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Fink N, Yacoub B, Schoepf UJ, Zsarnoczay E, Pinos D, Vecsey-Nagy M, Rapaka S, Sharma P, O’Doherty J, Ricke J, Varga-Szemes A, Emrich T. Artificial Intelligence Provides Accurate Quantification of Thoracic Aortic Enlargement and Dissection in Chest CT. Diagnostics (Basel) 2024; 14:866. [PMID: 38732280 PMCID: PMC11083497 DOI: 10.3390/diagnostics14090866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
This study evaluated a deep neural network (DNN) algorithm for automated aortic diameter quantification and aortic dissection detection in chest computed tomography (CT). A total of 100 patients (median age: 67.0 [interquartile range 55.3/73.0] years; 60.0% male) with aortic aneurysm who underwent non-enhanced and contrast-enhanced electrocardiogram-gated chest CT were evaluated. All the DNN measurements were compared to manual assessment, overall and between the following subgroups: (1) ascending (AA) vs. descending aorta (DA); (2) non-obese vs. obese; (3) without vs. with aortic repair; (4) without vs. with aortic dissection. Furthermore, the presence of aortic dissection was determined (yes/no decision). The automated and manual diameters differed significantly (p < 0.05) but showed excellent correlation and agreement (r = 0.89; ICC = 0.94). The automated and manual values were similar in the AA group but significantly different in the DA group (p < 0.05), similar in obese but significantly different in non-obese patients (p < 0.05) and similar in patients without aortic repair or dissection but significantly different in cases with such pathological conditions (p < 0.05). However, in all the subgroups, the automated diameters showed strong correlation and agreement with the manual values (r > 0.84; ICC > 0.9). The accuracy, sensitivity and specificity of DNN-based aortic dissection detection were 92.1%, 88.1% and 95.7%, respectively. This DNN-based algorithm enabled accurate quantification of the largest aortic diameter and detection of aortic dissection in a heterogenous patient population with various aortic pathologies. This has the potential to enhance radiologists' efficiency in clinical practice.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, 1083 Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
- Heart and Vascular Center, Semmelweis University, Varosmajor utca 68, 1122 Budapest, Hungary
| | - Saikiran Rapaka
- Siemens Healthineers, Princeton, NJ 08540, USA; (S.R.); (P.S.)
| | - Puneet Sharma
- Siemens Healthineers, Princeton, NJ 08540, USA; (S.R.); (P.S.)
| | | | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, 55131 Mainz, Germany
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Aquino GJ, Decker JA, Schoepf UJ, Carson L, Paladugu N, Yacoub B, Brandt V, Emrich AL, Schwarz F, Burt JR, Bayer R, Varga-Szemes A, Emrich T. Feasibility of Coronary CT Angiography-derived Left Ventricular Long-Axis Shortening as an Early Marker of Ventricular Dysfunction in Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2022; 4:e210205. [PMID: 35833168 DOI: 10.1148/ryct.210205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/18/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the value of using left ventricular (LV) long-axis shortening (LAS) derived from coronary CT angiography (CCTA) to predict mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods Patients with severe AS who underwent CCTA for preprocedural TAVR planning between September 2014 and December 2019 were included in this retrospective study. CCTA covered the whole cardiac cycle in 10% increments. Image series reconstructed at end systole and end diastole were used to measure LV-LAS. All-cause mortality within 24 months of follow-up after TAVR was recorded. Cox regression analysis was performed, and hazard ratios (HRs) are presented with 95% CIs. The C index was used to evaluate model performance, and the likelihood ratio χ2 test was performed to compare nested models. Results The study included 175 patients (median age, 79 years [IQR, 73-85 years]; 92 men). The mortality rate was 22% (38 of 175). When adjusting for predictive clinical confounders, it was found that LV-LAS could be used independently to predict mortality (adjusted HR, 2.83 [95% CI: 1.13, 7.07]; P = .03). In another model using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), LV-LAS remained significant (adjusted HR, 3.38 [95 CI: 1.48, 7.72]; P = .004), and its use improved the predictive value of the STS-PROM, increasing the STS-PROM C index from 0.64 to 0.71 (χ2 = 29.9 vs 19.7, P = .001). In a subanalysis of patients with a normal LV ejection fraction (LVEF), the significance of LV-LAS persisted (adjusted HR, 3.98 [95 CI: 1.56, 10.17]; P = .004). Conclusion LV-LAS can be used independently to predict mortality in patients undergoing TAVR, including those with a normal LVEF.Keywords: CT Angiography, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Outcomes Analysis, Cardiomyopathies, Left Ventricle, Aortic Valve Supplemental material is available for this article. © RSNA, 2022See also the commentary by Everett and Leipsic in this issue.
