1
|
Zhou B, Tang Z, Huang X, Zhu H, Li X, Xiong H, Yu J, Liao R, Zhang D. Subtraction coronary CT angiography in patients with high heart rate. Acta Cardiol 2023; 78:99-108. [PMID: 35384795 DOI: 10.1080/00015385.2022.2061111] [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: 11/01/2022]
Abstract
All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA (p < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR.
Collapse
Affiliation(s)
- Bi Zhou
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hongzhang Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| |
Collapse
|
2
|
Pang K, Pan D, Xu H, Ma Y, Wang J, Xu P, Wang H, Zang G. Advances in physical diagnosis and treatment of male erectile dysfunction. Front Physiol 2023; 13:1096741. [PMID: 36699684 PMCID: PMC9868413 DOI: 10.3389/fphys.2022.1096741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
Erectile dysfunction (ED) is the most common male sexual dysfunction by far and the prevalence is increasing year after year. As technology advances, a wide range of physical diagnosis tools and therapeutic approaches have been developed for ED. At present, typical diagnostic devices include erection basic parameter measuring instrument, erection hardness quantitative analysis system, hemodynamic testing equipment, nocturnal erection measuring instrument, nerve conduction testing equipment, etc. At present, the most commonly used treatment for ED is pharmacological therapy represented by phosphodiesterase five inhibitors (PDE5i). As a first-line drug in clinical, PDE5i has outstanding clinical effects, but there are still some problems that deserve the attention of researchers, such as cost issues and some side effects, like visual disturbances, indigestion, myalgia, and back pain, as well as some non-response rates. Some patients have to consider alternative treatments. Moreover, the efficacy in some angiogenic EDs (diabetes and cardiovascular disease) has not met expectations, so there is still a need to continuously develop new methods that can improve hemodynamics. While drug have now been shown to be effective in treating ED, they only control symptoms and do not restore function in most cases. The increasing prevalence of ED also makes us more motivated to find safer, more effective, and simpler treatments. The exploration of relevant mechanisms can also serve as a springboard for the development of more clinically meaningful physiotherapy approaches. Therefore, people are currently devoted to studying the effects of physical therapy and physical therapy combined with drug therapy on ED. We reviewed the diagnosis of ED and related physical therapy methods, and explored the pathogenesis of ED. In our opinion, these treatment methods could help many ED patients recover fully or partially from ED within the next few decades.
Collapse
Affiliation(s)
- Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China
| | - Deng Pan
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Hao Xu
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Yuyang Ma
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Jingkai Wang
- Graduate School, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Peng Xu
- Graduate School, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Hailuo Wang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China
| | - Guanghui Zang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China,*Correspondence: Guanghui Zang,
| |
Collapse
|
3
|
Mander GT, Dobeli K, Steffensen C, Munn Z. Diagnostic accuracy of prospectively gated, 128-slice or greater CTCA at high heart rates: a systematic review and meta-analysis. J Med Radiat Sci 2021; 68:435-445. [PMID: 34235885 PMCID: PMC8656183 DOI: 10.1002/jmrs.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Prospectively gated 64-slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128-slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm. METHODS A systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full-text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS-2 tool. RESULTS Ten studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta-analysis, including six of which reported data at the patient level. Meta-analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88). CONCLUSIONS Prospectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128-slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.
