergoing revascularization, while HRPC served as an independent predictor of MACE in patients not undergoing revascularization. These findings suggest the potential clinical value of FAI and HRPC in the assessment of coronary heart disease risk, particularly in patients with newly developed chest pain excluding acute myocardial infarction.
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Affiliation(s)
- Xuelong Zhang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zelong Cao
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jianan Xu
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xing Guan
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Honghou He
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Linan Duan
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lishuang Ji
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Liu
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qifeng Guo
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yang You
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mingqi Zheng
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Key Laboratory of Heart and Metabolism, Shijiazhuang, Hebei, China
| | - Mei Wei
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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2
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Wei J, Pan B, Gan Y, Li X, Liu D, Sang B, Gao X. Temporal Relationship-Aware Treadmill Exercise Test Analysis Network for Coronary Artery Disease Diagnosis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2705. [PMID: 38732812 PMCID: PMC11085865 DOI: 10.3390/s24092705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/13/2024]
Abstract
The treadmill exercise test (TET) serves as a non-invasive method for the diagnosis of coronary artery disease (CAD). Despite its widespread use, TET reports are susceptible to external influences, heightening the risk of misdiagnosis and underdiagnosis. In this paper, we propose a novel automatic CAD diagnosis approach. The proposed approach introduces a customized preprocessing method to obtain clear electrocardiograms (ECGs) from individual TET reports. Additionally, it presents TETDiaNet, a novel neural network designed to explore the temporal relationships within TET ECGs. Central to TETDiaNet is the TETDia block, which mimics clinicians' diagnostic processes to extract essential diagnostic information. This block encompasses an intra-state contextual learning module and an inter-state contextual learning module, modeling the temporal relationships within a single state and between states, respectively. These two modules help the TETDia block to capture effective diagnosis information by exploring the temporal relationships within TET ECGs. Furthermore, we establish a new TET dataset named TET4CAD for CAD diagnosis. It contains simplified TET reports for 192 CAD patients and 224 non-CAD patients, and each patient undergoes coronary angiography for labeling. Experimental results on TET4CAD underscore the superior performance of the proposed approach, highlighting the discriminative value of the temporal relationships within TET ECGs for CAD diagnosis.
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Affiliation(s)
- Jianze Wei
- Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China; (J.W.); (B.P.)
| | - Bocheng Pan
- Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China; (J.W.); (B.P.)
| | - Yu Gan
- Cardiology Department, Beijing Hospital, Beijing 100730, China; (Y.G.); (X.L.); (B.S.)
- National Center of Gerontology, National Health Commission Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xuedi Li
- Cardiology Department, Beijing Hospital, Beijing 100730, China; (Y.G.); (X.L.); (B.S.)
- National Center of Gerontology, National Health Commission Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Deping Liu
- Cardiology Department, Beijing Hospital, Beijing 100730, China; (Y.G.); (X.L.); (B.S.)
- National Center of Gerontology, National Health Commission Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Botao Sang
- Cardiology Department, Beijing Hospital, Beijing 100730, China; (Y.G.); (X.L.); (B.S.)
- University of Chinese Academy of Sciences, Beijing 100006, China
| | - Xingyu Gao
- Institute of Microelectronics, Chinese Academy of Sciences, Beijing 100029, China; (J.W.); (B.P.)
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Shah H, Alim S, Akther S, Irfan M, Rahmatova J, Arshad A, Kok CHP, Zahra SA. Update on cardiac imaging: A critical analysis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(24)00022-6. [PMID: 38594128 DOI: 10.1016/j.arteri.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024]
Abstract
Imaging is instrumental in diagnosing and directing the management of atherosclerosis. In 1958 the first diagnostic coronary angiography (CA) was performed, and since then further development has led to new methods such as coronary CT angiography (CTA), optical coherence tomography (OCT), positron tomography (PET), and intravascular ultrasound (IVUS). Currently, CA remains powerful for visualizing coronary arteries; however, recent studies show the benefits of using other non-invasive techniques. This review identifies optimum imaging techniques for diagnosing and monitoring plaque stability. This becomes even direr now, given the rapidly rising incidence of atherosclerosis in society today. Many acute coronary events, including acute myocardial infarctions and sudden deaths, are attributable to plaque rupture. Although fatal, these events can be preventable. We discuss the factors affecting plaque integrity, such as increased inflammation, medications like statins, and increased lipid content. Some of these precipitating factors are identifiable through imaging. However, we also highlight significant complications arising in some modalities; in CA this can include ventricular arrhythmia and even death. Extending this, we elucidated from the literature that risk can also vary based on the location of arteries and their plaques. Promisingly, there are less invasive methods being trialled for assessing plaque stability, such as Cardiac Magnetic Resonance Imaging (CMR), which is already in use for other cardiac diseases like cardiomyopathies. Therefore, future research focusing on using imaging modalities in conjunction may be sensible, to bridge between the effectiveness of modalities, at the expense of increased complications, and vice versa.
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Affiliation(s)
- Halia Shah
- St George's, University of London Medical School, United Kingdom
| | - Samina Alim
- St George's, University of London Medical School, United Kingdom
| | - Sonia Akther
- University of Leeds Medical School, United Kingdom
| | - Mahnoor Irfan
- St George's, University of London Medical School, United Kingdom
| | - Jamolbi Rahmatova
- Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, United Kingdom
| | - Aneesa Arshad
- St George's, University of London Medical School, United Kingdom
| | | | - Syeda Anum Zahra
- Imperial College School of Medicine, United Kingdom; The Hillingdon Hospital NHS Trust, United Kingdom.
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Dreesen HJH, Stroszczynski C, Lell MM. Optimizing Coronary Computed Tomography Angiography Using a Novel Deep Learning-Based Algorithm. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01033-w. [PMID: 38438697 DOI: 10.1007/s10278-024-01033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
Coronary computed tomography angiography (CCTA) is an essential part of the diagnosis of chronic coronary syndrome (CCS) in patients with low-to-intermediate pre-test probability. The minimum technical requirement is 64-row multidetector CT (64-MDCT), which is still frequently used, although it is prone to motion artifacts because of its limited temporal resolution and z-coverage. In this study, we evaluate the potential of a deep-learning-based motion correction algorithm (MCA) to eliminate these motion artifacts. 124 64-MDCT-acquired CCTA examinations with at least minor motion artifacts were included. Images were reconstructed using a conventional reconstruction algorithm (CA) and a MCA. Image quality (IQ), according to a 5-point Likert score, was evaluated per-segment, per-artery, and per-patient and was correlated with potentially disturbing factors (heart rate (HR), intra-cycle HR changes, BMI, age, and sex). Comparison was done by Wilcoxon-Signed-Rank test, and correlation by Spearman's Rho. Per-patient, insufficient IQ decreased by 5.26%, and sufficient IQ increased by 9.66% with MCA. Per-artery, insufficient IQ of the right coronary artery (RCA) decreased by 18.18%, and sufficient IQ increased by 27.27%. Per-segment, insufficient IQ in segments 1 and 2 decreased by 11.51% and 24.78%, respectively, and sufficient IQ increased by 10.62% and 18.58%, respectively. Total artifacts per-artery decreased in the RCA from 3.11 ± 1.65 to 2.26 ± 1.52. HR dependence of RCA IQ decreased to intermediate correlation in images with MCA reconstruction. The applied MCA improves the IQ of 64-MDCT-acquired images and reduces the influence of HR on IQ, increasing 64-MDCT validity in the diagnosis of CCS.
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Affiliation(s)
- H J H Dreesen
- Department of Radiology, University Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
- Department of Radiology, Neuroradiology and Nuclear Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
| | - C Stroszczynski
- Department of Radiology, University Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - M M Lell
- Department of Radiology, Neuroradiology and Nuclear Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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Al Rifai M, Winchester D. When should myocardial perfusion imaging be a first-test choice? J Nucl Cardiol 2024; 33:101824. [PMID: 38360263 DOI: 10.1016/j.nuclcard.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - David Winchester
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
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Bhatt MC, Singhal M, Pilania RK, Bansal SC, Khandelwal N, Gupta P, Singh S. Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease. World J Clin Pediatr 2023; 12:230-236. [PMID: 37753492 PMCID: PMC10518747 DOI: 10.5409/wjcp.v12.i4.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND There is evolving role of computed tomography coronary angiography (CTCA) in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease (KD). Despite this, there is lack of data on radiation dose in this group of children undergoing CTCA. AIM To audit the radiation dose of CTCA in children with KD. METHODS Study (December 2013-February 2018) was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering. The dose length product (DLP in milligray-centimeters-mGy.cm) was recorded. Effective radiation dose (millisieverts-mSv) was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection. Radiation dose was compared across the groups (0-1, 1-5, 5-10, and > 10 years). RESULTS Eighty-five children (71 boys, 14 girls) with KD underwent CTCA. The median age was 5 years (range, 2 mo-11 years). Median DLP and effective dose was 21 mGy.cm, interquartile ranges (IQR) = 15 (13, 28) and 0.83 mSv, IQR = 0.33 (0.68, 1.01) respectively. Mean DLP increased significantly across the age groups. Mean effective dose in infants (0.63 mSv) was significantly lower than the other age groups (1-5 years 0.85 mSv, 5-10 years 1.04 mSv, and > 10 years 1.38 mSv) (P < 0.05). There was no significant difference in the effective dose between the other groups of children. All the CTCA studies were of diagnostic quality. No child required a repeat examination. CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD. Thus, CTCA has the potential to be an important adjunctive imaging modality in children with KD.
