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Xu R, Jing M, Zhu H, Xi H, Ren W, Zhou J. Relationship between different clinical characteristics and pericoronary adipose tissue attenuation values quantified from coronary computed tomographic angiography (CCTA) in patients without coronary heart disease (CHD). Quant Imaging Med Surg 2024; 14:4054-4066. [PMID: 38846302 PMCID: PMC11151263 DOI: 10.21037/qims-23-1814] [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: 12/21/2023] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
Background Pericoronary adipose tissue (PCAT) is a sensor of vascular inflammation. Elevated PCAT attenuation values indicate the presence of coronary inflammation in patients. However, it is unclear which clinical characteristics are associated with increased PCAT attenuation values in patients without coronary heart disease (CHD). The study aims to investigate the relationship between increased PCAT attenuation values and clinical characteristics of patients without CHD. Methods We recruited 785 eligible patients without CHD who underwent coronary computed tomographic angiography (CCTA). Clinical data were recorded for each patient, and PCAT attenuation values for the left anterior descending branch (LADPCAT), left circumflex branch (LCXPCAT), and right coronary artery (RCAPCAT) were quantified by CCTA using fully automated software. Univariate and multivariate analyses were performed to identify the associations between different clinical characteristics and elevated LADPCAT, LCXPCAT, and RCAPCAT. Results Univariate analysis showed body mass index (BMI) to be positively associated with LADPCAT (rs=0.109), LCXPCAT (rs=0.076), and RCAPCAT (rs=0.083). Moreover, the duration of smoking, and drinking was positively associated with LADPCAT (rs=0.099, 0.165). Hyperlipidemia was positively associated with LADPCAT (rs=0.089) and RCAPCAT (rs=0.334), while statin use was negatively associated with RCAPCAT (rs=-0.145). Multivariate analysis showed that the significant determinants of LADPCAT were BMI (β=0.359, P=0.001), duration of smoking (β=2.612, P=0.002), drinking (β=4.106, P<0.001), and hyperlipidemia (β=1.664, P=0.027). LCXPCAT was associated with BMI (β=0.218, P=0.024), while RCAPCAT was associated with hyperlipidemia (β=6.110, P<0.001) and statin use (β=-3.338, P<0.001). Conclusions In patients without CHD, the PCAT attenuation values measured using CCTA were associated with various clinical characteristics. LADPCAT was associated with BMI, smoking duration, drinking, and hyperlipidemia. On the other hand, LCXPCAT was associated with BMI, while RCAPCAT was associated with hyperlipidemia and statin use.
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Affiliation(s)
- Rui Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Wei Ren
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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Guglielmo M, Penso M, Carerj ML, Giacari CM, Volpe A, Fusini L, Baggiano A, Mushtaq S, Annoni A, Cannata F, Cilia F, Del Torto A, Fazzari F, Formenti A, Frappampina A, Gripari P, Junod D, Mancini ME, Mantegazza V, Maragna R, Marchetti F, Mastroiacovo G, Pirola S, Tassetti L, Baessato F, Corino V, Guaricci AI, Rabbat MG, Rossi A, Rovera C, Costantini P, van der Bilt I, van der Harst P, Fontana M, Caiani EG, Pepi M, Pontone G. DEep LearnIng-based QuaNtification of epicardial adipose tissue predicts MACE in patients undergoing stress CMR. Atherosclerosis 2024:117549. [PMID: 38679562 DOI: 10.1016/j.atherosclerosis.2024.117549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND AIMS This study investigated the additional prognostic value of epicardial adipose tissue (EAT) volume for major adverse cardiovascular events (MACE) in patients undergoing stress cardiac magnetic resonance (CMR) imaging. METHODS 730 consecutive patients [mean age: 63 ± 10 years; 616 men] who underwent stress CMR for known or suspected coronary artery disease were randomly divided into derivation (n = 365) and validation (n = 365) cohorts. MACE was defined as non-fatal myocardial infarction and cardiac deaths. A deep learning algorithm was developed and trained to quantify EAT volume from CMR. EAT volume was adjusted for height (EAT volume index). A composite CMR-based risk score by Cox analysis of the risk of MACE was created. RESULTS In the derivation cohort, 32 patients (8.7 %) developed MACE during a follow-up of 2103 days. Left ventricular ejection fraction (LVEF) < 35 % (HR 4.407 [95 % CI 1.903-10.202]; p<0.001), stress perfusion defect (HR 3.550 [95 % CI 1.765-7.138]; p<0.001), late gadolinium enhancement (LGE) (HR 4.428 [95%CI 1.822-10.759]; p = 0.001) and EAT volume index (HR 1.082 [95 % CI 1.045-1.120]; p<0.001) were independent predictors of MACE. In a multivariate Cox regression analysis, adding EAT volume index to a composite risk score including LVEF, stress perfusion defect and LGE provided additional value in MACE prediction, with a net reclassification improvement of 0.683 (95%CI, 0.336-1.03; p<0.001). The combined evaluation of risk score and EAT volume index showed a higher Harrel C statistic as compared to risk score (0.85 vs. 0.76; p<0.001) and EAT volume index alone (0.85 vs.0.74; p<0.001). These findings were confirmed in the validation cohort. CONCLUSIONS In patients with clinically indicated stress CMR, fully automated EAT volume measured by deep learning can provide additional prognostic information on top of standard clinical and imaging parameters.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Marco Penso
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milano, Italy
| | - Maria Ludovica Carerj
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina, Italy
| | - Carlo Maria Giacari
- Department of Valvular and Structural Interventional Cardiology, Centro Cardiologico, Monzino IRCCS, Milan, Italy
| | - Alessandra Volpe
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Annoni
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Cannata
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Cilia