Collapse
Affiliation(s)
- Gordon T.W. Mander
- Toowoomba HospitalDarling Downs HealthQueensland HealthToowoombaQueenslandAustralia
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Karen Dobeli
- Royal Brisbane and Women’s HospitalMetro North Hospital and Health ServiceQueensland HealthHerstonQueenslandAustralia
| | - Caitlin Steffensen
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Philips Australia and New ZealandBrisbaneQueenslandAustralia
| | - Zachary Munn
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
4
|
Sun Z, Chaichana T. An investigation of correlation between left coronary bifurcation angle and hemodynamic changes in coronary stenosis by coronary computed tomography angiography-derived computational fluid dynamics. Quant Imaging Med Surg 2017; 7:537-548. [PMID: 29184766 DOI: 10.21037/qims.2017.10.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the correlation between left coronary bifurcation angle and coronary stenosis as assessed by coronary computed tomography angiography (CCTA)-generated computational fluid dynamics (CFD) analysis when compared to the CCTA analysis of coronary lumen stenosis and plaque lesion length with invasive coronary angiography (ICA) as the reference method. Methods Thirty patients (22 males, mean age: 59±6.9 years) with calcified plaques at the left coronary artery were included in the study with all patients undergoing CCTA and ICA examinations. CFD simulation was performed to analyze hemodynamic changes to the left coronary artery models in terms of wall shear stress, wall pressure and flow velocity, with findings correlated to the coronary stenosis and degree of bifurcation angle. Calcified plaque length was measured in the left coronary artery with diagnostic value compared to that from coronary lumen and bifurcation angle assessments. Results Of 26 significant stenosis at left anterior descending (LAD) and 13 at left circumflex (LCx) on CCTA, only 14 and 5 of them were confirmed to be >50% stenosis at LAD and LCx respectively on ICA, resulting in sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 52%, 49% and 100%. The mean plaque length was measured 5.3±3.6 and 4.4±1.9 mm at LAD and LCx, respectively, with diagnostic sensitivity, specificity, PPV and NPV being 92.8%, 46.7%, 61.9% and 87.5% for extensively calcified plaques. The mean bifurcation angle was measured 83.9±13.6º and 83.8±13.3º on CCTA and ICA, respectively, with no significant difference (P=0.98). The corresponding sensitivity, specificity, PPV and NPV were 100%, 78.6%, 84.2% and 100% based on bifurcation angle measurement on CCTA, 100%, 73.3%, 78.9% and 100% based on bifurcation angle measurements on ICA, respectively. Wall shear stress was noted to increase in the LAD and LCx models with significant stenosis and wider angulation (>80º), but demonstrated little or no change in most of the coronary models with no significant stenosis and narrower angulation (<80º). Conclusions This study further clarifies the relationship between left coronary bifurcation angle and significant stenosis, with angulation measurement serving as a more accurate approach than coronary lumen assessment or plaque lesion length for determining significant coronary stenosis. Left coronary bifurcation angle is suggested to be incorporated into coronary artery disease (CAD) assessment when diagnosing significant CAD.
Collapse
Affiliation(s)
- Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Thanapong Chaichana
- Department of Mathematics and Computer Science, Liverpool Hope University, Liverpool, England, UK
| |
Collapse
|
5
|
Diagnostic value of four-dimensional CT angiography in arterial erectile dysfunction using 320-detector row dynamic volume CT. Biosci Rep 2017; 37:BSR20170200. [PMID: 28710184 PMCID: PMC5563537 DOI: 10.1042/bsr20170200] [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: 03/03/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/23/2022] Open
Abstract
The present study aims to evaluate the diagnostic value of four-dimensional CT angiography (4D-CTA) in the diagnosis of arterial erectile dysfunction (ED) using 320-detector row dynamic volume CT. Arterial ED patients attributed to arterial insufficiency were enrolled. To induce penile erection, an intracavernous injection (ICI) of corpus cavernosum with a vasoactive drug was administered. Patients were assigned into the erection hardness score (EHS) 1/2 group or EHS 3/4 group. Color duplex Doppler ultrasound (CDDU) was used to analyze blood flow spectrum. Each patient was examined using 4D-CTA. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of 4D-CTA in arterial ED. According to Irwin Goldstein, the EHS 3/4 group (n=38) had a shorter course of ED and low proportion with history of hypertension, hyperlipidemia, and diabetes than the EHS 1/2 group (n=35). The peak systolic velocity (PSV), end diastolic velocity (EDV), and resistant index (RI) in the EHS 3/4 group were lower than those of the EHS 1/2 group. 4D-CTA showed there were a total of 35 cases in the EHS 1/2 group (two cases missed) and 38 cases in the EHS 3/4 group (seven cases misdiagnosed). Using 4D-CTA to diagnose arterial ED, the area under the ROC curve yielded a value of 0.879, with a specificity of 93.9% and a sensitivity of 82.5%. These findings indicated that 4D-CTA using 320-detector row dynamic volume CT is a promising and reliable utility in diagnosing arterial ED.