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Affiliation(s)
- Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Landin Carson
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Namrata Paladugu
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Anna Lena Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Florian Schwarz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Jeremy R Burt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Richard Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
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Abadia AF, Yacoub B, Stringer N, Snoddy M, Kocher M, Schoepf UJ, Aquino GJ, Kabakus I, Dargis D, Hoelzer P, Sperl JI, Sahbaee P, Vingiani V, Mercer M, Burt JR. Diagnostic Accuracy and Performance of Artificial Intelligence in Detecting Lung Nodules in Patients With Complex Lung Disease: A Noninferiority Study. J Thorac Imaging 2022; 37:154-161. [PMID: 34387227 DOI: 10.1097/rti.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study is to investigate the performance of artificial intelligence (AI) convolutional neural networks (CNN) in detecting lung nodules on chest computed tomography of patients with complex lung disease, and demonstrate its noninferiority when compared against an experienced radiologist through clinically relevant assessments. METHODS A CNN prototype was used to retrospectively evaluate 103 complex lung disease cases and 40 control cases without reported nodules. Computed tomography scans were blindly evaluated by an expert thoracic radiologist; a month after initial analyses, 20 positive cases were re-evaluated with the assistance of AI. For clinically relevant applications: (1) AI was asked to classify each patient into nodules present or absent and (2) AI results were compared against standard radiology reports. Standard statistics were performed to determine detection performance. RESULTS AI was, on average, 27 seconds faster than the expert and detected 8.4% of nodules that would have been missed. AI had a sensitivity of 67.7%, similar to an accuracy reported for experienced radiologists. AI correctly classified each patient (nodules present/absent) with a sensitivity of 96.1%. When matched against radiology reports, AI performed with a sensitivity of 89.4%. Control group assessment demonstrated an overall specificity of 82.5%. When aided by AI, the expert decreased the average assessment time per case from 2:44 minutes to 35.7 seconds, while reporting an overall increase in confidence. CONCLUSION In a group of patients with complex lung disease, the sensitivity of AI is similar to an experienced radiologist and the tool helps detect previously missed nodules. AI also helps experts analyze for lung nodules faster and more confidently, a feature that is beneficial to patients and favorable to hospitals due to increased patient load and need for shorter turnaround times.
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Affiliation(s)
- Andres F Abadia
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Natalie Stringer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Madalyn Snoddy
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Madison Kocher
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Gilberto J Aquino
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Ismail Kabakus
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Danielle Dargis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | | | | | | | - Vincenzo Vingiani
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- U.O.C. Radiologia, Ospedali Riuniti "Area Peninsola Sorrentina," P.O. Sorrento, Italy
| | - Megan Mercer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Jeremy R Burt
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
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Yacoub B, Kabakus IM, Schoepf UJ, Giovagnoli VM, Fischer AM, Wichmann JL, Martinez JD, Sharma P, Rapaka S, Sahbaee P, Hoelzer P, Burt JR, Varga-Szemes A, Emrich T. Performance of an Artificial Intelligence-Based Platform Against Clinical Radiology Reports for the Evaluation of Noncontrast Chest CT. Acad Radiol 2022; 29 Suppl 2:S108-S117. [PMID: 33714665 DOI: 10.1016/j.acra.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES Research on implementation of artificial intelligence (AI) in radiology workflows and its impact on reports remains scarce. In this study, we aim to assess if an AI platform would perform better than clinical radiology reports in evaluating noncontrast chest computed tomography (CT) scans. MATERIALS AND METHODS Consecutive patients who had undergone noncontrast chest CT were retrospectively identified. The radiology reports were reviewed in a binary fashion for reporting of pulmonary lesions, pulmonary emphysema, aortic dilatation, coronary artery calcifications (CAC), and vertebral compression fractures (VCF). CT scans were then processed using an AI platform. The reports' findings and the AI results were subsequently compared to a consensus read by two board-certificated radiologists as reference. RESULTS A total of 100 patients (mean age: 64.2 ± 14.8 years; 57% males) were included in this study. Aortic segmentation and calcium quantification failed to be processed by AI in 2 and 3 cases, respectively. AI showed superior diagnostic performance in identifying aortic dilatation (AI: sensitivity: 96.3%, specificity: 81.4%, AUC: 0.89) vs (Reports: sensitivity: 25.9%, specificity: 100%, AUC: 0.63), p <0.001; and CAC (AI: sensitivity: 89.8%, specificity: 100, AUC: 0.95) vs (Reports: sensitivity: 75.4%, specificity: 94.9%, AUC: 0.85), p = 0.005. Reports had better performance than AI in identifying pulmonary lesions (Reports: sensitivity: 97.6%, specificity: 100%, AUC: 0.99) vs (AI: sensitivity: 92.8%, specificity: 82.4%, AUC: 0.88), p = 0.024; and VCF (Reports: sensitivity:100%, specificity: 100%, AUC: 1.0) vs (AI: sensitivity: 100%, specificity: 63.7%, AUC: 0.82), p <0.001. A comparable diagnostic performance was noted in identifying pulmonary emphysema on AI (sensitivity: 80.6%, specificity: 66.7%. AUC: 0.74) and reports (sensitivity: 74.2%, specificity: 97.1%, AUC: 0.86), p = 0.064. CONCLUSION Our results demonstrate that incorporating AI support platforms into radiology workflows can provide significant added value to clinical radiology reporting.