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alberico Del Torto
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alberto Formenti
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Frappampina
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paola Gripari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Junod
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Elisabetta Mancini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Mantegazza
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | - Riccardo Maragna
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Marchetti
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giorgio Mastroiacovo
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Pirola
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Luigi Tassetti
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Valentina Corino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Andrea Igoren Guaricci
- Department of Interdisciplinary Medicine Cardiology University Unit, University Hospital Polyclinic of Bari, Bari, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | | | - Pietro Costantini
- Radiology Department, Ospedale Maggiore Della Carita' University Hospital, Novara, Italy
| | - Ivo van der Bilt
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Enrico G Caiani
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milano, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Mauro Pepi
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
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Yi X, He Y, Gao S, Li M. A review of the application of deep learning in obesity: From early prediction aid to advanced management assistance. Diabetes Metab Syndr 2024; 18:103000. [PMID: 38604060 DOI: 10.1016/j.dsx.2024.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/23/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND AIMS Obesity is a chronic disease which can cause severe metabolic disorders. Machine learning (ML) techniques, especially deep learning (DL), have proven to be useful in obesity research. However, there is a dearth of systematic reviews of DL applications in obesity. This article aims to summarize the current trend of DL usage in obesity research. METHODS An extensive literature review was carried out across multiple databases, including PubMed, Embase, Web of Science, Scopus, and Medline, to collate relevant studies published from January 2018 to September 2023. The focus was on research detailing the application of DL in the context of obesity. We have distilled critical insights pertaining to the utilized learning models, encompassing aspects of their development, principal results, and foundational methodologies. RESULTS Our analysis culminated in the synthesis of new knowledge regarding the application of DL in the context of obesity. Finally, 40 research articles were included. The final collection of these research can be divided into three categories: obesity prediction (n = 16); obesity management (n = 13); and body fat estimation (n = 11). CONCLUSIONS This is the first review to examine DL applications in obesity. It reveals DL's superiority in obesity prediction over traditional ML methods, showing promise for multi-omics research. DL also innovates in obesity management through diet, fitness, and environmental analyses. Additionally, DL improves body fat estimation, offering affordable and precise monitoring tools. The study is registered with PROSPERO (ID: CRD42023475159).
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Affiliation(s)
- Xinghao Yi
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yangzhige He
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Shan Gao
- Department of Endocrinology, Xuan Wu Hospital, Capital Medical University, Beijing 10053, China
| | - Ming Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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Matsunaga T, Kono A, Matsuo H, Kitagawa K, Nishio M, Hashimura H, Izawa Y, Toba T, Ishikawa K, Katsuki A, Ohmura K, Murakami T. Development of Pericardial Fat Count Images Using a Combination of Three Different Deep-Learning Models: Image Translation Model From Chest Radiograph Image to Projection Image of Three-Dimensional Computed Tomography. Acad Radiol 2024; 31:822-829. [PMID: 37914626 DOI: 10.1016/j.acra.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 11/03/2023]
Abstract
RATIONALE AND OBJECTIVES Pericardial fat (PF)-the thoracic visceral fat surrounding the heart-promotes the development of coronary artery disease by inducing inflammation of the coronary arteries. To evaluate PF, we generated pericardial fat count images (PFCIs) from chest radiographs (CXRs) using a dedicated deep-learning model. MATERIALS AND METHODS We reviewed data of 269 consecutive patients who underwent coronary computed tomography (CT). We excluded patients with metal implants, pleural effusion, history of thoracic surgery, or malignancy. Thus, the data of 191 patients were used. We generated PFCIs from the projection of three-dimensional CT images, wherein fat accumulation was represented by a high pixel value. Three different deep-learning models, including CycleGAN were combined in the proposed method to generate PFCIs from CXRs. A single CycleGAN-based model was used to generate PFCIs from CXRs for comparison with the proposed method. To evaluate the image quality of the generated PFCIs, structural similarity index measure (SSIM), mean squared error (MSE), and mean absolute error (MAE) of (i) the PFCI generated using the proposed method and (ii) the PFCI generated using the single model were compared. RESULTS The mean SSIM, MSE, and MAE were 8.56 × 10-1, 1.28 × 10-2, and 3.57 × 10-2, respectively, for the proposed model, and 7.62 × 10-1, 1.98 × 10-2, and 5.04 × 10-2, respectively, for the single CycleGAN-based model. CONCLUSION PFCIs generated from CXRs with the proposed model showed better performance than those generated with the single model. The evaluation of PF without CT may be possible using the proposed method.