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Affiliation(s)
- Mahesh Chandra Bhatt
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subhash Chand Bansal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Singhal M, Pilania RK, Gupta P, Johnson N, Singh S. Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease. World J Clin Pediatr 2023; 12:97-106. [PMID: 37342454 PMCID: PMC10278081 DOI: 10.5409/wjcp.v12.i3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Nameirakpam Johnson
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
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Hu D, Pan L, Chen X, Xiao S, Wu Q. A novel vessel segmentation algorithm for pathological en-face images based on matched filter. Phys Med Biol 2023; 68. [PMID: 36745931 DOI: 10.1088/1361-6560/acb98a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/06/2023] [Indexed: 02/08/2023]
Abstract
The vascular information in fundus images can provide important basis for detection and prediction of retina-related diseases. However, the presence of lesions such as Coroidal Neovascularization can seriously interfere with normal vascular areas in optical coherence tomography (OCT) fundus images. In this paper, a novel method is proposed for detecting blood vessels in pathological OCT fundus images. First of all, an automatic localization and filling method is used in preprocessing step to reduce pathological interference. Afterwards, in terms of vessel extraction, a pore ablation method based on capillary bundle model is applied. The ablation method processes the image after matched filter feature extraction, which can eliminate the interference caused by diseased blood vessels to a great extent. At the end of the proposed method, morphological operations are used to obtain the main vascular features. Experimental results on the dataset show that the proposed method achieves 0.88 ± 0.03, 0.79 ± 0.05, 0.66 ± 0.04, results in DICE, PRECISION and TPR, respectively. Effective extraction of vascular information from OCT fundus images is of great significance for the diagnosis and treatment of retinal related diseases.
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Affiliation(s)
- Derong Hu
- School of Mechanical Engineering, Jiangsu University of Technology, Changzhou, People's Republic of China
| | - Lingjiao Pan
- School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, People's Republic of China
| | - Xinjian Chen
- School of Electronics and Information Engineering, Soochow University, Suzhou, People's Republic of China
| | - Shuyan Xiao
- School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, People's Republic of China
| | - Quanyu Wu
- School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, People's Republic of China
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A Deep Learning Approach to Visualize Aortic Aneurysm Morphology Without the Use of Intravenous Contrast Agents. Ann Surg 2023; 277:e449-e459. [PMID: 33913675 PMCID: PMC8691372 DOI: 10.1097/sla.0000000000004835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intravenous contrast agents are routinely used in CT imaging to enable the visualization of intravascular pathology, such as with abdominal aortic aneurysms. However, the injection is contraindicated in patients with iodine allergy and is associated with renal complications. OBJECTIVES In this study, we investigate if the raw data acquired from a noncontrast CT image contains sufficient information to differentiate blood and other soft tissue components. A deep learning pipeline underpinned by generative adversarial networks was developed to simulate contrast enhanced CTA images using noncontrast CTs. METHODS AND RESULTS Two generative models (cycle- and conditional) are trained with paired noncontrast and contrast enhanced CTs from seventy-five patients (total of 11,243 pairs of images) with abdominal aortic aneurysms in a 3-fold cross-validation approach with a training/testing split of 50:25 patients. Subsequently, models were evaluated on an independent validation cohort of 200 patients (total of 29,468 pairs of images). Both deep learning generative models are able to perform this image transformation task with the Cycle-generative adversarial network (GAN) model outperforming the Conditional-GAN model as measured by aneurysm lumen segmentation accuracy (Cycle-GAN: 86.1% ± 12.2% vs Con-GAN: 85.7% ± 10.4%) and thrombus spatial morphology classification accuracy (Cycle-GAN: 93.5% vs Con-GAN: 85.7%). CONCLUSION This pipeline implements deep learning methods to generate CTAs from noncontrast images, without the need of contrast injection, that bear strong concordance to the ground truth and enable the assessment ofimportant clinical metrics. Our pipeline is poised to disrupt clinical pathways requiring intravenous contrast.
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10
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Penso M, Moccia S, Caiani EG, Caredda G, Lampus ML, Carerj ML, Babbaro M, Pepi M, Chiesa M, Pontone G. A token-mixer architecture for CAD-RADS classification of coronary stenosis on multiplanar reconstruction CT images. Comput Biol Med 2023; 153:106484. [PMID: 36584604 DOI: 10.1016/j.compbiomed.2022.106484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE In patients with suspected Coronary Artery Disease (CAD), the severity of stenosis needs to be assessed for precise clinical management. An automatic deep learning-based algorithm to classify coronary stenosis lesions according to the Coronary Artery Disease Reporting and Data System (CAD-RADS) in multiplanar reconstruction images acquired with Coronary Computed Tomography Angiography (CCTA) is proposed. METHODS In this retrospective study, 288 patients with suspected CAD who underwent CCTA scans were included. To model long-range semantic information, which is needed to identify and classify stenosis with challenging appearance, we adopted a token-mixer architecture (ConvMixer), which can learn structural relationship over the whole coronary artery. ConvMixer consists of a patch embedding layer followed by repeated convolutional blocks to enable the algorithm to learn long-range dependences between pixels. To visually assess ConvMixer performance, Gradient-Weighted Class Activation Mapping (Grad-CAM) analysis was used. RESULTS Experimental results using 5-fold cross-validation showed that our ConvMixer can classify significant coronary artery stenosis (i.e., stenosis with luminal narrowing ≥50%) with accuracy and sensitivity of 87% and 90%, respectively. For CAD-RADS 0 vs. 1-2 vs. 3-4 vs. 5 classification, ConvMixer achieved accuracy and sensitivity of 72% and 75%, respectively. Additional experiments showed that ConvMixer achieved a better trade-off between performance and complexity compared to pyramid-shaped convolutional neural networks. CONCLUSIONS Our algorithm might provide clinicians with decision support, potentially reducing the interobserver variability for coronary artery stenosis evaluation.
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Affiliation(s)
- Marco Penso
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy.
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Enrico G Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy; Istituto Auxologico Italiano IRCCS, Milan, Italy.
| | - Gloria Caredda
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Maria Luisa Lampus
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Maria Ludovica Carerj
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina, Italy.
| | - Mario Babbaro
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Mattia Chiesa
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy.
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.
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Ippolito D, Talei Franzesi C, Cangiotti C, Riva L, De Vito A, Gandola D, Maino C, Marra P, Muscogiuri G, Sironi S. Inter-observer agreement and image quality of model-based algorithm applied to the Coronary Artery Disease-Reporting and Data System score. Insights Imaging 2022; 13:176. [DOI: 10.1186/s13244-022-01286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
To evaluate the inter-observer agreement of the CAD-RADS reporting system and compare image quality between model-based iterative reconstruction algorithm (MBIR) and standard iterative reconstruction algorithm (IR) of low-dose cardiac computed tomography angiography (CCTA).
Methods
One-hundred-sixty patients undergone a 256-slice MDCT scanner using low-dose CCTA combined with prospective ECG-gated techniques were enrolled. CCTA protocols were reconstructed with both MBIR and IR. Each study was evaluated by two readers using the CAD-RADS lexicon. Vessels enhancement, image noise, signal-to-noise (SNR), and contrast-to-noise (CNR) were computed in the axial native images, and inter-observer agreement was assessed. Radiation dose exposure as dose–length product (DLP) and effective dose were finally reported.
Results
The reliability analysis between the two readers was almost perfect for all CAD-RADS standard categories. Moreover, a significantly higher value of subjective qualitative analysis, SNR, and CNR in MBIR images compared to IR were found, due to a lower noise level (all p < 0.05). The mean DLP measured was 63.9 mGy*cm, and the mean effective dose was 0.9 mSv.
