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Salihu A, Meier D, Noirclerc N, Skalidis I, Mauler-Wittwer S, Recordon F, Kirsch M, Roguelov C, Berger A, Sun X, Abbe E, Marcucci C, Rancati V, Rosner L, Scala E, Rotzinger DC, Humbert M, Muller O, Lu H, Fournier S. A study of ChatGPT in facilitating Heart Team decisions on severe aortic stenosis. EUROINTERVENTION 2024; 20:e496-e503. [PMID: 38629422 PMCID: PMC11017225 DOI: 10.4244/eij-d-23-00643] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/01/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Multidisciplinary Heart Teams (HTs) play a central role in the management of valvular heart diseases. However, the comprehensive evaluation of patients' data can be hindered by logistical challenges, which in turn may affect the care they receive. AIMS This study aimed to explore the ability of artificial intelligence (AI), particularly large language models (LLMs), to improve clinical decision-making and enhance the efficiency of HTs. METHODS Data from patients with severe aortic stenosis presented at HT meetings were retrospectively analysed. A standardised multiple-choice questionnaire, with 14 key variables, was processed by the OpenAI Chat Generative Pre-trained Transformer (GPT)-4. AI-generated decisions were then compared to those made by the HT. RESULTS This study included 150 patients, with ChatGPT agreeing with the HT's decisions 77% of the time. The agreement rate varied depending on treatment modality: 90% for transcatheter valve implantation, 65% for surgical valve replacement, and 65% for medical treatment. CONCLUSIONS The use of LLMs offers promising opportunities to improve the HT decision-making process. This study showed that ChatGPT's decisions were consistent with those of the HT in a large proportion of cases. This technology could serve as a failsafe, highlighting potential areas of discrepancy when its decisions diverge from those of the HT. Further research is necessary to solidify our understanding of how AI can be integrated to enhance the decision-making processes of HTs.
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Affiliation(s)
- Adil Salihu
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Nathalie Noirclerc
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sarah Mauler-Wittwer
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Frederique Recordon
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Berger
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Xiaowu Sun
- Institute of Mathematics and School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Emmanuel Abbe
- Institute of Mathematics and School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Valentina Rancati
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Rosner
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Emanuelle Scala
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - David C Rotzinger
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marc Humbert
- Department of Geriatrics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Salihu A, Rotzinger DC, Fahrni G, Nowacka A, Antiochos P, Fournier S, Muller O, Kirsch M, Lu H. Transcarotid vascular access for transcatheter aortic valve implantation: is choosing the left side always right? J Cardiothorac Surg 2024; 19:196. [PMID: 38600556 PMCID: PMC11008044 DOI: 10.1186/s13019-024-02661-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The transcarotid (TC) vascular access for transcatheter aortic valve implantation (TAVI) has emerged as the first-choice alternative to the transfemoral access, in patients unsuitable for the latter. The use of both the left and right common carotid arteries (CCAs) for TC-TAVI has been described, but the optimal side is subject to debate. We conducted this pilot study to compare the level of vessel tortuosity and plaque burden from either the left CCA to the aortic annulus, or the right CCA to the aortic annulus, considering them as surrogates for technical and procedural complexity. METHODS Consecutive patients who underwent TC-TAVI between 2018 and 2021 in our institution were included. Using three-dimensional reconstruction, pre-TAVI neck and chest computed tomography angiography exams were reviewed to assess the tortuosity index (TI), sum of angles metric, as well as plaque burden, between each CCA and the aortic annulus. RESULTS We included 46 patients who underwent TC-TAVI. No significant difference regarding the mean TIs between the left and right sides (respectively 1.20 and 1.19, p = 0.82), the mean sum of angles (left side: 396°, right side: 384°, p = 0.27), and arterial plaque burden (arterial plaque found in 30% of left CCAs and 45% of right CCAs, p = 0.19) was found. CONCLUSIONS We found no convincing data favoring the use of one particular access side over the other one. The choice of the CCA side in TC-TAVI should to be made on a case-by-case basis, in a multidisciplinary fashion, and may also depend on the operators' experience.
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Affiliation(s)
- Adil Salihu
- Division of Cardiology, Lausanne University Hospital and University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University Hospital, Lausanne, 1011, Switzerland
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University Hospital, Lausanne, 1011, Switzerland
| | - Anna Nowacka
- Division of Cardiovascular Surgery, Lausanne University Hospital and University Hospital, Lausanne, 1011, Switzerland
| | - Panagiotis Antiochos
- Division of Cardiology, Lausanne University Hospital and University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Stephane Fournier
- Division of Cardiology, Lausanne University Hospital and University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Olivier Muller
- Division of Cardiology, Lausanne University Hospital and University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Matthias Kirsch
- Division of Cardiovascular Surgery, Lausanne University Hospital and University Hospital, Lausanne, 1011, Switzerland
| | - Henri Lu
- Division of Cardiology, Lausanne University Hospital and University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
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Michaud K, Rotzinger DC, Faouzi M, Grabherr S, Qanadli SD, van der Wal AC, Magnin V. High-risk coronary plaque of sudden cardiac death victims: postmortem CT angiographic features and histopathologic findings. Int J Legal Med 2024:10.1007/s00414-024-03228-w. [PMID: 38594500 DOI: 10.1007/s00414-024-03228-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
High-risk coronary plaques (HRP) are characterized in clinical radiological imaging by the presence of low plaque attenuation, a napkin-ring sign (NRS), spotty calcifications (SC) and a positive remodeling index (RI). To evaluate if these signs are detectable in postmortem imaging by a multi-phase postmortem CT angiography (MPMCTA), a retrospective study of a series of autopsy well-documented coronary plaques related to sudden cardiac death (SCD) was performed. Then correlations between histological and radiological findings were described. Fourty SCD cases due to acute coronary syndrome based on clinical history and confirmed at autopsy were selected (28 men and 12 women, age 53.3 ± 10.9). The culprit lesion was mainly situated in the proximal segments of coronary arteries, in the right coronary artery in 23 cases (57.5%), the left anterior descending artery in 13 cases (32.5%), the circumflex artery in 3 cases (7.5%) and in one case in the left main stem. MPMCTA showed a positive RI (≥ 1.1) in 75% of cases with a mean RI 1.39 ± 0.71. RI values were lower in cases with fibrotic plaques. NRS was observed in 40% of cases, low attenuation plaque in 46.3%, and SC in 48.7% of cases. There were significant correlations of the radiological presence of NRS for fibrolipid composition of the plaque (p-value 0.007), severe intraplaque inflammation (p-value 0.017), severe adventitial inflammation (p-value 0.021) and an increased vasa vasorum (p-value 0.012). A significant correlation (p-value 0.002) was observed between the presence of SC at radiological examination and the presence of punctuate/fragmented calcification at histology. In addition, in 58.3% of cases, plaque enhancement was observed, which correlated with plaque inflammation and the fibrolipid composition of the plaque. The coronary artery calcium score was 314 (± 455). There was a poor agreement between stenosis of the lumen at histology versus radiology. Our study shows that the various radiological signs of HRP can be detected in all plaques by MPMCTA, but individually only to a variable extent; plaque enhancement appeared as a new sign of vulnerability. In the postmortem approach, these radiological markers of HRP, should always be applied in combination, which can be useful for developing a predictive model for diagnosing coronary SCD.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland.