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Affiliation(s)
- Takaaki Matsunaga
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.)
| | - Atsushi Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.)
| | - Hidetoshi Matsuo
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.)
| | - Kaoru Kitagawa
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan (K.K., K.I.)
| | - Mizuho Nishio
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.).
| | - Hiromi Hashimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.)
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan (Y.I., T.T.)
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan (Y.I., T.T.)
| | - Kazuki Ishikawa
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan (K.K., K.I.)
| | | | | | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (T.M., A.K., H.M., H.H., T.M.)
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Santos da Silva G, Casanova D, Oliva JT, Rodrigues EO. Cardiac fat segmentation using computed tomography and an image-to-image conditional generative adversarial neural network. Med Eng Phys 2024; 124:104104. [PMID: 38418017 DOI: 10.1016/j.medengphy.2024.104104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/17/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
In recent years, research has highlighted the association between increased adipose tissue surrounding the human heart and elevated susceptibility to cardiovascular diseases such as atrial fibrillation and coronary heart disease. However, the manual segmentation of these fat deposits has not been widely implemented in clinical practice due to the substantial workload it entails for medical professionals and the associated costs. Consequently, the demand for more precise and time-efficient quantitative analysis has driven the emergence of novel computational methods for fat segmentation. This study presents a novel deep learning-based methodology that offers autonomous segmentation and quantification of two distinct types of cardiac fat deposits. The proposed approach leverages the pix2pix network, a generative conditional adversarial network primarily designed for image-to-image translation tasks. By applying this network architecture, we aim to investigate its efficacy in tackling the specific challenge of cardiac fat segmentation, despite not being originally tailored for this purpose. The two types of fat deposits of interest in this study are referred to as epicardial and mediastinal fats, which are spatially separated by the pericardium. The experimental results demonstrated an average accuracy of 99.08% and f1-score 98.73 for the segmentation of the epicardial fat and 97.90% of accuracy and f1-score of 98.40 for the mediastinal fat. These findings represent the high precision and overlap agreement achieved by the proposed methodology. In comparison to existing studies, our approach exhibited superior performance in terms of f1-score and run time, enabling the images to be segmented in real time.
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Affiliation(s)
- Guilherme Santos da Silva
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Dalcimar Casanova
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Jefferson Tales Oliva
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Erick Oliveira Rodrigues
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil; Graduate Program of Production and Systems Engineering, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil.
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Mallio CA, Di Gennaro G, Greco F, Pescosolido A, Bernetti C, Piccolo CL, Buffa V, Quattrocchi CC, Beomonte Zobel B. Visceral adiposity in patients with lipomatous hypertrophy of the interatrial septum. Heart Vessels 2024; 39:160-166. [PMID: 37792006 DOI: 10.1007/s00380-023-02319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac mass determined by abnormal deposition of adipose tissue in the interatrial septum. The quantitative relationship between LHIS and visceral adiposity has not been explored to date.In this retrospective study, three groups of consecutive patients undergoing CT imaging were enrolled: L + with LHIS, L- without LHIS, and LO- without both LHIS and history of malignancies. Areas of total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and LHIS areas were calculated on CT images. The relationship between LHIS and abdominal fat distribution was investigated with linear regression models. Bonferroni correction was applied to account for multiple testing. Statistical significance was set at 5%. In this study we enrolled a total of 175 subjects: 58 (33.14%) with LHIS (L +), 51(29.14%) without LHIS (L-) and 66 (37.71%) without both LHIS and medical history of malignancies (LO-). VAT (coeff: 105.82; 95% CI 59.37-152.27), SAT (coeff: 74.59; 95% CI 31.63-117.54), and TAT (coeff: 190.37; 95% CI 115.02-265.72), were significantly higher in L + patients. Moreover, VAT (coeff: 24.95; 95% CI 6.94-42.96) and TAT (coeff: 36.58; 95% CI 8.75-64.41) were statistically significant linear predictors for LHIS area. Here, we report a novel association between LHIS and visceral adiposity using a quantitative CT-based imaging approach. The results are of great importance also because they might drive early identification of subjects with LHIS at risk for visceral obesity, and trigger lifestyle interventions aimed at weight loss.