Conclusion
Inter-observer agreement of CAD-RADS was excellent confirming the importance, the feasibility, and the reproducibility of the CAD-RADS scoring system for CCTA. Moreover, lower noise and higher image quality with MBIR compared to IR were found.
Implications for practice
MBIR, by reducing noise and improving image quality, can help a better assessment of CAD-RADS, in comparison with standard IR algorithm.
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12
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王 雨, 杨 丹, 徐 彬, 张 欣, 王 旭. [Research on inversion method of intravascular blood flow velocity based on convolutional neural network]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2022; 39:561-569. [PMID: 35788526 PMCID: PMC10950770 DOI: 10.7507/1001-5515.202112038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Blood velocity inversion based on magnetoelectric effect is helpful for the development of daily monitoring of vascular stenosis, but the accuracy of blood velocity inversion and imaging resolution still need to be improved. Therefore, a convolutional neural network (CNN) based inversion imaging method for intravascular blood flow velocity was proposed in this paper. Firstly, unsupervised learning CNN is constructed to extract weight matrix representation information to preprocess voltage data. Then the preprocessing results are input to supervised learning CNN, and the blood flow velocity value is output by nonlinear mapping. Finally, angiographic images are obtained. In this paper, the validity of the proposed method is verified by constructing data set. The results show that the correlation coefficients of blood velocity inversion in vessel location and stenosis test are 0.884 4 and 0.972 1, respectively. The above research shows that the proposed method can effectively reduce the information loss during the inversion process and improve the inversion accuracy and imaging resolution, which is expected to assist clinical diagnosis.
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Affiliation(s)
- 雨忱 王
- 东北大学 智能工业数据解析与优化教育部重点实验室(沈阳 110819)Key Laboratory of Data Analytics and Optimization for Smart Industry Ministry of Education, Northeastern University, Shenyang 110819, P. R. China
- 东北大学 信息科学与工程学院(沈阳 110819)School of Information Science and Engineering, Northeastern University, Shenyang 110819, P. R. China
| | - 丹 杨
- 东北大学 智能工业数据解析与优化教育部重点实验室(沈阳 110819)Key Laboratory of Data Analytics and Optimization for Smart Industry Ministry of Education, Northeastern University, Shenyang 110819, P. R. China
- 东北大学 信息科学与工程学院(沈阳 110819)School of Information Science and Engineering, Northeastern University, Shenyang 110819, P. R. China
| | - 彬 徐
- 东北大学 智能工业数据解析与优化教育部重点实验室(沈阳 110819)Key Laboratory of Data Analytics and Optimization for Smart Industry Ministry of Education, Northeastern University, Shenyang 110819, P. R. China
| | - 欣宇 张
- 东北大学 智能工业数据解析与优化教育部重点实验室(沈阳 110819)Key Laboratory of Data Analytics and Optimization for Smart Industry Ministry of Education, Northeastern University, Shenyang 110819, P. R. China
| | - 旭 王
- 东北大学 智能工业数据解析与优化教育部重点实验室(沈阳 110819)Key Laboratory of Data Analytics and Optimization for Smart Industry Ministry of Education, Northeastern University, Shenyang 110819, P. R. China
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Welch T, Rampersad F, Motilal S, Seecheran NA. Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study. Open Heart 2022; 9:openhrt-2021-001922. [PMID: 35354659 PMCID: PMC8968509 DOI: 10.1136/openhrt-2021-001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. Methods Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. Results One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). Conclusions Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. Trial registration number NCT04774861.
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Affiliation(s)
- Tonya Welch
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Fidel Rampersad
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
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Tiwari N, Nagraj S, Tzoumas A, Arfaras-Melainis A, Katamreddy A, Sohal S, Palaiodimos L. Diagnostic accuracy of coronary computed tomography angiography in ischemic workup of heart failure: a meta-analysis. Future Cardiol 2022; 18:325-335. [PMID: 35118872 DOI: 10.2217/fca-2021-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: The role of coronary computed tomography angiography (CCTA) in evaluating the etiology of heart failure with reduced ejection fraction (HFrEF) is unclear. This is a meta-analysis assessing the pooled diagnostic accuracy of CCTA in diagnosing significant coronary artery disease in HFrEF. Materials & methods: Electronic databases were searched for studies comparing CCTA with invasive coronary angiography in HFrEF. A random-effects model meta-analysis was conducted. Results: Five studies comprising 269 patients were included. On patient-based analysis, pooled sensitivity and specificity of CCTA were 0.99 (95% CI: 0.94-1.00) and 0.94 (95% CI: 0.90-0.97), respectively. On segment-based analysis, pooled sensitivity and specificity were 0.74 (95% CI: 0.67-0.80) and 0.99 (95% CI: 0.98-0.99), respectively. Conclusion: CCTA has excellent diagnostic accuracy in diagnosing significant coronary artery disease in newly diagnosed HFrEF.
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Affiliation(s)
- Nidhish Tiwari
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Andreas Tzoumas
- Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 541 24, Greece
| | - Angelos Arfaras-Melainis
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Adarsh Katamreddy
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sumit Sohal
- Department of Cardiology, RWJBH-Newark Beth Israel Medical Center, Newark, NJ 07112, USA
| | - Leonidas Palaiodimos
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
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15
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Wu PW, Tsay PK, Sun Z, Peng SJ, Lee CY, Hsu MY, Ko YS, Hsieh IC, Wen MS, Wan YL. Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques. Diagnostics (Basel) 2022; 12:diagnostics12020390. [PMID: 35204481 PMCID: PMC8871267 DOI: 10.3390/diagnostics12020390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries.
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Affiliation(s)
- Patricia Wanping Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan;
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Bentley, WA 6102, Australia;
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan;
| | - Chia-Yen Lee
- Department of Electrical Engineering, National United University, Miaoli 360302, Taiwan;
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
| | - Yu-Shien Ko
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - I-Chang Hsieh
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - Ming-Shien Wen
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (Y.-S.K.); (I.-C.H.); (M.-S.W.)
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan; (P.W.W.); (M.-Y.H.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 2575)
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Koons E, VanMeter P, Rajendran K, Yu L, McCollough C, Leng S. Improved quantification of coronary artery luminal stenosis in the presence of heavy calcifications using photon-counting detector CT. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12031. [PMID: 35677467 DOI: 10.1117/12.2613019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Coronary CT Angiography (cCTA) is commonly used to detect and quantify luminal stenoses in patients with coronary artery disease (CAD). However, its use is limited in patients with heavy coronary calcifications due to calcium blooming, which is caused by insufficient spatial resolution. This study evaluated the ability of a photon-counting-detector (PCD) CT in quantifying luminal stenosis in the presence of heavy calcifications relative to an energy-integrating-detector (EID) CT. Cylindrical rods of 4.5 mm diameter (with 3 mm lumen), which contained calcium hydroxyapatite (CaHA) to emulate calcifications of varying shapes and sizes and an iodine or blood analog to emulate the coronary lumen, were placed within an anthropomorphic thorax phantom and scanned at matched dose on an EID-CT and a PCD-CT scanner. Stenoses were qualitatively evaluated and quantified using commercial software. Measured percent area stenosis was compared to reference values. PCD-CT provided better visualization of calcium plaques and the patent lumen, and more accurate stenosis quantification for all plaques. In one rod (75% occlusion with ring-shaped plaque), only PCD-CT was able to determine that the vessel was not fully obstructed. The phantom results indicate luminal stenoses that were previously considered non-assessable due to the presence of heavily-calcified plaques can be assessed using PCD-CT. Clinical studies to support these conclusions are underway.
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Affiliation(s)
- Emily Koons
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Sane R, Mandole R, Amin G. Use of reverse diet kit as a treatment to regress atheroma in a known CAD patient: A case report. J Ayurveda Integr Med 2021; 13:100511. [PMID: 34973885 PMCID: PMC8814396 DOI: 10.1016/j.jaim.2021.08.004] [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: 12/03/2020] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
The way people eat have changed rapidly across the globe and is one of the reasons for developing coronary artery disease (CAD). Atheroma is caused due to the accumulation of fatty deposits and scar tissue leading to the degeneration of the walls of the arteries, restriction of the circulation and a risk of thrombosis. This single case experimental study shows that regression in atheroma may be achieved by replacing the normal diet with a low calories diet used in the reverse diet kit. The patient complained of angina on minor exertion. Post admission the patient underwent a computed tomography angiogram (CT-angiogram) to measure the plaque volumes of left anterior descending artery (LAD), left circumflex artery (LXC) and right coronary artery (RCA) of the heart. The patient was monitored for 12 weeks with the administration of reverse diet as a treatment method. The change in weight, blood pressure and heart rate was monitored every week. After 12 weeks, CT-angiogram was performed again. There was a 7.3 kg decrease in weight along with normalization of blood pressure (BP). A 92.8 mm3 regression of the total atheroma volume was observed. The diet provided may help in reducing atheroma burden in this CAD patient.