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Affiliation(s)
- Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
| | - Vincent M Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; University Hospital Basel, University of Basel, Department of Radiology, Basel, Switzerland
| | - Julian L Wichmann
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany; Siemens Healthineers, Erlangen, Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | - Jeremy R Burt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; University Medical Center Mainz, Department of Diagnostic and Interventional Radiology, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany
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5
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Aquino GJ, Chamberlin J, Mercer M, Kocher M, Kabakus I, Akkaya S, Fiegel M, Brady S, Leaphart N, Dippre A, Giovagnoli V, Yacoub B, Jacob A, Gulsun MA, Sahbaee P, Sharma P, Waltz J, Schoepf UJ, Baruah D, Emrich T, Zimmerman S, Field ME, Agha AM, Burt JR. Deep learning model to quantify left atrium volume on routine non-contrast chest CT and predict adverse outcomes. J Cardiovasc Comput Tomogr 2021; 16:245-253. [PMID: 34969636 DOI: 10.1016/j.jcct.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) are performed routinely for lung cancer screening. However, a large amount of nonpulmonary data from these scans remains unassessed. We aimed to validate a deep learning model to automatically segment and measure left atrial (LA) volumes from routine NCCT and evaluate prediction of cardiovascular outcomes. METHODS We retrospectively evaluated 273 patients (median age 69 years, 55.5% male) who underwent LDCT for lung cancer screening. LA volumes were quantified by three expert cardiothoracic radiologists and a prototype AI algorithm. LA volumes were then indexed to the body surface area (BSA). Expert and AI LA volume index (LAVi) were compared and used to predict cardiovascular outcomes within five years. Logistic regression with appropriate univariate statistics were used for modelling outcomes. RESULTS There was excellent correlation between AI and expert results with an LAV intraclass correlation of 0.950 (0.936-0.960). Bland-Altman plot demonstrated the AI underestimated LAVi by a mean 5.86 mL/m2. AI-LAVi was associated with new-onset atrial fibrillation (AUC 0.86; OR 1.12, 95% CI 1.08-1.18, p < 0.001), HF hospitalization (AUC 0.90; OR 1.07, 95% CI 1.04-1.13, p < 0.001), and MACCE (AUC 0.68; OR 1.04, 95% CI 1.01-1.07, p = 0.01). CONCLUSION This novel deep learning algorithm for automated measurement of LA volume on lung cancer screening scans had excellent agreement with manual quantification. AI-LAVi is significantly associated with increased risk of new-onset atrial fibrillation, HF hospitalization, and major adverse cardiac and cerebrovascular events within 5 years.
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Affiliation(s)
- Gilberto J Aquino
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Jordan Chamberlin
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Megan Mercer
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Madison Kocher
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Ismail Kabakus
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Selcuk Akkaya
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Matthew Fiegel
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Sean Brady
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Nathan Leaphart
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Andrew Dippre
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Vincent Giovagnoli
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Basel Yacoub
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | | | | | | | | | - Jeffrey Waltz
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - U Joseph Schoepf
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Dhiraj Baruah
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Tilman Emrich
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA
| | - Stefan Zimmerman
- Johns Hopkins Hospital, Department of Radiology and Radiological Science, USA
| | - Michael E Field
- Medical University of South Carolina, Department of Medicine, USA
| | - Ali M Agha
- Baylor College of Medicine, Department of Medicine, USA
| | - Jeremy R Burt
- Medical University of South Carolina, Department of Radiology and Radiological Science, USA.
