1
|
Dell’Aversana S, Ascione R, Vitale RA, Cavaliere F, Porcaro P, Basile L, Napolitano G, Boccalatte M, Sibilio G, Esposito G, Franzone A, Di Costanzo G, Muscogiuri G, Sironi S, Cuocolo R, Cavaglià E, Ponsiglione A, Imbriaco M. CT Coronary Angiography: Technical Approach and Atherosclerotic Plaque Characterization. J Clin Med 2023; 12:7615. [PMID: 38137684 PMCID: PMC10744060 DOI: 10.3390/jcm12247615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) currently represents a robust imaging technique for the detection, quantification and characterization of coronary atherosclerosis. However, CCTA remains a challenging task requiring both high spatial and temporal resolution to provide motion-free images of the coronary arteries. Several CCTA features, such as low attenuation, positive remodeling, spotty calcification, napkin-ring and high pericoronary fat attenuation index have been proved as associated to high-risk plaques. This review aims to explore the role of CCTA in the characterization of high-risk atherosclerotic plaque and the recent advancements in CCTA technologies with a focus on radiomics plaque analysis.
Collapse
Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy; (S.D.); (G.D.C.); (E.C.)
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Raffaella Antonia Vitale
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Fabrizia Cavaliere
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Piercarmine Porcaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Luigi Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | | | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy; (M.B.); (G.S.)
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy; (M.B.); (G.S.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy; (S.D.); (G.D.C.); (E.C.)
| | - Giuseppe Muscogiuri
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (G.M.); (S.S.)
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (G.M.); (S.S.)
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy;
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy; (S.D.); (G.D.C.); (E.C.)
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.A.); (R.A.V.); (F.C.); (P.P.); (L.B.); (G.E.); (A.F.); (M.I.)
| |
Collapse
|
2
|
Cundari G, Alkadhi H, Eberhard M. The role of CT in arrhythmia management-treatment planning and post-procedural imaging surveillance. Br J Radiol 2023; 96:20230028. [PMID: 37191058 PMCID: PMC10607403 DOI: 10.1259/bjr.20230028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Several interventional treatment options exist in patients with atrial and ventricular arrhythmia. Cardiac CT is routinely performed prior to occlusion of the left atrial appendage, pulmonary vein isolation, and cardiac device implantation. Besides the evaluation of coronary artery disease, cardiac CT provides isotropic, high-resolution CT images of the cardiac anatomy with the possibility of multiplanar reformations and three-dimensional reconstructions which are helpful to guide interventional treatment. In addition, cardiac CT is increasingly used to rapidly evaluate periprocedural complications and for the routine post-procedural imaging surveillance in patients after interventions. This review article will discuss current applications of pre- and post-interventional CT imaging in patients with arrhythmia.
Collapse
Affiliation(s)
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
3
|
Afrakhteh S, Iacca G, Demi L. High Frame Rate Ultrasound Imaging by Means of Tensor Completion: Application to Echocardiography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:41-51. [PMID: 36399594 DOI: 10.1109/tuffc.2022.3223499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
High frame rate ultrasound (US) imaging enables the monitoring of fast-moving organs. In echocardiography, this is especially needed due to the existence of rapidly moving structures, such as the heart valves. In the last two decades, various methods have been proposed to improve the frame rate. Here, we propose a novel method, based on binary coding patterns (BCPs) and tensor completion (TC), to increase the temporal resolution (i.e., frame rate) in the preprocessing stage of conventional focused ultrasound imaging (CFUI). The rationale behind our proposal is to perform, at first, the beamforming of a fraction of the scan lines, randomly selected in each frame based on BCP. Then, we reconstruct the missing scan lines through TC. The latter is an effective technique for recovering missing information from a low-rank tensor, based on a small number of observations using rank minimization. Following our approach, reducing the transmissions events needed to generate an image, the frame rate is increased by the same proportion. We have applied the proposed technique to a pre-beamformed radio frequency (RF) echocardiographic dataset. Our results show that we can improve the frame rate by a factor from 3 to 4, while keeping the structural similarity (SSIM) of the reconstructed tensor and the original one at values higher than 0.98.
Collapse
|
4
|
Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. Semin Ultrasound CT MR 2022; 43:184-193. [PMID: 35688530 DOI: 10.1053/j.sult.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered.
Collapse
Affiliation(s)
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, Albuquerque, NM..
| |
Collapse
|
5
|
Graef J, Leidel BA, Bressem KK, Vahldiek JL, Hamm B, Niehues SM. Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition. Diagnostics (Basel) 2021; 11:diagnostics11061122. [PMID: 34205468 PMCID: PMC8235148 DOI: 10.3390/diagnostics11061122] [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: 05/26/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.
Collapse
Affiliation(s)
- Jessica Graef
- Department of Radiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany; (K.K.B.); (J.L.V.); (B.H.)
