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Elwany MN, Abskharoun M, Dawood M, Al-Tahan SM, Sanhoury M. The utility and effectiveness of the newer generation high-resolution coronary computed tomography angiography in the evaluation of coronary in-stent restenosis. Curr Probl Cardiol 2024; 49:102212. [PMID: 37993007 DOI: 10.1016/j.cpcardiol.2023.102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The importance of coronary computerized tomography angiography (CCTA) in detecting native coronary artery stenosis has been established. However, very few studies investigated the efficacy of CCTA in the assessment of in-stent restenosis (ISR) in symptomatic patients after percutaneous coronary intervention (PCI). AIM OF THE STUDY To evaluate the value of CCTA in diagnosing ISR. METHODS We included 102 symptomatic patients with stable angina, presented one to five years after PCI. All patients were subjected to CCTA, and the patients with significant coronary artery disease were directed for invasive coronary angiography (ICA). CCTA results were compared to ICA as the gold standard tool for detecting ISR. RESULTS In 88 (86.3 %) patients, CCTA could successfully exclude ISR together with the ICA (true negative), but in two cases, ICA detected an ISR which was not detected by CCTA (false negative). In eight patients, CCTA detected ISR. These were confirmed by ICA (true positive) and revascularized. In four patients (3.9 %), ISR was suspected by CCTA but excluded by ICA (false positive). In our study, according to the agreement of CCTA in detection or exclusion of ISR, sensitivity, specificity, PPV, NPV and accuracy were 80.0 %, 96.65 %, 66.67 %, 97.78 %, 94.12 %, respectively. These results were statistically significant (P < 0.001). CONCLUSIONS In up to 86 % of symptomatic patients with previous PCI, ISR was accurately excluded by CCTA. CCTA was demonstrated by this study as a high yielding tool for ruling out ISR, abolishing the need for more invasive and expensive diagnostic procedures.
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Affiliation(s)
- Mostafa N Elwany
- Lecturer of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Michael Abskharoun
- MBBCh, Resident at Cardiology and Angiology Department, Alexandria University, Egypt
| | - Moustafa Dawood
- Assistant Lecturer of Cardiology and Angiology, Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt.
| | - Salah M Al-Tahan
- Professor of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Sanhoury
- Assistant Professor of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
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Computed tomography of coronary artery atherosclerosis: A review. J Med Imaging Radiat Sci 2021; 52:S19-S39. [PMID: 34479831 DOI: 10.1016/j.jmir.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022]
Abstract
Coronary artery atherosclerosis resulting in ischemic cardiac disease is the leading cause of mortality in the United States. In symptomatic patients, invasive diagnostic methods like catheter angiography, intravascular ultrasound, or vascular endoscopy may be used. However, for primary prevention of atherosclerotic coronary artery disease in asymptomatic patients, non-invasive methods are more commonly utilized like stress imaging, single-photon emission computed tomography (SPECT) and coronary artery calcification scoring. Coronary computed tomographic angiography (CCTA) is an excellent diagnostic tool for detection of coronary artery plaque and ability to identify resultant stenoses with an excellent negative predictive value which can potentially result in optimal exclusion of the presence of coronary artery disease. Long term follow up after a negative CCTA has repeatedly demonstrated very low incidence of future adverse coronary events, attesting its predictive value. CCTA based management is associated with improved CAD outcome in stable angina. Coronary CTA is valuable in acute chest pain evaluation in the emergency department helping in better triage. CT perfusion and CT-FFR are both very promising tools for assessment of hemodynamic significance of coronary artery stenosis.
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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Liu HF, Wang M, Xu YS, Shrestha MK, Lu XR, Lei JQ. Diagnostic accuracy of dual-source and 320-row computed tomography angiography in detecting coronary in-stent restenosis: a systematic review and meta-analysis. Acta Radiol 2019; 60:149-159. [PMID: 29758995 DOI: 10.1177/0284185118774956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dual-source and 320-row computed tomography angiography (CTA) are increasingly used in diagnosing coronary in-stent restenosis (CISR). PURPOSE We sought to perform this meta-analysis to evaluate the diagnostic accuracy of dual-source computed tomography angiography (DSCTA) and 320-row CTA in detecting CISR when compared to invasive coronary angiography. MATERIAL AND METHODS Five scientific databases (PubMed, Embase, Scopus, The Cochrane Library, and Web of Science) were searched for research studies in which DSCTA and/or 320-row CTA were used as diagnostic tools for CISR, as recently as October 2017. Study inclusion, data extraction, systematic review, pooled meta-analysis, and subgroup analysis were conducted by two researchers independently. RESULTS Thirteen studies with 1384 assessable stents on DSCTA and five studies including 622 assessable stents on 320-row CTA were finally included. The sensitivity, specificity, and area under the curve (AUC) of DSCTA in diagnosing CISR were 0.92 (0.87-0.96), 0.91 (0.87-0.94), and 0.97 (0.95-0.98), respectively, and they were 0.91 (0.82-0.96), 0.95 (0.88-0.98), and 0.96 (0.94-0.97) for 320-row CTA. Subgroup analysis result suggested that DSTCA performed significantly better in CISR detection when the stent diameter was ≥ 3 mm compared to stent diameter < 3 mm: 0.98 (0.97-0.99) vs. 0.82 (0.79-0.86) with P < 0.05. CONCLUSION Our meta-analysis indicated both DSCTA and 320-row CTA had high diagnostic accuracy in detecting CISR and may serve as alternatives for further patient evaluation with CISR, especially for stent diameters ≥ 3 mm.