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6
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Aquino GJ, Abadia AF, Schoepf UJ, Emrich T, Yacoub B, Kabakus I, Violette A, Wiley C, Moreno A, Sahbaee P, Schwemmer C, Bayer RR, Varga-Szemes A, Steinberg D, Amoroso N, Kocher M, Waltz J, Ward TJ, Burt JR. Coronary CT Fractional Flow Reserve before Transcatheter Aortic Valve Replacement: Clinical Outcomes. Radiology 2021; 302:50-58. [PMID: 34609200 DOI: 10.1148/radiol.2021210160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The role of CT angiography-derived fractional flow reserve (CT-FFR) in pre-transcatheter aortic valve replacement (TAVR) assessment is uncertain. Purpose To evaluate the predictive value of on-site machine learning-based CT-FFR for adverse clinical outcomes in candidates for TAVR. Materials and Methods This observational retrospective study included patients with severe aortic stenosis referred to TAVR after coronary CT angiography (CCTA) between September 2014 and December 2019. Clinical end points comprised major adverse cardiac events (MACE) (nonfatal myocardial infarction, unstable angina, cardiac death, or heart failure admission) and all-cause mortality. CT-FFR was obtained semiautomatically using an on-site machine learning algorithm. The ability of CT-FFR (abnormal if ≤0.75) to predict outcomes and improve the predictive value of the current noninvasive work-up was assessed. Survival analysis was performed, and the C-index was used to assess the performance of each predictive model. To compare nested models, the likelihood ratio χ2 test was performed. Results A total of 196 patients (mean age ± standard deviation, 75 years ± 11; 110 women [56%]) were included; the median time of follow-up was 18 months. MACE occurred in 16% (31 of 196 patients) and all-cause mortality in 19% (38 of 196 patients). Univariable analysis revealed CT-FFR was predictive of MACE (hazard ratio [HR], 4.1; 95% CI: 1.6, 10.8; P = .01) but not all-cause mortality (HR, 1.2; 95% CI: 0.6, 2.2; P = .63). CT-FFR was independently associated with MACE (HR, 4.0; 95% CI: 1.5, 10.5; P = .01) when adjusting for potential confounders. Adding CT-FFR as a predictor to models that include CCTA and clinical data improved their predictive value for MACE (P = .002) but not all-cause mortality (P = .67), and it showed good discriminative ability for MACE (C-index, 0.71). Conclusion CT angiography-derived fractional flow reserve was associated with major adverse cardiac events in candidates for transcatheter aortic valve replacement and improved the predictive value of coronary CT angiography assessment. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Choe in this issue.
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Affiliation(s)
- Gilberto J Aquino
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Andres F Abadia
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Basel Yacoub
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Ismail Kabakus
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Alexis Violette
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Courtney Wiley
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Andreina Moreno
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Pooyan Sahbaee
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Chris Schwemmer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Richard R Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Daniel Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Nicholas Amoroso
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Madison Kocher
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Jeffrey Waltz
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Thomas J Ward
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Jeremy R Burt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
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7
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Altmann S, Halfmann MC, Abidoye I, Yacoub B, Schmidt M, Wenzel P, Forman C, Schoepf UJ, Xiong F, Dueber C, Kreitner KF, Varga-Szemes A, Emrich T. Compressed sensing acceleration of cardiac cine imaging allows reliable and reproducible assessment of volumetric and functional parameters of the left and right atrium. Eur Radiol 2021; 31:7219-7230. [PMID: 33779815 PMCID: PMC8452582 DOI: 10.1007/s00330-021-07830-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 11/05/2022]
Abstract
Objectives To compare volumetric and functional parameters of the atria derived from highly accelerated compressed sensing (CS)–based cine sequences in comparison to conventional (Conv) cine imaging. Methods CS and Conv cine sequences were acquired in 101 subjects (82 healthy volunteers (HV) and 19 patients with heart failure with reduced ejection fraction (HFrEF)) using a 3T MR scanner in this single-center study. Time-volume analysis of the left (LA) and right atria (RA) were performed in both sequences to evaluate atrial volumes and function (total, passive, and active emptying fraction). Inter-sequence and inter- and intra-reader agreement were analyzed using correlation, intraclass correlation (ICC), and Bland-Altman analysis. Results CS-based cine imaging led to a 69% reduction of acquisition time. There was significant difference in atrial parameters between CS and Conv cine, e.g., LA minimal volume (LAVmin) (Conv 24.0 ml (16.7–32.7), CS 25.7 ml (19.2–35.2), p < 0.0001) or passive emptying fraction (PEF) (Conv 53.9% (46.7–58.4), CS 49.0% (42.0–54.1), p < 0.0001). However, there was high correlation between the techniques, yielding good to excellent ICC (0.76–0.99) and small mean of differences in Bland-Altman analysis (e.g. LAVmin − 2.0 ml, PEF 3.3%). Measurements showed high inter- (ICC > 0.958) and intra-rater (ICC > 0.934) agreement for both techniques. CS-based parameters (PEF AUC = 0.965, LAVmin AUC = 0.864) showed equivalent diagnostic ability compared to Conv cine imaging (PEF AUC = 0.989, LAVmin AUC = 0.859) to differentiate between HV and HFrEF. Conclusion Atrial volumetric and functional evaluation using CS cine imaging is feasible with relevant reduction of acquisition time, therefore strengthening the role of CS in clinical CMR for atrial imaging. Key Points • Reliable assessment of atrial volumes and function based on compressed sensing cine imaging is feasible. • Compressed sensing reduces scan time and has the potential to overcome obstacles of conventional cine imaging. • No significant differences for subjective image quality, inter- and intra-rater agreement, and ability to differentiate healthy volunteers and heart failure patients were detected between conventional and compressed sensing cine imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07830-z.