- Correspondence: (J.G.); (S.M.N.)
| | - Bernd A. Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany;
| | - Keno K. Bressem
- Department of Radiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany; (K.K.B.); (J.L.V.); (B.H.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Janis L. Vahldiek
- Department of Radiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany; (K.K.B.); (J.L.V.); (B.H.)
| | - Bernd Hamm
- Department of Radiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany; (K.K.B.); (J.L.V.); (B.H.)
| | - Stefan M. Niehues
- Department of Radiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, 12203 Berlin, Germany; (K.K.B.); (J.L.V.); (B.H.)
- Correspondence: (J.G.); (S.M.N.)
| |
Collapse
|
6
|
Osawa K, Nakanishi R, Ceponiene I, Nezarat N, French WJ, Budoff MJ. Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement. Tex Heart Inst J 2020; 47:78-85. [PMID: 32603460 DOI: 10.14503/thij-17-6290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03-1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05-1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.
Collapse
Affiliation(s)
- Kazuhiro Osawa
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| | - Rine Nakanishi
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| | - Indre Ceponiene
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| | - Negin Nezarat
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| | - William J French
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502
| |
Collapse
|
7
|
Miller RJH, Eisenberg E, Friedman J, Cheng V, Hayes S, Tamarappoo B, Thomson L, Berman DS. Impact of heart rate on coronary computed tomographic angiography interpretability with a third-generation dual-source scanner. Int J Cardiol 2019; 295:42-47. [PMID: 31427117 DOI: 10.1016/j.ijcard.2019.07.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Guidelines suggest coronary computed tomography angiography (CCTA) should be performed with a heart rate (HR) below 60. Third-generation dual-source CT (DSCT) scanners, with improved temporal resolution, and end-systolic acquisition may facilitate imaging at higher HRs. We determined the influence of HR and end-systolic acquisition on image interpretability and quality with a third-generation DSCT. METHODS Patients who underwent CCTA between July 2017 and December 2018 were retrospectively identified. All images were acquired using a SOMATOM Force scanner (Siemens Healthcare). The primary outcome was the presence of any uninterpretable coronary segment. The association between HR and CCTA with uninterpretable segments was assessed with multivariable logistic regression, correcting for demographics and imaging variables. RESULTS In total, 2620 patients were included, mean age 61.4 ± 12.9 years and 61.2% male, with uninterpretable segments present in 229 (8.7%) scans. In multivariable analysis, HR 80-89 was associated with an increased likelihood of having a scan with uninterpretable segments (adjusted odds ratio [OR] 4.53, p < 0.001). However, no significant association was present with end-systolic acquisition (HR 80-89, adjusted OR 2.32, p = 0.125). HR ≥ 90 was associated with a decreased likelihood of good or excellent image quality (adjusted OR 0.26, 95% CI 0.11-0.63, p = 0.003). CONCLUSIONS With third-generation dual-source CT scanners, patients with HR 60-80 can be imaged without impacting image interpretability. End-systolic image acquisition facilitates imaging at HRs > 80 without increasing non-diagnostic scans. Routine use of systolic gating could omit the need for strict HR control and pre-test beta blockade currently required for CCTA.
Collapse
Affiliation(s)
- Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Evann Eisenberg
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - John Friedman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Victor Cheng
- Department of Cardiac Imaging, Oklahoma Heart Institute, Tulsa, OK, United States
| | - Sean Hayes
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Balaji Tamarappoo
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Louise Thomson
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| |
Collapse
|
8
|
Diagnosis of coronary artery disease in patients with atrial fibrillation using low tube voltage coronary CT angiography with isotonic low-concentration contrast agent. Int J Cardiovasc Imaging 2019; 35:2239-2248. [PMID: 31363878 DOI: 10.1007/s10554-019-01678-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
This prospective study evaluated the image quality and accuracy of coronary computed tomography angiography (CCTA) for diagnosing coronary artery disease (CAD) in patients with atrial fibrillation (AF), in which CCTA used adaptive iterative dose reduction (AIDR) with a low tube voltage and low concentration of isotonic contrast agent. Sixty-eight consecutive patients with AF and suspected CAD were equally and randomly apportioned to two groups and underwent CCTA. In the experimental group, the contrast agent was iodixanol (270 mg I/mL), patients were scanned with 100 kV, and reconstruction was by AIDR. In the conventional scanning (control) group, the contrast agent was iopromide (370 mg I/mL), patients were scanned with 120 kV, and reconstruction was by filtered back projection. The image quality, effective radiation dose (E), and total iodine intake of the groups were compared. Thirty-nine patients with coronary artery stenosis later were given invasive coronary angiography (ICA). The groups were similar with regard to mean CT value, noise, and signal-to-noise and contrast-to-noise ratios. The figure of merit of the experimental group was significantly higher than that of the control group, while the E and total iodine were significantly lower. Using ICA as the diagnostic reference, the groups shared similar sensitivity, specificity, and false positive and false negative rates for diagnosing coronary artery stenosis. For determining CAD in patients with AF, CCTA with isotonic low-concentration contrast agent and low-voltage scanning is a feasible alternative that improves accuracy and reduces radiation dose and iodine intake.