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Affiliation(s)
- Rohit Sane
- Madhavbaug Cardiac Hospitals and Clinics, India
| | - Rahul Mandole
- Department of Research Development, Madhavbaug Cardiac Clinic and Hospital, Thane, Maharashtra, India.
| | - Gurudatta Amin
- Madhavbaug Cardiac Clinic and Hospital, Thane, Maharashtra, India
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18
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Sun Z, Ng CKC, Wong YH, Yeong CH. 3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts. Biomolecules 2021; 11:biom11091307. [PMID: 34572520 PMCID: PMC8468360 DOI: 10.3390/biom11091307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
- Correspondence: ; Tel.: +61-8-9266-7509; Fax: +61-8-9266-2377
| | - Curtise Kin Cheung Ng
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Yin How Wong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
| | - Chai Hong Yeong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
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Coronary arterial abnormalities detected in children over 10 years following initial Kawasaki disease using cardiac computed tomography. Cardiol Young 2021; 31:998-1002. [PMID: 33504398 DOI: 10.1017/s1047951121000020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether Kawasaki disease predisposes to premature atherosclerosis and to assess status of coronary artery abnormalities at least 10 years after diagnosis. MATERIAL AND METHODS A prospective study was carried out on 21 patients who were diagnosed with Kawasaki disease at least 10 years back and are on regular follow-up. The study was conducted on 128 Slice Dual Source computed tomography scanner with electrocardiography-triggered radiation optimised protocols for assessment of coronary artery abnormalities and calcifications. RESULTS Study cohort had 21 subjects - 15 males and 6 females (age range: 11-23 years; mean: 15.76 + 3.72 years). Mean age at time of diagnosis was 3.21 + 2.48 years. Mean time interval from diagnosis of Kawasaki disease to computed tomography coronary angiography was 12.59 + 2.89 years. Four children had evidence of coronary artery abnormalities on transthoracic echocardiography at time of diagnosis. Of these, two had persistent abnormalities on computed tomography coronary angiography. One subject (4.76%) had coronary calcification that was localised to abnormal coronary artery segment. Four coronary artery abnormalities (one saccular; three fusiform aneurysms) were noted in two subjects. CONCLUSION Prevalence of coronary artery calcification is low and, if present, is localised to abnormal segments. This calcification is likely dystrophic rather than atherosclerotic. It appears that coronary artery abnormalities can persist for several years after acute episode of Kawasaki disease. Periodic follow-up by computed tomography coronary angiography is now a feasible non-invasive imaging modality for long term surveillance of patients with Kawasaki disease who had coronary artery abnormalities at time of diagnosis.
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Truong U, Meinel K, Haddad F, Koestenberger M, Carlsen J, Ivy D, Jone PN. Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1604-1624. [PMID: 33224776 DOI: 10.21037/cdt-20-272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span. The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katharina Meinel
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Liu Y, Liu G, Yang D, Xu B. Application of Linear Gradient Magnetic Field in Arterial Profile Scanning Imaging. SENSORS 2020; 20:s20164547. [PMID: 32823785 PMCID: PMC7472423 DOI: 10.3390/s20164547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Cardiovascular and cerebrovascular diseases caused by arterial stenosis and sclerosis are the main causes of human death. Although there are mature diagnostic techniques in clinical practice, they are not suitable for early disease prediction and monitoring due to their high cost and complex operation. The purpose of this paper is to study the coupling effect of arterial blood flow and linear gradient magnetic field, and to propose a method for the reconstruction of the arterial profile, which will lay a theoretical foundation for new electromagnetic artery scanning imaging technology. Methods and Models: A combination coil composed of gradient coils and drive coils is applied as a magnetic field excitation source. By controlling the excitation current, a linearly gradient magnetic field with a line-shaped zero magnetic field is generated, and the zero magnetic field is driven to scan in a specific direction. According to the magnetoelectric effect of blood flow, under the action of the external magnetic field, the voltage signals on the body surface can be detected by measuring electrodes. The location of the artery center line can be determined by the time–space relationship between voltage signals and zero magnetic field scanning. In addition, based on the reciprocity theorem integral equation, a numerical model between the amplitude of the voltage signal and the arterial radius is derived to reconstruct the arterial radius. The above physical process was simulated in the finite element analysis software COMSOL, and the voltage signals obtained from the simulation verified the arterial profile reconstruction. Results: Through finite element simulation verification, the imaging method based on a linear gradient magnetic field has a numerical accuracy of 90% and a spatial resolution of 1 mm. Moreover, under 100 Hz low-frequency alternating current excitation, the single scanning time is 0.005 s, which is far shorter than the arterial blood flow change cycle, meeting the requirements of real-time imaging. The results demonstrate the effectiveness and high theoretical feasibility of the proposed method in real-time arterial imaging. Conclusions: This study indicates the potential application of linear gradient magnetic fields in arterial profile imaging. Compared with traditional electromagnetic imaging methods, the proposed method has the advantages of fast imaging speed and high resolution, showing the certain application value in early real-time imaging of arterial disease. However, further studies are necessary to confirm its effectiveness in clinical practice by more medical data and real cases.
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Affiliation(s)
- Yanjun Liu
- College of Information Science and Engineering, Northeastern University, Shenyang 110819, China;
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing 100190, China
| | - Guoqiang Liu
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing 100190, China
- School of Electronics, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100190, China
- Correspondence: (G.L.); (D.Y.)
| | - Dan Yang
- College of Information Science and Engineering, Northeastern University, Shenyang 110819, China;
- Key Laboratory of Data Analytics and Optimization for Smart Industry MOE, Northeastern University, Shenyang 110819, China
- Liaoning Province Key Laboratory of Infrared Optoelectric Materials and Micro-Nano Devices, Northeastern University, Shenyang 110819, China
- Correspondence: (G.L.); (D.Y.)
| | - Bin Xu
- College of Computer Science and Engineering, Northeastern University, Shenyang 110819, China;
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Ghiasi MM, Zendehboudi S, Mohsenipour AA. Decision tree-based diagnosis of coronary artery disease: CART model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 192:105400. [PMID: 32179311 DOI: 10.1016/j.cmpb.2020.105400] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVE As the most common cardiovascular defect, coronary artery disease (CAD), also called ischemic heart disease, is one of the substantial causes of death globally. Several diagnosis approaches such as baseline electrocardiography, echocardiography, magnetic resonance imaging, and coronary angiography are suggested for screening the suspected patients that may suffer from CAD. However, applying such methods may have health side effects and/or expensive costs. METHODS As an alternative to the available diagnosis tools/methods, this research involves a decision tree learning algorithm called classification and regression tree (CART) for a simple and reliable diagnosis of CAD. Several CART models are developed based on the recently CAD dataset published in the literature. RESULTS Utilizing all the features of the dataset (55 independent parameters), it was found that only 40 independent parameters influence the CAD diagnosis and consequently development of the predictive model. Based on the feature importance obtained from the first CART model, three new CART models are then developed using 18, 10, and 5 selected features. Except for the five-feature CART model, the outcomes of developed CART models demonstrate the maximum achievable accuracy, sensitivity, and specificity for CAD diagnosis (100%), while comparing the predictions with the reported targets. The error analysis reveals that the literature models including sequential minimal optimization (SMO), bagging SMO, Naïve Bayes (NB), artificial neural network (ANN), C4.5, J48, Bagging, and ANN in conjunction with the genetic algorithm (GA) do not outperform the CART methodology in classifying patients as normal or CAD. CONCLUSIONS Hence, the robustness of the tree-based algorithm in accurate and fast predictions is confirmed, implying the proposed classification technique can be successfully utilized to develop a coherent decision-making system for the CAD diagnosis.