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Affiliation(s)
- Sebastian Altmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ibukun Abidoye
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Afe Babalola University/Multisystem Hospital, Km 8.5, Afe Babalola way, Ado-Ekiti, Ekiti, Nigeria
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Michaela Schmidt
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christoph Forman
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Fei Xiong
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Christoph Dueber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
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Xu P, Xue Y, Schoepf UJ, Varga-Szemes A, Griffith J, Yacoub B, Zhou F, Zhou C, Yang Y, Xing W, Zhang L. Radiomics: The Next Frontier of Cardiac Computed Tomography. Circ Cardiovasc Imaging 2021; 14:e011747. [PMID: 33722057 DOI: 10.1161/circimaging.120.011747] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radiomics uses advanced image analysis to extract massive amounts of quantitative information from digital images, which is not otherwise distinguishable to the human eye. The mined data can be used to explore and establish new and undiscovered correlations between these imaging features and clinical end points. Cardiac computed tomography (CT) is a first-line imaging modality for evaluating coronary artery disease and has a primary role in the assessment of cardiac structures. Conventional interpretation of cardiac CT images relies mostly on subjective and qualitative analysis, as well as basic geometric quantification. To date, some proof-of-concept studies have demonstrated the feasibility and diagnostic performance of cardiac CT radiomics analysis. This review describes the current literature on radiomics in cardiac CT and discusses its advantages, challenges, and future directions. Although much evidences are needed in this field, cardiac CT radiomics has a lot to offer to patients and physicians with potential to define cardiac disease phenotypes on imaging with higher precision.
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Affiliation(s)
- Pengpeng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (P.X., F.Z., C.Z., L.Z.)
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu Province, China (Y.X., Y.Y., L.Z.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., A.V.-S., J.G., B.Y.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., A.V.-S., J.G., B.Y.)
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., A.V.-S., J.G., B.Y.)
| | - Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., A.V.-S., J.G., B.Y.)
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (P.X., F.Z., C.Z., L.Z.)
| | - Changsheng Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (P.X., F.Z., C.Z., L.Z.)
| | - Yuting Yang
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu Province, China (Y.X., Y.Y., L.Z.)
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University and Changzhou First People's Hospital, Jiangsu, China (W.X.)
| | - Longjiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu Province, China (Y.X., Y.Y., L.Z.)
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Burt JR, O'Dell MC, Yacoub B, Chamberlin J, Waltz J, Wallace C, Kocher M, Sacerdote M, Gonzalez A, Feranec N, Hernandez M, Agha A, Liu B. Prevalence of Abnormal Coronary Findings on Coronary Computed Tomography Angiography Among Young Adults Presenting With Chest Pain. J Thorac Imaging 2021; 36:116-121. [PMID: 33003106 DOI: 10.1097/rti.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the prevalence of coronary stenosis on coronary computed tomography angiography (CCTA) in patients aged 18 to 30 years, who presented to the emergency department with chest pain. We also examined the risk factors potentially associated with abnormal coronary findings on CCTA in this age group. MATERIALS AND METHODS A total of 884 patients were retrospectively evaluated. Indication for CCTA was guided by our hospital's chest pain protocol based on ACC/AHA guidelines. These were performed using the standard technique and interpreted based on CAD-RADS guidelines. Scans were identified as abnormal if atherosclerotic coronary artery disease (CAD), myocardial bridging (MB), or any anatomic coronary artery anomaly were present. RESULTS Twenty-two percent of patients had a coronary abnormality on CCTA. The most common abnormality was MB (17.3%), followed by CAD (4.4%) and coronary anomalies (1.5%). A small minority had stenosis (2.8%), most commonly caused by CAD. Most cases with stenosis were minimal to mild (72%) with 0.8% having coronary stenosis ≥50%. Age and male sex were risk factors for both coronary artery stenosis (odds ratio: 1.32 and 4.50, 95% confidence interval: 1.03-1.69, and 1.23-16.46, P=0.028 and 0.023, respectively) and CAD (odds ratio: 1.52 and 3.67, 95% confidence interval: 1.14-2.04, and 1.26-10.66, P=0.005 and 0.017, respectively). CONCLUSIONS Epicardial coronary stenosis is rarely the cause of chest pain among young adult patients presenting to the emergency department. Age and male sex were both risk factors for coronary artery stenosis/disease in this age group.