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Affiliation(s)
- Hai Feng Liu
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
| | - Min Wang
- Department of Anesthesia, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
| | - Yong Sheng Xu
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
| | - Manish Kumar Shrestha
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
| | - Xing Ru Lu
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
| | - Jun Qiang Lei
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, PR China
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Detoxification and activating blood circulation decoction reduces restenosis involving the TLR4/NF-κB pathway after balloon injury. Prostaglandins Other Lipid Mediat 2019; 140:1-8. [DOI: 10.1016/j.prostaglandins.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 11/20/2022]
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Liu WJ, Li GZ, Liu HF, Lei JQ. Diagnostic accuracy of dual-source computed tomography angiography for the detection of coronary in-stent restenosis: A systematic review and meta-analysis. Echocardiography 2018; 35:541-550. [PMID: 29569751 DOI: 10.1111/echo.13863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We sought to perform a meta-analysis to comprehensively evaluate the diagnostic accuracy of dual-source computed tomography angiography (DSCTA) in detecting coronary in-stent restenosis (CISR) when compared to invasive coronary angiography. The stent-based research studies in which DSCTA was used as diagnostic tool for CISR, as recent as of October 2017, from several reputed scientific libraries (PubMed, Embase, Scopus, The Cochrane Library, and Web of Science) were evaluated. Study inclusion, data extraction, and risk bias assessment were conducted by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under summary receiver operator characteristics (SROC) curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were also carried out. A total of 13 studies with a total of 894 patients and 1384 assessable stents were included. The pooled results of DSCTA diagnosing CISR were as follows: SEN 0.92 (95% confidence interval [CI] 0.87-0.96), SPE 0.91 (95% CI 0.87-0.94), PLR 9.83 (95% CI 6.93-13.94), NLR 0.09 (95% CI 0.05-0.15), DOR 114.73 (95% CI 64.12-205.28), and AUC 0.97 (95% CI 0.95-0.98), respectively. The subgroup analysis result suggested that DSTCA performed significantly better in CISR detection when the stent diameter was ≥3 mm compared with the stent diameter <3 mm: (0.98 [0.97-0.99] vs 0.82 [0.79-0.86]) with P < .05. This study revealed that DSCTA has excellent diagnostic performance for detecting CISR and may serve as an alternative for further patient evaluation with CISR, especially for stent diameter ≥3 mm.
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Affiliation(s)
- Wen-Jun Liu
- Department of Radiology, Qingyang City Hospital of Traditional Chinese Medcine, Qingyang, Gansu, China
| | - Gui-Zhen Li
- Department of Radiology, Qingyang City Hospital of Traditional Chinese Medcine, Qingyang, Gansu, China
| | - Hai-Feng Liu
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, China
| | - Jun-Qiang Lei
- Department of Radiology, First Hospital of LanZhou University, Lanzhou, Gansu, China
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Funama Y, Utsunomiya D, Hirata K, Taguchi K, Nakaura T, Oda S, Kidoh M, Yuki H, Yamashita Y. Improved Estimation of Coronary Plaque and Luminal Attenuation Using a Vendor-specific Model-based Iterative Reconstruction Algorithm in Contrast-enhanced CT Coronary Angiography. Acad Radiol 2017; 24:1070-1078. [PMID: 28396126 DOI: 10.1016/j.acra.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. MATERIALS AND METHODS We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen-plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. RESULTS At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15-44 HU for FBP and 10-31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was -12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. CONCLUSIONS The FIRST method controls the increase in plaque density and the lumen-plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto 862-0976, Japan.
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Hirata
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsuyuki Taguchi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:817-823. [PMID: 27928222 PMCID: PMC5131195 DOI: 10.11909/j.issn.1671-5411.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. METHODS We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. RESULTS There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. CONCLUSION DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min.