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
- Center for Primary Care and Public Health, Division of Biostatistics, Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
| | - Salah D Qanadli
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Riviera-Chablais Hospital, Rennaz, 1847, Switzerland
| | - Allard C van der Wal
- Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
- Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Chemin de la Vulliette 4, Lausanne 25, CH - 1000, Switzerland
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Rotzinger DC, Magnin V, van der Wal AC, Grabherr S, Qanadli SD, Michaud K. Coronary CT angiography for the assessment of atherosclerotic plaque inflammation: postmortem proof of concept with histological validation. Eur Radiol 2024; 34:1755-1763. [PMID: 37658143 PMCID: PMC10873449 DOI: 10.1007/s00330-023-10169-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES To evaluate the diagnostic utility of multiphase postmortem CT angiography (PMCTA) to detect plaque enhancement as a surrogate marker of inflammation, using fatal coronary plaques obtained from autopsies following sudden cardiac death. METHODS In this retrospective study, we included 35 cases (12 women, 34%; median [IQR] age, 52 [11] years), with autopsy-proven coronary thrombosis, histological examination, and multiphase PMCTA. Two radiologists blinded towards histological findings assessed PMCTA for plaque enhancement of the culprit lesion in consensus. Two forensic pathologists determined the culprit lesion and assessed histological samples in consensus. Cases with concomitant vasa vasorum density increase and intraplaque and periadventital inflammation were considered positive for plaque inflammation. Finally, we correlated radiology and pathology findings. RESULTS All 35 cases had histological evidence of atherosclerotic plaque disruption and thrombosis; 30 (85.7%) had plaque inflammation. Plaque enhancement at multiphase PMCTA was reported in 21 (60%) and resulted in a PPV of 95.2% (77.3-99.2%) and an NPV of 28.6% (17-43.9%). Median histological ratings indicated higher intraplaque inflammation (p = .024) and vasa vasorum density (p = .032) in plaques with enhancement. We found no evidence of a difference in adventitial inflammation between CT-negative and CT-positive plaques (p = .211). CONCLUSIONS Plaque enhancement was found in 2/3 of fatal atherothrombotic occlusions at coronary postmortem CT angiography. Furthermore, plaque enhancement correlated with histopathological plaque inflammation and increased vasa vasorum density. Plaque enhancement on multiphase CT angiography could potentially serve as a noninvasive marker of inflammation in high-risk populations. CLINICAL RELEVANCE STATEMENT Phenotyping coronary plaque more comprehensively is one of the principal challenges cardiac imaging is facing. Translating our ex vivo findings of CT-based plaque inflammation assessment into clinical studies might help pave the way in defining high-risk plaque better. KEY POINTS • Most thrombosed coronary plaques leading to fatality in our series had histological signs of inflammation. • Multiphase postmortem CT angiography can provide a noninvasive interrogation of plaque inflammation through contrast enhancement. • Atherosclerotic plaque enhancement at multiphase postmortem CT angiography correlated with histopathological signs of plaque inflammation and could potentially serve as an imaging biological marker of plaque vulnerability.
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Affiliation(s)
- David C Rotzinger
- Division of Cardiothoracic and Vascular Imaging, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Virginie Magnin
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Allard C van der Wal
- Department of Pathology, Amsterdam University Medical Centers (AUMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Silke Grabherr
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Salah D Qanadli
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Riviera-Chablais Hospital (HRC), 1847, Rennaz, Switzerland
| | - Katarzyna Michaud
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Rotzinger DC, Fahrni G. The evolving role of transcatheter aortic valve implantation computed tomography in coronary artery assessment: a deeper dive into efficiency, challenges, and future perspectives. J Thorac Dis 2024; 16:829-832. [PMID: 38505081 PMCID: PMC10944751 DOI: 10.21037/jtd-23-1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/10/2024] [Indexed: 03/21/2024]
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Fahrni G, Mingas T, Deliessche A, Hraichi S, Rotzinger DC, Si-Mohamed SA, Boccalini S, Douek P. Low-iodine 40-keV virtual monoenergetic CT angiography of the lower extremities. Front Cardiovasc Med 2023; 10:1276738. [PMID: 37942065 PMCID: PMC10629994 DOI: 10.3389/fcvm.2023.1276738] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction To evaluate a reduced iodine volume protocol for lower extremity CT angiography (CTA) using dual-energy CT (DECT). Methods This retrospective study included consecutive patients who underwent lower extremity CTA from June to December 2022. A 10 ml 1:1 mixed test bolus was performed, followed by a 40 ml full bolus at a 2.5/s injection rate, using 400 mg/ml iodine contrast media. Conventional and 40 keV virtual monoenergetic images (VMI) were reconstructed. For both reconstructions, five main artery segments were assessed with a 3-point image quality score as well as quantitative attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements with diagnostic quality thresholds (respectively >150 HU and >3). Results Forty patients were included in the study (mean age 68 ± 12 yo). 200 artery segments were assessed. Median qualitative image scores were 3 [IQR, 3, 3] for both reconstructions. 40 keV VMI upgraded qualitative scores for 51 (26%) of patients, including 9 (5%) from nondiagnostic to diagnostic quality. 40 keV VMI obtained attenuation and CNR diagnostic quality for respectively 100% and 100% of segments, compared with 96% and 98% for conventional images (p < 0.001). Distal artery segments showed the most differences between 40 keV VMI and conventional images. Conclusion A low-iodine lower extremity CTA protocol is feasible, with 40 keV virtual monoenergetic spectral reconstruction enabling maintained diagnostic image quality at the distal artery segments.
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Affiliation(s)
- Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Thomas Mingas
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Arthur Deliessche
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Smail Hraichi
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salim A. Si-Mohamed
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Sara Boccalini
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Philippe Douek
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
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Fahrni G, Gullo G, Touray A, Fournier S, Jouannic AM, Lu H, Racine D, Muller O, Pozzessere C, Qanadli SD, Rotzinger DC. Investigating the Influence of High-Speed Gantry Rotation in Cardiac CT on Motion Artifacts in Aortic Stenosis Patients Not Premedicated with β-Blockers: The FAST-CCT Randomized Trial Protocol. J Cardiovasc Dev Dis 2023; 10:424. [PMID: 37887871 PMCID: PMC10607475 DOI: 10.3390/jcdd10100424] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60-65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. METHODS We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. PRIMARY OUTCOME rate of CCTAs with coronary motion artifacts hindering interpretation. SECONDARY OUTCOMES assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. CLINICALTRIALS gov identifier: NCT05709652.
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Affiliation(s)
- Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Giuseppe Gullo
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Aisha Touray
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Stéphane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Anne-Marie Jouannic
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Henri Lu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Damien Racine
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 46, 1007 Lausanne, Switzerland;
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Salah D. Qanadli
- Riviera-Chablais Hospital, Rte du Vieux Séquoia 20, 1847 Rennaz, Switzerland;
- Faculty of Biology and Medicine (FBM), University of Lausanne, 1015 Lausanne, Switzerland
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
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Papadimitriou-Olivgeris M, Monney P, Rotzinger DC, Kamani CH, Fahrni G, Prior JO, Ianculescu N, Messaoudi Y, Tozzi P, Kirsch M, Guery B. Impact of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis. Eur J Intern Med 2023; 116:82-88. [PMID: 37328399 DOI: 10.1016/j.ejim.2023.06.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Embolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan. The present study aimed to describe the role of thoracoabdominal imaging, either thoracoabdominal-pelvic Computed Tomography or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography, on diagnosis and management of patients with suspected IE. METHODS This study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. RESULTS Among 966 episodes with suspected IE and thoracoabdominal imaging, 528 (55%) patients were asymptomatic. At least one EE was found in 205 (21%) episodes. Based on thoracoabdominal imaging findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively. Among the 413 patients with IE, at least one EE was found on thoracoabdominal imaging in 143 (35%) episodes. Together with the presence of left-side valvular vegetation >10 mm, the results of thoracoabdominal imaging established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. CONCLUSIONS Thoracoabdominal imaging performed in asymptomatic patients with suspected IE improved the diagnosis in only a small proportion of patients. Thoracoabdominal imaging led to a new surgical indication (in association with left-side valvular vegetation >10 mm) in only a small percentage of patients.
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Affiliation(s)
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C Rotzinger
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christel H Kamani
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Guillaume Fahrni
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicoleta Ianculescu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yosra Messaoudi
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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9
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Pavon AG, Rubimbura V, Nowacka A, Hocquelet A, Schwitter J, Rotzinger DC. Case report: Acute pericarditis following hepatic microwave ablation for liver metastasis. Front Cardiovasc Med 2023; 10:1100916. [PMID: 37273871 PMCID: PMC10237370 DOI: 10.3389/fcvm.2023.1100916] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Hepatic microwave ablation (MWA) is a growing treatment modality in the field of primary and secondary liver cancer. One potential side effect is thermal damage to adjacent structures, including the pericardium if the hepatic lesion is located near the diaphragm. Hemorrhagic cardiac tamponade is known to be a rare but potentially life-threatening complication. Here we present the first case of cardiac complication following MWA treatment in a 55-year-old man who presented with late cardiac tamponade. Adequate and timely management is essential, and clinicians should be fully aware of the need to perform early transthoracic echocardiography to detect signs of pericardial effusion when cardiac involvement is suspected.