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Affiliation(s)
- Mohammad M Ghiasi
- Faculty of Engineering and Applied Science, Memorial University, St. John's, NL A1B 3X5, Canada.
| | - Sohrab Zendehboudi
- Faculty of Engineering and Applied Science, Memorial University, St. John's, NL A1B 3X5, Canada
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24
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Chen CC, Wu PW, Tsay PK, Wang CC, Toh CH, Wan YL. Subtracted Computed Tomography Angiography in the Evaluation of Coronary Arteries With Severe Calcification or Stents Using a 320-Row Computed Tomography Scanner. J Thorac Imaging 2020; 35:317-325. [PMID: 32073538 DOI: 10.1097/rti.0000000000000480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Coronary computed tomography angiography (CCTA) has its limitations in evaluating arteries with stents or heavy calcification. This study compares the diagnostic performance of subtracted coronary computed tomography angiography (SCCTA) and nonsubtracted coronary computed tomography angiography (NSCCTA) in evaluating coronary artery disease (CAD) and in-stent restenosis (ISR). MATERIALS AND METHODS Twelve patients with stents and 20 patients with heavy coronary calcifications (total Agatston's score >400) underwent both SCCTA and invasive coronary angiography (ICA) with an interval of <3 months. Four subjects in the stented group also had heavy calcifications. Overall, 30 stented segments and 202 calcified segments were assessed to compare the diagnostic performance of SCCTA and NSCCTA in detecting ISR and CAD. RESULTS For the 30 stented segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) (shown in %) of 66.7/100, 100/55.6, 96.7/60, 100/20, and 96.4/100 in diagnosing ISR, respectively. For the 202 calcified segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, PPV, and NPV of 68.8/84.4, 97.6/76.5, 93.1/77.7, 84.6/40.3, and 94.3/96.3 in diagnosing CAD, respectively. For both stented and calcified segments, SCCTA was significantly superior to NSCCTA in specificity and accuracy. For the calcified segments, SCCTA was significantly superior to NSCCTA in PPV. There was no significant difference in the diagnostic performance of SCCTA between the stented and calcified segments. CONCLUSIONS The diagnostic accuracy and specificity of SCCTA are significantly superior to those of NSCCTA in evaluating CAD and ISR. SCCTA shows no statistical difference in its diagnostic performance between the stented and calcified segments.
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Affiliation(s)
- Chun-Chi Chen
- Section of Cardiology, Department of Internal Medicine
| | - Patricia Wanping Wu
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
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Yuan XC, Hu J, Zeng X, Zhou AY, Chen L. Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery. Medicine (Baltimore) 2019; 98:e18046. [PMID: 31764828 PMCID: PMC6882605 DOI: 10.1097/md.0000000000018046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this research is to investigate the application value of TTE in the diagnosis of the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).The echocardiographic findings of 11 patients with ALCAPA confirmed by surgery in our hospital from October 2007 to December 2018 were retrospectively analyzed and compared with the preoperative computed tomography angiography (CTA) diagnosis and intraoperative diagnosis.Surgery was performed in all of the patients to establish the dual coronary artery system. Four underwent the Takeuchi procedure and 7 had re-implantation of the anomalous left coronary artery. The CTA diagnoses of the 11 patients were consistent with the surgical diagnoses, and the diagnostic accuracy was 100% (11/11). Echocardiographic diagnosis showed consistent results in 10 cases, while one case was misdiagnosed as endocardial fibroelastosis; the diagnostic accuracy was 90.9% (10/11). The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 10 patients; enlargement of the right coronary artery in 8 patients; abundant intercoronary septal collaterals in 6 patients; and moderate and significant mitral regurgitation in 7 patients. Echocardiography showed that the left ventricular end-diastolic diameter and left ventricular end-systolic diameter before surgery were significantly different from those after surgery (P < .05) and that the left ventricular ejection fraction and fractional shortening before surgery were not significantly different from those after surgery (P > .05).Transthoracic echocardiography can diagnose ALCAPA in a timely, accurate, and noninvasive manner, and it could be of great significance in guiding clinical operations and in predicting prognosis.
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Al-Umairi RS, Al-Kindi F, Al-Tai S. Prevalence and Spectrum of Coronary Anomalies Detected on Coronary Computed Tomography Angiography: A single centre experience in Oman. Sultan Qaboos Univ Med J 2019; 19:e108-e113. [PMID: 31538008 PMCID: PMC6736262 DOI: 10.18295/squmj.2019.19.02.005] [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: 10/01/2018] [Revised: 12/26/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives Coronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2–2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman. Methods This retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included. Results A total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12–80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%). Conclusion The prevalence of CAAs was 1.3% which is similar to the literature.
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Affiliation(s)
| | | | - Saqar Al-Tai
- Department of Radiology, Royal Hospital, Muscat, Oman
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Chen K, Zhang X, Li D, Chen H, Zhang Z, Chen L. A noninvasive and highly sensitive approach for the assessment of coronary collateral circulation by 192-slice third-generation dual-source computed tomography. Medicine (Baltimore) 2019; 98:e17014. [PMID: 31567938 PMCID: PMC6756702 DOI: 10.1097/md.0000000000017014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).Eight hundred patients (450 men and 350 women, mean age: 56 ± 11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ± 3.7 days (Range: 1-15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91-0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ± 0.04 mSv (range, 0.35-0.43 mSv).The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.
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Affiliation(s)
- Kebin Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Xiaoge Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Daling Li
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Honglei Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Zhixu Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Lei Chen
- Department of Lab Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
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Yang CC, Law WY, Lu KM, Wu TH. Relationship between heart rate and optimal reconstruction phase in coronary CT angiography performed on a 256-slice multidetector CT. Br J Radiol 2019; 92:20180945. [PMID: 31322906 DOI: 10.1259/bjr.20180945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the relationship between heart rate (HR) and optimal reconstruction phase in prospectively electrocardiogram (ECG)-triggered coronary CT angiography (CCTA) performed on a newly introduced 256-slice multidetector CT (MDCT). METHODS All the cases were selected retrospectively from the patients scheduled for CCTA in our department between January and April 2017. The scanner selected the optimal exposure phase based on 10 s ECG recordings. To ensure the success of CCTA, the operator also checked patient's age, breathing control, emotional status and past medical history to decide whether the automatically selected scan phase needs manual adjustment or not. Images were reconstructed in 1% steps of the R-R interval to determine the cardiac phase with least coronary motion. If CCTA images showed moderate motion blurring or discontinuity in the course of coronary segments, a cardiac motion correction algorithm was applied to the reconstructed images. Subjective diagnostic image quality was evaluated with 4-point grading scale. RESULTS A total of 87 consecutive CCTA examinations were investigated in this study. Diastolic reconstruction was applied to all vessel segments in patients with HR <63 bpm, where 36.5 and 77.8% of vessel segments were reconstructed with the use of motion correction in HR ≤57 and 58-62 bpm, respectively. As for patients with HR ≥63 bpm, 89.3 and 71.7% of vessel segments were reconstructed in diastole in HR 63-67 and ≥68 bpm, respectively, while 81 and 100% of vessel segments were reconstructed with the use of motion correction in the same HR groups. CONCLUSION Based on our results, a HR less than 67 bpm can be used to identify appropriate patients for diastolic reconstruction. Although the motion correction algorithm is an effective approach to reduce the impact of cardiac motion in CCTA, HR control is still important to optimize the image quality of CCTA. The relationship between HR and optimal reconstruction phase established in this study could be further used to tailor the ECG pulsing window for dose reduction in patients undergoing CCTA performed on the 256-slice MDCT. ADVANCES IN KNOWLEDGE The HR thresholds to identify patients who are the best suitable candidates for diastolic or systolic reconstruction are scanner specific. This study investigated the relationship between HR and optimal reconstruction phase in prospectively ECG-triggered CCTA for a newly introduced 256-slice MDCT. Once the relationship is established, it could be used to tailor the ECG pulsing window for radiation dose reduction.
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Affiliation(s)
- Ching-Ching Yang
- 1Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Yip Law
- 2Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kun-Mu Lu
- 2Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tung-Hsin Wu
- 3Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
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30
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Radiation exposure related to cardiovascular CT examination: comparison between conventional 64-MDCT and third-generation dual-source MDCT. Radiol Med 2019; 124:753-761. [DOI: 10.1007/s11547-019-01036-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 01/02/2023]
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Hur DJ, Sugeng L. Non-invasive Multimodality Cardiovascular Imaging of the Right Heart and Pulmonary Circulation in Pulmonary Hypertension. Front Cardiovasc Med 2019; 6:24. [PMID: 30931315 PMCID: PMC6427926 DOI: 10.3389/fcvm.2019.00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary arterial pressure (mPAP) ≥25 millimeters of mercury (mmHg) via right heart (RH) catheterization (RHC), where increased afterload in the pulmonary arterial vasculature leads to alterations in RH structure and function. Mortality rates have remained high despite therapy, however non-invasive imaging holds the potential to expedite diagnosis and lead to earlier initiation of treatment, with the hope of improving prognosis. While historically the right ventricle (RV) had been considered a passive chamber with minimal role in the overall function of the heart, in recent years in the evaluation of PH and RH failure the anatomical and functional assessment of the RV has received increased attention regarding its performance and its relationship to other structures in the RH-pulmonary circulation. Today, the RV is the key determinant of patient survival. This review provides an overview and summary of non-invasive imaging methods to assess RV structure, function, flow, and tissue characterization in the setting of imaging's contribution to the diagnostic, severity stratification, prognostic risk, response of treatment management, and disease surveillance implications of PH's impact on RH dysfunction and clinical RH failure.