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Coronary in-stent restenosis: predisposing clinical and stent-related factors, diagnostic performance and analyses of inaccuracies in 320-row computed tomography angiography. Int J Cardiovasc Imaging 2016; 32 Suppl 1:105-15. [DOI: 10.1007/s10554-016-0872-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study. Eur Radiol 2015; 26:1871-8. [PMID: 26373752 DOI: 10.1007/s00330-015-3997-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/18/2015] [Accepted: 09/01/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the impact of an advanced monoenergetic (ME) reconstruction algorithm on CT coronary stent imaging in a phantom model. MATERIALS AND METHODS Three stents with lumen diameters of 2.25, 3.0 and 3.5 mm were examined with a third-generation dual-source dual-energy CT (DECT). Tube potential was set at 90/Sn150 kV for DE and 70, 90 or 120 kV for single-energy (SE) acquisitions and advanced modelled iterative reconstruction was used. Overall, 23 reconstructions were evaluated for each stent including three SE acquisitions and ten advanced and standard ME images with virtual photon energies from 40 to 130 keV, respectively. In-stent luminal diameter was measured and compared to nominal lumen diameter to determine stent lumen visibility. Contrast-to-noise ratio was calculated. RESULTS Advanced ME reconstructions substantially increased lumen visibility in comparison to SE for stents ≤3 mm. 130 keV images produced the best mean lumen visibility: 86 % for the 2.25 mm stent (82 % for standard ME and 64 % for SE) and 82 % for the 3.0 mm stent (77 % for standard ME and 69 % for SE). Mean DLP for SE 120 kV and DE acquisitions were 114.4 ± 9.8 and 58.9 ± 2.2 mGy × cm, respectively. CONCLUSION DECT with advanced ME reconstructions improves the in-lumen visibility of small stents in comparison with standard ME and SE imaging. KEY POINTS • An advanced image-based monoenergetic reconstruction algorithm improves lumen visualization in stents ≤3.0 mm. • Application of high keV reconstructions significantly improves in-stent lumen visualization. • DECT acquisition resulted in 49 % radiation dose reduction compared with 120 kV SE.
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Geyer LL, Glenn GR, De Cecco CN, Van Horn M, Canstein C, Silverman JR, Krazinski AW, Kemper JM, Bucher A, Ebersberger U, Costello P, Bamberg F, Schoepf UJ. CT Evaluation of Small-Diameter Coronary Artery Stents: Effect of an Integrated Circuit Detector with Iterative Reconstruction. Radiology 2015; 276:706-14. [DOI: 10.1148/radiol.15140427] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GBJ, Nieman K, Pontone G, Raff GL. SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8:342-58. [PMID: 25301040 DOI: 10.1016/j.jcct.2014.07.003] [Citation(s) in RCA: 689] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/21/2014] [Indexed: 12/18/2022]
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Funama Y, Utsunomiya D, Taguchi K, Oda S, Shimonobo T, Yamashita Y. Automatic exposure control at single- and dual-heartbeat CTCA on a 320-MDCT volume scanner: Effect of heart rate, exposure phase window setting, and reconstruction algorithm. Phys Med 2014; 30:385-90. [DOI: 10.1016/j.ejmp.2013.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/16/2013] [Accepted: 10/22/2013] [Indexed: 12/27/2022] Open
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Westwood M, Al M, Burgers L, Redekop K, Lhachimi S, Armstrong N, Raatz H, Misso K, Severens J, Kleijnen J. A systematic review and economic evaluation of new-generation computed tomography scanners for imaging in coronary artery disease and congenital heart disease: Somatom Definition Flash, Aquilion ONE, Brilliance iCT and Discovery CT750 HD. Health Technol Assess 2013; 17:1-243. [PMID: 23463937 DOI: 10.3310/hta17090] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Computed tomography (CT) is important in diagnosing and managing many conditions, including coronary artery disease (CAD) and congenital heart disease. Current CT scanners can very accurately diagnose CAD requiring revascularisation in most patients. However, imaging technologies have developed rapidly and new-generation computed tomography (NGCCT) scanners may benefit patients who are difficult to image (e.g. obese patients, patients with high or irregular heart beats and patients who have high levels of coronary calcium or a previous stent or bypass graft). OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of NGCCT for diagnosing clinically significant CAD in patients who are difficult to image using 64-slice computed tomography and treatment planning in complex congenital heart disease. DATA SOURCES Bibliographic databases were searched from 2000 to February/March 2011, including MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database and Science Citation Index (SCI). Trial registers and conference proceedings were searched. REVIEW METHODS Systematic review methods followed published guidance. Risk of bias was assessed using QUADAS-2. Results were stratified by patient group. Summary sensitivity and specificity were calculated using a bivariate summary receiver operating characteristic, or random effects model. Heterogeneity was assessed using the chi-squared statistic and I(2)-statistic. Cost-effectiveness of NGCCT was modelled separately for suspected and known CAD, evaluating invasive coronary