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Affiliation(s)
- Jeremy R Burt
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | | | - Basel Yacoub
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | - Jordan Chamberlin
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | - Jeffrey Waltz
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | - Charlotte Wallace
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | - Madison Kocher
- Department or Radiology, Medical University of South Carolina, Charleston, SC
| | | | | | | | | | - Ali Agha
- Department of Internal Medicine, University of Texas, Houston, TX
| | - Bo Liu
- Department of Radiology, Baptist Hospital of Miami, FL
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10
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Burt JR, Waltz J, Ramirez A, Abadia A, Yacoub B, Burt SA, Tissavirasingham F, Kocher MR. Predictive value of initial imaging and staging with long-term outcomes in young adults diagnosed with colorectal cancer. Abdom Radiol (NY) 2021; 46:909-918. [PMID: 32936419 DOI: 10.1007/s00261-020-02727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate how initial abdominopelvic CT findings and staging correlate with outcomes in a cohort of patients aged 18-40 years. METHODS We evaluated all young adult patients at a single tertiary center diagnosed with histopathologically confirmed CRC who also had CT of the abdomen and pelvis at the time of initial diagnosis. Demographics, symptoms, CT findings, staging, treatments, and outcomes at 1 year and 5 years were recorded. RESULTS Of 91 patients who met initial inclusion criteria, 81.8% had a mass present on CT, with an average size of 4.8 cm ± 2.9. A majority of patients were surgical stage III or IV (64.3%). Advanced AJCC stage was more common with rectal tumors and metastatic disease on initial CT (p < 0.0001). In a subgroup analysis, almost all patients initially staged 4A or higher had progression of disease. At the final follow-up visit, by RECIST 1.1 criteria, 58.8% had progressive disease, 35.3% complete response, and 3.9% stable disease. The overall 5-year survival rate in this subgroup was 40% with lower survival probability with increasing stage (p = 0.0001). CONCLUSION Most young adult patients presented with large tumors on imaging, increasing the likelihood of identification on CT. Tumors initially presenting in the rectum with enlarged lymph nodes and/or with distant metastases on CT were more often associated with advanced surgical stage and poorer prognosis. A majority of patients presented at an advanced stage, most commonly stage 4A, and had progression of disease at follow-up.
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Affiliation(s)
- Jeremy R Burt
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA.
| | - Jeffrey Waltz
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA
| | - Ashley Ramirez
- School of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Andres Abadia
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA
| | - Basel Yacoub
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA
| | - Sydney A Burt
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA
| | - Fiona Tissavirasingham
- Department of Internal Medicine, Canton Medical Education Foundation, 2600 6th St SW, Canton, OH, 44710, USA
| | - Madison R Kocher
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA
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11
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Yacoub B, Stroud RE, Piccini D, Schoepf UJ, Heerfordt J, Yerly J, Di Sopra L, Rollins JD, Turner DA, Emrich T, Xiong F, Suranyi P, Varga-Szemes A. Measurement accuracy of prototype non-contrast, compressed sensing-based, respiratory motion-resolved whole heart cardiovascular magnetic resonance angiography for the assessment of thoracic aortic dilatation: comparison with computed tomography angiography. J Cardiovasc Magn Reson 2021; 23:7. [PMID: 33557887 PMCID: PMC7871614 DOI: 10.1186/s12968-020-00697-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with thoracic aortic dilatation who undergo annual computed tomography angiography (CTA) are subject to repeated radiation and contrast exposure. The purpose of this study was to evaluate the feasibility of a non-contrast, respiratory motion-resolved whole-heart cardiovascular magnetic resonance angiography (CMRA) technique against reference standard CTA, for the quantitative assessment of cardiovascular anatomy and monitoring of disease progression in patients with thoracic aortic dilatation. METHODS: Twenty-four patients (68.6 ± 9.8 years) with thoracic aortic dilatation prospectively underwent clinical CTA and research 1.5T CMRA between July 2017 and November 2018. Scans were repeated in 15 patients 1 year later. A prototype free-breathing 3D radial balanced steady-state free-precession whole-heart CMRA sequence was used in combination with compressed sensing-based reconstruction. Area, circumference, and diameter measurements were obtained at seven aortic levels by two experienced and two inexperienced readers. In addition, area and diameter measurements of the cardiac chambers, pulmonary arteries and pulmonary veins were also obtained. Agreement between the two modalities was assessed with intraclass correlation coefficient (ICC) analysis, Bland-Altman plots and scatter plots. RESULTS Area, circumference and diameter measurements on a per-level analysis showed good or excellent agreement between CTA and CMRA (ICCs > 0.84). Means of differences on Bland-Altman plots were: area 0.0 cm2 [- 1.7; 1.6]; circumference 1.0 mm [- 10.0; 12.0], and diameter 0.6 mm [- 2.6; 3.6]. Area and diameter measurements of the left cardiac chambers showed good agreement (ICCs > 0.80), while moderate to good agreement was observed for the right chambers (all ICCs > 0.56). Similar good to excellent inter-modality agreement was shown for the pulmonary arteries and veins (ICC range 0.79-0.93), with the exception of the left lower pulmonary vein (ICC < 0.51). Inter-reader assessment demonstrated mostly good or excellent agreement for both CTA and CMRA measurements on a per-level analysis (ICCs > 0.64). Difference in maximum aortic diameter measurements at baseline vs follow up showed excellent agreement between CMRA and CTA (ICC = 0.91). CONCLUSIONS The radial whole-heart CMRA technique combined with respiratory motion-resolved reconstruction provides comparable anatomical measurements of the thoracic aorta and cardiac structures as the reference standard CTA. It could potentially be used to diagnose and monitor patients with thoracic aortic dilatation without exposing them to radiation or contrast media.
