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Wu Z, Han Q, Liang Y, Zheng Z, Wu M, Ai Z, Ma K, Xiang Z. Enhancing diagnostic performance and image quality in coronary CT angiography: Impact of SnapShot Freeze 2 algorithm across varied heart rates in stent patients. J Appl Clin Med Phys 2024; 25:e14412. [PMID: 38807292 PMCID: PMC11302822 DOI: 10.1002/acm2.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE To investigate the enhancement of image quality achieved through the utilization of SnapShot Freeze 2 (SSF2), a comparison was made against the results obtained from the original SnapShot Freeze algorithm (SSF) and standard motion correction (STND) in stent patients undergoing coronary CT angiography (CCTA) across the entire range of heart rates. MATERIALS AND METHODS A total of 118 patients who underwent CCTA, were retrospectively included in this study. Images of these patients were reconstructed using three different algorithms: SSF2, SSF, and STND. Objective assessments include signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diameters of stents and artifact index (AI). The image quality was subjectively evaluated by two readers. RESULTS Compared with SSF and STND, SSF2 had similar or even higher quality in the parameters (AI, SNR, CNR, inner diameters) of coronary artery, stent, myocardium, MV (mitral valve), TV (tricuspid valve), AV (aorta valve), and PV (pulmonary valve), and aortic root (AO). Besides the above structures, SSF2 also demonstrated comparable or even higher subjective scores in atrial septum (AS), ventricular septum (VS), and pulmonary artery root (PA). Furthermore, the enhancement in image quality with SSF2 was significantly greater in the high heart rate group compared to the low heart rate group. Moreover, the improvement in both high and low heart rate groups was better in the SSF2 group compared to the SSF and STND group. Besides, when using the three algorithms, an effect of heart rate variability on stent image quality was not detected. CONCLUSION Compared to SSF and STND, SSF2 can enhance the image quality of whole-heart structures and mitigate artifacts of coronary stents. Furthermore, SSF2 has demonstrated a significant improvement in the image quality for patients with a heart rate equal to or higher than 85 bpm.
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Affiliation(s)
- Zhehao Wu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central HospitalGuangzhouChina
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Qijia Han
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Yuying Liang
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Zhijuan Zheng
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central HospitalGuangzhouChina
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Minyi Wu
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Zhu Ai
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Kun Ma
- CT Imaging Research CenterGE HealthCare ChinaGuangzhouChina
| | - Zhiming Xiang
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
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Kim C, Park CH, Lee BY, Park CH, Kang EJ, Koo HJ, Kitagawa K, Cha MJ, Krittayaphong R, Choi SI, Yong HS, Ko SM, Kim SM, Hwang SH, Trang NN, Lee W, Kim YJ, Lee J, Yang DH. 2024 Consensus Statement on Coronary Stenosis and Plaque Evaluation in CT Angiography From the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT). Korean J Radiol 2024; 25:331-342. [PMID: 38528691 PMCID: PMC10973734 DOI: 10.3348/kjr.2024.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
The Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) is an instructional initiative of the ASCI School designed to enhance educational standards. In 2021, the ASCI-PT was convened with the goal of formulating a consensus statement on the assessment of coronary stenosis and coronary plaque using coronary CT angiography (CCTA). Nineteen experts from four countries conducted thorough reviews of current guidelines and deliberated on eight key issues to refine the process and improve the clarity of reporting CCTA findings. The experts engaged in both online and on-site sessions to establish a unified agreement. This document presents a summary of the ASCI-PT 2021 deliberations and offers a comprehensive consensus statement on the evaluation of coronary stenosis and coronary plaque in CCTA.
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Affiliation(s)
- Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sang Il Choi
- Department of Radiology, Seoul University Bundang Hospital, Seongnam, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Cuellar-Calabria H, Burcet G, Juarez-Garcia MS, Reyes-Juárez JL, Pizzi MN, Aguadé-Bruix S, Roque A. Implementing a coronary CT angiography protocol based on the body mass index: Radiation dose reduction, image quality, and diagnostic performance. RADIOLOGIA 2024; 66:2-12. [PMID: 38365351 DOI: 10.1016/j.rxeng.2022.01.004] [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: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To evaluate the relation between the coronary calcium score and the posterior choice of kilovoltage according to radiologists' criteria in a standard coronary CT angiography protocol to rule out coronary disease. To quantify the reduction in ionizing radiation after linking kilovoltage to patients' body mass index in a low-dose protocol with iterative model reconstruction. To evaluate the image quality and diagnostic performance of the low-dose protocol. MATERIAL AND METHODS We compared anthropometric characteristics, calcium score, kilovoltage levels, size-specific dose estimates (SSDE), and the dose-length product (DLP) between a group of 50 patients who were prospectively recruited to undergo coronary CT angiography with a low-dose protocol and a historical group of 50 patients who underwent coronary CT angiography with the standard protocol. We correlated these parameters, the number of coronary segments that could not be evaluated with and without temporal padding, the attenuation, and the signal-to-noise ratio in the ascending aorta in the low-dose protocol with excellent imaging quality according to a semiquantitative scale. To calculate the diagnostic performance per patient, we used 24-month clinical follow-up including all tests as the gold standard. RESULTS In the standard protocol, the presence of coronary calcium correlated with the selection of high kilovoltage (p = 0.02); this correlation was not found in the low-dose protocol (p = 0.47). Median values of SSDE and DLP were significantly (p < 0.001) lower and less dispersed in the low-dose protocol [9.22 mGy (IQR 7.84-12.1 mGy) vs. 26.5 mGy (IQR 21.3-36.3 mGy) in the standard protocol] and [97 mGy cm (IQR 78-134 mGy cm) vs. 253 mGy cm (IQR 216-404 mGy cm) in the standard protocol], respectively. The overall quality of the images obtained with the low-dose protocol was considered good or excellent in 96% of the studies. The parameters associated with image quality in a multivariable model (C statistic = 0.792) were heart rate (estimated coefficient, -0,12 [95% confidence interval: -0.2, -0.04]; p < 0.01) and the SSDE (estimated coefficient, -0,26 [95% confidence interval: -0.51, -0.01]; p < 0.05). The CAD-RADS modifier for a not fully evaluable or diagnostic study was used on two occasions (4%); the final measures for the diagnosis of coronary disease were sensitivity 100%, specificity 94%, and efficacy 94%. CONCLUSIONS In the standard protocol, the radiologist selects higher kilovoltage for CT angiography studies for patients whose previous calcium score indicates the presence of coronary calcium. In the low-dose protocol, linking kilovoltage with body mass index enables the dose of radiation to be reduced by 65% while obtaining excellent or good image quality in 96% of studies and excellent diagnostic performance.
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Affiliation(s)
- H Cuellar-Calabria
- Àrea d'Imatge Cardiovascular, Servicio de Radiodiagnóstico, Institut Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - G Burcet
- Àrea d'Imatge Cardiovascular, Servicio de Radiodiagnóstico, Institut Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M S Juarez-Garcia
- Àrea d'Imatge Cardiovascular, Servicio de Radiodiagnóstico, Institut Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J L Reyes-Juárez
- Àrea d'Imatge Cardiovascular, Servicio de Radiodiagnóstico, Institut Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - M N Pizzi
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Aguadé-Bruix
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Roque
- Àrea d'Imatge Cardiovascular, Servicio de Radiodiagnóstico, Institut Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Wu H, Liang L, Qiu F, Han W, Yang Z, Qi J, Deng J, Tang Y, Shou X, Chen H. Diagnostic Performance of Noninvasive Coronary Computed Tomography Angiography-Derived FFR for Coronary Lesion-Specific Ischemia Based on Deep Learning Analysis. Rev Cardiovasc Med 2024; 25:20. [PMID: 39077668 PMCID: PMC11262400 DOI: 10.31083/j.rcm2501020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 07/31/2024] Open
Abstract
Background The noninvasive computed tomography angiography-derived fractional flow reserve (CT-FFR) can be used to diagnose coronary ischemia. With advancements in associated software, the diagnostic capability of CT-FFR may have evolved. This study evaluates the effectiveness of a novel deep learning-based software in predicting coronary ischemia through CT-FFR. Methods In this prospective study, 138 subjects with suspected or confirmed coronary artery disease were assessed. Following indication of 30%-90% stenosis on coronary computed tomography (CT) angiography, participants underwent invasive coronary angiography and fractional flow reserve (FFR) measurement. The diagnostic performance of the CT-FFR was determined using the FFR as the reference standard. Results With a threshold of 0.80, the CT-FFR displayed an impressive diagnostic accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and negative predictive value (NPV) of 97.1%, 96.2%, 97.7%, 0.98, 96.2%, and 97.7%, respectively. At a 0.75 threshold, the CT-FFR showed a diagnostic accuracy, sensitivity, specificity, AUC, PPV, and NPV of 84.1%, 78.8%, 85.7%, 0.95, 63.4%, and 92.8%, respectively. The Bland-Altman analysis revealed a direct correlation between the CT-FFR and FFR (p < 0.001), without systematic differences (p = 0.085). Conclusions The CT-FFR, empowered by novel deep learning software, demonstrates a strong correlation with the FFR, offering high clinical diagnostic accuracy for coronary ischemia. The results underline the potential of modern computational approaches in enhancing noninvasive coronary assessment.