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Affiliation(s)
- Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anna Nowacka
- Cardio Surgery Department, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jurg Schwitter
- Centre of Cardiac Magnetic Resonance, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Racine D, Mergen V, Viry A, Eberhard M, Becce F, Rotzinger DC, Alkadhi H, Euler A. Photon-Counting Detector CT With Quantum Iterative Reconstruction: Impact on Liver Lesion Detection and Radiation Dose Reduction. Invest Radiol 2023; 58:245-252. [PMID: 36094810 DOI: 10.1097/rli.0000000000000925] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 11/25/2022]
Abstract
OBJECTIVES To assess image noise, diagnostic performance, and potential for radiation dose reduction of photon-counting detector (PCD) computed tomography (CT) with quantum iterative reconstruction (QIR) in the detection of hypoattenuating and hyperattenuating focal liver lesions compared with energy-integrating detector (EID) CT. MATERIALS AND METHODS A medium-sized anthropomorphic abdominal phantom with liver parenchyma and lesions (diameter, 5-10 mm; hypoattenuating and hyperattenuating from -30 HU to +90 HU at 120 kVp) was used. The phantom was imaged on ( a ) a third-generation dual-source EID-CT (SOMATOM Force, Siemens Healthineers) in the dual-energy mode at 100 and 150 kVp with tin filtration and ( b ) a clinical dual-source PCD-CT at 120 kVp (NAEOTOM Alpha, Siemens). Scans were repeated 10 times for each of 3 different radiation doses of 5, 2.5, and 1.25 mGy. Datasets were reconstructed as virtual monoenergetic images (VMIs) at 60 keV for both scanners and as linear-blended images (LBIs) for EID-CT. For PCD-CT, VMIs were reconstructed with different strength levels of QIR (QIR 1-4) and without QIR (QIR-off). For EID-CT, VMIs and LBIs were reconstructed using advanced modeled iterative reconstruction at a strength level of 3. Noise power spectrum was measured to compare image noise magnitude and texture. A channelized Hotelling model observer was used to assess diagnostic accuracy for lesion detection. The potential for radiation dose reduction using PCD-CT was estimated for the QIR strength level with the highest area under the curve compared with EID-CT for each radiation dose. RESULTS Image noise decreased with increasing QIR level at all radiation doses. Using QIR-4, noise reduction was 41%, 45%, and 59% compared with EID-CT VMIs and 12%, 18%, and 33% compared with EID-CT LBIs at 5, 2.5, and 1.25 mGy, respectively. The peak spatial frequency shifted slightly to lower frequencies at higher QIR levels. Lesion detection accuracy increased at higher QIR levels and was higher for PCD-CT compared with EID-CT VMIs. The improvement in detection with PCD-CT was strongest at the lowest radiation dose, with an area under the receiver operating curve of 0.917 for QIR-4 versus 0.677 for EID-CT VMIs for hyperattenuating lesions, and 0.900 for QIR-4 versus 0.726 for EID-CT VMIs for hypoattenuating lesions. Compared with EID-CT LBIs, detection was higher for QIR 1-4 at 2.5 mGy and for QIR 2-4 at 1.25 mGy (eg, 0.900 for QIR-4 compared with 0.854 for EID-CT LBIs at 1.25 mGy). Radiation dose reduction potential of PCD-CT with QIR-4 was 54% at 5 mGy compared with VMIs and 39% at 2.5 mGy compared with LBIs. CONCLUSIONS Compared with EID-CT, PCD-CT with QIR substantially improved focal liver lesion detection, especially at low radiation dose. This enables substantial radiation dose reduction while maintaining diagnostic accuracy.
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Affiliation(s)
- Damien Racine
- From the Institute of Radiation Physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne
| | - Victor Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich
| | - Anaïs Viry
- From the Institute of Radiation Physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich
| | - André Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich
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11
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Fahrni G, Rocha AC, Gudmundsson L, Pozzessere C, Qanadli SD, Rotzinger DC. Impact of COVID-19 pneumonia on pulmonary vascular volume. Front Med (Lausanne) 2023; 10:1117151. [PMID: 37035332 PMCID: PMC10073514 DOI: 10.3389/fmed.2023.1117151] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Background Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.
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Affiliation(s)
- Guillaume Fahrni
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana-Carolina Rocha
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Pozzessere
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Riviera Chablais Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Rotzinger DC, Qanadli SD, Fahrni G. Imaging the Vulnerable Carotid Plaque with CT: Caveats to Consider. Comment on Wang et al. Identification Markers of Carotid Vulnerable Plaques: An Update. Biomolecules 2022, 12, 1192. Biomolecules 2023; 13:biom13020397. [PMID: 36830766 PMCID: PMC9953174 DOI: 10.3390/biom13020397] [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] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
We read with great interest the review by Wang et al. entitled "Identification Markers of Carotid Vulnerable Plaques: An Update", recently published in Biomolecules [...].
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Affiliation(s)
- David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-44-75
| | - Salah D. Qanadli
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
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13
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Rezaei-Kalantari K, Fahrni G, Rotzinger DC, Qanadli SD. Insights into pelvic venous disorders. Front Cardiovasc Med 2023; 10:1102063. [PMID: 36742076 PMCID: PMC9892065 DOI: 10.3389/fcvm.2023.1102063] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Pelvic venous disorders (PeVD), sometimes referred to as pelvic congestion syndrome (PCS), widely impact affected patients-mainly young women's quality of life, causing puzzling, uncomfortable symptoms sometimes requiring months or years to get an explanation, while simply remaining undiagnosed in other cases. Because pelvic pain is a non-specific symptom, an appropriate diagnosis requires a careful patient workup, including a correlation between history and non-invasive imaging. Invasive imaging is frequently required to confirm the diagnosis and plan treatment. Current therapeutic approaches principally rely on minimally invasive techniques delivered through endovascular access. However, while comprehensive descriptive classifications such as the symptoms-varices-pathophysiology (SVP) classification exist, universally accepted guidelines regarding therapy to apply for each SVP category are still lacking. This review strongly focuses on PeVD imaging and discusses available therapeutic approaches with regard to pathophysiological mechanisms. It proposes a new classification scheme assisting clinical decision-making about endovascular management to help standardize the link between imaging findings and treatment.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular, Medical and Research Center, Cardio-Oncology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,*Correspondence: Guillaume Fahrni,
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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14
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Skalidis I, Roux O, Rotzinger DC, Fournier S, Rosner L, Eeckhout E, Deglise S, Muller O, Roguelov C. Endovascular Stent Grafting for Descending Thoracic Aortic Rupture During TAVR. JACC Cardiovasc Interv 2022; 15:1880-1882. [DOI: 10.1016/j.jcin.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
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15
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Boccalini S, Si-Mohamed S, Matzuzzi M, Tillier M, Rotzinger DC, Revel D, Boussel L, Douek P. Effect of contrast material injection protocol on first-pass myocardial perfusion assessed by dual-energy dual-layer computed tomography. Quant Imaging Med Surg 2022; 12:3903-3916. [PMID: 35782242 PMCID: PMC9246727 DOI: 10.21037/qims-21-809] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/09/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND Dual-energy dual-layer computed tomography (CT) scanners can provide useful tools, such as iodine maps and virtual monochromatic images (VMI), for the evaluation of myocardial perfusion defects. Data about the influence of acquisition protocols and normal values are still lacking. METHODS Clinically indicated coronary CT-angiographies performed between January-October 2018 in a single university hospital with dual-energy dual-layer CT (DE-DLCT) and different injection protocols were retrospectively evaluated. The two protocols were: 35 mL in patients <80 kg and 0.5 mL/kg in patients >80 kg at 2.5 mL/s (group A) or double contrast dose at 5 mL/s (group B). Patients with coronary stenosis >50% were excluded. Regions of interest were manually drawn on 16 myocardial segments and iodine concentration was measured in mg/mL. Signal-to-noise, contrast-to-noise ratios (CNR) and image noise were measured on conventional images and VMI. RESULTS A total of 30 patients were included for each protocol. With iodine concentrations of 1.38±0.41 mg/mL for protocol A and 2.07±0.73 mg/mL for protocol B, the two groups were significantly different (P<0.001). No significant iodine concentration differences were found between the 16 segments (P=0.47 and P=0.09 for group A and B respectively), between basal, mid and apical segments for group A and B (P=0.28 and P=0.12 for group A and B respectively) and between wall regions for group A (P=0.06 on normalised data). In group B, iodine concentration was significantly different between three wall regions [highest values for the lateral wall, median =2.03 (1.06) mg/mL]. Post-hoc analysis showed highest contrast-to-noise and signal-to-noise in VMI at 40 eV (P<0.05). CONCLUSIONS Iodine concentration in left ventricular myocardium of patients without significant coronary artery stenosis varied depending on the injection protocol and appeared more heterogeneous in different wall regions at faster injection rate and greater iodine load. Signal-to-noise and contrast-to-noise gradually improved when decreasing VMI energy, although at the expenses of higher noise, demonstrating the potential of DE-DLCT to enhance objective image quality.