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Affiliation(s)
- Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Robert E Stroud
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - John Heerfordt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonathan D Rollins
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - D Alan Turner
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Fei Xiong
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Cardiovascular MR R&D, Siemens Medical Solutions USA Inc, Charleston, SC, USA
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
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12
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Fischer AM, Yacoub B, Savage RH, Martinez JD, Wichmann JL, Sahbaee P, Grbic S, Varga-Szemes A, Schoepf UJ. Machine Learning/Deep Neuronal Network: Routine Application in Chest Computed Tomography and Workflow Considerations. J Thorac Imaging 2021; 35 Suppl 1:S21-S27. [PMID: 32317574 DOI: 10.1097/rti.0000000000000498] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The constantly increasing number of computed tomography (CT) examinations poses major challenges for radiologists. In this article, the additional benefits and potential of an artificial intelligence (AI) analysis platform for chest CT examinations in routine clinical practice will be examined. Specific application examples include AI-based, fully automatic lung segmentation with emphysema quantification, aortic measurements, detection of pulmonary nodules, and bone mineral density measurement. This contribution aims to appraise this AI-based application for value-added diagnosis during routine chest CT examinations and explore future development perspectives.
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Affiliation(s)
- Andreas M Fischer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Rock H Savage
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - John D Martinez
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | | | | | | | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
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13
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Abstract
Background Marijuana is the most popular drug of abuse in the United States. The association between its use and coronary artery disease has not yet been fully elucidated. This study aims to determine the frequency of coronary artery disease among young to middle aged adults presenting with chest pain who currently use marijuana as compared to nonusers. Methods In this retrospective study, 1,420 patients with chest pain or angina equivalent were studied. Only men between 18 and 40 years and women between 18 and 50 years of age without history of cardiac disease were included. All patients were queried about current or prior cannabis use and underwent coronary CT angiography. Each coronary artery on coronary CT angiography was assessed based on the CAD-RADS reporting system. Results A total of 146 (10.3%) out of 1,420 patients with chest pain were identified as marijuana users. Only 6.8% of the 146 marijuana users had evidence of coronary artery disease on coronary CT angiography. In comparison, the rate was 15.0% among the 1,274 marijuana nonusers (p = 0.008). After accounting for other cardiac risk factors in a multivariate analysis, the negative association between marijuana use and coronary artery disease on coronary CT angiography diminished (p = 0.12, 95% CI 0.299–1.15). A majority of marijuana users were younger than nonusers and had a lower frequency of hypertension and diabetes than nonusers. There was no statistical difference in lipid panel values between the two groups. Only 2 out of 10 marijuana users with coronary artery disease on coronary CT angiography had hemodynamically significant stenosis. Conclusion Among younger patients being evaluated for chest pain, self-reported cannabis use conferred no additional risk of coronary artery disease as detected on coronary CT angiography.