Collapse
|
6
|
Comprehensive assessment of cavernosography with 320-row dynamic volume CT versus conventional cavernosography in erectile dysfunction patients caused by venous leakage. Biosci Rep 2017; 37:BSR20170112. [PMID: 28424371 PMCID: PMC5426282 DOI: 10.1042/bsr20170112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/13/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022] Open
Abstract
The present study aims to investigate and compare the diagnostic and prognostic value of cavernosography with 320-row dynamic volume computed tomography (DVCT) versus conventional cavernosography in men with erectile dysfunction (ED) caused by venous leakage. A total of 174 patients diagnosed with ED were enrolled and received cavernosography with 320-row DVCT (DVCT group) and conventional cavernosography scans (control group) respectively. The diagnosis, complications, and prognosis of patients were evaluated. The DVCT group provided high-resolution images with less processing and testing time, as well as lowered radiological agent and contrast agent compared with the control group. In the DVCT group, 89 patients who were diagnosed with venous ED had six various venous leakage, namely superficial venous leakage, profundus venous leakage, the mixed type, cavernosal venous leakage, crural venous leakage, and also venous leakage between the penis and urethra cavernosum (9, 21, 32, 6, 18, and 3 cases respectively). Similarly, 74 patients out of the 81 who suffered from venous ED were classified to have superficial venous leakage (11), profundus venous leakage (14), the mixed type venous leakage (26), and middle venous leakage (23). Six out of 25 patients in the DVCT group, had improvements in ED while the remaining 19 achieved full erectile function recovery with no penile fibrosis and erectile pain. Cavernosography with 320-row DVCT is a reliable system that can be used to diagnose ED caused by venous leakage. This is especially useful in accurately determining the type of venous and allows for a better prognosis and direction of treatment.
Collapse
|
7
|
Nerlekar N, Ko BS, Nasis A, Cameron JD, Leung M, Brown AJ, Wong DTL, Ngu PJ, Troupis JM, Seneviratne SK. Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography. Cardiovasc Diagn Ther 2017; 7:296-304. [PMID: 28567355 DOI: 10.21037/cdt.2017.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA). METHODS Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm). A wider phase window was used for the elevated HR group (30-80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score. RESULTS Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61-80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort. CONCLUSIONS In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.
Collapse
Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Philip J Ngu
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - John M Troupis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia.,Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| |
Collapse
|
8
|
Influence of the coronary calcium score on the ability to rule out coronary artery stenoses by coronary CT angiography in patients with suspected coronary artery disease. J Cardiovasc Comput Tomogr 2016; 10:343-50. [DOI: 10.1016/j.jcct.2016.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
|
9
|
Di Marco L, Rosset M, Zhang-Yin J, Ohana M. [Multimodal imaging of ischemic heart diseases: A 2015 update]. Rev Med Interne 2016; 37:350-62. [PMID: 26775644 DOI: 10.1016/j.revmed.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/08/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022]
Abstract
Current realities and future possibilities of imaging in the ischemic heart diseases are very broad and constantly evolving, with the improvement of existing technologies and the introduction of new features such as dual-energy CT, strain ultrasound, multimodality fusion or perfusion MRI. Regular collaboration between prescribing clinicians, cardiologists, radiologists and nuclear radiologists is therefore essential to tailor the examination to the specific clinical question. The indications for each modality will therefore depend on its diagnostic performance, cost, acquisition and post-processing times and eventual radiation exposure. This review will detail principles and applications of current cardiac imaging examinations: echocardiography, nuclear medicine, MRI, CT and coronary angiography, emphasizing their current strengths and weaknesses in the ischemic heart diseases management.