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Affiliation(s)
- Sara Boccalini
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- Univerisity Claude Bernard Lyon 1, Lyon, France
| | - Salim Si-Mohamed
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Maxime Matzuzzi
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - Manon Tillier
- Faculty of Medicine Rockfeller, University Claude Bernard Lyon 1, Lyon, France
| | - David C. Rotzinger
- Department of Radiology, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Didier Revel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Loic Boussel
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Philippe Douek
- Department of Cardiovascular and Thoracic Radiology, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
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16
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Darçot E, Jreige M, Rotzinger DC, Gidoin Tuyet Van S, Casutt A, Delacoste J, Simons J, Long O, Buela F, Ledoux JB, Prior JO, Lovis A, Beigelman-Aubry C. Comparison Between Magnetic Resonance Imaging and Computed Tomography in the Detection and Volumetric Assessment of Lung Nodules: A Prospective Study. Front Med (Lausanne) 2022; 9:858731. [PMID: 35573012 PMCID: PMC9096346 DOI: 10.3389/fmed.2022.858731] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/25/2022] [Indexed: 11/22/2022] Open
Abstract
Rationale and Objectives Computed tomography (CT) lung nodule assessment is routinely performed and appears very promising for lung cancer screening. However, the radiation exposure through time remains a concern. With the overall goal of an optimal management of indeterminate lung nodules, the objective of this prospective study was therefore to evaluate the potential of optimized ultra-short echo time (UTE) MRI for lung nodule detection and volumetric assessment. Materials and Methods Eight (54.9 ± 13.2 years) patients with at least 1 non-calcified nodule ≥4 mm were included. UTE under high-frequency non-invasive ventilation (UTE-HF-NIV) and in free-breathing at tidal volume (UTE-FB) were investigated along with volumetric interpolated breath-hold examination at full inspiration (VIBE-BH). Three experienced readers assessed the detection rate of nodules ≥4 mm and ≥6 mm, and reported their location, 2D-measurements and solid/subsolid nature. Volumes were measured by two experienced readers. Subsequently, two readers assessed the detection and volume measurements of lung nodules ≥4mm in gold-standard CT images with soft and lung kernel reconstructions. Volumetry was performed with lesion management software (Carestream, Rochester, New York, USA). Results UTE-HF-NIV provided the highest detection rate for nodules ≥4 mm (n = 66) and ≥6 mm (n = 32) (35 and 50%, respectively). No dependencies were found between nodule detection and their location in the lung with UTE-HF-NIV (p > 0.4), such a dependency was observed for two readers with VIBE-BH (p = 0.002 and 0.03). Dependencies between the nodule's detection and their size were noticed among readers and techniques (p < 0.02). When comparing nodule volume measurements, an excellent concordance was observed between CT and UTE-HF-NIV, with an overestimation of 13.2% by UTE-HF-NIV, <25%-threshold used for nodule's growth, conversely to VIBE-BH that overestimated the nodule volume by 28.8%. Conclusion UTE-HF-NIV is not ready to replace low-dose CT for lung nodule detection, but could be used for follow-up studies, alternating with CT, based on its volumetric accuracy.
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Affiliation(s)
- Emeline Darçot
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stacey Gidoin Tuyet Van
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alessio Casutt
- Department of Pulmonology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jean Delacoste
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Julien Simons
- Department of Physiotherapy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Olivier Long
- Department of Physiotherapy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Flore Buela
- Department of Physiotherapy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - John O Prior
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alban Lovis
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Pulmonology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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17
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Fahrni G, Rotzinger DC, Nakajo C, Dehmeshki J, Qanadli SD. Three-Dimensional Adaptive Image Compression Concept for Medical Imaging: Application to Computed Tomography Angiography for Peripheral Arteries. J Cardiovasc Dev Dis 2022; 9:jcdd9050137. [PMID: 35621848 PMCID: PMC9145618 DOI: 10.3390/jcdd9050137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Advances in computed tomography (CT) have resulted in a substantial increase in the size of datasets. We built a new concept of medical image compression that provides the best compromise between compression rate and image quality. The method is based on multiple contexts and regions-of-interest (ROI) defined according to the degree of clinical interest. High priority areas (primary ROIs) are assigned a lossless compression. Other areas (secondary ROIs and background) are compressed with moderate or heavy losses. The method is applied to a whole dataset of CT angiography (CTA) of the lower extremity vasculature. It is compared to standard lossy compression techniques in terms of quantitative and qualitative image quality. It is also compared to standard lossless compression techniques in terms of image size reduction and compression ratio. The proposed compression method met quantitative criteria for high-quality encoding. It obtained the highest qualitative image quality rating score, with a statistically significant difference compared to other methods. The average compressed image size was up to 61% lower compared to standard compression techniques, with a 9:1 compression ratio compared with original non-compressed images. Our new adaptive 3D compression method for CT images can save data storage space while preserving clinically relevant information.
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Affiliation(s)
- Guillaume Fahrni
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (D.C.R.); (C.N.); (S.D.Q.)
- Correspondence:
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (D.C.R.); (C.N.); (S.D.Q.)
- Imaging and Image-Guided Therapies Lab (IGT-L), University of Lausanne, 1015 Lausanne, Switzerland
| | - Chiaki Nakajo
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (D.C.R.); (C.N.); (S.D.Q.)
| | - Jamshid Dehmeshki
- Department of Computer Science, Kingston University, Kingston-upon-Thames KT1 2QT, UK;
| | - Salah Dine Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (D.C.R.); (C.N.); (S.D.Q.)
- Imaging and Image-Guided Therapies Lab (IGT-L), University of Lausanne, 1015 Lausanne, Switzerland
- Department of Computer Science, Kingston University, Kingston-upon-Thames KT1 2QT, UK;
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18
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Poletti J, Bach M, Yang S, Sexauer R, Stieltjes B, Rotzinger DC, Bremerich J, Walter Sauter A, Weikert T. Automated lung vessel segmentation reveals blood vessel volume redistribution in viral pneumonia. Eur J Radiol 2022; 150:110259. [PMID: 35334245 DOI: 10.1016/j.ejrad.2022.110259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE It is known from histology studies that lung vessels are affected in viral pneumonia. However, their diagnostic potential as a chest CT imaging parameter has only rarely been exploited. The purpose of this study is to develop a robust method for automated lung vessel segmentation and morphology analysis and apply it to a large chest CT dataset. METHODS In total, 509 non-enhanced chest CTs (NECTs) and 563 CT pulmonary angiograms (CTPAs) were included. Sub-groups were patients with healthy lungs (group_NORM, n = 634) and those RT-PCR-positive for Influenza A/B (group_INF, n = 159) and SARS-CoV-2 (group_COV, n = 279). A lung vessel segmentation algorithm (LVSA) based on traditional image processing was developed, validated with a point-of-interest approach, and applied to a large clinical dataset. Total blood vessel volume in lung (TBV) and the blood vessel volume percentage (BV%) of three blood vessel size types were calculated and compared between groups: small (BV5%, cross-sectional area < 5 mm2), medium (BV5-10%, 5-10 mm2) and large (BV10%, >10 mm2). RESULTS Sensitivity of the LVSA was 84.6% (95 %CI: 73.9-95.3) for NECTs and 92.8% (95 %CI: 90.8-94.7) for CTPAs. In viral pneumonia, besides an increased TBV, the main finding was a significantly decreased BV5% in group_COV (n = 14%) and group_INF (n = 15%) compared to group_NORM (n = 18%) [p < 0.001]. At the same time, BV10% was increased (group_COV n = 15% and group_INF n = 14% vs. group_NORM n = 11%; p < 0.001). CONCLUSION In COVID-19 and Influenza, the blood vessel volume is redistributed from small to large vessels in the lung. Automated LSVA allows researchers and clinicians to derive imaging parameters for large amounts of CTs. This can enhance the understanding of vascular changes, particularly in infectious lung diseases.