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Affiliation(s)
- Carlo A Mallio
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro Magna Græcia, Catanzaro, Italy
| | - Federico Greco
- U.O.C. Diagnostica per Immagini Territoriale Aziendale, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Lecce, Italy
| | - Andrea Pescosolido
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Caterina Bernetti
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Claudia Lucia Piccolo
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Avtanski D, Hadzi-Petrushev N, Josifovska S, Mladenov M, Reddy V. Emerging technologies in adipose tissue research. Adipocyte 2023; 12:2248673. [PMID: 37599422 PMCID: PMC10443968 DOI: 10.1080/21623945.2023.2248673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Technologies are transforming the understanding of adipose tissue as a complex and dynamic tissue that plays a critical role in energy homoeostasis and metabolic health. This mini-review provides a brief overview of the potential impact of novel technologies in biomedical research and aims to identify areas where these technologies can make the most significant contribution to adipose tissue research. It discusses the impact of cutting-edge technologies such as single-cell sequencing, multi-omics analyses, spatial transcriptomics, live imaging, 3D tissue engineering, microbiome analysis, in vivo imaging, and artificial intelligence/machine learning. As these technologies continue to evolve, we can expect them to play an increasingly important role in advancing our understanding of adipose tissue and improving the treatment of related diseases.
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Affiliation(s)
- Dimiter Avtanski
- Friedman Diabetes Institute, Lenox Hill Hospital, New York, NY, USA
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Nikola Hadzi-Petrushev
- Faculty of Natural Sciences and Mathematics, Institute of Biology, “Ss. Cyril and Methodius” University, Skopje, North Macedonia
| | - Slavica Josifovska
- Faculty of Natural Sciences and Mathematics, Institute of Biology, “Ss. Cyril and Methodius” University, Skopje, North Macedonia
| | - Mitko Mladenov
- Faculty of Natural Sciences and Mathematics, Institute of Biology, “Ss. Cyril and Methodius” University, Skopje, North Macedonia
| | - Varun Reddy
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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Aromiwura AA, Settle T, Umer M, Joshi J, Shotwell M, Mattumpuram J, Vorla M, Sztukowska M, Contractor S, Amini A, Kalra DK. Artificial intelligence in cardiac computed tomography. Prog Cardiovasc Dis 2023; 81:54-77. [PMID: 37689230 DOI: 10.1016/j.pcad.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for automated data analysis and processing, data generation, and prediction with applications in visual perception, speech understanding, and language translation. AI in healthcare uses machine learning (ML) and other predictive analytical techniques to help sort through vast amounts of data and generate outputs that aid in diagnosis, clinical decision support, workflow automation, and prognostication. Coronary computed tomography angiography (CCTA) is an ideal union for these applications due to vast amounts of data generation and analysis during cardiac segmentation, coronary calcium scoring, plaque quantification, adipose tissue quantification, peri-operative planning, fractional flow reserve quantification, and cardiac event prediction. In the past 5 years, there has been an exponential increase in the number of studies exploring the use of AI for cardiac computed tomography (CT) image acquisition, de-noising, analysis, and prognosis. Beyond image processing, AI has also been applied to improve the imaging workflow in areas such as patient scheduling, urgent result notification, report generation, and report communication. In this review, we discuss algorithms applicable to AI and radiomic analysis; we then present a summary of current and emerging clinical applications of AI in cardiac CT. We conclude with AI's advantages and limitations in this new field.
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Affiliation(s)
| | - Tyler Settle
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
| | - Muhammad Umer
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jonathan Joshi
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Matthew Shotwell
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Mounica Vorla
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Maryta Sztukowska
- Clinical Trials Unit, University of Louisville, Louisville, KY, USA; University of Information Technology and Management, Rzeszow, Poland
| | - Sohail Contractor
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Amir Amini
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Dinesh K Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA.
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9
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Tatsugami F, Nakaura T, Yanagawa M, Fujita S, Kamagata K, Ito R, Kawamura M, Fushimi Y, Ueda D, Matsui Y, Yamada A, Fujima N, Fujioka T, Nozaki T, Tsuboyama T, Hirata K, Naganawa S. Recent advances in artificial intelligence for cardiac CT: Enhancing diagnosis and prognosis prediction. Diagn Interv Imaging 2023; 104:521-528. [PMID: 37407346 DOI: 10.1016/j.diii.2023.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
Recent advances in artificial intelligence (AI) for cardiac computed tomography (CT) have shown great potential in enhancing diagnosis and prognosis prediction in patients with cardiovascular disease. Deep learning, a type of machine learning, has revolutionized radiology by enabling automatic feature extraction and learning from large datasets, particularly in image-based applications. Thus, AI-driven techniques have enabled a faster analysis of cardiac CT examinations than when they are analyzed by humans, while maintaining reproducibility. However, further research and validation are required to fully assess the diagnostic performance, radiation dose-reduction capabilities, and clinical correctness of these AI-driven techniques in cardiac CT. This review article presents recent advances of AI in the field of cardiac CT, including deep-learning-based image reconstruction, coronary artery motion correction, automatic calcium scoring, automatic epicardial fat measurement, coronary artery stenosis diagnosis, fractional flow reserve prediction, and prognosis prediction, analyzes current limitations of these techniques and discusses future challenges.