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Affiliation(s)
- David J Hur
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Division of Cardiology, Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Echocardiography Laboratory, Yale New Haven Hospital, New Haven, CT, United States
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Xu MX, Liu JM, He YM, Yang XJ, Li YG, Liu C, Zhao X, Wei C, Wang HP, Zhu JF. Coronary artery anatomy in peri-crux cordis area on computed coronary tomography angiography. J Thorac Dis 2019; 11:848-856. [PMID: 31019773 DOI: 10.21037/jtd.2019.02.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The peri-crux area is an anatomical structure of the heart. Unfortunately, important information on this area mainly derives from autopsy heart with a small, under-representative sample size, resulting in limited clinical applications. Furthermore, little has been done to standardize the definition of the peri-crux area on coronary computed tomography angiography (CCTA) images or to investigate coronary artery anatomy wherein potential values are attracting experienced inventional cardiologists in terms of the revascularization strategies. The current study aimed to identify the peri-crux cordis area and to observe coronary artery anatomical distributions in this area on CCTA. Methods A total of 1,006 consecutive patients undergoing CCTA exams were enrolled. We delineated the peri-crux cordis area based on the posterior interatrial sulcus, posterior interventricular sulcus (PIS), left and right posterior atrioventricular groove on the diaphragmatic surface of the heart. Then we observed the coronary artery distributions in the peri-crux cordis area in different sexes. Results We have defined the peri-crux cordis area according to the anatomical landmarks on the diaphragmatic surface of the heart on CCTA images. We have observed 8 coronary artery distributions in the peri-crux cordis area. Right dominance has 4 types (types 1-4); left, 1 type (type 0) and balanced, 3 types (types 5-7). Out of the 1,006 cases, the type 1 is commonest with 834 cases (82.9%). There are no statistically significant differences in terms of coronary dominances and coronary artery distributions in the peri-crux cordis area between sexes (P>0.05). Conclusions We have defined the peri-crux cordis area utilizing the anatomical landmarks of the heart on CCTA images, where 8 types of coronary artery distributions have been identified. The current study may provide interventional cardiologists with useful information on recognition of coronary artery dominance, use of collateral channels for revascularization of chronic total occluded lesions, and evaluation of prognosis in patients with coronary artery disease (CAD).
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Affiliation(s)
- Ming-Xing Xu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.,The Third Hospital Affiliated to Anhui Medical University/First People's Hospital of Hefei City, Hefei 230061, China
| | - Jin-Mei Liu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yong-Ming He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiang-Jun Yang
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yong-Gang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chang Liu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xin Zhao
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chao Wei
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Hai-Peng Wang
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jing-Fen Zhu
- The Third Hospital Affiliated to Anhui Medical University/First People's Hospital of Hefei City, Hefei 230061, China
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Velasco Forte MN, Valverde I, Prabhu N, Correia T, Narayan SA, Bell A, Mathur S, Razavi R, Hussain T, Pushparajah K, Henningsson M. Visualization of coronary arteries in paediatric patients using whole-heart coronary magnetic resonance angiography: comparison of image-navigation and the standard approach for respiratory motion compensation. J Cardiovasc Magn Reson 2019; 21:13. [PMID: 30798789 PMCID: PMC6388473 DOI: 10.1186/s12968-019-0525-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To investigate the use of respiratory motion compensation using image-based navigation (iNAV) with constant respiratory efficiency using single end-expiratory thresholding (CRUISE) for coronary magnetic resonance angiography (CMRA), and compare it to the conventional diaphragmatic navigator (dNAV) in paediatric patients with congenital or suspected heart disease. METHODS iNAV allowed direct tracking of the respiratory heart motion and was generated using balanced steady state free precession startup echoes. Respiratory gating was achieved using CRUISE with a fixed 50% efficiency. Whole-heart CMRA was acquired with 1.3 mm isotropic resolution. For comparison, CMRA with identical imaging parameters were acquired using dNAV. Scan time, visualization of coronary artery origins and mid-course, imaging quality and sharpness was compared between the two sequences. RESULTS Forty patients (13 females; median weight: 44 kg; median age: 12.6, range: 3 months-17 years) were enrolled. 25 scans were performed in awake patients. A contrast agent was used in 22 patients. The scan time was significantly reduced using iNAV for awake patients (iNAV 7:48 ± 1:26 vs dNAV 9:48 ± 3:11, P = 0.01) but not for patients under general anaesthesia (iNAV = 6:55 ± 1:50 versus dNAV = 6:32 ± 2:16; P = 0.32). In 98% of the cases, iNAV image quality had an equal or higher score than dNAV. The visual score analysis showed a clear difference, favouring iNAV (P = 0.002). The right coronary artery and the left anterior descending vessel sharpness was significantly improved (iNAV: 56.8% ± 10.1% vs dNAV: 53.7% ± 9.9%, P < 0.002 and iNAV: 55.8% ± 8.6% vs dNAV: 53% ± 9.2%, P = 0.001, respectively). CONCLUSION iNAV allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients. Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Israel Valverde
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Nanda Prabhu
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Teresa Correia
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Srinivas Ananth Narayan
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Aaron Bell
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Reza Razavi
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Tarique Hussain
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Kuberan Pushparajah
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Markus Henningsson
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ramanathan S, Al Heidous M, Alkuwari M. Coronary Artery Disease-Reporting and Data System (CAD-RADS): strengths and limitations. Clin Radiol 2019; 74:411-417. [PMID: 30765109 DOI: 10.1016/j.crad.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 11/01/2018] [Accepted: 01/16/2019] [Indexed: 01/24/2023]
Abstract
A new standardised reporting system was introduced recently for coronary computed tomography (CT) angiography interpretation called CAD-RADS (Coronary Artery Disease-Reporting and Data System). Like any other new reporting platform, CAD-RADS has both advantages and disadvantages. Consistency in reporting, better clarity of communication, and more streamlined clinical recommendations are the major strengths of CAD-RADS. It has many limitations such as misinterpretation of CT angiography findings inherent to any CT angiography examination and unique disadvantages like misclassification of abnormalities, potential to misguide the referring physicians by suggesting management based on a single score. In addition, CAD-RADS does not include the details on location and extent of disease in the coronary arteries, coronary anomalies and other cardiac and extra cardiac findings.