angiography (ICA) only, ICA after positive NGCCT (NGCCT-ICA), and NGCCT only. The cost-effectiveness of NGCCT, compared with 64-slice CT, in reducing imaging-associated radiation in congenital heart disease was assessed. RESULTS Twenty-four studies reported accuracy of NGCCT for diagnosing CAD in difficult-to-image patients. No clinical effectiveness studies of NGCCT in congenital heart disease were identified. The pooled per-patient estimates of sensitivity were 97.7% [95% confidence interval (CI) 88.0% to 99.9%], 97.7% (95% CI 93.2% to 99.3%) and 96.0% (95% CI 88.8% to 99.2%) for patients with arrhythmias, high heart rates and previous stent, respectively. The corresponding estimates of specificity were 81.7% (95% CI 71.6% to 89.4%), 86.3% (95% CI 80.2% to 90.7%) and 81.6% (95% CI 74.7% to 87.3%), respectively. In patients with high coronary calcium scores, previous bypass grafts or obesity, only per-segment or per-artery data were available. Sensitivity estimates remained high (> 90% in all but one study). In patients with suspected CAD, the NGCCT-only strategy appeared most cost-effective; the incremental cost-effectiveness ratio (ICER) of NGCCT-ICA compared with NGCCT only was £71,000. In patients with known CAD, the most cost-effective strategy was NGCCT-ICA (highest cost saving, dominates ICA only). The ICER of NGCCT only compared with NGCCT-ICA was £726,230. For radiation exposure only, the ICER for NGCCT compared with 64-slice CT in congenital heart disease ranged from £521,000 for the youngest patients to £90,000 for adults. LIMITATIONS Available data were limited, particularly for obese patients and patients with previous bypass grafts. All studies of the accuracy of NGCCT assume that the reference standard (ICA) is 100% sensitive and specific; however, there is some evidence that ICA may sometimes underestimate the extent and severity of stenosis. Patients with more than one criterion that could contribute to difficulty in imaging were often excluded from studies; the effect on test accuracy of multiple difficult to image criteria remains uncertain. CONCLUSIONS NGCCT may be sufficiently accurate to diagnose clinically significant CAD in some or all difficult-to-image patient groups. Economic analyses suggest that NGCCT is likely to be considered cost-effective for difficult-to-image patients with CAD, at current levels of willingness to pay in the NHS. For patients with suspected CAD, NGCCT only would be most favourable; for patients with known CAD, NGCCT-ICA would be most favourable. No studies assessing the effects of NGCCT on therapeutic decision making, or subsequent patient outcomes, were identified. The ideal study to address these questions would be a large multi-centre RCT. However, one possible alternative might be to establish a multicentre tracker study. High-quality test accuracy studies, particularly in obese patients, patients with high coronary calcium, and those with previous bypass grafts are needed to confirm the findings of our systematic review. These studies should include patients with multiple difficult to image criteria. FUNDING The National Institute for Health Research Health Technology Assessment programme. This project was funded by the HTA programme, on behalf of NICE, as project number 10/107/01.
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Affiliation(s)
- M Westwood
- Kleijnen Systematic Reviews, Escrick, York, UK
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Tahir H, Bona-Casas C, Hoekstra AG. Modelling the effect of a functional endothelium on the development of in-stent restenosis. PLoS One 2013; 8:e66138. [PMID: 23785479 PMCID: PMC3681932 DOI: 10.1371/journal.pone.0066138] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/01/2013] [Indexed: 11/19/2022] Open
Abstract
Treatment of stenosed coronary arteries by balloon angioplasty and stenting results in arterial injury including severe damage to the endothelium at the site of treatment and initiates a complex cascade of inflammatory processes that may lead to the development of in-stent restenosis (ISR). Many clinical and biological factors involved in the progression of restenotic lesions have been studied in detail over the past few years but the mystery behind the pathophysiological mechanisms of this disease is still unresolved. In the present work, the effects of re-endothelialization and nitric oxide release on neointimal growth are investigated in-silico using a two dimensional multi-scale model of ISR. The effect of stent deployment depths on the development of ISR is studied as a function of time after stenting. Two dimensional domains were prepared by deploying bare metal stent struts at three different deployment depths into the tissue. Shear stress distribution on endothelial cells, obtained by blood flow simulations, was translated into nitric oxide production that keeps the smooth muscle cells in quiescent state. The cellular growth trends were plotted as a function of time and the data indicate a positive correlation between the neointimal growths and strut deployment depths in the presence of a functional endothelium, in qualitative agreement with in-vivo data. Additionally, no ISR is observed if a functional endothelium appears much earlier.
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Affiliation(s)
- Hannan Tahir
- Computational Science, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands.