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Affiliation(s)
- Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medicine, 1-1-1 Honjo Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Shohei Fujita
- Departmen of Radiology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital N15, W5, Kita-Ku, Sapporo 060-8638, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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10
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Hu Y, Jiang S, Yu X, Huang S, Lan Z, Yu Y, Zhang X, Chen J, Zhang J. Automatic epicardial adipose tissue segmentation in pulmonary computed tomography venography using nnU-Net. Quant Imaging Med Surg 2023; 13:6482-6492. [PMID: 37869313 PMCID: PMC10585557 DOI: 10.21037/qims-23-233] [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: 02/25/2023] [Accepted: 07/21/2023] [Indexed: 10/24/2023]
Abstract
Background Epicardial adipose tissue (EAT) is a key aspect in the investigation of cardiac pathophysiology. We sought to develop a deep learning (DL) model for fully automatic extraction and quantification of EAT through pulmonary computed tomography venography (PCTV) images. Methods In this retrospective study, we included 128 patients with atrial fibrillation and PCTV from 2 hospitals. A DL model for automated EAT segmentation was developed from a training set of 51 patients and a validation set of 13 patients from hospital A. The algorithm was further validated using an internal test set of 16 patients from hospital A and an external test set of 48 patients from hospital B. The consistency and measurement agreement of EAT quantification were compared between the DL model and the conventional manual protocol using the Dice score coefficient (DSC), Hausdorff distance (HD95), Pearson correlation coefficient, and Bland-Altman plot. Results In the internal and external test set, automated segmentation with DL was successful in all cases. The total analysis time was shorter for DL than for manual reconstruction (5.43±2.52 vs. 106.20±15.90 min; P<0.001). The EAT segmented with the DL model had good consistency with manual segmentation (the DSC of the internal and external test sets were 0.92±0.02 and 0.88±0.03, respectively). The quantification of EAT evaluated with the 2 methods showed excellent correlation (all correlation coefficients >0.9; all P values <0.001) and minimal measurement difference. Conclusions The proposed DL model achieved fully automatic quantification of EAT from PCTV images. The yielded results were highly consistent with those of manual quantification.
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Affiliation(s)
- Yifan Hu
- Department of Radiology, Dongtai People’s Hospital, Yancheng, China
| | - Shanshan Jiang
- Department of Clinical and Technical Support, Philips Healthcare, Xi’an, China
| | - Xiaojin Yu
- Department of Radiology, Dongtai People’s Hospital, Yancheng, China
| | - Sicong Huang
- Department of Clinical and Technical Support, Philips Healthcare, Xi’an, China
| | - Ziting Lan
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yarong Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Zhang
- Department of Clinical Science, Philips Healthcare, Shanghai, China
| | - Jin Chen
- Department of Radiology, Dongtai People’s Hospital, Yancheng, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dey D, Arnaout R, Antani S, Badano A, Jacques L, Li H, Leiner T, Margerrison E, Samala R, Sengupta PP, Shah SJ, Slomka P, Williams MC, Bandettini WP, Sachdev V. Proceedings of the NHLBI Workshop on Artificial Intelligence in Cardiovascular Imaging: Translation to Patient Care. JACC Cardiovasc Imaging 2023; 16:1209-1223. [PMID: 37480904 PMCID: PMC10524663 DOI: 10.1016/j.jcmg.2023.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 07/24/2023]
Abstract
Artificial intelligence (AI) promises to revolutionize many fields, but its clinical implementation in cardiovascular imaging is still rare despite increasing research. We sought to facilitate discussion across several fields and across the lifecycle of research, development, validation, and implementation to identify challenges and opportunities to further translation of AI in cardiovascular imaging. Furthermore, it seemed apparent that a multidisciplinary effort across institutions would be essential to overcome these challenges. This paper summarizes the proceedings of the National Heart, Lung, and Blood Institute-led workshop, creating consensus around needs and opportunities for institutions at several levels to support and advance research in this field and support future translation.
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Affiliation(s)
- Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rima Arnaout
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Aldo Badano
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Huiqing Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Edward Margerrison
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ravi Samala
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Sanjiv J Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; British Heart Foundation Data Science Centre, London, United Kingdom
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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12
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Chen C, Tang W, Chen Y, Xu W, Yu N, Liu C, Li Z, Tang Z, Zhang X. Computed tomography angiography-based radiomics model to identify high-risk carotid plaques. Quant Imaging Med Surg 2023; 13:6089-6104. [PMID: 37711840 PMCID: PMC10498225 DOI: 10.21037/qims-23-158] [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: 02/10/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Abstract
Background Extracranial atherosclerosis is one of the major causes of stroke. Carotid computed tomography angiography (CTA) is a widely used imaging modality that allows detailed assessments of plaque characteristics. This study aimed to develop and test radiomics models of carotid plaques and perivascular adipose tissue (PVAT) to distinguish symptomatic from asymptomatic plaques and compare the diagnostic value between radiomics models and traditional CTA model. Methods A total of 144 patients with carotid plaques were divided into symptomatic and asymptomatic groups. The traditional CTA model was built by the traditional radiological features of carotid plaques measured on CTA images which were screened by univariate analysis and multivariable logistic regression. We extracted and screened radiomics features from carotid plaques and PVAT. Then, a support vector machine was used for building plaque and PVAT radiomics models, as well as a combined model using traditional CTA features and radiomics features. The diagnostic value between radiomics models and traditional CTA model was compared in identifying symptomatic carotid plaques by Delong method. Results The area under curve (AUC) values of traditional CTA model were 0.624 and 0.624 for the training and validation groups, respectively. The plaque radiomics model and PVAT radiomics model achieved AUC values of 0.766, 0.740 and 0.759, 0.618 in the two groups, respectively. Meanwhile, the combined model of plaque and PVAT radiomics features and traditional CTA features had AUC values of 0.883 and 0.840 for the training and validation groups, respectively, and the receiver operating characteristic curves of combined model were significantly better than those of traditional CTA model in the training group (P<0.001) and validation group (P=0.029). Conclusions The combined model of the radiomics features of carotid plaques and PVAT and the traditional CTA features significantly contributes to identifying high-risk carotid plaques compared with traditional CTA model.