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Affiliation(s)
- Jeremy R. Burt
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Ali M. Agha
- Department of Internal Medicine, McGovern Medical School at University of Texas - Houston, Houston, Texas, United States of America
| | - Basel Yacoub
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Aryan Zahergivar
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Julie Pepe
- Translational Research Institute, AdventHealth Orlando, Orlando, Florida, United States of America
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14
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El Hajj A, Yacoub B, Mansour M, Khauli R, Bulbul M, Nassif S, Haidar MB. Diagnostic performance of Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography in intermediate and high risk prostate cancer. Medicine (Baltimore) 2019; 98:e17491. [PMID: 31689752 PMCID: PMC6946244 DOI: 10.1097/md.0000000000017491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (Ga-68 PSMA PET/CT) is an imaging modality that promises improved sensitivity and specificity of detection of prostate cancer lesions based on their increased uptake of PSMA-based radiotracers. It remains an emerging modality that has not yet been endorsed in the guidelines for the management of prostate cancer pending more established evidence to prove its efficacy. The objective of the study is to assess the value of Ga-68 PSMA PET/CT in the detection and localization of patients diagnosed with intermediate or high risk prostate cancer.Twenty three patients with intermediate or high risk prostate cancer had undergone Ga-68 PSMA PET/CT imaging prior to robotic assisted radical prostatectomy. Surgical specimens were then submitted for histological examinations. Lesions visualized on PET/CT and histology were independently mapped unto a 36-segment (Prostate Imaging Reporting and Data System version 2 [PI-RADS v.2]) map of the prostate. Concordance of visualization on PET/CT as compared to the histology as gold standard reference was then assessed. Lesions visualized on PET/CT and histology were independently mapped unto a 36-segment (PI-RADS v.2) map of the prostate. Concordance of visualization on PET/CT as compared to the histology as gold standard reference was then assessed.Sensitivity for all lesions identified on Ga-68 PSMA PET/CT was 42.37%; specificity was 88.61%. Both parameters were higher when considering only index lesions for which sensitivity was 68.42% and specificity was 98.23%. Sensitivity for the index lesions in intermediate risk group was 53.2% and was higher in the high risk group reaching 83.33%.Ga-68 PSMA PET/CT provides accurate localization of tumor lesions in patients with intermediate and high risk prostate cancer.
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Affiliation(s)
| | | | | | | | | | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Al-Ibraheem A, Yacoub B, Barakat A, Dergham MY, Maroun G, Haddad H, Saleh A, Khoury N, Hourani M, Haidar MB. Case report of epithelioid osteoblastoma of the mandible: findings on positron emission tomography/computed tomography and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e16-e20. [DOI: 10.1016/j.oooo.2018.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
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16
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Abou-Abbass H, Bahmad H, Ghandour H, Fares J, Wazzi-Mkahal R, Yacoub B, Darwish H, Mondello S, Harati H, El Sayed MJ, Tamim H, Kobeissy F. Epidemiology and clinical characteristics of traumatic brain injury in Lebanon: A systematic review. Medicine (Baltimore) 2016; 95:e5342. [PMID: 27893670 PMCID: PMC5134863 DOI: 10.1097/md.0000000000005342] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a debilitating medical and emerging public health problem that is affecting people worldwide due to a multitude of factors including both domestic and war-related acts. The objective of this paper is to systematically review the status of TBI in Lebanon - a Middle Eastern country with a weak health system that was chartered by several wars and intermittent outbursts of violence - in order to identify the present gaps in knowledge, direct future research initiatives and to assist policy makers in planning progressive and rehabilitative policies. METHODS OVID/Medline, PubMed, Scopus databases and Google Scholar were lastly searched on April 15, 2016 to identify all published research studies on TBI in Lebanon. Studies published in English, Arabic or French that assessed Lebanese patients afflicted by TBI in Lebanon were warranting inclusion in this review. Case reports, reviews, biographies and abstracts were excluded. Throughout the whole review process, reviewers worked independently and in duplicate during study selection, data abstraction and methodological assessment using the Downs and Black Checklist. RESULTS In total, 11 studies were recognized eligible as they assessed Lebanese patients afflicted by TBI on Lebanese soils. Considerable methodological variation was found among the identified studies. All studies, except for two that evaluated domestic causes such as falls, reported TBI due to war-related injuries. Age distribution of TBI victims revealed two peaks, young adults between 18 and 40 years, and older adults aged 60 years and above, where males constituted the majority. Only three studies reported rates of mild TBI. Mortality, rehabilitation and systemic injury rates were rarely reported and so were the complications involved; infections were an exception. CONCLUSION Apparently, status of TBI in Lebanon suffers from several gaps which need to be bridged through implementing more basic, epidemiological, clinical and translational research in this field in the future.
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Affiliation(s)
- Hussein Abou-Abbass
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center
- Faculty of Medicine, Beirut Arab University
| | - Hisham Bahmad
- Faculty of Medicine, Beirut Arab University
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut
| | - Hiba Ghandour
- Faculty of Medicine, American University of Beirut Medical Center
| | - Jawad Fares
- Faculty of Medicine, American University of Beirut Medical Center
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University
| | | | - Basel Yacoub
- Faculty of Medicine, American University of Beirut Medical Center
| | - Hala Darwish
- Faculty of Medicine-Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University
| | - Mazen J. El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center
| | - Hani Tamim
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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