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Aljizeeri A, Cocker MS, Chow BJW. CT vs SPECT: CT is the first-line test for the diagnosis and prognosis of stable coronary artery disease. J Nucl Cardiol 2013; 20:465-72. [PMID: 23572313 DOI: 10.1007/s12350-013-9690-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Non-invasive cardiac imaging is pivotal in the diagnosis and prognosis of patients with stable CAD. Nuclear SPECT, PET, stress echocardiography and more recently cardiac magnetic resonance imaging have been utilized with excellent diagnostic accuracy. However, along with their inherent individual limitations, most modalities detect ischemia but lack the ability to define coronary anatomy or evaluate for subclinical atherosclerosis. A modality that not only accurately diagnoses obstructive CAD and also facilitates early identification of non-obstructive CAD may be of interest because it may allow for earlier aggressive risk factor modification and primary prevention. Cardiac computerized tomographic angiography (CCTA) has the potential to accurately detect or exclude luminal stenosis, as well as identify and quantify subclinical atherosclerosis in the absence if luminal narrowing. However CCTA, being a relatively a new modality, has less supporting evidence when compared to more mature modalities such as SPECT. Therefore, the question that begs to be addressed is whether CCTA can be utilized as a first line test in establishing the diagnosis and prognosis of CAD.
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Affiliation(s)
- Ahmed Aljizeeri
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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Westwood ME, Raatz HDI, Misso K, Burgers L, Redekop K, Lhachimi SK, Armstrong N, Kleijnen J. Systematic review of the accuracy of dual-source cardiac CT for detection of arterial stenosis in difficult to image patient groups. Radiology 2013; 267:387-95. [PMID: 23392425 DOI: 10.1148/radiol.13121136] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the diagnostic performance of dual-source cardiac (DSC) computed tomography (CT) newer-generation CT instruments for identifying anatomically significant coronary artery disease (CAD) in patients who are difficult to image by using 64-section CT. MATERIALS AND METHODS A literature search comprised bibliographic databases (January 1, 2000, to March 22, 2011, with a pragmatic update on September 6, 2012), trial registries, and conference proceedings. Only studies using invasive coronary angiography as reference standard were included. Risk of bias was assessed (QUADAS-2). Results were stratified according to patient group on the basis of clinical characteristics. Summary estimates of sensitivity and specificity of DSC CT for detecting 50% or greater arterial stenosis were calculated by using a bivariate summary receiver operating characteristic or random-effects model. RESULTS Twenty-five studies reported accuracy of DSC CT for diagnosing CAD in difficult to image patients; in 22 studies, one of two CT units of the same manufacturer (Somatom Definition or Somatom Definition Flash) was used, and in the remaining three, a different CT unit of another manufacturer (Aquilion One) was used. The pooled, per-patient estimates of sensitivity were 97.7% (95% confidence interval [CI]: 88.0%, 99.9%) and 97.7% (95% CI: 93.2%, 99.3%) for patients with arrhythmias and high heart rates, respectively. The corresponding pooled estimates of specificity were 81.7% (95% CI: 71.6%, 89.4%) and 86.3% (95% CI: 80.2%, 90.7%), respectively. All data were acquired by using Somatom Definition. In two studies with Somatom and one study with Aquilion One, sensitivity estimates of 90% or greater were reported in patients with previous stent implantations; specificities were 81.7% and 89.5% for Somatom and 81.0% for Aquilion One. In patients with high coronary calcium scores, previous bypass grafts, or obesity, only per-segment or per-artery data were available. Sensitivity estimates remained high (>90% in all but one study), and specificities ranged from 79.1% to 100%. All data were acquired by using Somatom Definition. CONCLUSION DSC CT may be sufficiently accurate to diagnose clinically significant CAD in some or all difficult to image patients. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121136/-/DC1.
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Affiliation(s)
- Marie E Westwood
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, England
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Xia Y, Junjie Y, Ying Z, Bai H, Qi W, Qinhua J, Yundai C. Accuracy of 128-slice dual-source CT using high-pitch spiral mode for the assessment of coronary stents: first in vivo experience. Eur J Radiol 2012; 82:617-22. [PMID: 23265926 DOI: 10.1016/j.ejrad.2012.11.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/18/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the accuracy of 128-slice dual-source CT using high-pitch spiral mode (HPS) for the assessment of coronary stents. METHODS We conducted a prospective study on patients with previous stent implantation due to recurred suspicious symptoms of angina with positive findings at stress testing scheduled for coronary angiography (CA), while dual source computed tomography (DSCT) examinations were randomly done by one of the three different scan modes [HPS, sequential mode (SEQ), low-pitch spiral mode (LPS)] one week before CA examinations. The image quality, radiation dose and stent patency of DSCT were evaluated blinded to the results of CA. RESULTS 180 patients with total 256 stents were enrolled in this study. There was no significant difference on the image quality of DSCT by HPS (1.4±0.5), SEQ (1.5±0.5) and LPS (1.3±0.6) (P>0.05). The noise of images reconstructed with B26f kernel in HPS is significantly increased than in SEQ/LPS (P<0.05), while no significant difference with images reconstructed with B46f kernel (P>0.05). Heart rate (HR) variability had a slight impact on the image quality for HPS (P<0.05), not for LPS/SEQ (P>0.05). In the assessment of stent restenosis compared with CA on per-stent basis, there was no significant difference on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DSCT using HPS (100%, 97.1%, 83.3%, 100%), LPS (92.3%, 95.9%, 80%, 98.6%) and SEQ (93.3%, 97.3%, 87.5%, 98.6%) (P>0.05). The effective dose of DSCT by HPS (1.0±0.5mSv) is significant less than that by SEQ (3.0±1.4mSv) or LPS (13.0±5.4mSv) (P<0.01). CONCLUSIONS DSCT using HPS provides good diagnostic accuracy on coronary stent patency compared with CA, similar to that by SEQ/LPS, whereas with lower effective dose in patients with HR lower than 65bpm.