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Affiliation(s)
- Chao Chen
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Wei Tang
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhan Xu
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Ningjun Yu
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Chao Liu
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Zenghui Li
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Zhao Tang
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
| | - Xiaoming Zhang
- Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology, Affiliated Hospital, North Sichuan Medical College, Nanchong, China
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13
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Perone F, Bernardi M, Redheuil A, Mafrica D, Conte E, Spadafora L, Ecarnot F, Tokgozoglu L, Santos-Gallego CG, Kaiser SE, Fogacci F, Sabouret A, Bhatt DL, Paneni F, Banach M, Santos R, Biondi Zoccai G, Ray KK, Sabouret P. Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions. J Clin Med 2023; 12:5563. [PMID: 37685628 PMCID: PMC10487991 DOI: 10.3390/jcm12175563] [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: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy;
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale, Sorbonne University, INSERM 1146, CNRS 7371, 75005 Paris, France;
| | - Dario Mafrica
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Edoardo Conte
- Cardiology Department, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20100 Milan, Italy;
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, 25000 Besancon, France;
| | - Lale Tokgozoglu
- Department of Cardiology, Medical Faculty, Hacettepe University, 06230 Ankara, Turkey;
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Sergio Emanuel Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil;
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Francesco Paneni
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland;
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland;
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Raul Santos
- Heart Institute, University of Sao Paulo Medical School, São Paulo 05403-903, Brazil;
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterranea Cardiocentro, 80122 Napoli, Italy
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Department of Public Health and Primary Care, Imperial College London, London SW7 2BX, UK;
| | - Pierre Sabouret
- Heart Institute, Cardiology Department, Paris and National College of French Cardiologists, Pitié-Salpétrière Hospital, Sorbonne University, 75013 Paris, France
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14
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Greco F, Beomonte Zobel B, Mallio CA. Impact of Quantitative Computed Tomography-Based Analysis of Abdominal Adipose Tissue in Patients with Lymphoma. Hematol Rep 2023; 15:474-482. [PMID: 37606494 PMCID: PMC10443254 DOI: 10.3390/hematolrep15030049] [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: 02/28/2023] [Revised: 04/10/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
Quantitative abdominal adipose tissue analysis is important for obtaining information about prognosis and clinical outcomes on a wide array of diseases. In recent years, the effects of abdominal adipose tissue compartments in patients with lymphoma and the changes in their distribution after therapies have been studied. This information could facilitate the improvement of therapies in patients with lymphoma, to prevent or treat both visceral obesity and sarcopenia. Opportunistic analysis of body composition on computed tomography (CT) images might contribute to the improvement of patient management and clinical outcomes together with implementation of targeted patient-tailored therapies. The purpose of this literature review is to describe the role of CT to evaluate abdominal adipose tissue quantity and distribution in patients with lymphoma.