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Affiliation(s)
- Haoyu Wu
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Fuyu Qiu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310018 Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang, 310018 Hangzhou, Zhejiang, China
| | - Wenqi Han
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Zheng Yang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Jie Qi
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Jizhao Deng
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Yida Tang
- Department of Cardiovascular Medicine, Peking University Third Hospital, 100191 Beijing, China
| | - Xiling Shou
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
| | - Haichao Chen
- Department of Cardiology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi, China
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Wang A, Li W, Huang W, Luo M, Xiao W, Qin C, Dong S, Liu H, Li Z, Diao K. Dual-layer spectral computed tomography aortography using a seventy-five-percent-reduced iodine dose protocol and multiparameter spectral imaging: comparison with conventional computed tomography imaging. Quant Imaging Med Surg 2023; 13:6456-6467. [PMID: 37869326 PMCID: PMC10585532 DOI: 10.21037/qims-23-101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
Background Computed tomography angiography (CTA) is the recommended diagnostic and follow-up imaging modality for acute aortic dissection (AD). However, the high-contrast medium burden associated with repeated CT aortography follow-ups remains a significant concern. This prospective study aimed to assess whether an ultra-low contrast dose (75% cutoff) aortic CTA protocol on dual-layer spectral CT could achieve comparable image quality with the full dose protocol. We also investigated the image quality of the virtual noncontrast (VNC) images derived from the ultra-low dose protocol. Methods This study included 37 consecutive patients who were referred to aortic CTA from May 2022 to August 2022. The enrolled patients underwent full-dose contrast CTA and ultra-low dose (reduced to 25% of conventional) contrast CTA on dual-layer spectral CT in 1 day. Virtual monochromatic images (VMIs) were reconstructed with 40 and 70 keV. The VNC images were reconstructed for both protocols. Objective image quality evaluation, recorded as signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs), was compared between the groups using 1-way analysis of variance and post hoc analysis with Bonferroni correction. Subjective image quality was also compared between the groups. Finally, VNC images derived from the low-dose (VNClow) and full-dose (VNCfull) protocols were compared to the true noncontrast (TNC) images. Results Neither CNR nor SNR was lower for the 40-keV images reconstructed from the ultra-low dose group compared to the conventional images. Both were significantly higher than those of the 70-keV images. Regarding subjective image quality, vessel enhancement was not significantly different between the 40-keV VMI and full-dose images [ascending aorta (AAO): 4.37±0.46 vs. 4.57±0.48, P=0.096; brachiocephalic arteries: 4.34±0.45 vs. 4.51±0.49, P=0.152; abdominal aortic side branch: 4.42±0.48 vs. 4.51±0.49, P=0.480]. The VNClow images were similar to the TNC images but significantly different from the VNCfull images (P<0.001). Conclusions Ultra-low contrast aortic CTA with a 75%-reduced iodine dose using dual-layer spectral CT and the derived VNC achieved image quality comparable to that of conventional CTA and TNC images.
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Affiliation(s)
- Aijie Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjiang Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wenyu Huang
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mao Luo
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wendan Xiao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Shushan Dong
- Clinical Science, Philips Healthcare, Beijing, China
| | - Haiwei Liu
- Advanced Clinical Application, Philips Healthcare, Beijing, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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Kim K, Lee SJ, Seo J, Suh YJ, Cho I, Hong GR, Ha JW, Kim YJ, Shim CY. Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography. Front Cardiovasc Med 2022; 9:1035244. [PMID: 36601069 PMCID: PMC9807240 DOI: 10.3389/fcvm.2022.1035244] [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: 09/02/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background In this study, we investigate the utility of geometric orifice area (GOA) on cardiac computed tomography (CT) and differences from effective orifice area (EOA) on Doppler echocardiography in patients with bicuspid aortic stenosis (AS). Methods A total of 163 patients (age 64 ± 10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. To calculate the aortic valve area, GOACT was measured by multiplanar CT planimetry, and EOAEcho was calculated by the continuity equation with Doppler echocardiography. The relationships between GOACT and EOAEcho and patient symptom scale, biomarkers, and left ventricular (LV) functional variables were analyzed. Results There was a significant but modest correlation between EOAEcho and GOACT (r = 0.604, p < 0.001). Both EOAEcho and GOACT revealed significant correlations with mean pressure gradient and peak transaortic velocity, and the coefficients were higher in EOAEcho than in GOACT. EOAEcho of 1.05 cm2 and GOACT of 1.25 cm2 corresponds to hemodynamic cutoff values for diagnosing severe AS. EOAEcho was well correlated with the patient symptom scale and log NT-pro BNP, but GOACT was not. In addition, EOAEcho had a higher correlation coefficient with estimated LV filling pressure and LV global longitudinal strain than GOACT. Conclusion GOACT can be used to evaluate the severity of bicuspid AS. The threshold for GOACT for diagnosing severe AS should be higher than that for EOAEcho. However, EOAEcho is still the method of choice because EOAEcho showed better correlations with clinical and functional variables than GOACT.
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Affiliation(s)
- Kyu Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Ji Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chun SH, Suh YJ, Han K, Kwon Y, Kim AY, Choi BW. Deep learning-based reconstruction on cardiac CT yields distinct radiomic features compared to iterative and filtered back projection reconstructions. Sci Rep 2022; 12:15171. [PMID: 36071138 PMCID: PMC9452656 DOI: 10.1038/s41598-022-19546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
We aimed to determine the effects of deep learning-based reconstruction (DLR) on radiomic features obtained from cardiac computed tomography (CT) by comparing with iterative reconstruction (IR), and filtered back projection (FBP). A total of 284 consecutive patients with 285 cardiac CT scans that were reconstructed with DLR, IR, and FBP, were retrospectively enrolled. Radiomic features were extracted from the left ventricular (LV) myocardium, and from the periprosthetic mass if patients had cardiac valve replacement. Radiomic features of LV myocardium from each reconstruction were compared using a fitting linear mixed model. Radiomics models were developed to diagnose periprosthetic abnormality, and the performance was evaluated using the area under the receiver characteristics curve (AUC). Most radiomic features of LV myocardium (73 of 88) were significantly different in pairwise comparisons between all three reconstruction methods (P < 0.05). The radiomics model on IR exhibited the best diagnostic performance (AUC 0.948, 95% CI 0.880-1), relative to DLR (AUC 0.873, 95% CI 0.735-1) and FBP (AUC 0.875, 95% CI 0.731-1), but these differences did not reach significance (P > 0.05). In conclusion, applying DLR to cardiac CT scans yields radiomic features distinct from those obtained with IR and FBP, implying that feature robustness is not guaranteed when applying DLR.
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Affiliation(s)
- Sei Hyun Chun
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Young Joo Suh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Yonghan Kwon
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea
| | | | - Byoung Wook Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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Yun HR, Joo YS, Kim HW, Park JT, Chang TI, Son NH, Yoo TH, Kang SW, Sung S, Lee KB, Lee J, Oh KH, Han SH. Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease. J Am Soc Nephrol 2022; 33:1590-1601. [PMID: 35654602 PMCID: PMC9342644 DOI: 10.1681/asn.2022010080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/07/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated. METHODS We studied 1936 participants with CKD (stages G1-G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1-100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy. RESULTS During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1-100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1-100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate. CONCLUSION Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.