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Affiliation(s)
- Yang Xia
- Cardiology Department, Chinese PLA General Hospital, Beijing 100853, China.
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Funama Y, Oda S, Utsunomiya D, Taguchi K, Shimonobo T, Yamashita Y, Awai K. Coronary artery stent evaluation by combining iterative reconstruction and high-resolution kernel at coronary CT angiography. Acad Radiol 2012; 19:1324-31. [PMID: 22951109 DOI: 10.1016/j.acra.2012.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/15/2012] [Accepted: 06/23/2012] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate stent lumen visualization by combining high-resolution cardiac kernel and the iterative reconstruction (iDose) on an anthropomorphic moving heart phantom and in patients at coronary computed tomography (CT) angiography. MATERIALS AND METHODS We used the moving heart phantom and a 64 detector-row CT, retrospectively gated helical scanning, and image reconstruction. The heart rate was set at nonpulsating condition of 0 beats/min, 50 beats/min, and 80 beats/min. The 120-kV images were reconstructed in synchronization with electrocardiogram data using filtered back projection (FBP) or iDose algorithm and standard kernel/filter (CB) or high-resolution kernel/filter (CD). We measured image noise, the kurtosis, and stent lumen diameter in the phantom study. We also assessed the visual inspections by two radiologists. RESULTS With cardiac motion at 50 and 80 beats/min, the difference of kurtosis improved with CD relative to CB (P < .05). iDose algorithm with level 7 provided lowest noise, with no statistically significance in difference of the kurtosis relative to level 4 (P > .05). Without cardiac motion at 0 beats/min, the stent lumen diameter measurements with CD kernel were better relative to CB kernel (P < .05). In addition, no significant difference was found in stent lumen diameter between iDose level 4 and level 7 (P > .05). CONCLUSION The use of iDose and a sharp kernel allowed improved stent visualization at a lower radiation dose.
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Mahnken AH. CT Imaging of Coronary Stents: Past, Present, and Future. ISRN CARDIOLOGY 2012; 2012:139823. [PMID: 22997590 PMCID: PMC3446716 DOI: 10.5402/2012/139823] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/16/2012] [Indexed: 11/23/2022]
Abstract
Coronary stenting became a mainstay in coronary revascularization therapy. Despite tremendous advances in therapy, in-stent restenosis (ISR) remains a key problem after coronary stenting. Coronary CT angiography evolved as a valuable tool in the diagnostic workup of patients after coronary revascularization therapy. It has a negative predictive value in the range of 98% for ruling out significant ISR. As CT imaging of coronary stents depends on patient and stent characteristics, patient selection is crucial for success. Ideal candidates have stents with a diameter of 3 mm and more. Nevertheless, even with most recent CT scanners, about 8% of stents are not accessible mostly due to blooming or motion artifacts. While the diagnosis of ISR is currently based on the visual assessment of the stent lumen, functional information on the hemodynamic significance of in-stent stenosis became available with the most recent generation of dual source CT scanners. This paper provides a comprehensive overview on previous developments, current techniques, and clinical evidence for cardiac CT in patients with coronary artery stents.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
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Imaging of Coronary Stents by Coronary CT-Angiography: Current Status. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9155-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Anomalous coronary arteries: Depiction at dual-source computed tomographic coronary angiography. J Thorac Cardiovasc Surg 2012; 143:1286-91. [DOI: 10.1016/j.jtcvs.2011.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/20/2011] [Accepted: 11/09/2011] [Indexed: 11/18/2022]
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Zhang X, Yang L, Ju H, Zhang F, Wu J, He B, Chen Y. Prevalence and prognosis of coronary stent gap detected by multi-detector CT: a follow-up study. Eur Radiol 2012; 22:1896-903. [DOI: 10.1007/s00330-012-2458-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/19/2012] [Accepted: 03/22/2012] [Indexed: 01/01/2023]
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Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. Br J Radiol 2012; 85:495-510. [PMID: 22253353 DOI: 10.1259/bjr/15296170] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted.