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Affiliation(s)
- S Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - M Al Heidous
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar
| | - M Alkuwari
- Department of Radiology, Heart Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar
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Sun Z, Ng CKC, Squelch A. Synchrotron radiation computed tomography assessment of calcified plaques and coronary stenosis with different slice thicknesses and beam energies on 3D printed coronary models. Quant Imaging Med Surg 2019; 9:6-22. [PMID: 30788242 DOI: 10.21037/qims.2018.09.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background To investigate the effect of different slice thicknesses and beam energies on the visualization and assessment of coronary artery stenosis caused by calcified plaques using synchrotron radiation computed tomography (CT) based on 3D printed coronary artery models. Methods Patient-specific 3D coronary models were created based on 3 sample coronary CT angiographic cases with calcified plaques in the left coronary arteries. In addition to the original significant coronary stenosis (>70%) shown on these CT images, stenoses of <50% and >90% were created in the segmented coronary models for simulation of different degrees of stenosis. The coronary lumen and calcification were printed with soft and rigid materials to simulate properties of coronary wall and calcified plaque, respectively. The models were scanned with synchrotron radiation CT with beam energies of 30, 40 and 50 keV and spatial resolution of 0.019×0.019×0.019 mm3 voxel size. Original high-resolution images were reconstructed with slice thicknesses of 0.095, 0.208, 0.302 and 0.491 mm to determine the effect of spatial resolution on plaque and coronary stenosis assessment based on 2D axial and 3D virtual intravascular endoscopy (VIE) images. Results Three coronary artery models were successfully printed with plaques placed in the coronary arteries to simulate different degrees of stenosis. 2D and 3D VIE images reconstructed with slice thicknesses of 0.095, 0.208 and 0.302 mm allowed for accurate assessment of coronary plaques and lumen stenosis with no significant differences (P>0.05). Synchrotron radiation CT images reconstructed with a slice thickness of 0.491 mm resulted in overestimation of coronary stenosis when compared to other images on 2D and 3D VIE views (<50% vs. 55-72%; 70-79% vs. 80-90%) with significant differences (P<0.05). Similarly, irregular plaque appearances were observed on 2D and 3D VIE images with a slice thickness of 0.491 mm when compared to others using thin slice thicknesses. The scanning protocol with beam energy of 30 keV provided optimal visualization of coronary lumen and plaque appearances. Conclusions This study shows the feasibility of using 3D printed coronary artery models to simulate calcifications and different degrees of coronary stenosis. High resolution synchrotron radiation CT imaging with the 30 keV beam energy enables accurate assessment of coronary stenosis in the presence of calcification, thus highlighting the importance of high spatial resolution in the diagnosis of calcified coronary plaques.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, Western Australia, Australia.,Computational Image Analysis Group, Curtin Institute for Computation, Curtin University, Perth, Western Australia, Australia
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Ma H, Gros E, Baginski SG, Laste ZR, Kulkarni NM, Okerlund D, Schmidt TG. Automated quantification and evaluation of motion artifact on coronary CT angiography images. Med Phys 2018; 45:5494-5508. [PMID: 30339290 DOI: 10.1002/mp.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study developed and validated a Motion Artifact Quantification algorithm to automatically quantify the severity of motion artifacts on coronary computed tomography angiography (CCTA) images. The algorithm was then used to develop a Motion IQ Decision method to automatically identify whether a CCTA dataset is of sufficient diagnostic image quality or requires further correction. METHOD The developed Motion Artifact Quantification algorithm includes steps to identify the right coronary artery (RCA) regions of interest (ROIs), segment vessel and shading artifacts, and to calculate the motion artifact score (MAS) metric. The segmentation algorithms were verified against ground-truth manual segmentations. The segmentation algorithms were also verified by comparing and analyzing the MAS calculated from ground-truth segmentations and the algorithm-generated segmentations. The Motion IQ Decision algorithm first identifies slices with unsatisfactory image quality using a MAS threshold. The algorithm then uses an artifact-length threshold to determine whether the degraded vessel segment is large enough to cause the dataset to be nondiagnostic. An observer study on 30 clinical CCTA datasets was performed to obtain the ground-truth decisions of whether the datasets were of sufficient image quality. A five-fold cross-validation was used to identify the thresholds and to evaluate the Motion IQ Decision algorithm. RESULTS The automated segmentation algorithms in the Motion Artifact Quantification algorithm resulted in Dice coefficients of 0.84 for the segmented vessel regions and 0.75 for the segmented shading artifact regions. The MAS calculated using the automated algorithm was within 10% of the values obtained using ground-truth segmentations. The MAS threshold and artifact-length thresholds were determined by the ROC analysis to be 0.6 and 6.25 mm by all folds. The Motion IQ Decision algorithm demonstrated 100% sensitivity, 66.7% ± 27.9% specificity, and a total accuracy of 86.7% ± 12.5% for identifying datasets in which the RCA required correction. The Motion IQ Decision algorithm demonstrated 91.3% sensitivity, 71.4% specificity, and a total accuracy of 86.7% for identifying CCTA datasets that need correction for any of the three main vessels. CONCLUSION The Motion Artifact Quantification algorithm calculated accurate (<10% error) motion artifact scores using the automated segmentation methods. The developed algorithms demonstrated high sensitivity (91.3%) and specificity (71.4%) in identifying datasets of insufficient image quality. The developed algorithms for automatically quantifying motion artifact severity may be useful for comparing acquisition techniques, improving best-phase selection algorithms, and evaluating motion compensation techniques.
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Affiliation(s)
- Hongfeng Ma
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, 53233, USA
| | - Eric Gros
- GE Healthcare, Waukesha, WI, 53188, USA
| | - Scott G Baginski
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Zachary R Laste
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Naveen M Kulkarni
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Taly G Schmidt
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, 53233, USA
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Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, Thomas S, Herdman L, Kotanidis CP, Thomas KE, Griffin BP, Flamm SD, Antonopoulos AS, Shirodaria C, Sabharwal N, Deanfield J, Neubauer S, Hopewell JC, Channon KM, Achenbach S, Antoniades C. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018; 392:929-939. [PMID: 30170852 PMCID: PMC6137540 DOI: 10.1016/s0140-6736(18)31114-0] [Citation(s) in RCA: 552] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Milind Y Desai
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Jennifer Mancio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alaa Alashi
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | | | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Brian P Griffin
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Scott D Flamm
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Cheerag Shirodaria
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Caristo Diagnostics, Oxford, UK
| | - Nikant Sabharwal
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Deanfield
- University College London Institute of Cardiovascular Science, London, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK.
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Gambre AS, Liew C, Hettiarachchi G, Lee SSG, MacDonald M, Kam CJW, Poh ACC. Accuracy and clinical outcomes of coronary CT angiography for patients with suspected coronary artery disease: a single-centre study in Singapore. Singapore Med J 2018; 59:413-418. [PMID: 30175374 DOI: 10.11622/smedj.2018096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to assess the accuracy and outcomes of coronary computed tomography angiography (CCTA) performed in a regional hospital in Singapore. METHODS The Changi General Hospital CCTA database was retrospectively analysed over a 24-month period. Electronic hospital records, catheter coronary angiography (CCA) and CCTA electronic databases were used to gather data on major adverse cardiovascular events (MACE) and CCA results. CCTA findings were deemed positive if coronary artery stenosis ≥ 50% was reported or if the stenosis was classified as moderate or severe. CCA findings were considered positive if coronary artery stenosis ≥ 50% was reported. RESULTS The database query returned 679 patients who had undergone CCTA for the evaluation of suspected coronary artery disease. Of the 101 patients in the per-patient accuracy analysis group, there were six true negatives, one false negative, 81 true positives and 13 false positives, resulting in a negative predictive value of 85.7% and positive predictive value of 86.2%. The mean age of the study sample was 53 ± 13 years and 255 (37.6%) patients were female. Mean duration of patient follow-up was 360 days. Of the 513 negative CCTA patients, none developed MACE during the follow-up period, and of the 164 positive CCTA patients, 19 (11.6%) developed MACE (p < 0.001). CONCLUSION Analysis of CCTA studies suggested accuracy and outcomes that were consistent with published clinical data. There was a one-year MACE-free warranty period following negative CCTA findings.
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Affiliation(s)
| | - Charlene Liew
- Department of Radiology, Changi General Hospital, Singapore
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Faggioni L, Gabelloni M, Accogli S, Angelillis M, Costa G, Spontoni P, Petronio AS, Caramella D. Preprocedural planning of transcatheter mitral valve interventions by multidetector CT: What the radiologist needs to know. Eur J Radiol Open 2018; 5:131-140. [PMID: 30182038 PMCID: PMC6120726 DOI: 10.1016/j.ejro.2018.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
Mitral regurgitation is the most common valve disorder in the Western world, and although surgery is the established therapeutic gold standard, percutaneous transcatheter mitral interventions are gaining acceptance in selected patients who are inoperable or at an exceedingly high surgical risk. For such patients, multidetector computed tomography (MDCT) can provide a wealth of valuable morphological and functional information in the preoperative setting. Our aim is to give an overview of the MDCT image acquisition protocols, post-processing techniques, and imaging findings with which radiologists should be familiar to convey all relevant information to the Heart Team for successful treatment planning.