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Affiliation(s)
- Hae-Ryong Yun
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Su Joo
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joongyub Lee
- Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Republic of Korea
| | - Kook-Hwan Oh
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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9
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Ahn Y, Choi SJ, Lim S, Kim JB, Song JM, Kang DH, Song JK, Kim HJ, Kang JW, Yang DH, Kim DH, Koo HJ. Classification of severe aortic stenosis and outcomes after aortic valve replacement. Sci Rep 2022; 12:7506. [PMID: 35525841 PMCID: PMC9079063 DOI: 10.1038/s41598-022-11491-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
Abstract
Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS (aortic stenosis) severity, but it is unclear that whether CT findings would have additional value to discriminate significant AS subtypes including high gradient severe AS, classic low-flow, low gradient (LF-LG) AS, paradoxical LF-LG AS, and moderate AS. In this study, we examined the preoperative clinical and cardiac CT findings of different subtypes of AS in patients with surgical aortic valve replacement (AVR) and evaluated the subtype classification as a factor affecting post-surgical outcomes. This study included 511 (66.9 ± 8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVAecho) and by CT (AVACT) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as (1) high-gradient severe (n = 438), (2) classic LF-LG (n = 18), and (3) paradoxical LF-LG (n = 55) based on echocardiography. In all patients, 455 (89.0%) patients were categorized as severe AS according to the AVACT. However, 56 patients were re-classified as moderate AS (43 [9.8%] high-gradient severe AS, 5 [27.8%] classic LF-LG AS, and 8 [14.5%] paradoxical LF-LG AS) by AVACT. The classic LF-LG AS group presented larger AVACT and aortic annulus than those in high-gradient severe AS group and one third of them had AVACT ≥ 1.2 cm2. After multivariable adjustment, old age (hazard ratio [HR], 1.04, P = 0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P < 0.001), preoperative atrial fibrillation (HR, 2.75; P = 0.003), classic LF-LG AS (HR, 5.53, P = 0.004), and small aortic annulus on CT (HR, 0.57; P = 0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE) after surgical AVR.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Se Jin Choi
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Soyeoun Lim
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea.
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea.
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10
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Lee S, Han K, Suh YJ. Quality assessment of radiomics research in cardiac CT: a systematic review. Eur Radiol 2022; 32:3458-3468. [PMID: 34981135 DOI: 10.1007/s00330-021-08429-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess the quality of current radiomics research on cardiac CT using radiomics quality score (RQS) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) systems. METHODS Systematic searches of PubMed and EMBASE were performed to identify all potentially relevant original research articles about cardiac CT radiomics. Fifteen original research articles were selected. Two cardiac radiologists assessed the quality of the methodology adopted in those studies according to the RQS and TRIPOD guidelines. Basic adherence rates for the following six key domains were evaluated: image protocol and reproducibility, feature reduction and validation, biologic/clinical utility, performance index, high level of evidence, and open science. RESULTS Among the 15 included articles, six (40%) were about coronary artery disease and six (40%) were about myocardial infarction. The mean RQS was 9.9 ± 7.3 (27.4% of the ideal score of 36), and the basic adherence rate was 44.6%. Fourteen (93.3%) and nine (60%) studies performed feature selection and validation, but only two (13.3%) of them performed external validation. Two studies (13.3%) were prospective, and only one study (6.7%) conducted calibration analysis and stated the potential clinical utility. None of the studies conducted phantom study and cost-effective analysis. The overall adherence rate for TRIPOD was 63%. CONCLUSION The quality of radiomics studies in cardiac CT is currently insufficient. A higher level of evidence is required, and analysis of clinical utility and calibration of model performance need to be improved. KEY POINTS • The quality of science of radiomics studies in cardiac CT is currently insufficient. • No study conducted a phantom study or cost-effective analysis, with further limitations being demonstrated in a high level of evidence for radiomics studies. • Analysis of clinical utility and calibration of model performance need to be improved, and a higher level of evidence is required.
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Affiliation(s)
- Suji Lee
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Young Joo Suh
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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11
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Cuellar-Calabria H, Burcet G, Juarez-Garcia M, Reyes-Juárez J, Pizzi M, Aguadé-Bruix S, Roque A. Implantación de un protocolo de angio-TC coronaria basado en el índice de masa corporal: reducción de dosis, calidad de imagen y rendimiento diagnóstico. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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13
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Park SH. Introducing "Recommendation and Guideline" of the Korean Journal of Radiology. Korean J Radiol 2021; 22:1929-1933. [PMID: 34825529 PMCID: PMC8628153 DOI: 10.3348/kjr.2021.0785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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14
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Jo Y, Kim J, Park CH, Lee JW, Hur JH, Yang DH, Lee BY, Im DJ, Hong SJ, Kim EY, Park EA, Kim PK, Yong HS. Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 1: Standardized Protocol. Korean J Radiol 2020; 20:1313-1333. [PMID: 31464111 PMCID: PMC6715561 DOI: 10.3348/kjr.2019.0398] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.
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Affiliation(s)
- Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jae Wook Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea.
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15
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Lim SJ, Koo HJ, Jung SC, Kang DY, Ahn JM, Park DW, Park SJ, Yang DH, Kang JW. Sinus of Valsalva Thrombosis Detected on Computed Tomography after Transcatheter Aortic Valve Replacement. Korean Circ J 2020; 50:572-582. [PMID: 32281322 PMCID: PMC7321751 DOI: 10.4070/kcj.2019.0385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis. METHODS Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated. RESULTS The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants. CONCLUSIONS Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.
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Affiliation(s)
- Su Jin Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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16
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Lee JW, Hur JH, Yang DH, Lee BY, Im DJ, Hong SJ, Kim EY, Park EA, Jo Y, Kim J, Park CH, Yong HS. Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 2: Interpretation of Cine, Flow, and Angiography Data. Korean J Radiol 2020; 20:1477-1490. [PMID: 31606953 PMCID: PMC6791819 DOI: 10.3348/kjr.2019.0407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technological advances and the expanded national insurance coverage of CMR assessments. For improved patient care, proper acquisition of CMR images as well as their accurate interpretation by well-trained personnel are equally important. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology. KOSCI has also created a formal Committee on CMR guidelines to create updated practices. The members of this committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.
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Affiliation(s)
- Jae Wook Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
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17
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Yang DH. [CT Imaging for Mitral Valve Surgery and Intervention]. TAEHAN YONGSANG UIHAKHOE CHI 2020; 81:290-301. [PMID: 36237393 PMCID: PMC9431805 DOI: 10.3348/jksr.2020.81.2.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/02/2022]
Abstract
The surgical technique of mitral valvuloplasty or transcatheter mitral valve (MV) replacement has been developed recently. Surgeons and interventionists require detailed anatomical information on the MV for the purpose of treatment planning. In this review, we discussed the anatomic features of the MV on CT and the method of evaluating the MV for treatment planning, as well as its preservation, for interventional procedures.
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18
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Yoon YE, Kim KM, Lee W, Han JS, Chun EJ, Ahn S, Choi SI, Yun BL, Suh JW. Breast Arterial Calcification is Associated with the Progression of Coronary Atherosclerosis in Asymptomatic Women: A Preliminary Retrospective Cohort Study. Sci Rep 2020; 10:2755. [PMID: 32066804 PMCID: PMC7026413 DOI: 10.1038/s41598-020-59606-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
We evaluated whether breast arterial calcification (BAC) is associated with the progression of coronary atherosclerosis in asymptomatic women. This retrospective observational cohort study analysed asymptomatic women from the BBC registry. In 126 consecutive women (age, 54.5 ± 7.0 years) who underwent BAC evaluation and repeated coronary computed tomography angiography (CCTA) examinations, the coronary arterial calcification score (CACS) and segment stenosis score (SSS) were evaluated to assess the progression of coronary arterial calcification (CAC) and coronary atherosclerotic plaque (CAP). CAC and CAP progression were observed in 42 (33.3%) and 26 (20.6%) women, respectively (median interscan time, 4.3 years), and were associated with the presence of BAC and a higher BAC score at baseline. Women with BAC demonstrated higher CAC and CAP progression rates and showed higher chances for CAC and CAP progression during follow-up (p < 0.001 for both). In multivariable analyses, the BAC score remained independently associated with both CAC and CAP progression rates after adjustment for clinical risk factors (β = 0.087, p = 0.029; and β = 0.020, p = 0.010, respectively) and with additional adjustment for baseline CACS (β = 0.080, p = 0.040; and β = 0.019, p = 0.012, respectively) or SSS (β = 0.079, p = 0.034; and β = 0.019, p = 0.011, respectively). Thus, BAC may be related to the progression of coronary atherosclerosis and its evaluation may facilitate decision-making.