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Affiliation(s)
- Julien Poletti
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Michael Bach
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Shan Yang
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Raphael Sexauer
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Bram Stieltjes
- Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Alexander Walter Sauter
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Thomas Weikert
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Research and Analysis, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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19
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Rezaei-Kalantari K, Rotzinger DC, Qanadli SD. Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up. Front Cardiovasc Med 2022; 9:746748. [PMID: 35310979 PMCID: PMC8927289 DOI: 10.3389/fcvm.2022.746748] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Mortality rates associated with venous thromboembolism (VTE) are high. Inferior vena cava filters (IVCFs) have been frequently placed for these patients as part of their treatment, albeit the paucity of data showing their ultimate efficacy and potential risk of complications. Issues regarding long-term filter dwell time are accounted for in society guidelines. This topic has led to an FDA mandate for filter retrieved as soon as protection from pulmonary embolism is no longer needed. However, even though most are retrievable, some were inadvertently left as permanent, which carries an incremental lifetime risk to the patient. In the past decade, attempts have aimed to determine the optimal time interval during which filter needs to be removed. In addition, distinct strategies have been implemented to boost retrieval rates. This review discusses current conflicts in indications, the not uncommon complications, the rationale and need for timely retrieval, and different quality improvement strategies to fulfill this aim.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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20
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Qanadli SD, Gudmundsson L, Gullo G, Ponti A, Saltiel S, Jouannic AM, Faouzi M, Rotzinger DC. Virtually Augmented Self-Hypnosis applied to endovascular interventions (VA-HYPO): Randomized Controlled Trial Protocol. PLoS One 2022; 17:e0263002. [PMID: 35196310 PMCID: PMC8865664 DOI: 10.1371/journal.pone.0263002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients’ experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients’ experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia. Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.
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Affiliation(s)
- Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Gullo
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Saltiel
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
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21
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Rubimbura V, Girod G, Delabays A, Meier D, Rotzinger DC, Muller O, Qanadli SD, Eeckhout É. Case Report: Coronary-Pulmonary Fistula Closure by Percutaneous Approach: Learning From Mistakes. Front Cardiovasc Med 2022; 8:779716. [PMID: 35146007 PMCID: PMC8823088 DOI: 10.3389/fcvm.2021.779716] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.
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Affiliation(s)
- Vladimir Rubimbura
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
- *Correspondence: Vladimir Rubimbura
| | - Grégoire Girod
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Department, Sion Hospital, Sion, Switzerland
| | - Alain Delabays
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - David Meier
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Éric Eeckhout
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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22
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Rotzinger DC, Racine D, Becce F, Lahoud E, Erhard K, Si-Mohamed SA, Greffier J, Viry A, Boussel L, Meuli RA, Yagil Y, Monnin P, Douek PC. Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer. Diagnostics (Basel) 2021; 11:2376. [PMID: 34943611 PMCID: PMC8700425 DOI: 10.3390/diagnostics11122376] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
AIMS To evaluate spectral photon-counting CT's (SPCCT) objective image quality characteristics in vitro, compared with standard-of-care energy-integrating-detector (EID) CT. METHODS We scanned a thorax phantom with a coronary artery module at 10 mGy on a prototype SPCCT and a clinical dual-layer EID-CT under various conditions of simulated patient size (small, medium, and large). We used filtered back-projection with a soft-tissue kernel. We assessed noise and contrast-dependent spatial resolution with noise power spectra (NPS) and target transfer functions (TTF), respectively. Detectability indices (d') of simulated non-calcified and lipid-rich atherosclerotic plaques were computed using the non-pre-whitening with eye filter model observer. RESULTS SPCCT provided lower noise magnitude (9-38% lower NPS amplitude) and higher noise frequency peaks (sharper noise texture). Furthermore, SPCCT provided consistently higher spatial resolution (30-33% better TTF10). In the detectability analysis, SPCCT outperformed EID-CT in all investigated conditions, providing superior d'. SPCCT reached almost perfect detectability (AUC ≈ 95%) for simulated 0.5-mm-thick non-calcified plaques (for large-sized patients), whereas EID-CT had lower d' (AUC ≈ 75%). For lipid-rich atherosclerotic plaques, SPCCT achieved 85% AUC vs. 77.5% with EID-CT. CONCLUSIONS SPCCT outperformed EID-CT in detecting simulated coronary atherosclerosis and might enhance diagnostic accuracy by providing lower noise magnitude, markedly improved spatial resolution, and superior lipid core detectability.
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Affiliation(s)
- David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH 1011 Lausanne, Switzerland; (F.B.); (R.A.M.)
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
| | - Damien Racine
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
- Institute of Radiation Physics, Lausanne University Hospital (CHUV), CH 1007 Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH 1011 Lausanne, Switzerland; (F.B.); (R.A.M.)
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
| | - Elias Lahoud
- CT/AMI Research and Development, Philips Medical Systems, Haifa 31004, Israel; (E.L.); (Y.Y.)
| | - Klaus Erhard
- Philips GmbH Innovative Technologies, Philips Research Laboratories, 22335 Hamburg, Germany;
| | - Salim A. Si-Mohamed
- Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (S.A.S.-M.); (L.B.); (P.C.D.)
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, 69100 Lyon, France
| | - Joël Greffier
- Department of Medical Imaging, CHU Nimes, University of Montpellier, 30900 Nimes, France;
| | - Anaïs Viry
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
- Institute of Radiation Physics, Lausanne University Hospital (CHUV), CH 1007 Lausanne, Switzerland
| | - Loïc Boussel
- Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (S.A.S.-M.); (L.B.); (P.C.D.)
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, 69100 Lyon, France
| | - Reto A. Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH 1011 Lausanne, Switzerland; (F.B.); (R.A.M.)
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
| | - Yoad Yagil
- CT/AMI Research and Development, Philips Medical Systems, Haifa 31004, Israel; (E.L.); (Y.Y.)
| | - Pascal Monnin
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), CH 1015 Lausanne, Switzerland; (D.R.); (A.V.); (P.M.)
- Institute of Radiation Physics, Lausanne University Hospital (CHUV), CH 1007 Lausanne, Switzerland
| | - Philippe C. Douek
- Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (S.A.S.-M.); (L.B.); (P.C.D.)
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, 69100 Lyon, France
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Ponti A, Saltiel S, Rotzinger DC, Qanadli SD. Insights Into Endovascular Management of Superior Vena Cava Obstructions. Front Cardiovasc Med 2021; 8:765798. [PMID: 34901225 PMCID: PMC8652054 DOI: 10.3389/fcvm.2021.765798] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Circulation to the heart may persist through various collateral vessels whose development depends on the level of obstruction. Depending on the level and degree of occlusive disease, the severity of clinical symptoms may vary considerably, up to lethal. Etiologies have changed dramatically in recent years, mainly due to the increasing use of intravascular devices. However, guidelines for treatment are lacking, and various options are available. Endovascular therapies developed considerably in recent years, may offer a rapid improvement in symptoms and proved to be safe. However, knowledge and selection of appropriate techniques are essential to venous angioplasty, involving specific tools to guarantee satisfying outcomes. This review aims to discuss the particular venous anatomy of the upper body, the physiopathology of superior vena cava obstruction, and specificities of endovascular treatment compared with other management options.