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Affiliation(s)
- Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Michela Gabelloni
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Sandra Accogli
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Giulia Costa
- Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Paolo Spontoni
- Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Anna Sonia Petronio
- Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - 56100 Pisa, Italy
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Sun Z, Ng CKC, Sá Dos Reis C. Synchrotron radiation computed tomography versus conventional computed tomography for assessment of four types of stent grafts used for endovascular treatment of thoracic and abdominal aortic aneurysms. Quant Imaging Med Surg 2018; 8:609-620. [PMID: 30140623 DOI: 10.21037/qims.2018.07.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To determine the accuracy of synchrotron radiation computed tomography (CT) for measurement of stent wire diameters for in vitro simulation of endovascular aneurysm repair by four different types of stent grafts when compared to conventional CT images. Methods This study was performed using an aorta model with implantation of four aortic stent grafts for endovascular treatment of thoracoabdominal and abdominal aortic aneurysms. The aorta model was scanned using synchrotron radiation CT with beam energies ranging from 60 to 90 keV with 10 keV increment at each scan and spatial resolution of 41.6 µm per pixel. Stent wire diameters were measured at the top and body regions of each stent graft based on 2-dimensional (2D) axial and 3-dimensional (3D) reconstruction images, with measurements compared to those obtained from 128-slice CT images which were acquired with slice thickness of 0.5 mm. Results Synchrotron radiation CT images clearly demonstrated stent graft details with accurate assessment of stent wire diameters, with measurements at the top of stent grafts (between 0.32±0.02 and 0.47±0.02 mm) similar to the actual diameters (between 0.32±0.01 and 0.48±0.01 mm) when the beam energies of 70 and 80 keV were used, regardless of the types of stent grafts assessed. A beam energy of 60 keV resulted in stent wires thicker than the actual sizes, although this did not reach statistical significance (P=0.07-0.29), while the beam energy of 90 keV led to stent wires smaller than the actual sizes at the top (P=0.16) and body region (P=0.02) of stent grafts on 2D axial images. The stent wire sizes measured at the body region of stent grafts on 3D synchrotron radiation images (between 0.19±0.02 and 0.43±0.02 mm) were significantly smaller than the actual diameters (P=0.02-0.04). Stent wires were overestimated on conventional CT images with diameters more than 2-fold larger than the actual sizes (P=0.007-0.03) at both top and body regions of all four stent grafts. Conclusions This study further confirms the accuracy of high-resolution synchrotron radiation CT in image visualization and size measurement of different aortic stent grafts with measured wire diameters similar to the actual ones, thus allowing for more accurate assessment of stent wire details for endovascular repair of aortic aneurysms.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Cláudia Sá Dos Reis
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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Patient-related factors influencing detectability of coronary arteries in 320-row CT angiography in infants with complex congenital heart disease. Int J Cardiovasc Imaging 2018; 34:1485-1491. [DOI: 10.1007/s10554-018-1363-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
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Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women. Can J Cardiol 2018; 34:400-412. [DOI: 10.1016/j.cjca.2018.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/17/2023] Open
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Amin MI, Hassan HA, Mousa MI. Utility of 128-row multidetector CT in quantitative evaluation of global left ventricular function in patients with coronary artery disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Duvall WL, Tandon TS, Henzlova MJ. The time is now: Dose reduction for myocardial perfusion imaging. J Nucl Cardiol 2018; 25:131-133. [PMID: 27535414 DOI: 10.1007/s12350-016-0639-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- W Lane Duvall
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.
| | - Tarun S Tandon
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - Milena J Henzlova
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
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Gong H, Li B, Jia X, Cao G. Physics Model-Based Scatter Correction in Multi-Source Interior Computed Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:349-360. [PMID: 28829306 DOI: 10.1109/tmi.2017.2741259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Multi-source interior computed tomography (CT) has a great potential to provide ultra-fast and organ-oriented imaging at low radiation dose. However, X-ray cross scattering from multiple simultaneously activated X-ray imaging chains compromises imaging quality. Previously, we published two hardware-based scatter correction methods for multi-source interior CT. Here, we propose a software-based scatter correction method, with the benefit of no need for hardware modifications. The new method is based on a physics model and an iterative framework. The physics model was derived analytically, and was used to calculate X-ray scattering signals in both forward direction and cross directions in multi-source interior CT. The physics model was integrated to an iterative scatter correction framework to reduce scatter artifacts. The method was applied to phantom data from both Monte Carlo simulations and physical experimentation that were designed to emulate the image acquisition in a multi-source interior CT architecture recently proposed by our team. The proposed scatter correction method reduced scatter artifacts significantly, even with only one iteration. Within a few iterations, the reconstructed images fast converged toward the "scatter-free" reference images. After applying the scatter correction method, the maximum CT number error at the region-of-interests (ROIs) was reduced to 46 HU in numerical phantom dataset and 48 HU in physical phantom dataset respectively, and the contrast-noise-ratio at those ROIs increased by up to 44.3% and up to 19.7%, respectively. The proposed physics model-based iterative scatter correction method could be useful for scatter correction in dual-source or multi-source CT.
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Kim J, Kang JW, Kim K, Choi SI, Chun EJ, Kim YG, Kim WY, Seo DW, Shin J, Lee H, Jin KN, Ahn S, Hwang SS, Kim KP, Jeong RB, Ha SO, Choi B, Yoon CH, Suh JW, Kim HL, Kim JK, Jang S, Seo JS. SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial. Clin Exp Emerg Med 2018; 4:208-213. [PMID: 29306269 PMCID: PMC5758626 DOI: 10.15441/ceem.17.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Goon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Huijai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang-Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Sik Hwang
- Department of Preventive Medicine, Seoul National University School of Public Health, Seoul, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Suwon, Korea
| | - Ru-Bi Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hack-Lyoung Kim
- Department of Cardiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Kyoung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Seon Seo
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Alkhulaifi AM, Chooriyil N, Alkuwari M, Ghareep AN, Carr C. Coronary artery anomalies: Unusually high incidence of anomalies with a malignant course in an Asian population. SAGE Open Med 2017; 5:2050312117741823. [PMID: 29163951 PMCID: PMC5692126 DOI: 10.1177/2050312117741823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/16/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives: Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes. Methods: We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms. Results: During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery. Conclusion: There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.
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Affiliation(s)
| | | | - Maryam Alkuwari
- Department of Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Cornelia Carr
- CT Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Szilveszter B, Kolossváry M, Karády J, Jermendy ÁL, Károlyi M, Panajotu A, Bagyura Z, Vecsey-Nagy M, Cury RC, Leipsic JA, Merkely B, Maurovich-Horvat P. Structured reporting platform improves CAD-RADS assessment. J Cardiovasc Comput Tomogr 2017; 11:449-454. [DOI: 10.1016/j.jcct.2017.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
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Kalisz K, Halliburton S, Abbara S, Leipsic JA, Albrecht MH, Schoepf UJ, Rajiah P. Update on Cardiovascular Applications of Multienergy CT. Radiographics 2017; 37:1955-1974. [DOI: 10.1148/rg.2017170100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Marwan M, Hell M, Schuhbäck A, Gauss S, Bittner D, Pflederer T, Achenbach S. CT Attenuation of Pericoronary Adipose Tissue in Normal Versus Atherosclerotic Coronary Segments as Defined by Intravascular Ultrasound. J Comput Assist Tomogr 2017; 41:762-767. [PMID: 28914752 DOI: 10.1097/rct.0000000000000589] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The factors influencing genesis of atherosclerosis at specific regions within the coronary arterial system are currently uncertain. Local mechanical factors such as shear stress as well as metabolic factors, including inflammatory mediators released from epicardial fat, have been proposed. We analyzed computed tomographic (CT) attenuation of pericoronary adipose tissue in normal versus atherosclerotic coronary segments as defined by intravascular ultrasound (IVUS). PATIENTS AND METHODS We evaluated the data sets of 29 patients who were referred for invasive coronary angiography and in whom IVUS of 1 coronary vessel was performed for clinical reasons. Coronary CT angiography was performed within 24 hours from invasive coronary angiography. Computed tomographic angiography was performed using dual-source CT (Siemens Healthcare; Forchheim, Germany). A contrast-enhanced volume data set was acquired (120 kV, 400 mA/rot, collimation 2 × 64 × 0.6 mm, 60-80 mL intravenous contrast agent). Intravascular ultrasound was performed using a 40-MHz IVUS catheter (Atlantis; Boston Scientific Corporation, Natick, Mass) and motorized pullback at 0.5 mm/s. Sixty corresponding coronary artery segments within the coronary artery system were identified in both dual source computed tomography and IVUS using bifurcation points as fiducial markers. In dual source computed tomography data sets, 8 serial parallel cross sections (2-mm slice thickness) were rendered orthogonal to the center line of the coronary artery for each segment. For each cross section, pericoronary adipose tissue within a radius of 3 mm from the coronary artery and enclosed within the epicardium (excluding coronary veins and myocardium) was manually traced and mean CT attenuation values were obtained. Intravascular ultrasound was used to define coronary segments as follows: presence of predominantly fibrous atherosclerotic plaque (hyperechoic), presence of predominantly lipid-rich atherosclerotic plaque (hypoechoic), and absence of atherosclerotic plaque. RESULTS In IVUS, 20 coronary segments with fibrous plaque, 20 segments with lipid-rich plaque, and 20 coronary segments without plaque were identified. The mean CT attenuation of pericoronary adipose tissue for segments with any coronary atherosclerotic plaque was -34 ± 14 Hounsfield units (HU), as compared with -56 ± 16 HU for segments without plaque (P = 0.005). The density of pericoronary fat in segments with fibrous versus lipid-rich plaque as defined by IVUS was not significantly different (-35 ± 19 HU vs -36 ± 16 HU, P = 0.8). CONCLUSIONS Mean CT attenuation of pericoronary adipose tissue is significantly lower for normal versus atherosclerotic coronary segments. This supports a hypothesis of different types of pericoronary adipose tissue, the more metabolically active of which might exert local effects on the coronary vessels, thus contributing to atherogenesis.
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Affiliation(s)
- Mohamed Marwan
- From the Department of Cardiology, University of Erlangen, Germany
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