Collapse
Affiliation(s)
- L Di Marco
- Imagerie, Bocage Central, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - M Rosset
- Cardiologie, hôpital Louis-Pradel, 28, avenue du Doyen-Jean-Lépine, 69500 Bron, France
| | - J Zhang-Yin
- Médecine nucléaire, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - M Ohana
- Imagerie, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg, France
| |
Collapse
|
10
|
Assessment of Extracardiac and Intracardiac Anatomy by MD-CT. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
11
|
Takaoka H, Funabashi N, Fujimoto Y, Kobayashi Y. Detection of significant stenosis in the Left Anterior Descending Artery by ‘Virtual Myocardial Perfusion’ Bolus Tracking, 320 Slice Computed Tomography. Int J Cardiol 2014; 177:1001-7. [DOI: 10.1016/j.ijcard.2014.09.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 09/10/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
|
12
|
Li XY, Zhang GM, Zhang HM, Sun G, Han SF, Tan H, Gao YQ, Jin Q, Li YM, Fang J. Value of segmental coronary calcium score on diagnosis and interventional treatment of coronary lesions by 320-slice DVCT. Int J Clin Exp Med 2014; 7:2223-2229. [PMID: 25232412 PMCID: PMC4161572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/27/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED The global coronary calcium score has been widely used in the evaluation of coronary plaque burden and cardiovascular disease events. In this study, we investigated the value of segmental coronary calcium score (SCCS) on the diagnosis and interventional treatment. We studied 87 patients with coronary angiography (CAG) and coronary CT angiography (CTA) by 320-slice dynamic volume CT (DVCT). SCCS was determined for each segmental separately. All lesions which SCCS was greater than 0 were enrolled, and were divided into three groups, mild calcification group (SCCS were less than 80), Moderate calcification group (SCCS were more than 80 and less than 200) and Severe calcification group (SCCS were more than 200). From above three groups, lesions received the intervention treatment were elected as subgroup. The position of lesions, plaque morphology, calcification proportion and interventional treatment data were analyzed. Severe calcification group were more frequent in the proximal lesions, stenosis with lesser extent, nubbly and nodular types of plaque, and the inconsistency with CAG was higher than the other two groups (P < 0.05). In the subgroup, more pre-dilatation and post-dilatation balloon were used in severe calcification group, with higher expansion pressure of balloon and stent (P < 0.05), but the diameter of stents was no difference between the three groups. CONCLUSION SCCS is better than GCCS in the evaluation of coronary calcification, and play an important role in the judgment of stenosis by coronary CT and in the choice of interventional therapeutic devices.
Collapse
Affiliation(s)
- Xiao-Yan Li
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Guo-Ming Zhang
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Hong-Ming Zhang
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Gang Sun
- Department of Radiology, Jinan Military General Hospital Jinan 250031, China
| | - Shu-Fang Han
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Hong Tan
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Yu-Qi Gao
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Qun Jin
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Yan-Min Li
- Department of Cardiology, Jinan Military General Hospital Jinan 250031, China
| | - Jie Fang
- Graduate School of Liaoning Medical University Jinzhou, Liaoning 121001, China
| |
Collapse
|
13
|
False-positive findings in 320-slice cardiac CT for detection of severe coronary stenosis in comparison with invasive coronary angiography indicate poor prognosis for occurrence of MACE. Int J Cardiol 2014; 172:235-7. [DOI: 10.1016/j.ijcard.2013.12.213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/29/2013] [Indexed: 11/18/2022]
|
14
|
Li M, Du XM, Jin ZT, Peng ZH, Ding J, Li L. The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis. PLoS One 2014; 9:e84937. [PMID: 24465453 PMCID: PMC3897406 DOI: 10.1371/journal.pone.0084937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/20/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. MATERIALS AND METHODS PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. RESULTS 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%. CONCLUSION The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
Collapse
Affiliation(s)
- Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Xiang-min Du
- Department of Medical Engineering, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Zhi-tao Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - Zhao-hui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Juan Ding
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Li Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| |