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Affiliation(s)
- Alexandre Ponti
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Sarah Saltiel
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
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24
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Porretta AP, Rotzinger DC, Pruvot E, Pavon AG. Arrhythmic mitral valve prolapse: an iconic case with first documentation on a cardiac CT scan. Eur Heart J Cardiovasc Imaging 2021:jeab159. [PMID: 34387649 DOI: 10.1093/ehjci/jeab159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alessandra Pia Porretta
- Cardiovascular Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Etienne Pruvot
- Cardiovascular Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anna Giulia Pavon
- Cardiovascular Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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25
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Rotzinger DC, Qanadli SD. Should Vascular Abnormalities Be Integrated Into the Chest CT Imaging Signature of Coronavirus Disease 2019? Chest 2021; 159:2107-2108. [PMID: 33965133 PMCID: PMC8097331 DOI: 10.1016/j.chest.2020.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Qanadli SD, Rocha AC, Rotzinger DC. Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena? Front Med (Lausanne) 2021; 8:639152. [PMID: 33634156 PMCID: PMC7900139 DOI: 10.3389/fmed.2021.639152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 01/09/2023] Open
Abstract
Up to now, COVID-19-related vascular changes were mainly described as thrombo-embolic events. A handful of researchers reported another type of vascular abnormality referred to as "vascular thickening" or "vascular enlargement," without specifying whether the dilated vessels are arteries or veins nor providing a physiopathological hypothesis. Our observations indicate that the vascular dilatation occurs in the venous compartment, and underlying mechanisms might include increased blood flow due to inflammation and the activation of arteriovenous anastomoses.
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Affiliation(s)
- Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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27
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Rotzinger DC, Rezaei-Kalantari K, Aubert JD, Qanadli SD. Pulmonary angioplasty: A step further in the continuously changing landscape of chronic thromboembolic pulmonary hypertension management. Eur J Radiol 2021; 136:109562. [PMID: 33524919 DOI: 10.1016/j.ejrad.2021.109562] [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] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially fatal and frequently undiagnosed form of pulmonary hypertension (PH), classified within group 4 by the World Health Organization (WHO). It is a type of precapillary PH, which uncommonly develops as a peculiar sequel of acute pulmonary embolism due to the partial resolution of the mechanically obstructing thrombus with a coexisting inflammatory response from pulmonary vessels. CTEPH is one of the potentially treatable forms of PH whose current standard of care is surgical pulmonary endarterectomy. Medical therapy with few drugs in non-operable disease is approved and has shown improvement in patients' hemodynamic condition and functional ability. Recently, balloon pulmonary angioplasty (BPA) has shown promising results as a treatment option for technically inoperable patients, those with unacceptable risk-to-benefit ratio and in a case of residual PH after endarterectomy. Lack of meticulous CTEPH screening programs in post-pulmonary embolism patients leading to underdiagnosis of this condition, complex operability assessment, and diversity in BPA techniques among different institutions are still the issues that need to be addressed. In this paper, we review the recent achievements in the management of non-operable CTEPH, their outcome and safety, based on available data.
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Affiliation(s)
- David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Kiara Rezaei-Kalantari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - John-David Aubert
- Transplantation Center, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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28
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Rotzinger DC, Knebel JF, Jouannic AM, Adler G, Qanadli SD. CT Pulmonary Angiography for Risk Stratification of Patients with Nonmassive Acute Pulmonary Embolism. Radiol Cardiothorac Imaging 2020; 2:e190188. [PMID: 33778598 DOI: 10.1148/ryct.2020190188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/24/2020] [Accepted: 04/21/2020] [Indexed: 01/21/2023]
Abstract
Purpose To investigate the prognostic value of an integrative approach combining clinical variables and the Qanadli CT obstruction index (CTOI) in patients with nonmassive acute pulmonary embolism (PE). Materials and Methods This retrospective study included 705 consecutive patients (mean age, 63 years; range, 18-95 years) with proven PE. Clot burden was quantified using the CTOI, which reflects the ratio of fully or partially obstructed pulmonary arteries to normal arteries. Patients were subdivided into two groups according to the presence (group A) or absence (group B) of preexisting cardiopulmonary disease. Thirty-day and 3-month mortality was evaluated. CTOI thresholds of 20% and 40% were used to stratify patients regarding outcome (low, intermediate, and high risk). The predictive value of CTOI was assessed through logistic regression analysis. Results Analysis included 690 patients (mean age, 63.3 years ± 18 [standard deviation]) with complete follow-up data: 247 (36%) in group A and 443 (64%) in group B. The mean CTOI was 23% ± 19, 30-day mortality was 9.7%, and 3-month mortality was 11.6%. Three-month mortality was higher in group A than in group B (17.8% and 8.1%, respectively; P = .001). Within group B, CTOI predicted outcome and allowed stratification: significantly higher mortality with CTOI greater than 40% (P < .001) and lower mortality with CTOI less than 20% (P = .05). CTOI did not predict outcome in group A. Age was an independent mortality risk factor (P ≤ .04). Conclusion CTOI predicted outcome in this cohort of patients with PE and no cardiopulmonary disease, and it may provide a simple single-examination-based approach for risk stratification in this subset of patients.© RSNA, 2020See also the commentary by Kay and Abbara in this issue.
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Affiliation(s)
- David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Jean-François Knebel
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Ghazal Adler
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
| | - Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology (D.C.R., A.M.J., S.D.Q.) and EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology (J.F.K.), Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland (D.C.R., J.F.K., S.D.Q.); and Imagerive Diagnostic Radiology Institute, Geneva, Switzerland (G.A.)
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Qanadli SD, Gudmundsson L, Rotzinger DC. Catheter-directed thrombolysis in COVID-19 pneumonia with acute PE: Thinking beyond the guidelines. Thromb Res 2020; 192:9-11. [PMID: 32416366 PMCID: PMC7205661 DOI: 10.1016/j.thromres.2020.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/16/2023]
Abstract
•Patients having COVID-19 pneumonia are at risk of venous thromboembolism. •Prophylaxis versus anticoagulation for severely ill patients is currently debated. •No specific guidelines for the management of severe pulmonary embolism exist. •Endovascular pulmonary embolism therapy may play a critical role in severe COVID-19.
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Affiliation(s)
- S D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - L Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - D C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Qanadli SD, Malekzadeh S, Villard N, Jouannic AM, Bodenmann D, Tozzi P, Rotzinger DC. A New Clinically Driven Classification for Acute Aortic Dissection. Front Surg 2020; 7:37. [PMID: 32656225 PMCID: PMC7324626 DOI: 10.3389/fsurg.2020.00037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified (“non-A, non-B”). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.
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Affiliation(s)
- Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sonaz Malekzadeh
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicolas Villard
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daniel Bodenmann
- Department of Radiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Piergiorgio Tozzi
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Heart and Vessels, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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31
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Pavon AG, Meier D, Samim D, Rotzinger DC, Fournier S, Marquis P, Monney P, Muller O, Schwitter J. First Documentation of Persistent SARS-Cov-2 Infection Presenting With Late Acute Severe Myocarditis. Can J Cardiol 2020; 36:1326.e5-1326.e7. [PMID: 32522523 PMCID: PMC7834643 DOI: 10.1016/j.cjca.2020.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/23/2023] Open
Abstract
A 64-year-old man presented with severe myocarditis 6 weeks after an initial almost asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection. He was found to have a persistent positive swab. Mechanisms explaining myocardial injury in patients with COVID-19 remains unclear, but this case suggests that severe acute myocarditis can develop in the late phase of COVID-19 infection, even after a symptom-free interval.
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Affiliation(s)
- Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daryoush Samim
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - David C Rotzinger
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Marquis
- Intensive Care Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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32
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Rotzinger DC, Lu TL, Kawkabani A, Marques-Vidal PM, Fetz G, Qanadli SD. Computed Tomography Angiography in Peripheral Arterial Disease: Comparison of Three Image Acquisition Techniques to Optimize Vascular Enhancement-Randomized Controlled Trial. Front Cardiovasc Med 2020; 7:68. [PMID: 32411728 PMCID: PMC7198850 DOI: 10.3389/fcvm.2020.00068] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives: To prospectively compare three image acquisition techniques in lower extremity CT angiography: the “standard” anterograde technique (SA), the adaptive anterograde technique (AA), and the retrograde acquisition technique (RA). Materials and Methods: Sixty consecutive patients were prospectively enrolled and randomized into three acquisition groups: 20 patients were evaluated with SA, 20 with AA as described by Qanadli et al., and 20 with caudocranial acquisition from the feet to the abdominal aorta (RA). Quantitative image quality was assessed by measuring the intraluminal attenuation at different levels of interest, with a total of 536 levels. Qualitative image quality was assessed by two radiologists in consensus using a Likert scale to rate the arterial enhancement and venous return. For each patient and limb, the presence of occlusive or aneurysmal disease was documented. Results: In quantitative analysis, RA showed lower attenuation values than SA and AA (p < 0.01). AA showed the highest and most homogeneous attenuation along the arterial tree. In qualitative analysis, AA had the lowest rate of non-diagnostic vascular segments (3.9%) compared to SA and RA (4.7 and 13.1%, respectively, p < 0.01). The influence of venous return was significantly different among the different techniques; venous contamination was particularly prevalent at the aortic level with RA (9.4% of patients, 0% with SA and AA, p < 0.01). The presence of stenosis or occlusion had no significant influence on the attenuation values across all levels and acquisition techniques. Conversely, the presence of aneurysmal disease had a significant effect on the luminal attenuation in AA (higher attenuation) and RA (lower attenuation) at the iliac (p = 0.03 and 0.04, respectively) and femoral levels (p = 0.02 and <0.01, respectively). Conclusion: Considering both quantitative and qualitative analysis, AA performed better than SA and RA, providing the highest percentage of optimal vascular enhancement. AA should be recommended as the technique of choice, specifically in the presence of aneurysmal disease. Alternatively, SA can be useful in case of renal failure, as the test bolus is unnecessary. Finally, the increasing availability of fast CT systems will likely overcome the limitations of RA.