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Affiliation(s)
- Yeonyee Elizabeth Yoon
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Departments of Endocrinology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonjae Lee
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Han
- Departments of Health Promotion Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Chun
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Departments of Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Il Choi
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo La Yun
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung-Won Suh
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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19
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Suh YJ, Lee S, Chang BC, Shim CY, Hong GR, Choi BW, Kim YJ. Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement. Korean J Radiol 2019; 20:352-363. [PMID: 30799566 PMCID: PMC6389816 DOI: 10.3348/kjr.2018.0350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/05/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. MATERIALS AND METHODS A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. RESULTS During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05). CONCLUSION Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chi Young Shim
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu Ru Hong
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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20
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Ko SM, Kim TH, Chun EJ, Kim JY, Hwang SH. Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean J Radiol 2019; 20:333-351. [PMID: 30799565 PMCID: PMC6389818 DOI: 10.3348/kjr.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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21
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Incremental Value of Subtended Myocardial Mass for Identifying FFR-Verified Ischemia Using Quantitative CT Angiography. JACC Cardiovasc Imaging 2019; 12:707-717. [DOI: 10.1016/j.jcmg.2017.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/13/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
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22
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Koo HJ, Yang DH, Kang JW, Lee JY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Lim TH. Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: comparison with intra-operative findings. Eur Heart J Cardiovasc Imaging 2019; 19:199-207. [PMID: 28329276 DOI: 10.1093/ehjci/jex010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/16/2017] [Indexed: 12/25/2022] Open
Abstract
Aims We aimed to compare imaging findings of infective endocarditis between computed tomography (CT) and transoesophageal echocardiography (TEE) using surgical inspection as a reference standard. Methods and results Forty-nine patients (aged 54 ± 17 years, 69% men) who underwent pre-operative CT and TEE for infective endocarditis were included. Twelve of these patients had prosthetic valve endocarditis. Imaging findings of infective endocarditis were classified as vegetation, leaflet perforation, abscess/pseudoaneurysm, and paravalvular leakage. Diagnostic performances of CT and TEE were evaluated using surgical inspection as a reference standard. Interobserver agreements for CT findings were obtained using Cohen's κ test. The detection rates of infective endocarditis per patient with CT and TEE were 93.9% (46/49) and 95.9% (47/49), respectively. In per-imaging analysis, the sensitivities of CT and TEE were not significantly different for both native and prosthetic valve infective endocarditis (sensitivity: vegetation, 100% in TEE and 90.9% in CT; leaflet perforation, 87.5% in TEE and 50.0% in CT; abscess/pseudoaneurysm, 40.0% in TEE and 60.0% in CT; paravalvular leakage, 100% in TEE and 50.0% in CT). Interobserver agreements for CT findings were substantial or excellent (0.79-0.88). Conclusion Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent.
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Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Song
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Kwan Song
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Jae-Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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23
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Ko SM, Hwang SH, Lee HJ. Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases. J Cardiovasc Imaging 2019; 27:73-92. [PMID: 30993942 PMCID: PMC6470070 DOI: 10.4250/jcvi.2019.27.e17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
Multimodality imaging is indicated for the evaluation of left ventricular (LV) myocardial diseases. Cardiac magnetic resonance (CMR) allows morphological and functional assessment of the LV along with soft tissue characterization. Technological advances in cardiac computed tomography (CT) have led to the development of techniques for diagnostic acquisition in LV myocardial disease. Cardiac CT facilitates the characterization of LV myocardial disease based on anatomy, function, and enhancement pattern. LV regional and global functional parameters are evaluated using multi-phasic cine CT images. CT myocardial perfusion facilitates the identification of hemodynamically significant coronary artery stenosis. Cardiac CT with delayed enhancement is used to detect myocardial scarring or fibrosis in myocardial infarction and non-ischemic cardiomyopathy, and for the measurement of extracellular volume fraction in non-ischemic cardiomyopathy. In this review, we review imaging techniques and key imaging features of cardiac CT used for the evaluation of myocardial diseases, along with CMR findings.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Hye Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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24
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Choe YH. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology. Korean J Radiol 2019; 20:1555-1561. [PMID: 31854145 PMCID: PMC6923209 DOI: 10.3348/kjr.2019.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Mei M, Nie J, Yang ZS, Sun HW, Wang H, Kang XM. Comparison of echocardiography and 64-slice spiral computed tomography in the diagnosis of congenital heart disease in children. J Cell Biochem 2018; 120:3969-3977. [PMID: 30321464 DOI: 10.1002/jcb.27682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
The diagnosis of congenital heart disease in children has been an issue in the medical community. Timely diagnosis and treatment can provide a greater guarantee for children's healthy growth. In recent years, there have been more and more studies on the diagnosis of congenital heart disease in children. This paper compares the advantages and disadvantages of echocardiography and 64-slice spiral computed tomography (CT) in the diagnosis of congenital heart disease in children. In clinical trials, we also tested 64 patients with spiral computed tomography (SCT) and transthoracic echocardiography (TTE) detection of patients and then confirmed the accuracy of the diagnosis by the surgical methods. The two methods of detection, the rate of missed diagnosis, and the rate of misdiagnosis were counted. Through the test results and pathological diagnosis results, the diagnostic accuracy of the two methods were all above 90%, each with its own advantages and disadvantages. The sensitivity of echocardiographic in detecting intracardiac structure abnormalities was relatively high, but when the diagnosis of extracardiac structural abnormalities less than 64-slice spiral CT method, misdiagnosis of TTE was mainly due to extracardiac vascular malformations. Therefore, it is recommended to combine the two methods to improve the diagnosis of congenital heart disease in children.
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Affiliation(s)
- Mei Mei
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Jing Nie
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Zhan Shuang Yang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Hua Wei Sun
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - He Wang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Xiao Ming Kang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
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26
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Koo HJ, Kang JW, Oh SY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Yang DH. Cardiac computed tomography for the localization of mitral valve prolapse: scallop-by-scallop comparisons with echocardiography and intraoperative findings. Eur Heart J Cardiovasc Imaging 2018; 20:550-557. [DOI: 10.1093/ehjci/jey139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/07/2018] [Indexed: 12/07/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
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27
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Cardiac CT: Global Use and Comparison of International Guidelines. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9464-2] [Citation(s) in RCA: 1] [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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28
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Wang XP, Zhu XM, Zhu YS, Liu WY, Yang XH, Huang WW, Xu Y, Tang LJ. Automatic tube potential selection with tube current modulation in coronary CT angiography: Can it achieve consistent image quality among various individuals? Exp Ther Med 2018; 16:253-259. [PMID: 29896246 PMCID: PMC5995055 DOI: 10.3892/etm.2018.6158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/06/2018] [Indexed: 11/06/2022] Open
Abstract
The present study included a total of 111 consecutive patients who had undergone coronary computed tomography (CT) angiography, using a first-generation dual-source CT with automatic tube potential selection and tube current modulation. Body weight (BW) and body mass index (BMI) were recorded prior to CT examinations. Image noise and attenuation of the proximal ascending aorta (AA) and descending aorta (DA) at the middle level of the left ventricle were measured. Correlations between BW, BMI and objective image quality were evaluated using linear regression. In addition, two subgroups based on BMI (BMI ≤25 and >25 kg/m2) were analyzed. Subjective image quality, image noise, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) were all compared between those. The image noise of the AA increased with the BW and BMI (BW: r=0.453, P<0.001; BMI: r=0.545, P<0.001). The CNR and SNR of the AA were inversely correlated with BW and BMI, respectively. The image noise of the DA and the CNR and SNR of the DA exhibited a similar association to those with the BW or BMI. The BMI >25 kg/m2 group had a significant increase in image noise (33.1±6.9 vs. 27.8±4.0 HU, P<0.05) and a significant reduction in CNR and SNR, when compared with those in the BMI ≤25 kg/m2 group (CNR: 18.9±4.3 vs. 16.1±3.7, P<0.05; SNR: 16.0±3.8 vs. 13.6±3.2, P<0.05). Patients with a BMI of ≤25 kg/m2 had more coronary artery segments scored as excellent, compared with patients with a BMI of >25 kg/m2 (P=0.02). In conclusion, this method is not able to achieve a consistent objective image quality across the entire patient population. The impact of BW and BMI on objective image quality was not completely eliminated. BMI-based adjustment of the tube potential may achieve a more consistent image quality compared to automatic tube potential selection, particularly in patients with a larger body habitus.