Collapse
|
9
|
Grosse A, Grosse C, Lang I. Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension. PLoS One 2018; 13:e0201468. [PMID: 30059549 PMCID: PMC6066236 DOI: 10.1371/journal.pone.0201468] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/16/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome. METHODS Vascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF). RESULTS The majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors. CONCLUSION The majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.
Collapse
Affiliation(s)
- Alexandra Grosse
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Grosse
- Department of Radiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Irene Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Wen B, Xu L, Liang J, Fan Z, Sun Z. A Preliminary Study of Computed Tomography Coronary Angiography Within a Single Cardiac Cycle in Patients With Atrial Fibrillation Using 256-Row Detector Computed Tomography. J Comput Assist Tomogr 2018. [PMID: 29528910 DOI: 10.1097/rct.0000000000000683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the image quality and radiation dose of computed tomography (CT) coronary angiography using a 256-row detector CT scanner in a single cardiac cycle in patients with atrial fibrillation (AF). METHODS Seventy consecutive patients (41 men and 29 women; age range was from 37 to 84 years, mean age was 61.7 ± 10.2 years; body mass index range was from 15.08 to 36.45 kg/m, mean body mass index was 25.9 ± 3.5 kg/m) with persistent or paroxysmal AF during acquisition, who were not receiving any medications for heart rate (HR) regulation, were imaged with a 256-row detector CT scanner (Revolution CT, GE healthcare). According to the HR or HR variability (HRV) the patients were divided into 4 groups: group A (HR, ≥75 bpm; n = 36), group B (HR, <75 bpm; n = 34), group C (HRV, ≥50 bpm; n = 26), and group D (HRV, <50 bpm; n = 44). The snapshot freeze algorithm reconstruction was used to reduce motion artifacts whenever necessary. Two experienced radiologists, who were blinded to the electrocardiograph and reconstruction information, independently graded the CT images in terms of visibility and artifacts with a 4-grade rating scale (1, excellent; 2, good; 3, poor; 4, insufficient) using the 18-segment model. Subjective image quality scores and effective dose (ED) were calculated and compared between these groups. RESULTS The HR during acquisition ranged from 47 to 222 bpm (88.24 ± 36.80 bpm). A total of 917 in 936 coronary artery segments were rated as diagnostically evaluable (98.2 ± 0.04%). There was no significant linear correlation between mean image quality and HR or HRV (P > 0.05). Snapshot freeze reconstruction technique was applied in 28 patients to reduce motion artifacts and thus showed image quality was improved from 93.2% to 98.4%. The ED was 3.05 ± 2.23 mSv (0.49-11.86 mSv) for all patients, and 3.76 ± 2.22 mSv (0.92-11.17 mSv), 2.30 ± 2.02 mSv (0.49-11.86 mSv), 3.89 ± 2.35 mSv (1.18-11.86 mSv), and 2.56 ± 2.03 mSv (0.49-11.17 mSv) for groups A, B, C, and D, respectively. There were significant differences in mean ED between groups A and B, as well as C and D (P <0.05). CONCLUSIONS This study shows that CT coronary angiography with use of a new 256-row detector CT in single cardiac cycle achieves diagnostic image quality but with lower radiation dose in patients with AF. Heart rate or HRV has no significant effect on image quality.
Collapse
|
11
|
Ikeda A, Nakajima T, Hiramatsu Y, Jikuya T. Localized Aortic Root Dissection with a Superior Mesenteric Artery Aneurysm. Ann Vasc Dis 2017; 10:cr.16-00127. [PMID: 29147150 PMCID: PMC5684149 DOI: 10.3400/avd.cr.16-00127] [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: 11/24/2016] [Accepted: 04/10/2017] [Indexed: 11/21/2022] Open
Abstract
In this study, the case of a 46-year-old female patient with localized aortic root dissection and a superior mesenteric artery (SMA) aneurysm is described. Computed tomographic angiography could not clearly delineate an intimal flap in the aortic root, but it detected SMA aneurysm, which implied the presence of a vulnerability of the aortic wall. Finally, transesophageal echocardiography (TEE) evidently showed the intimal flap localized in the aortic root. The present case suggests that TEE is of paramount importance for detecting localized aortic root dissection. In addition, a coexisting vascular lesion may be a clue to diagnose another vascular lesion.
Collapse
Affiliation(s)
- Akihiko Ikeda
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoaki Jikuya
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| |
Collapse
|