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Affiliation(s)
- David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tri-Linh Lu
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Aida Kawkabani
- Groupement Hospitalier de L'Ouest Lémanique, Nyon, Switzerland
| | - Pedro-Manuel Marques-Vidal
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Pozzessere C, Rotzinger DC, Ghaye B, Lamoth F, Beigelman-Aubry C. Incidentally discovered COVID-19 pneumonia: the role of diagnostic imaging. Eur Radiol 2020; 30:5211-5213. [PMID: 32367421 PMCID: PMC7197918 DOI: 10.1007/s00330-020-06914-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Chiara Pozzessere
- Department of Radiology, AUSL Toscana Centro San Giuseppe Hospital, Empoli, Italy
| | - David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Imaging Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Benoit Ghaye
- Department of Radiology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Frédéric Lamoth
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Laboratories, Institute of Microbiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thromb Res 2020; 190:58-59. [PMID: 32302782 PMCID: PMC7151364 DOI: 10.1016/j.thromres.2020.04.011] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [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: 03/23/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To raise awareness for possible benefits of examining known COVID-19 patients presenting sudden clinical worsening with CT pulmonary angiography instead of standard non-contrast chest CT.
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Affiliation(s)
- D C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - C Beigelman-Aubry
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - C von Garnier
- Department of Respiratory Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - S D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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35
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Affiliation(s)
- Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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36
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Rotzinger DC, Dunet V, Ilic V, Hugli OW, Meuli RA, Schmidt S. Pulmonary embolism during pregnancy: a 17-year single-center retrospective MDCT pulmonary angiography study. Eur Radiol 2020; 30:1780-1789. [PMID: 31728689 PMCID: PMC7033070 DOI: 10.1007/s00330-019-06501-4] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/23/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the prevalence of pulmonary embolism (PE) and alternative diagnoses detected by computed tomography pulmonary angiography (CTPA) in pregnant women; and to assess changes over time regarding radiation dose, technical quality, and examination frequency. MATERIALS AND METHODS This retrospective study included all pregnant women referred for CTPA due to clinically suspected PE over 17 years. Two blinded radiologists reviewed the CTPAs in consensus with regard to PE, alternative diagnoses, and technical quality. We retrieved patient data regarding radiation dose metrics and associated clinical and laboratory parameters. Subgroup comparisons were performed (Wilcoxon and Kruskal-Wallis tests). RESULTS Of the 237 identified patients, 8 (3.3%) were excluded due to inadequate technical CTPA quality, and 229 patients were analyzed (mean age, 31.7 years; mean gestational age, 28 ± 7 weeks). The four different CT systems used over the study period had similar technical quality (p = 0.28). Of 229 patients 16 (7%) patients had PE, 144 (62.9%) had no abnormal findings, and 69 (30.1%) had an alternative diagnosis (consolidation, other pulmonary opacities, pleural effusion, and basal atelectasis). Gestational age, symptoms, and D-dimer levels were not significantly different between patients with or without PE (p > 0.05). Over time, radiation dose exposure decreased by 30% (p < 0.001), while the number of annual examinations increased by > 4-folds. CONCLUSIONS In pregnant women, CTPA rarely indicates PE and more often shows alternative diagnoses. Over 17 years, the use of CTPA in pregnancy has notably increased, while the radiation dose exposure has decreased by one third. KEY POINTS • The use of CTPA in pregnancy has steadily risen over the last 17 years • In pregnant women, CTPA rarely reveals PE and more often shows alternative diagnoses • Recent technical improvements have substantially decreased the radiation dose exposure inherent in CTPA without reducing diagnostic image quality.
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Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vesna Ilic
- Centre d'Imagerie du Nord Vaudois (CINOV), Yverdon-les-Bains, Switzerland
| | - Olivier W Hugli
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Emergency Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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Tzimas G, Rotzinger DC, Muller O, Monney P. Myocardial oedema detected by T2-mapping: a key marker of recent ischaemia after resuscitated sudden cardiac death. Eur Heart J Cardiovasc Imaging 2019; 20:1319. [DOI: 10.1093/ehjci/jez198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Georgios Tzimas
- Department of Heart-Vessels, Service of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - David C Rotzinger
- Department of Radiology, Service of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Olivier Muller
- Department of Heart-Vessels, Service of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Pierre Monney
- Department of Heart-Vessels, Service of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
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Rotzinger DC, Si-Mohamed SA, Shapira N, Douek PC, Meuli RA, Boussel L. "Dark-blood" dual-energy computed tomography angiography for thoracic aortic wall imaging. Eur Radiol 2019; 30:425-431. [PMID: 31332557 DOI: 10.1007/s00330-019-06336-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/22/2019] [Revised: 05/23/2019] [Accepted: 06/21/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To assess the capability of a newly developed material decomposition method from contrast-enhanced dual-energy CT images, aiming to better visualize the aortic wall and aortic intramural hematoma (IMH), compared with true non-contrast (TNC) CT. MATERIALS AND METHODS Twenty-two patients (11 women; mean age, 61 ± 20 years) with acute chest pain underwent 25 dual-layer non-contrast and contrast-enhanced CT. CT-angiography images were retrospectively processed using two-material decomposition analysis, where we defined the first material as the content of a region of interest placed in the ascending aorta for each patient, and the second material as water. Two independent radiologists assessed the images from the second material termed "dark-blood" images and the TNC images regarding contrast-to-noise ratio (CNR) between the wall and the lumen, diagnostic quality regarding the presence of aortic wall thickening, and the inner/outer vessel wall conspicuity. RESULTS Diagnostic quality scores in normal aortic segments were 0.9 ± 0.3 and 2.7 ± 0.6 (p < 0.001) and wall conspicuity scores were 0.7 ± 0.5 and 1.8 ± 0.3 (p < 0.001) on TNC and dark-blood images, respectively. In aortic segments with IMH, diagnostic quality scores were 1.7 ± 0.5 and 2.4 ± 0.6 (p < 0.001) and wall conspicuity scores were 0.7 ± 0.7 and 1.8 ± 0.3 (p < 0.001) on TNC and dark-blood images, respectively. In normal aortic segments, CNRs were 0.3 ± 0.2 and 2.8 ± 0.9 on TNC and dark-blood images, respectively (p < 0.001). In aortic segments with IMH, CNRs were 0.3 ± 0.2 and 4.0 ± 1.0 on TNC and dark-blood images, respectively (p < 0.001). CONCLUSIONS Compared with true non-contrast CT, dark-blood material decomposition maps enhance quantitative and qualitative image quality for the assessment of normal aortic wall and IMH. KEY POINTS • Current dual-energy CT-angiography provides virtual non-contrast and bright-blood images. • Dark-blood images represent a new way to assess the vascular wall structure with dual-energy CT and can improve the lumen-to-wall contrast compared with true non-contrast CT. • This dual-energy CT material decomposition method is likely to improve contrast resolution in other applications as well, taking advantage of the high spatial resolution of CT.