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Affiliation(s)
- Federico Greco
- Department of Radiology, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Piazza Filippo Bottazzi, 2, 73100 Lecce, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Carlo Augusto Mallio
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
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15
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Bays HE, Fitch A, Cuda S, Gonsahn-Bollie S, Rickey E, Hablutzel J, Coy R, Censani M. Artificial intelligence and obesity management: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023. OBESITY PILLARS (ONLINE) 2023; 6:100065. [PMID: 37990659 PMCID: PMC10662105 DOI: 10.1016/j.obpill.2023.100065] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of Artificial Intelligence, focused on the management of patients with obesity. Methods The perspectives of the authors were augmented by scientific support from published citations and integrated with information derived from search engines (i.e., Chrome by Google, Inc) and chatbots (i.e., Chat Generative Pretrained Transformer or Chat GPT). Results Artificial Intelligence (AI) is the technologic acquisition of knowledge and skill by a nonhuman device, that after being initially programmed, has varying degrees of operations autonomous from direct human control, and that performs adaptive output tasks based upon data input learnings. AI has applications regarding medical research, medical practice, and applications relevant to the management of patients with obesity. Chatbots may be useful to obesity medicine clinicians as a source of clinical/scientific information, helpful in writings and publications, as well as beneficial in drafting office or institutional Policies and Procedures and Standard Operating Procedures. AI may facilitate interactive programming related to analyses of body composition imaging, behavior coaching, personal nutritional intervention & physical activity recommendations, predictive modeling to identify patients at risk for obesity-related complications, and aid clinicians in precision medicine. AI can enhance educational programming, such as personalized learning, virtual reality, and intelligent tutoring systems. AI may help augment in-person office operations and telemedicine (e.g., scheduling and remote monitoring of patients). Finally, AI may help identify patterns in datasets related to a medical practice or institution that may be used to assess population health and value-based care delivery (i.e., analytics related to electronic health records). Conclusions AI is contributing to both an evolution and revolution in medical care, including the management of patients with obesity. Challenges of Artificial Intelligence include ethical and legal concerns (e.g., privacy and security), accuracy and reliability, and the potential perpetuation of pervasive systemic biases.
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Affiliation(s)
- Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | | | - Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway Ste 145, San Antonio, TX, 78218, USA
| | - Sylvia Gonsahn-Bollie
- Embrace You Weight & Wellness, 8705 Colesville Rd Suite 103, Silver Spring, MD, 10, USA
| | - Elario Rickey
- Obesity Medicine Association, 7173 S. Havana St. #600-130, Centennial, CO, 80112, USA
| | - Joan Hablutzel
- Obesity Medicine Association, 7173 S. Havana St. #600-130, Centennial, CO, 80112, USA
| | - Rachel Coy
- Obesity Medicine Association, 7173 S. Havana St. #600-130, Centennial, CO, 80112, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
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16
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Santhanam P, Nath T, Peng C, Bai H, Zhang H, Ahima RS, Chellappa R. Artificial intelligence and body composition. Diabetes Metab Syndr 2023; 17:102732. [PMID: 36867973 DOI: 10.1016/j.dsx.2023.102732] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
AIMS Although obesity is associated with chronic disease, a large section of the population with high BMI does not have an increased risk of metabolic disease. Increased visceral adiposity and sarcopenia are also risk factors for metabolic disease in people with normal BMI. Artificial Intelligence (AI) techniques can help assess and analyze body composition parameters for predicting cardiometabolic health. The purpose of the study was to systematically explore literature involving AI techniques for body composition assessment and observe general trends. METHODS We searched the following databases: Embase, Web of Science, and PubMed. There was a total of 354 search results. After removing duplicates, irrelevant studies, and reviews(a total of 303), 51 studies were included in the systematic review. RESULTS AI techniques have been studied for body composition analysis in the context of diabetes mellitus, hypertension, cancer and many specialized diseases. Imaging techniques employed for AI methods include CT (Computerized Tomography), MRI (Magnetic Resonance Imaging), ultrasonography, plethysmography, and EKG(Electrocardiogram). Automatic segmentation of body composition by deep learning with convolutional networks has helped determine and quantify muscle mass. Limitations include heterogeneity of study populations, inherent bias in sampling, and lack of generalizability. Different bias mitigation strategies should be evaluated to address these problems and improve the applicability of AI to body composition analysis. CONCLUSIONS AI assisted measurement of body composition might assist in improved cardiovascular risk stratification when applied in the appropriate clinical context.
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Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Tanmay Nath
- Department Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Cheng Peng
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Harrison Bai
- Department of Radiology and Radiology Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Helen Zhang
- The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Rexford S Ahima
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Rama Chellappa
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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17
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Baeßler B, Götz M, Antoniades C, Heidenreich JF, Leiner T, Beer M. Artificial intelligence in coronary computed tomography angiography: Demands and solutions from a clinical perspective. Front Cardiovasc Med 2023; 10:1120361. [PMID: 36873406 PMCID: PMC9978503 DOI: 10.3389/fcvm.2023.1120361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is increasingly the cornerstone in the management of patients with chronic coronary syndromes. This fact is reflected by current guidelines, which show a fundamental shift towards non-invasive imaging - especially CCTA. The guidelines for acute and stable coronary artery disease (CAD) of the European Society of Cardiology from 2019 and 2020 emphasize this shift. However, to fulfill this new role, a broader availability in adjunct with increased robustness of data acquisition and speed of data reporting of CCTA is needed. Artificial intelligence (AI) has made enormous progress for all imaging methodologies concerning (semi)-automatic tools for data acquisition and data post-processing, with outreach toward decision support systems. Besides onco- and neuroimaging, cardiac imaging is one of the main areas of application. Most current AI developments in the scenario of cardiac imaging are related to data postprocessing. However, AI applications (including radiomics) for CCTA also should enclose data acquisition (especially the fact of dose reduction) and data interpretation (presence and extent of CAD). The main effort will be to integrate these AI-driven processes into the clinical workflow, and to combine imaging data/results with further clinical data, thus - beyond the diagnosis of CAD- enabling prediction and forecast of morbidity and mortality. Furthermore, data fusing for therapy planning (e.g., invasive angiography/TAVI planning) will be warranted. The aim of this review is to present a holistic overview of AI applications in CCTA (including radiomics) under the umbrella of clinical workflows and clinical decision-making. The review first summarizes and analyzes applications for the main role of CCTA, i.e., to non-invasively rule out stable coronary artery disease. In the second step, AI applications for additional diagnostic purposes, i.e., to improve diagnostic power (CAC = coronary artery classifications), improve differential diagnosis (CT-FFR and CT perfusion), and finally improve prognosis (again CAC plus epi- and pericardial fat analysis) are reviewed.