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Affiliation(s)
- Xiao-Ping Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Mei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yin-Su Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wang-Yan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Han Yang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wei-Wei Huang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Li-Jun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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29
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Ha H, Koo HJ, Huh HK, Kim GB, Kweon J, Kim N, Kim YH, Kang JW, Lim TH, Song JK, Lee SJ, Yang DH. Effect of pannus formation on the prosthetic heart valve: In vitro demonstration using particle image velocimetry. PLoS One 2018; 13:e0199792. [PMID: 29953485 PMCID: PMC6023143 DOI: 10.1371/journal.pone.0199792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/13/2018] [Indexed: 02/06/2023] Open
Abstract
Although hemodynamic influence of the subprosthetic tissue, termed as pannus, may contribute to prosthetic aortic valve dysfunction, the relationship between pannus extent and hemodynamics in the prosthetic valve has rarely been reported. We investigated the fluid dynamics of pannus formation using in vitro experiments with particle image velocimetry. Subvalvular pannus formation caused substantial changes in prosthetic valve transvalvular peak velocity, transvalvular pressure gradient (TPG) and opening angle. Maximum flow velocity and corresponding TPG were mostly affected by pannus width. When the pannus width was 25% of the valve diameter, pannus formation elevated TPG to >2.5 times higher than that without pannus formation. Opening dysfunction was observed only for a pannus involvement angle of 360°. Although circumferential pannus with an involvement angle of 360° decreased the opening angle of the valve from approximately 82° to 58°, eccentric pannus with an involvement angle of 180° did not induce valve opening dysfunction. The pannus involvement angle largely influenced the velocity flow field at the aortic sinus and corresponding hemodynamic indices, including wall shear stress, principal shear stress and viscous energy loss distributions. Substantial discrepancy between the velocity-based TPG estimation and direct pressure measurements was observed for prosthetic valve flow with pannus formation.
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Affiliation(s)
- Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | - Hyun Jung Koo
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyung Kyu Huh
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Guk Bae Kim
- Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jihoon Kweon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae-Hwan Lim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Kwan Song
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Joon Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Di Cesare E, Patriarca L, Panebianco L, Bruno F, Palumbo P, Cannizzaro E, Splendiani A, Barile A, Masciocchi C. Coronary computed tomography angiography in the evaluation of intermediate risk asymptomatic individuals. Radiol Med 2018; 123:686-694. [PMID: 29713929 DOI: 10.1007/s11547-018-0898-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/20/2018] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease is still one of the main causes of death and an early identification of coronary artery disease (CAD) remains the primary step in clinical management of patients with cardiovascular risk factor. Coronary computed tomography angiography (CCTA) has shown high sensitivity in CAD detection and could be helpful as screening method. The purpose of this study was to assess the prevalence of coronary artery disease detected by CCTA in asymptomatic patients with an intermediate risk of CAD. MATERIALS AND METHODS We retrospectively selected 185 asymptomatic patients with an intermediate Framingan Risk Score (mean age was 62.3 ± 12.4 years); all patients underwent CCTA, using 640-slice CT. RESULTS Atherosclerotic plaques were present in 112 out of 185 patients (60.5%); 56 subjects (30.2%) had mild stenosis, 49 (26.5%) moderate stenosis, only 3 patients (1.6%) had severe stenosis and in 4 cases (2.2%) the "blooming effect" did not allow for evaluation of the degree of stenosis. Among the positive cases, a high number of patients (44.6%) [50] showed coronary artery disease in one vessel, 33 patients (29.4%) in two vessels, 22 patients (19.6%) in three vessels and 5 patients in four vessels or more (4.5%). Patients with moderate stenosis were older, had hypertension in most cases, higher total cholesterol levels and more often were smokers. The radiation dose (mSv) dispensed to the patients was 3.7 ± 1.6 mSv. CONCLUSION High prevalence of coronary stenosis detected by low-dose CCTA in patients not properly classified by the traditional methods of risk stratification commonly used in clinical practice emphasizes the need to extend the risk stratification to other diagnostic tools with higher capability to detect CAD.
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Affiliation(s)
- Ernesto Di Cesare
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy.
| | - Lucia Patriarca
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Luca Panebianco
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Federico Bruno
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Ester Cannizzaro
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi di L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
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Functional classification of aortic regurgitation using cardiac computed tomography: comparison with surgical inspection. Int J Cardiovasc Imaging 2018; 34:1295-1303. [PMID: 29564585 DOI: 10.1007/s10554-018-1341-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
In patients with aortic regurgitation (AR), a precise preoperative assessment of aortic valve (AV) pathology is important if AV repair or sparing operation is an alternative option. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) for evaluating the AR mechanism compared with surgical inspection. 59 patients with AR who underwent AV surgery and preoperative cardiac CT were evaluated. AR mechanism was classified into type 1 (aortic dilatation or cusp perforation), type 2 (prolapsed cusp) and type 3 (cusp retraction). Agreement between CT and surgical inspection was obtained. Correlation between aortic regurgitant orifice (ARO) and imaging parameters were evaluated. On surgical inspection, type 1 AR was noted in 22 patients, type 2 in 16 and type 3 in 21. Agreement regarding the AR mechanism on CT was excellent (intra-class correlation coefficient, 0.81). At the patient level, the Cohen's κ value for CT findings with surgical inspection was of 0.89. At the cusp level, moderate agreement was noted between CT and surgical inspection. In the per-cusp analysis, CT had a sensitivity of 72.6%, specificity of 85.1%, positive predictive value of 73.8% and negative predictive value of 84.3% for the detection of aortic cusp abnormality. The diameter, perimeter and area of aortic annulus had moderate correlation with ARO (r = 0.54-0.66, P < 0.001). CT-derived classification of AR mechanism showed excellent agreement with surgical inspection.
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Mantini C, Maffei E, Toia P, Ricci F, Seitun S, Clemente A, Malagò R, Runza G, La Grutta L, Midiri M, Cotroneo AR, Forte E, Cademartiri F. Influence of image reconstruction parameters on cardiovascular risk reclassification by Computed Tomography Coronary Artery Calcium Score. Eur J Radiol 2018; 101:1-7. [PMID: 29571781 DOI: 10.1016/j.ejrad.2018.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/19/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the influence of different CT reconstruction parameters on coronary artery calcium scoring (CACS) values and reclassification of predicted cardiovascular (CV) risk. METHODS CACS was evaluated in 113 patients undergoing ECG-gated 64-slice CT. Reference CACS protocol included standard kernel filter (B35f) with slice thickness/increment of 3/1.5 mm, and field-of-view (FOV) of 150-180 mm. Influence of different image reconstruction algorithms (reconstructed slice thickness/increment 2.0/1.0-1.5/0.8-3.0/2.0-3.0/3.0 mm; slice kernel B30f-B45f; FOV 200-250 mm) on Agatston score was assessed by Bland-Altman plots and concordance correlation coefficient (CCC) analysis. Classification of CV risk was based on the Mayo Clinic classification. RESULTS Different CACS reconstruction parameters showed overall good accuracy and precision when compared with reference protocol. Protocols with larger FOV, thinner slices and sharper kernels were associated with significant CV risk reclassification. Use of kernel B45f showed a moderate positive correlation with reference CACS protocol (Agatston CCC = 0.67), and yielded significantly higher CACS values (p < .05). Reconstruction parameters using B30f or B45f kernels, 250 mm FOV, or slice thickness/increment of 2.0/1.0 mm or 1.5/0.8 mm, were associated with significant reclassification of CV risk (p < .05). CONCLUSIONS Kernel, FOV, slice thickness and increment are major determinants of accuracy and precision of CACS measurement. Despite high agreement and overall good correlation of different reconstruction protocols, thinner slices thickness and increment, and sharper kernels were associated with significant upward reclassification of CV risk. Larger FOV determined both upward and downward reclassification of CV risk.