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Affiliation(s)
- Z Sun
- Department of Imaging and Applied Physics, Curtin University, Perth, Australia
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Dose profiles for lung and breast regions at prospective and retrospective CT coronary angiography using optically stimulated luminescence dosimeters on a 64-detector CT scanner. Phys Med 2012; 28:76-82. [DOI: 10.1016/j.ejmp.2011.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 01/05/2011] [Accepted: 01/22/2011] [Indexed: 11/21/2022] Open
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Jinzaki M, Yamada M, Tanami Y, Kuribayashi S. Evaluation of In-Stent Restenosis by High Spatial Resolution CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Combination of a low-tube-voltage technique with hybrid iterative reconstruction (iDose) algorithm at coronary computed tomographic angiography. J Comput Assist Tomogr 2011; 35:480-5. [PMID: 21765305 DOI: 10.1097/rct.0b013e31821fee94] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We compare the performance of low tube voltage with the hybrid iterative reconstruction (iDose) with standard and low tube voltage with the filtered backprojection (FBP) using phantoms at computed tomographic coronary angiography. In computed tomographic coronary angiography, application of the combined low tube voltage with iDose resulted in significant image quality improvements compared to the low tube voltage with FBP. Image quality was the same or better despite a reduction in the radiation dose by 76% compared with standard tube voltage with FBP.
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Hammas S, Amato A, Amabile N, Pesenti-Rossi D, Caussin C. Use of multislice computed tomography angiography in percutaneous coronary intervention. Interv Cardiol 2011. [DOI: 10.2217/ica.11.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Recent advances in multidetector-row computed tomography (MDCT) technology have created new opportunities in cardiac imaging and provided new insights into a variety of disease states. Use of 64-slice coronary computed tomography angiography has been validated for the evaluation of clinically relevant coronary artery stenosis with high negative predictive values for ruling out significant obstructive disease. This technology has also advanced the care of patients with acute chest pain by simultaneous assessment of acute coronary syndrome, pulmonary embolism, and acute aortic syndrome ("triple rule out"). Although MDCT has been instrumental in the advancement of cardiac imaging, there are still limitations in patients with high or irregular heart rates. Newer MDCT scanner generations hold promise to improve some of these limitations for noninvasive cardiac imaging. The evaluation of coronary artery stenosis remains the primary clinical indication for cardiac computed tomography angiography. However, the use of MDCT for simultaneous assessment of coronary artery stenosis, atherosclerotic plaque formation, ventricular function, myocardial perfusion, and viability with a single modality is under intense investigation. Recent technical developments hold promise for accomplishing this goal and establishing MDCT as a comprehensive stand-alone test for integrative imaging of coronary heart disease.
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Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease? Intern Med J 2011; 41:5-13. [DOI: 10.1111/j.1445-5994.2009.02066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Technical development has substantially improved diagnostic performance of coronary computed tomography angiography (CCTA). A large number of studies have addressed proof of concept, feasibility, and clinical robustness of this noninvasive diagnostic technique, and most have consistently described the ability of CCTA to reliably rule out significant coronary artery stenosis. Clinical evidence supports the significant role of CCTA in an increasing number of scenarios, including the detection of coronary disease in symptomatic patients who are at intermediate risk and evaluation of coronary revascularization procedures. After initial feasibility testing, the scientific evaluation of CCTA now points toward analyzing prognosis, outcome, and cost-effectiveness of this noninvasive diagnostic tool. In this article, appropriate clinical indications, diagnostic performance, current clinical applications, prognostic value, and cost-effectiveness of CCTA are reviewed.
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Donati OF, Burg MC, Desbiolles L, Karlo C, Stolzmann P, Bunck A, Baumueller S, Marincek B, Seifarth H, Alkadhi H, Leschka S, Maintz D. High-pitch 128-slice dual-source CT for the assessment of coronary stents in a phantom model. Acad Radiol 2010; 17:1366-74. [PMID: 20801697 DOI: 10.1016/j.acra.2010.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 06/14/2010] [Accepted: 06/14/2010] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the quality of stent lumen delineation using dual-source computed tomography (DSCT) in the standard-pitch mode (SP) as compared to the high-pitch mode (HP) in a phantom study. MATERIALS AND METHODS Forty different coronary stents placed in plastic tubes filled with contrast agent were imaged with a second generation DSCT system in a SP (pitch 0.23) and HP (pitch 3.4) mode in orientations of 0°, 45°, and 90° relative to the z-axis. Two observers independently measured the in-stent lumen and the attenuation values in the center of the stents. The artificial lumen narrowing (ALN) was calculated using the measured in-stent lumen and the nominal diameter of the plastic tube. RESULTS Interobserver correlation was excellent for in-stent lumen (0.86) and attenuation measurements (0.91). There was no significant difference neither for ALN (SP: 54.7-62.8%; HP: 55.8-64.0%) nor attenuation (SP: 356-395 Hounsfield units [HU]; HP: 352-384 HU) between SP and HP mode. For both modes, the orientation of the stent relative to the z-axis significantly affected ALN and attenuation (each P < .001). CT volume dose index was significantly lower using HP mode as compared to SP mode (P < .001). CONCLUSION The HP mode in DSCT provides visualization of the coronary in-stent lumen comparable to that measured in SP mode while reducing applied radiation dose in a stationary phantom model.