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Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Salim A Si-Mohamed
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
| | - Nadav Shapira
- CT/AMI Research and Development, Philips Medical Systems, Haifa, Israel
| | - Philippe C Douek
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Loïc Boussel
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
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Rotzinger DC, Breault S, Knebel JF, Beigelman-Aubry C, Jouannic AM, Qanadli SD. Can a Trained Radiology Technician Do Arterial Obstruction Quantification in Patients With Acute Pulmonary Embolism? Front Cardiovasc Med 2019; 6:38. [PMID: 31024932 PMCID: PMC6469400 DOI: 10.3389/fcvm.2019.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives: To assess interobserver variability between a trained radiology technician (RT) and an experienced radiologist in arterial obstruction quantification using the Qanadli obstruction index (QOI), in patients diagnosed with acute pulmonary embolism (APE) at CT pulmonary angiography (CTPA). Materials and Methods: A RT and a radiologist independently reviewed CTPAs of 97 consecutive, prospectively enrolled patients with APE, and calculated the QOI. They classified patients into three risk categories: high for QOI ≥40%, intermediate for QOI 20–37.5%, low for QOI <20%. Interobserver variability was investigated for QOI as a continuous variable and as a categorical variable (high, intermediate, and low-risk groups). Results: Mean QOI (±SD) was 39.5 ± 24.3% and 38.6 ± 18.9% for the RT and the radiologist, respectively. The mean QOI was not statistically different between the RT and the radiologist (p = 0.502), and the interobserver agreement was excellent (ICC = 0.905). The RT classified 54 patients (55.7%) as high, 17 (17.53%) as intermediate, and 26 (26.8%) as low risk. The radiologist classified 55 patients (56.7%) as high, 22 (22.7%) as intermediate, and 20 (20.6%) as low risk. The interrater agreement for risk stratification was excellent (weighted kappa = 0.844). Conclusion: Once the diagnosis of APE was established, an adequately trained RT achieved an accuracy comparable to that of an experienced radiologist regarding QOI calculation and risk assessment.
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Affiliation(s)
- David C Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéphane Breault
- Département D'imagerie Médicale, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Jean-François Knebel
- EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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Milani B, Ledoux JB, Rotzinger DC, Kanemitsu M, Vallée JP, Burnier M, Pruijm M. Image acquisition for intravoxel incoherent motion imaging of kidneys should be triggered at the instant of maximum blood velocity: evidence obtained with simulations and in vivo experiments. Magn Reson Med 2018; 81:583-593. [DOI: 10.1002/mrm.27393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bastien Milani
- Département de Medecine, Service de Néphrologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
- Département de Radiologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
- Center for Biomedical Imaging; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
| | - Jean-Baptiste Ledoux
- Département de Radiologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
- Center for Biomedical Imaging; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
| | - David C. Rotzinger
- Département de Radiologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
| | - Michiko Kanemitsu
- Département de Medecine, Service de Néphrologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
| | - Jean-Paul Vallée
- Département d'Imagerie et des Sciences de l'information Médicale; Hôpitaux Universitaires de Genève; Genève Switzerland
| | - Michel Burnier
- Département de Medecine, Service de Néphrologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
| | - Menno Pruijm
- Département de Medecine, Service de Néphrologie; Centre Hospitalier Universitaire Vaudois; Vaud Switzerland
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Meyer IA, Cereda CW, Correia PN, Zerlauth JB, Puccinelli F, Rotzinger DC, Amiguet M, Maeder P, Meuli RA, Michel P. Factors Associated With Focal Computed Tomographic Perfusion Abnormalities in Supratentorial Transient Ischemic Attacks. Stroke 2018; 49:68-75. [DOI: 10.1161/strokeaha.117.018635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ivo A. Meyer
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Carlo W. Cereda
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Pamela N. Correia
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Jean-Baptiste Zerlauth
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Francesco Puccinelli
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - David C. Rotzinger
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Michael Amiguet
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Philippe Maeder
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Reto A. Meuli
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Patrik Michel
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
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Guenego A, Zerlauth JB, Puccinelli F, Hajdu S, Rotzinger DC, Zibold F, Piechowiak EI, Mordasini P, Gralla J, Dobrocky T, Daniel RT, Chapot R, Mosimann PJ. Balloon-assisted coil embolization and large stent delivery for cerebral aneurysms with a new generation of dual lumen balloons (Copernic 2L). J Neurointerv Surg 2017; 10:395-400. [DOI: 10.1136/neurintsurg-2017-013218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/01/2017] [Accepted: 07/08/2017] [Indexed: 11/04/2022]
Abstract
IntroductionDual coaxial lumen balloon microcatheters through which small stents can be delivered have recently been described. We report a series of a new type of dual lumen balloon catheter with a parallel lumen design enabling enhanced inflation and deflation properties through which larger stents may be deployed, including flow diverters (FD).MethodsAll aneurysms that were treated with a Copernic 2L (COP2L) dual lumen balloon catheter at our institution between February 2014 and December 2016 were assessed. Patient demographics, aneurysm characteristics, clinical and angiographic follow-up, as well as adverse events were analyzed.ResultsA total of 18 aneurysms in 16 patients (14 women) were treated with the COP2L. Mean maximal aneurysm diameter was 6.4 mm, mean neck size was 3.3 mm (min 1; max 6.3), and mean aneurysm height/width was 1.1 (min 0.5; max 2.1). The COP2L was used for balloon-remodeled coiling exclusively in 2 aneurysms; coiling and FD stenting in 8; coiling and braided stent delivery in 3; coiling, braided and FD stenting in 1; and FD stenting without coiling in 4 (stenting alone). The rate of Roy–Raymond 1 (complete occlusion) changed from 22% in the immediate postoperative period to 100% at 3 months (mean imaging follow-up 8.2 months). There were three technical complications (3/16, 18.7%), including a perforation and two thromboembolic asymptomatic events that were rapidly controlled with the COP2L. There was no immediate or delayed morbidity or mortality (modified Rankin Scale score 0–1 in 100% of patients).ConclusionThe COP2L is a new type of dual lumen balloon catheter that may be useful for balloon and/or stent-assisted coiling of cerebral aneurysms. The same device can be used to deliver stents up to 4.5 mm and to optimize stent/wall apposition or serve as a life-saving tool in case of thromboembolic or hemorrhagic events. Long-term efficacy and safety need to be further assessed with larger case-controlled cohorts.
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Rotzinger DC, Mosimann PJ, Meuli RA, Maeder P, Michel P. Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2017; 38:868-874. [PMID: 28302611 DOI: 10.3174/ajnr.a5123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/13/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CTA can rapidly and accurately detect and localize occlusive disease in patients with ischemic stroke. We have used CTA to assess arterial stenosis and occlusion in an ischemic stroke population arriving at a tertiary stroke center within 24 hours of symptom onset in order to obtain a comprehensive picture of occlusive disease pattern, and to determine the proportion of eligible candidates for endovascular treatment. MATERIALS AND METHODS Data from consecutive patients with acute ischemic stroke admitted to a single center between 2003 and 2012, collected in the Acute Stroke Registry and Analysis of Lausanne data base, were retrospectively analyzed. Patients with a diagnostic CTA within 24 hours of symptom onset were selected. Relevant extra- and intracranial pathology, defined as stenosis of ≥50% and occlusions, were registered and classified into 21 prespecified segments. RESULTS Of the 2209 included patients (42.1% women; median age, 72 years), 1075 (48.7%) had pathology in and 308 (13.9%) had pathology outside the ischemic territory. In the 50,807 arterial segments available for revision, 1851 (3.6%) abnormal segments were in the ischemic (symptomatic) territory and another 408 (0.8%) were outside it (asymptomatic). In the 1211 patients with ischemic stroke imaged within 6 hours of symptom onset, 40.7% had symptomatic large, proximal occlusions potentially amenable to endovascular therapy. CONCLUSIONS CTA in patients with acute ischemic stroke shows large individual variations of occlusion sites and degrees. Approximately half of such patients have no visible occlusive disease, and 40% imaged within 6 hours show large, proximal segment occlusions amenable to endovascular therapy. These findings show the importance of early noninvasive imaging of extra- and intracranial arteries for identifying occlusive disease, planning recanalization strategies, and designing interventional trials.
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Affiliation(s)
- D C Rotzinger
- From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder)
| | - P J Mosimann
- From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder)
| | - R A Meuli
- From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder)
| | - P Maeder
- From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder)
| | - P Michel
- Neurology Service (P. Michel), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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