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Affiliation(s)
- Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Michael Götz
- Division of Experimental Radiology, Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Charalambos Antoniades
- British Heart Foundation Chair of Cardiovascular Medicine, Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Julius F. Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Meinrad Beer
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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18
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Chiocchi M, Cavallo AU, Pugliese L, Cesareni M, Pasquali D, Accardo G, De Stasio V, Spiritigliozzi L, Benelli L, D’Errico F, Cerimele C, Floris R, Garaci F, Di Donna C. Cardiac Computed Tomography Evaluation of Association of Left Ventricle Disfunction and Epicardial Adipose Tissue Density in Patients with Low to Intermediate Cardiovascular Risk. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020232. [PMID: 36837434 PMCID: PMC9960536 DOI: 10.3390/medicina59020232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.
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Affiliation(s)
- Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-3473154183
| | - Armando Ugo Cavallo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Radiology, Istituto Dermopatico dell’Immacolata, 00167 Rome, Italy
| | - Luca Pugliese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Daniela Pasquali
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Giacomo Accardo
- ASL Salerno Ds 63 Poliambulatorio Costa d’Amalfi, 84013 Salerno, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- IRCSS San Raffaele, 03043 Cassino, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Baykaner T, Narayan S. Machine learning of adipose tissue in atrial fibrillation. Heart Rhythm 2022; 19:2042-2043. [PMID: 36041687 PMCID: PMC10115142 DOI: 10.1016/j.hrthm.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Tina Baykaner
- Department of Internal Medicine, Division of Cardiology, Stanford University, Stanford, California
| | - Sanjiv Narayan
- Department of Internal Medicine, Division of Cardiology, Stanford University, Stanford, California.
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Tian H, Ding Z, Wu H, Yang K, Song D, Xu J, Dong F. Assessment of elastographic Q-analysis score combined with Prostate Imaging-Reporting and Data System (PI-RADS) based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion-guided biopsy in differentiating benign and malignant prostate. Quant Imaging Med Surg 2022; 12:3569-3579. [PMID: 35782253 PMCID: PMC9246736 DOI: 10.21037/qims-21-932] [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] [Received: 09/18/2021] [Accepted: 03/28/2022] [Indexed: 10/16/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has advantages in the diagnosis of prostate diseases, but there is also overdiagnosis. We compensate for this with fusion imaging and elastography. In this study, we want to evaluate Elastographic Q-analysis score (EQS) combined with Prostate Imaging Reporting and Data System (PI-RADS), based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion biopsy in differentiating benign and malignant prostate lesions. METHODS A total of 296 patients with 318 prostate lesions who underwent TRUS/MP-MRI fusion biopsy between October 2017 and October 2019 were retrospectively analysed. The performance of the EQS was evaluated on the sites of the suspicious areas of MP-MRI. The cut-off value of EQS was obtained according to receiver operating characteristic (ROC) curve, which was used to upgrade and downgrade the PI-RADS scores. The area under the curve (AUC), integrated discrimination improvement, and decision curve analysis were used to assess the new PI-RADS performance. RESULTS In total, 318 MP-MRI suspicious prostate lesions (94 malignant vs. 224 benign lesions). The EQS optimal threshold was 1.85, and the AUC was 0.816. All cases were constructed three models by using 1.85 as the cut-off value: upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS. The AUC of PI-RADS, upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS were 0.869, 0.867, 0.872 and 0.873 respectively. The diagnostic coincidence rate of PI-RADS was increased from 0.667 to 0.874 by using strain elastography, among which the diagnostic rate of prostate cancer was increased from 0.557 to 0.806, and the diagnostic rate of non-prostate cancer was increased from 0.775 to 0.967. The integrated discrimination improvement indicated that downgrade-PI-RADS had a better diagnostic capability (P<0.05). The net benefit of all models, which downgrade-PI-RADS can maximize the net benefit value of patients by decision curve analysis. CONCLUSIONS The combination of PI-RADS and EQS with TRUS/MP-MRI fusion, particularly downgrade-PI-RADS, can reduce unnecessary biopsy procedures and prevent overdiagnosis.
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Affiliation(s)
- Hongtian Tian
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Huaiyu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Keen Yang
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Di Song
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
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