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Affiliation(s)
- Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Patrizia Toia
- Department of Radiology, University of Palermo, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Italy; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sara Seitun
- Department of Radiology, Ospedale San Martino/IRCCS, Genova, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
| | | | - Giuseppe Runza
- Department of Radiology, P.O. Umberto I, Azienda Sanitaria Provinciale 8, Siracusa, Italy
| | | | | | | | - Ernesto Forte
- Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
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Koo HJ, Lee JY, Kim GH, Kang JW, Kim YH, Kim DH, Song JM, Kang DH, Song JK, Lim TH, Yang DH. Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features. Eur Heart J Cardiovasc Imaging 2018; 19:1419-1427. [DOI: 10.1093/ehjci/jex341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Young-Hak Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
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Yang DH, Park SH, Lee K, Kim T, Kim JB, Yun TJ, Kim GB, Kim N. Applications of Three-Dimensional Printing in Cardiovascular Surgery: A Case-Based Review. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Hyub Park
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Koeun Lee
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taehun Kim
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lim JW, Lee H, Her K, Park HW, Shin KE. Myocardial CT perfusion imaging for pre- and postoperative evaluation of myocardial ischemia in a patient with myocardial bridging: A case report. Medicine (Baltimore) 2017; 96:e8277. [PMID: 29049223 PMCID: PMC5662389 DOI: 10.1097/md.0000000000008277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although myocardial bridging (MB) is usually considered as benign, initial medical therapy and following surgical treatment in drug-refractory cases has been widely accepted for managing symptomatic MB. Before the patient proceeds to percutaneous or surgical intervention, however, the presence of objective ischemia in the corresponding myocardial territory should be documented. PATIENT CONCERN AND INTERVENTION We herein report a 43-year-old male complaining of chest pain in whom cardiac CT with myocardial perfusion (cCTP) showed an MB of left anterior descending artery (LAD) with preoperative perfusion defect in corresponding myocardium and normalization of perfusion after supra-arterial myotomy. DIAGNOSIS Myocardial bridging-induced ischemia. LESSONS This case illustrates the potential utility of cCTP for the simultaneous assessment of MB and its hemodynamic significance for treatment planning and post-therapeutic evaluation although further research is needed to establish the clinical usefulness of this technique.
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Affiliation(s)
| | - Heon Lee
- Division of Cardiovascular and Thoracic Imaging, Department of Radiology
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery
| | - Hyun Woo Park
- Department of Cardiology, Soonchunhyang University Hospital, Bucheon, Republic of Korea
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Beck KS, Kim JA, Choe YH, Hian SK, Hoe J, Hong YJ, Kim SM, Kim TH, Kim YJ, Kim YH, Kuribayashi S, Lee J, Leong L, Lim TH, Lu B, Park JH, Sakuma H, Yang DH, Yaw TS, Wan YL, Zhang Z, Zhao S, Yong HS. 2017 Multimodality Appropriate Use Criteria for Noninvasive Cardiac Imaging: Expert Consensus of the Asian Society of Cardiovascular Imaging. Korean J Radiol 2017; 18:871-880. [PMID: 29089819 PMCID: PMC5639152 DOI: 10.3348/kjr.2017.18.6.871] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/15/2022] Open
Abstract
In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.
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Affiliation(s)
| | - Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sim Kui Hian
- Department of Cardiology, Sarawak General Hospital Heart Centre, Sarawak 93586, Malaysia
| | - John Hoe
- Department of Radiology, Mount Elizabeth Hospital, Singapore 228510, Singapore
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yun Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Sachio Kuribayashi
- Department of Diagnostic Radiology, Keio University, Tokyo 9608582, Japan
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Lilian Leong
- Department of Radiology, Hong Kong College of Radiologists, Hong Kong 251114, China
| | - Tae-Hwan Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jae Hyung Park
- Department of Radiology, Myongji Hospital, Goyang 10475, Korea
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Mie 5148507, Japan
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Tan Swee Yaw
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Zhaoqi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shihua Zhao
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
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Suh YJ, Kim YJ, Kim JY, Chang S, Im DJ, Hong YJ, Choi BW. A whole-heart motion-correction algorithm: Effects on CT image quality and diagnostic accuracy of mechanical valve prosthesis abnormalities. J Cardiovasc Comput Tomogr 2017; 11:474-481. [PMID: 28966103 DOI: 10.1016/j.jcct.2017.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine the effect of a whole-heart motion-correction algorithm (new-generation snapshot freeze, NG SSF) on the image quality of cardiac computed tomography (CT) images in patients with mechanical valve prostheses compared to standard images without motion correction and to compare the diagnostic accuracy of NG SSF and standard CT image sets for the detection of prosthetic valve abnormalities. METHODS A total of 20 patients with 32 mechanical valves who underwent wide-coverage detector cardiac CT with single-heartbeat acquisition were included. The CT image quality for subvalvular (below the prosthesis) and valvular regions (valve leaflets) of mechanical valves was assessed by two observers on a four-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent). Paired t-tests or Wilcoxon signed rank tests were used to compare image quality scores and the number of diagnostic phases (image quality score≥3) between the standard image sets and NG SSF image sets. Diagnostic performance for detection of prosthetic valve abnormalities was compared between two image sets with the final diagnosis set by re-operation or clinical findings as the standard reference. RESULTS NG SSF image sets had better image quality scores than standard image sets for both valvular and subvalvular regions (P < 0.05 for both). The number of phases that were of diagnostic image quality per patient was significantly greater in the NG SSF image set than standard image set for both valvular and subvalvular regions (P < 0.0001). Diagnostic performance of NG SSF image sets for the detection of prosthetic abnormalities (20 pannus and two paravalvular leaks) was greater than that of standard image sets (P < 0.05). CONCLUSION Application of NG SSF can improve CT image quality and diagnostic accuracy in patients with mechanical valves compared to standard images.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea.
| | - Jin Young Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Suyon Chang
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
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Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol 2017; 18:786-798. [PMID: 28860896 PMCID: PMC5552462 DOI: 10.3348/kjr.2017.18.5.786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 12/26/2022] Open
Abstract
Vasculitis, characterized by inflammation of vessel walls, is comprised of heterogeneous clinicopathological entities, and thus poses a diagnostic challenge. The most widely used approach for classifying vasculitides is based on the International Chapel Hill Consensus Conference (CHCC) nomenclature system. Based on the recently revised CHCC 2012, we propose computed tomography (CT) features of vasculitides and a differential diagnosis based on location and morphological characteristics. Finally, vasculitis mimics should be differentiated, because erroneous application of immunosuppressive drugs on vasculitis mimics may be ineffective, even deteriorating. This article presents the utility of CT in the diagnosis and differential diagnosis of vasculitides.
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Affiliation(s)
- Jee Hye Hur
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Hyon Joo Kwag
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jin Young Yoo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jeong Jae Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Kim JH, Kim EY, Jin GY, Choi JB. A Review of the Use of Cardiac Computed Tomography for Evaluating the Mitral Valve before and after Mitral Valve Repair. Korean J Radiol 2017; 18:773-785. [PMID: 28860895 PMCID: PMC5552461 DOI: 10.3348/kjr.2017.18.5.773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/16/2017] [Indexed: 11/15/2022] Open
Abstract
The role of cardiac computed tomography (CT) for evaluating the mitral valve (MV) has been limited since echocardiography is the main method of evaluation. However, recent advances in cardiac CT have enable detailed evaluation of the anatomy and geometry of the MV. We describe assessments of the anatomy and coaptation geometric parameters of normal MVs, and also review repair of diseased/damaged MV. We also discuss pre- and post-surgical imaging of MV pathology using cardiac CT and various CT images. We found that cardiac CT could be used as an alternative imaging modality to echocardiography for pre-operative MV evaluation and to predict clinical outcomes following repair.