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Wolf F, Leschka S, Loewe C, Homolka P, Plank C, Schernthaner R, Bercaczy D, Goetti R, Lammer J, Friedrich G, Marincek B, Alkadhi H, Feuchtner G. Coronary artery stent imaging with 128-slice dual-source CT using high-pitch spiral acquisition in a cardiac phantom: comparison with the sequential and low-pitch spiral mode. Eur Radiol 2010; 20:2084-91. [PMID: 20397019 DOI: 10.1007/s00330-010-1792-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/20/2010] [Accepted: 02/20/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate coronary stents in vitro using 128-slice-dual-source computed tomography (CT). METHODS Twelve different coronary stents placed in a non-moving cardiac/chest phantom were examined by 128-slice dual-source CT using three CT protocols [high-pitch spiral (HPS), sequential (SEQ) and conventional spiral (SPIR)]. Artificial in-stent lumen narrowing (ALN), visible inner stent area (VIA), artificial in-stent lumen attenuation (ALA) in percent, image noise inside/outside the stent and CTDIvol were measured. RESULTS Mean ALN was 46% for HPS, 44% for SEQ and 47% for SPIR without significant difference. Mean VIA was similar with 31% for HPS, 30% for SEQ and 33% for SPIR. Mean ALA was, at 5% for HPS, significantly lower compared with -11% for SPIR (p = 0.024), but not different from SEQ with -1%. Mean image noise was significantly higher for HPS compared with SEQ and SPIR inside and outside the stent (p < 0.001). CTDIvol was lower for HPS (5.17 mGy), compared with SEQ (9.02 mGy) and SPIR (55.97 mGy), respectively. CONCLUSION The HPS mode of 128-slice dual-source CT yields fewer artefacts inside the stent lumen compared with SPIR and SEQ, but image noise is higher. ALN is still too high for routine stent evaluation in clinical practice. Radiation dose of the HPS mode is markedly (less than about tenfold) reduced.
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Affiliation(s)
- Florian Wolf
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Andreini D, Pontone G, Mushtaq S, Pepi M, Bartorelli AL. Multidetector Computed Tomography Coronary Angiography for the Assessment of Coronary In-Stent Restenosis. Am J Cardiol 2010; 105:645-55. [DOI: 10.1016/j.amjcard.2009.10.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/14/2009] [Accepted: 10/14/2009] [Indexed: 10/19/2022]
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In Vitro Evaluation of Metallic Coronary Artery Stents With 64-MDCT Using an ECG-Gated Cardiac Phantom: Relationship Between In-Stent Visualization, Stent Type, and Heart Rate. AJR Am J Roentgenol 2010; 194:W256-62. [DOI: 10.2214/ajr.09.2318] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nieman K. The challenge of coronary stent imaging. J Cardiovasc Comput Tomogr 2010; 4:38-40. [PMID: 20159626 DOI: 10.1016/j.jcct.2010.01.003] [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: 01/04/2010] [Accepted: 01/04/2010] [Indexed: 10/20/2022]
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Sun Z, Almutairi AMD. Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: A meta-analysis. Eur J Radiol 2010; 73:266-73. [DOI: 10.1016/j.ejrad.2008.10.025] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/18/2008] [Accepted: 10/28/2008] [Indexed: 11/25/2022]
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Bastarrika G, Schoepf UJ. [Clinical applications of computed tomography coronary angiography]. RADIOLOGIA 2009; 51:457-68. [PMID: 19748109 DOI: 10.1016/j.rx.2009.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/24/2009] [Accepted: 06/29/2009] [Indexed: 11/16/2022]
Abstract
The clinical applications of computed tomography coronary angiography (CTCA) are constantly evolving. Initially employed to quantify coronary artery calcification, multidetector CT also makes it possible to evaluate the anatomy and anatomical variations of coronary circulation, rule out coronary disease, and follow up surgical and percutaneous revascularization procedures. Moreover, CTCA may potentially be useful to quantify ventricular function, characterize non-calcified atherosclerotic plaques, and analyze myocardial perfusion and viability, providing anatomical, morphological, and functional information in patients with suspected ischemic heart disease.
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Affiliation(s)
- G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España.
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SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 2009; 3:122-36. [DOI: 10.1016/j.jcct.2009.01.001] [Citation(s) in RCA: 609] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/23/2009] [Indexed: 11/21/2022]
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Bastarrika G, Schoepf UJ. Evolving CT Applications in Ischemic Heart Disease. Semin Thorac Cardiovasc Surg 2008; 20:380-92. [DOI: 10.1053/j.semtcvs.2008.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2008] [Indexed: 11/11/2022]
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