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Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography. PLoS One 2022; 17:e0271189. [PMID: 35802711 PMCID: PMC9269916 DOI: 10.1371/journal.pone.0271189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA). Methods A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator (‘baseline CT’) and CCTA during continuous intravenous nitrate infusion (‘IV nitrate CT’). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT. Results Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm. Conclusions A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.
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Ismayl M, Abusnina W, El yousfi N, Aboeata A, Sricharoen N. Left main coronary artery vasospasm: A case report of misdiagnosed severe coronary artery disease. Ann Med Surg (Lond) 2022; 78:103691. [PMID: 35592822 PMCID: PMC9111888 DOI: 10.1016/j.amsu.2022.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 10/26/2022] Open
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Han X, Luo N, Xu L, Cao J, Guo N, He Y, Hong M, Jia X, Wang Z, Yang Z. Artificial intelligence stenosis diagnosis in coronary CTA: effect on the performance and consistency of readers with less cardiovascular experience. BMC Med Imaging 2022; 22:28. [PMID: 35177029 PMCID: PMC8851787 DOI: 10.1186/s12880-022-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background To investigate the influence of artificial intelligence (AI) based on deep learning on the diagnostic performance and consistency of inexperienced cardiovascular radiologists. Methods We enrolled 196 patents who had undergone both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 6 months. Four readers with less cardiovascular experience (Reader 1–Reader 4) and two cardiovascular radiologists (level II, Reader 5 and Reader 6) evaluated all images for ≥ 50% coronary artery stenosis, with ICA as the gold standard. Reader 3 and Reader 4 interpreted with AI system assistance, and the other four readers interpreted without the AI system. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (area under the receiver operating characteristic curve (AUC)) of the six readers were calculated at the patient and vessel levels. Additionally, we evaluated the interobserver consistency between Reader 1 and Reader 2, Reader 3 and Reader 4, and Reader 5 and Reader 6. Results The AI system had 94% and 78% sensitivity at the patient and vessel levels, respectively, which were higher than that of Reader 5 and Reader 6. AI-assisted Reader 3 and Reader 4 had higher sensitivity (range + 7.2–+ 16.6% and + 5.9–+ 16.1%, respectively) and NPVs (range + 3.7–+ 13.4% and + 2.7–+ 4.2%, respectively) than Reader 1 and Reader 2 without AI. Good interobserver consistency was found between Reader 3 and Reader 4 in interpreting ≥ 50% stenosis (Kappa value = 0.75 and 0.80 at the patient and vessel levels, respectively). Only Reader 1 and Reader 2 showed poor interobserver consistency (Kappa value = 0.25 and 0.37). Reader 5 and Reader 6 showed moderate agreement (Kappa value = 0.55 and 0.61). Conclusions Our study showed that using AI could effectively increase the sensitivity of inexperienced readers and significantly improve the consistency of coronary stenosis diagnosis via CCTA. Trial registration Clinical trial registration number: ChiCTR1900021867. Name of registry: Diagnostic performance of artificial intelligence-assisted coronary computed tomography angiography for the assessment of coronary atherosclerotic stenosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00756-y.
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Affiliation(s)
- Xianjun Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Nan Luo
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Lixue Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Jiaxin Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Jinhui Bd, Qiyang Rd, Beijing, 100102, People's Republic of China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Min Hong
- Department of Computer Software Engineering, Soonchunhyang University, Asan, South Korea
| | - Xibin Jia
- Beijing University of Technology, Beijing, People's Republic of China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People's Republic of China.
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Park J, Park B, Kang EJ, Lee J. CT Imaging Findings in Non-Atherosclerotic Coronary Artery Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:70-83. [PMID: 36237354 PMCID: PMC9238194 DOI: 10.3348/jksr.2021.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
급성 관동맥 증후군(acute coronary syndrome)은 대부분 죽상경화 관상동맥 질환(atherosclerotic coronary artery disease)에 의해 발생하지만, 비죽상경화 관상동맥 질환에서도 발생할 수 있다. 고식적 관상동맥 혈관조영술은 동맥 내강의 협착이나 확장 등의 형상에 대한 정보만을 제공하고, 동맥경화반이나 동맥벽에 대한 평가가 어려워 관상동맥 이상의 원인 질환의 진단에 낮은 특이도를 보인다. 반면, 관상동맥 전산화단층촬영 혈관조영술은 혈관경화반의 특징, 혈관벽의 조영증강뿐 아니라 연접한 대동맥이나 폐동맥의 변화 등도 함께 관찰할 수 있어, 비죽상경화 관상상동맥질환의 진단 및 다양한 원인 감별에 도움이 된다. 따라서 이 종설에서는 다양한 비죽상경화 관상동맥 질환들을 소개하고, 이의 병태생리 및 대표적인 관상동맥 전산화단층촬영 혈관조영술의 영상 소견에 대해 설명하고자 한다.
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Affiliation(s)
- Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
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Yoo SM, Jang S, Kim JA, Chun EJ. Troponin-Positive Non-Obstructive Coronary Arteries and Myocardial Infarction with Non-Obstructive Coronary Arteries: Definition, Etiologies, and Role of CT and MR Imaging. Korean J Radiol 2020; 21:1305-1316. [PMID: 32783414 PMCID: PMC7689141 DOI: 10.3348/kjr.2020.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/28/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
In approximately 10% of patients with acute myocardial infarction (MI), angiography does not reveal an obstructive coronary stenosis. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA), which has complex and multifactorial causes. However, this term can be confusing and open to dual interpretation, because MINOCA is also used to describe patients with acute myocardial injury caused by ischemia-related myocardial necrosis. Therefore, with regards to this specific context of MINOCA, the generic term for MINOCA should be replaced with troponin-positive with non-obstructive coronary arteries (TpNOCA). The causes of TpNOCA can be subcategorized into epicardial coronary (causes of MINOCA), myocardial, and extracardiac disorders. Cardiac magnetic resonance imaging can confirm MI and differentiate various myocardial causes, while cardiac computed tomography is useful to diagnose the extracardiac causes.
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Affiliation(s)
- Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Seongnam, Korea
| | - Sowon Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong A Kim
- Department of Radiology, Yonsei University Yongin Severance Hospital, Yongin, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
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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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