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Affiliation(s)
- Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Eun Young Kim
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences of Chonbuk National University Medical School, Jeonju 54907, Korea.,Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences of Chonbuk National University Medical School, Jeonju 54907, Korea
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
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Yu M, Li Y, Li W, Lu Z, Wei M, Zhang J. Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification. Korean J Radiol 2017; 18:753-762. [PMID: 28860893 PMCID: PMC5552459 DOI: 10.3348/kjr.2017.18.5.753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.
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Affiliation(s)
- Mengmeng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wenbin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Feng R, Tong J, Liu X, Zhao Y, Zhang L. High-Pitch Coronary CT Angiography at 70 kVp Adopting a Protocol of Low Injection Speed and Low Volume of Contrast Medium. Korean J Radiol 2017; 18:763-772. [PMID: 28860894 PMCID: PMC5552460 DOI: 10.3348/kjr.2017.18.5.763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the feasibility and image quality (IQ) of prospectively high-pitch coronary CT angiography (CCTA) with low contrast medium injection rate at 70 kVp. Materials and Methods One hundred and four patients with suspected coronary artery disease (body mass index < 26 kg/m2, sinus rhythm and heart rate < 70 beats/min) were prospectively enrolled and randomly divided into two groups. In group A and group B, 28 mL and 40 mL of 370 mgI/mL iodinated contrast media was administrated at a flow rate of 3.5 and 5 mL/s, respectively. CT values, noise, signal-to-noise ratio, contrast-to-noise ratio (CNR) of the proximal segments of coronary arteries and subjective IQ were evaluated. Results The CT values and noise in group A were significantly lower than those in group B (434–485 Hounsfield units [HU] vs. 772–851 HU, all p < 0.001; 17.8–22.3 vs. 23.3–26.4, all p < 0.005). The CNRs of the right coronary artery and left main artery showed no statistical difference between the two groups (42.1 ± 13.8 vs. 36.8 ± 16.0, p = 0.074; 38.7 ± 10.6 vs. 38.1 ± 17.0, p = 0.819). No statistical difference was observed between the two groups in IQ scores (3.04 ± 0.75 vs. 3.0 ± 0.79, p = 0.526) and diagnostic ratio (96.1% [50/52] vs. 94.2% [49/52], p = 0.647). Conclusion Prospective high-pitch CCTA at 70 kVp with 28 mL of contrast media and injection rate of 3.5 mL/s could provide diagnostic IQ for normal-weight patients with heart rate of < 70 beats/min.
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Affiliation(s)
- Ruiqi Feng
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China
| | - Jiajie Tong
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050051, P.R. China
| | - Xiaofei Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China
| | - Yu Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China
| | - Liang Zhang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China
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Yu M, Zhang Y, Li Y, Li M, Li W, Zhang J. Assessment of Myocardial Bridge by Cardiac CT: Intracoronary Transluminal Attenuation Gradient Derived from Diastolic Phase Predicts Systolic Compression. Korean J Radiol 2017; 18:655-663. [PMID: 28670160 PMCID: PMC5447641 DOI: 10.3348/kjr.2017.18.4.655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To study the predictive value of transluminal attenuation gradient (TAG) derived from diastolic phase of coronary computed tomography angiography (CCTA) for identifying systolic compression of myocardial bridge (MB). Materials and Methods Consecutive patients diagnosed with MB based on CCTA findings and without obstructive coronary artery disease were retrospectively enrolled. In total, 143 patients with 144 MBs were included in the study. Patients were classified into three groups: without systolic compression, with systolic compression < 50%, and with systolic compression ≥ 50%. TAG was defined as the linear regression coefficient between intraluminal attenuation in Hounsfield units (HU) and length from the vessel ostium. Other indices such as the length and depth of the MB were also recorded. Results TAG was the lowest in MB patients with systolic compression ≥ 50% (-19.9 ± 8.7 HU/10 mm). Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for identifying systolic compression ≥ 50%. The result indicated an optimal cutoff value of TAG as -18.8 HU/10 mm (area under curve = 0.778, p < 0.001), which yielded higher sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy (54.1, 80.5, 72.8, and 75.0%, respectively). In addition, the TAG of MB with diastolic compression was significantly lower than the TAG of MB without diastolic compression (-21.4 ± 4.8 HU/10 mm vs. -12.7 ± 8 HU/10 mm, p < 0.001). Conclusion TAG was a better predictor of MB with systolic compression ≥ 50%, compared to the length or depth of the MB. The TAG of MB with persistent diastolic compression was significantly lower than the TAG without diastolic compression.
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Affiliation(s)
- Mengmeng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yang Zhang
- Department of Pharmaceutical Science, School of Pharmacy, The Second Military Medical University, Shanghai 200433, China.,Department of Scientific Research, TongRen Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200050, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Minghua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wenbin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Hwang JS, Lee H, Lee B, Lee SJ, Jou SS, Lim HK, Suh J. Estimation of Diastolic Filling Pressure with Cardiac CT in Comparison with Echocardiography Using Tissue Doppler Imaging: Determination of Optimal CT Reconstruction Parameters. Korean J Radiol 2017; 18:632-642. [PMID: 28670158 PMCID: PMC5447639 DOI: 10.3348/kjr.2017.18.4.632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/30/2016] [Indexed: 01/08/2023] Open
Abstract
Objective To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. Materials and Methods Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm2). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. Results For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′ ≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. Conclusion Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.
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Affiliation(s)
- Ji-Sun Hwang
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
| | - Bora Lee
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | | | - Sung Shick Jou
- Department of Radiology, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea
| | - Jon Suh
- Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea
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Kang EJ, Lee KN, Choi WJ, Kim YD, Shin KM, Lim JK, Lee J. Left Ventricular Functional Parameters and Geometric Patterns in Korean Adults on Coronary CT Angiography with a 320-Detector-Row CT Scanner. Korean J Radiol 2017; 18:664-673. [PMID: 28670161 PMCID: PMC5447642 DOI: 10.3348/kjr.2017.18.4.664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/29/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the normal reference values of left ventricle (LV) functional parameters in Korean adults on coronary CT angiography (CCTA) with a 320-detector-row CT scanner, and to analyze sex-related differences and correlations with various clinical characteristics. MATERIALS AND METHODS This study retrospectively enrolled 172 subjects (107 men and 65 women; age, 58 ± 10.9 years; body surface area [BSA], 1.75 ± 0.2 m2) who underwent CCTA without any prior history of cardiac disease. The following parameters were measured by post-processing the CT data: LV volume, LV functional parameters (ejection fraction, stroke volume, cardiac output, etc.), LV myocardial mass, LV inner diameter, and LV myocardial thickness (including septal wall thickness [SWT], posterior wall thickness [PWT], and relative wall thickness [RWT = 2 × PWT / LV inner diameter]). All of the functional or volumetric parameters were normalized using the BSA. The general characteristics and co-morbidities for the enrolled subjects were recorded, and the correlations between these factors and the LV parameters were then evaluated. RESULTS The LV myocardial thickness (SWT, 1.08 ± 0.18 cm vs. 0.90 ± 0.17 cm, p < 0.001; PWT, 0.91 ± 0.15 cm vs. 0.78 ± 0.10 cm, p < 0.001; RWT, 0.38 ± 0.08 cm vs. 0.33 ± 0.05 cm, p < 0.001), LV volume (LV end-diastolic volume, 112.9 ± 26.1 mL vs. 98.2 ± 21.0 mL, p < 0.001; LV end-systolic volume, 41.7 ± 14.7 mL vs. 33.7 ± 12.2 mL, p = 0.001) and mass (145.0 ± 29.1 g vs. 107.9 ± 20.0 g, p < 0.001) were significantly greater in men than in women. However, these differences were not significant after normalization using BSA, except for the LV mass (LV mass index, 79.6 ± 14.0 g/m2 vs. 66.2 ± 11.0 g/m2, p < 0.001). The cardiac output and ejection fraction were not significantly different between the men and women (cardiac output, 4.3 ± 1.0 L/min vs. 4.2 ± 0.9 L/min, p = 0.452; ejection fraction, 63.4 ± 7.7% vs. 66.4 ± 7.6%, p = 0.079). Most of the LV parameters were positively correlated with BSA, body weight, and total Agatston score. CONCLUSION This study provides sex-related reference values and percentiles for LV on cardiac CT and should assist in interpreting results.