Collapse
|
15
|
Prospective ECG-Gated Coronary 320-MDCT Angiography With Absolute Acquisition Delay Strategy for Patients With Persistent Atrial Fibrillation. AJR Am J Roentgenol 2013; 201:1197-203. [DOI: 10.2214/ajr.12.10140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Li S, Ni Q, Wu H, Peng L, Dong R, Chen L, Liu J. Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: meta-analysis. Int J Cardiol 2013; 168:2699-705. [PMID: 23566493 DOI: 10.1016/j.ijcard.2013.03.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/26/2013] [Accepted: 03/17/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aims to review the recent literatures on the diagnostic accuracy of 320-slice computed tomography angiography (CTA) for detection of coronary artery stenosis, with invasive coronary angiography (ICA) as the reference standard. METHODS A PubMed and EMBASE cross-search of the literatures on use of 320-slice CTA compared with ICA for detection of coronary artery stenosis, with publication date limited to January 1, 2008 to December 31, 2012. Individual and pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated at the patient-, vessel- and segment-level. A positive result was defined as greater than or equal to 50%-diameter stenosis. RESULTS A total of ten studies were included in the present meta-analysis, examining 1088 patients, 1629 vessels and 12,406 segments. The meta-analysis at the patient-level indicated a pooled sensitivity of 93% (95%CI: 91%-95%), specificity of 86% (95%CI: 82%-89%), PPV of 90% (95%CI: 87%-92%) and NPV of 90% (95%CI: 87%-93%). At the vessel-level, the pooled sensitivity was 92% (95%CI: 89%-94%), specificity 95% (95%CI: 94%-96%), PPV 87% (95%CI: 83%-90%), and NPV 97% (95%CI: 96%-98%). At the segment-level, the pooled sensitivity was 78% (95%CI: 76%-80%), specificity 98% (95%CI: 97%-98%), PPV 82% (95%CI: 80%-84%), and NPV 97% (95%CI: 97%-97%). CONCLUSIONS 320-CTA can effectively identify the majority of patients with coronary artery disease (CAD). The high NPV makes it as an effective noninvasive alternative to ICA for the exclusion of stenosis.
Collapse
Affiliation(s)
- Suhua Li
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, Guangzhou 510630, China
| | | | | | | | | | | | | |
Collapse
|
17
|
Westwood ME, Raatz HDI, Misso K, Burgers L, Redekop K, Lhachimi SK, Armstrong N, Kleijnen J. Systematic review of the accuracy of dual-source cardiac CT for detection of arterial stenosis in difficult to image patient groups. Radiology 2013; 267:387-95. [PMID: 23392425 DOI: 10.1148/radiol.13121136] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the diagnostic performance of dual-source cardiac (DSC) computed tomography (CT) newer-generation CT instruments for identifying anatomically significant coronary artery disease (CAD) in patients who are difficult to image by using 64-section CT. MATERIALS AND METHODS A literature search comprised bibliographic databases (January 1, 2000, to March 22, 2011, with a pragmatic update on September 6, 2012), trial registries, and conference proceedings. Only studies using invasive coronary angiography as reference standard were included. Risk of bias was assessed (QUADAS-2). Results were stratified according to patient group on the basis of clinical characteristics. Summary estimates of sensitivity and specificity of DSC CT for detecting 50% or greater arterial stenosis were calculated by using a bivariate summary receiver operating characteristic or random-effects model. RESULTS Twenty-five studies reported accuracy of DSC CT for diagnosing CAD in difficult to image patients; in 22 studies, one of two CT units of the same manufacturer (Somatom Definition or Somatom Definition Flash) was used, and in the remaining three, a different CT unit of another manufacturer (Aquilion One) was used. The pooled, per-patient estimates of sensitivity were 97.7% (95% confidence interval [CI]: 88.0%, 99.9%) and 97.7% (95% CI: 93.2%, 99.3%) for patients with arrhythmias and high heart rates, respectively. The corresponding pooled estimates of specificity were 81.7% (95% CI: 71.6%, 89.4%) and 86.3% (95% CI: 80.2%, 90.7%), respectively. All data were acquired by using Somatom Definition. In two studies with Somatom and one study with Aquilion One, sensitivity estimates of 90% or greater were reported in patients with previous stent implantations; specificities were 81.7% and 89.5% for Somatom and 81.0% for Aquilion One. In patients with high coronary calcium scores, previous bypass grafts, or obesity, only per-segment or per-artery data were available. Sensitivity estimates remained high (>90% in all but one study), and specificities ranged from 79.1% to 100%. All data were acquired by using Somatom Definition. CONCLUSION DSC CT may be sufficiently accurate to diagnose clinically significant CAD in some or all difficult to image patients. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121136/-/DC1.
Collapse
Affiliation(s)
- Marie E Westwood
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, England
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Gaudio C, Pelliccia F, Evangelista A, Tanzilli G, Paravati V, Pannarale G, Pannitteri G, Barillà F, Greco C, Franzoni F, Speziale G, Pasceri V. 320-row computed tomography coronary angiography vs. conventional coronary angiography in patients with suspected coronary artery disease: a systematic review and meta-analysis. Int J Cardiol 2013; 168:1562-4. [PMID: 23347611 DOI: 10.1016/j.ijcard.2012.12.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/19/2012] [Accepted: 12/25/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Carlo Gaudio
- Department "Attilio Reale", Sapienza University, Rome, Italy; Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
den Dekker MAM, de Smet K, de Bock GH, Tio RA, Oudkerk M, Vliegenthart R. Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis. Eur Radiol 2012; 22:2688-98. [PMID: 22797978 DOI: 10.1007/s00330-012-2551-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Martijn A M den Dekker
- Center for Medical Imaging - North East Netherlands, Department of Radiology, University of Groningen/University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
20
|
Sun G, Li M, Jiang XS, Li L, Peng ZH, Li GY, Xu L. 320-detector row CT coronary angiography: effects of heart rate and heart rate variability on image quality, diagnostic accuracy and radiation exposure. Br J Radiol 2012; 85:e388-94. [PMID: 22374285 DOI: 10.1259/bjr/92160185] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the effects of heart rate and heart rate variability on image quality, patient dose and diagnostic accuracy of 320-detector row CT. METHODS 94 patients were prospectively enrolled. Heart rate was defined as the mean value of different intervals elapsing between two consecutive R waves in an electrocardiogram (R-R intervals) and the heart rate variability was calculated as the standard deviation from the average heart rate. The image quality was evaluated by four grades, according to motion artefacts ("step artefacts" and "blurring artefacts"). The diagnostic accuracy was analysed in 43 patients who were scheduled for invasive coronary angiography (ICA). The coeffects of heart rate and heart rate variability on image quality, radiation dose and diagnostic accuracy were evaluated by multivariate regression. RESULTS The mean image quality score was 1.2 ± 0.5 and the mean effective dose was 14.8 ± 9.8 mSv. The results showed that heart rate (74.0 ± 11.2 beats per minute) was the single factor influencing image quality (p<0.001) and radiation dose (p<0.001), while heart rate variability (3.7 ± 4.6) had no significant effect on them (p=0.16 and p=0.47, respectively). For 43 patients who underwent ICA, heart rate and heart rate variability showed no influence on the accuracy (p=0.17 and p=0.12, respectively). Overall sensitivity was 97.4% (37/38), specificity was 99.4% (351/353), positive predictive value was 94.9% (37/39) and negative predictive value was 99.7% (351/352). CONCLUSION 320-detector row CT, with improved longitudinal coverage of detector, resolves step artefact and high patient dose caused by irregular heart rate. However, it is still recommended to control heart rate to a lower level to eliminate blurring artefact and radiation dose.
Collapse
Affiliation(s)
- G Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shangdong Province, China.
| | | | | | | | | | | | | |
Collapse
|