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Affiliation(s)
- Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Ki-Nam Lee
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Won Jin Choi
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Young-Dae Kim
- Department of Cardiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jae-Kwang Lim
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
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Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, Jung SE, Do KH, Yong HS, Sheen S, Choi M, Baek JH. Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. Korean J Radiol 2017; 18:208-216. [PMID: 28096730 PMCID: PMC5240490 DOI: 10.3348/kjr.2017.18.1.208] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 02/07/2023] Open
Abstract
This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.
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Affiliation(s)
- Sol Ji Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ae Jeong Jo
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Jin A Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Min-Jeong Kim
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Min Lee
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kyung Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Chan M, Ridley L, Dunn DJ, Tian DH, Liou K, Ozdirik J, Cheruvu C, Cao C. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol 2016; 221:898-905. [PMID: 27439070 DOI: 10.1016/j.ijcard.2016.06.264] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/04/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The present meta-analysis aimed to compare the diagnostic accuracy of more recent computed tomography coronary angiography (CTCA) with invasive coronary angiography (ICA) in the assessment of graft patency after coronary artery bypass graft surgery (CABG). MATERIAL AND METHODS A systematic review was performed using nine electronic databases from their dates of inception to July 2015. Predefined inclusion criteria included studies reporting on comparative outcomes using ≥64 slice multidetector computed tomography (MDCT) and ICA. The primary endpoints included graft occlusion and significant graft stenosis ≥50%. Secondary analyses included the comparison of arterial versus venous graft conduits, and the use of different MDCT techniques. RESULTS Thirty-one studies were identified according to selection criteria, involving 1975 patients with 5364 assessed grafts. Combined assessment of stenosis and occlusion for all grafts demonstrated a sensitivity of 96.1% [95% confidence interval (CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA assessment of venous grafts demonstrated higher sensitivity compared to arterial grafts, when testing for both occlusion and stenosis (97.6% vs 89.2%, p=0.004). CONCLUSION Results of this study demonstrated that CTCA had a relatively high pooled sensitivity, specificity and negative predictive value compared to ICA. However, patient baseline characteristics varied between studies, and the results should be interpreted with caution. Nonetheless, our results indicate that CTCA should be recognized as an accurate and non-invasive investigation for graft patency in symptomatic patients after CABG.
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Affiliation(s)
- Michael Chan
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | | | - David H Tian
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Kevin Liou
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Jessica Ozdirik
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Chaitu Cheruvu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Christopher Cao
- The Collaborative Research Group, Macquarie University, Sydney, Australia.
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Song I, Park JA, Choi BH, Ko SM, Shin JK, Chee HK, Kim JS. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography. Korean J Radiol 2016; 17:463-71. [PMID: 27390538 PMCID: PMC4936169 DOI: 10.3348/kjr.2016.17.4.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/12/2016] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
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Affiliation(s)
- Inyoung Song
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jung Ah Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Je Kyoun Shin
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hyun Keun Chee
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jun Seok Kim
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
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Coronary artery calcium scores and cardiovascular risk factors in 31,545 asymptomatic Korean adults. Int J Cardiovasc Imaging 2016; 32 Suppl 1:139-45. [DOI: 10.1007/s10554-016-0892-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022]
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Park EA, Lee W, Kang DK, Kim SJ, Kim YJ, Kim Y, Sung YM, Song SY, Oh YW, Yong HS, Lee H, Jeon EY, Jin GY, Choi BW, Choi SI. Comparison of Iohexol-380 and Iohexol-350 for Coronary CT Angiography: A Multicenter, Randomized, Double-Blind Phase 3 Trial. Korean J Radiol 2016; 17:330-8. [PMID: 27134522 PMCID: PMC4842853 DOI: 10.3348/kjr.2016.17.3.330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/13/2016] [Indexed: 11/24/2022] Open
Abstract
Objective This multi-center, randomized, double-blind, phase 3 trial was conducted to compare the safety and efficacy of contrast agents iohexol-380 and iohexol-350 for coronary CT angiography in healthy subjects. Materials and Methods Volunteers were randomized to receive 420 mgI/kg of either iohexol-350 or iohexol-380 using a flow rate of 4 mL/sec. All adverse events were recorded. Two blinded readers independently reviewed the CT images and conflicting results were resolved by a third reader. Luminal attenuations (ascending aorta, left main coronary artery, and left ventricle) in Hounsfield units (HUs) and image quality on a 4-point scale were calculated. Results A total of 225 subjects were given contrast media (115 with iohexol-380 and 110 with iohexol-350). There was no difference in number of adverse drug reactions between groups: 75 events in 56 (48.7%) of 115 subjects in the iohexol-380 group vs. 74 events in 51 (46.4%) of 110 subjects in the iohexol-350 group (p = 0.690). No severe adverse drug reactions were recorded. Neither group showed an increase in serum creatinine. Significant differences in mean density between the groups was found in the ascending aorta: 375.8 ± 71.4 HU with iohexol-380 vs. 356.3 ± 61.5 HU with iohexol-350 (p = 0.030). No significant differences in image quality scores between both groups were observed for all three anatomic evaluations (all, p > 0.05). Conclusion Iohexol-380 provides improved enhancement of the ascending aorta and similar attenuation of the coronary arteries without any increase in adverse drug reactions, as compared with iohexol-350 using an identical amount of total iodine.
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Affiliation(s)
- Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Sung Jin Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Young-Ju Kim
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju 26426, Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea
| | - Yon Mi Sung
- Department of Radiology, Gachon University Gil Medical Center, Incheon 21565, Korea
| | - Soon-Young Song
- Department of Radiology, Hanyang University Seoul Hospital, Seoul 04763, Korea
| | - Yu-Whan Oh
- Department of Radiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul 08308, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Eui-Yong Jeon
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Gong-Yong Jin
- Department of Radiology, Chonbuk National University Medical School and Hospital, Institute of Medical Science, Research Institute of Clinical Medicine and Biomedical Research Institute, Jeonju 54907, Korea
| | - Byoung Wook Choi
- Department of Radiology, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea
| | - Sang-Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Liu K, Hsieh C, Zhuang N, Gao Y, Li Z, Ren X, Yang L, Zhang J, Budoff MJ, Lu B. Current utilization of cardiac computed tomography in mainland China: A national survey. J Cardiovasc Comput Tomogr 2015; 10:76-81. [PMID: 26699712 DOI: 10.1016/j.jcct.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/09/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surveys that describe the utilization of cardiac CT are available for the United States, Germany, and Taiwan, but not mainland China. OBJECTIVES To analyze the clinical utilization of cardiac CT in mainland China. METHODS A 25-item questionnaire was created and 240 tertiary hospitals were randomly selected to participate. Survey data were collected and confirmed by email as well as phone interviews. RESULTS In total, 237 (99%) hospitals consented to this survey, but 85 were excluded because of lack of cardiac CT patient volume or advanced technology. Finally, 152 (64%) questionnaires were available for analysis. Median patient volume was 1,037 patients (range: 150-8,072) annually. The most common clinical indications for coronary CT angiography were exclusion of coronary artery disease in patients with low to intermediate pretest likelihood, asymptomatic individuals with cardiovascular risk factors, and follow-up after coronary bypass grafting. The median heart rate threshold for beta blocker administration was >70 beats/min; most centers (86%) used sublingual nitroglycerin. Prospectively ECG triggered acquisition was the predominant technique in 44% of hospitals. Most (59%) providers adjusted the tube current to the body mass, but few (16%) adjusted the contrast injection rate. Per case, the mean examination duration was 14.2 min; post-processing time 13.6 min; and reporting time 18.0 min. CONCLUSIONS Cardiac CT is widely established in clinical practice in mainland China but there is a need for more uniform standards regarding performance and clinical utilization.
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Affiliation(s)
- Kun Liu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Christopher Hsieh
- Olin Business School, Washington University in St. Louis, 1 Brookings Drive, St. Louis 63130, MO, United States
| | - Nan Zhuang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, 5 Dongdansantiao Street, Beijing 100005, China
| | - Yang Gao
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Zhennan Li
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Xinshuang Ren
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Li Yang
- Department of Radiology, PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Matthew Jay Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 West Carson Street, Torrance 90502, CA, United States
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China.
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