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Vattay B, Boussoussou M, Vecsey-Nagy M, Kolossváry M, Juhász D, Kerkovits N, Balogh H, Nagy N, Vértes M, Kiss M, Kubovje A, Merkely B, Maurovich Horvat P, Szilveszter B. Qualitative and quantitative image quality of coronary CT angiography using photon-counting computed tomography: Standard and Ultra-high resolution protocols. Eur J Radiol 2024; 175:111426. [PMID: 38493558 DOI: 10.1016/j.ejrad.2024.111426] [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: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE We aimed to identify the optimal reconstruction settings based on qualitative and quantitative image quality parameters on standard and ultra-high resolution (UHR) images using photon-counting CT (PCCT). METHOD We analysed 45 patients, 29 with standard and 16 with UHR acquisition, applying both smoother and sharper kernel settings. Coronary CT angiography images were performed on a dual-source PCCT system using standard (0.4/0.6 mm slice thickness, Bv40/Bv44 kernels, QIR levels 0-4) or UHR acquisition (0.2/0.4 mm slice thickness, Bv44/Bv56 kernels, QIR levels 0-4). Qualitative image quality was assessed using a 4-point Likert scale. Image noise (SD), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated in both the proximal and distal segments. RESULTS On standard resolution, larger slice thickness resulted in an average increase of 12.5 % in CNR, whereas sharper kernel led to an average 8.7 % decrease in CNR. Highest CNR was measured on 0.6 mm, Bv40, QIR4 images and lowest on 0.4 mm, Bv44, QIR0 images: 25.8 ± 4.1vs.8.3 ± 1.6 (p < 0.001). On UHR images, highest CNR was observed on 0.4 mm, Bv40, QIR4 and lowest on 0.2 mm, Bv56 and QIR0 images: 21.5 ± 3.9vs.3.6 ± 0.8 (p < 0.001). Highest qualitative image quality was found on images with Bv44 kernel and QIR level 3/4 with both slice thicknesses on standard reconstruction. Additionally, Bv56 with QIR4 on 0.2 mm slice thickness images showed highest subjective image quality. Preserved distal vessel visualization was detected using QIR 2-4, Bv56 and 0.2 mm slice thickness. CONCLUSIONS Photon-counting CT demonstrated high qualitative and quantitative image quality for the assessment of coronaries and stents.
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Affiliation(s)
- Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Melinda Boussoussou
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29 Haller Utca, 1096, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi Ut 96/B, 1034, Budapest, Hungary
| | - Dénes Juhász
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Nóra Kerkovits
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Hanna Balogh
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Norbert Nagy
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Miklós Vértes
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Máté Kiss
- Siemens Healthcare GmbH, Forchheim, Germany
| | - Anikó Kubovje
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Pál Maurovich Horvat
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary.
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Magyar M, Tóth A, Nyilas LN, Biró I, Kozák RL, Gyebnár G, Rudas G, Maurovich Horvat P, Bereczki D, Barsi P. [The importance of MR imaging in the diagnosis and management of acute stroke]. Ideggyogy Sz 2023; 76:233-244. [PMID: 37471200 DOI: 10.18071/isz.76.0233] [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] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Background and purpose In our collaborative project, called MRI First!, every patient arriving with neurological symptoms of acute stroke and without contraindications was examined by MRI. Our aim was to detect the symptomatic lesions, to obtain appropriate information about the brain parenchyma and to analyse parenchymal perfusion and brain vasculature. . Methods The examinations were conducted on a Philips Ingenia 1.5 Tesla scanner with the following protocol: DWI-ADC, FLAIR, T2 FFE/SWI, PWI, and contrast-enhanced MRA. 415 patients were examined between January 2020 and May 2021. 179 patients arrived within-, and 136 patients after 4.5 hours symptoms onset time, while 100 patients had “wake-up” stroke. . Results Within the 4.5 hours group, 81 cases had acute ischemic lesion, 48 of them received reperfusion therapy. Acute ischemic lesion was found in 64 patients in the wake-up stroke group and in 64 in the 4.5-24 hours group. In these groups 10 and 12 patients obtained reperfusion therapy, respectively. Further 117 cases were considered as stroke mimics, in which cases unnecessary intravenous thrombolysis was avoidable. . Conclusion MRI is accepted as a sensitive diagnostic modality providing detailed information regarding the brain parenchyma, its perfusion and vasculature. Nonetheless, its worldwide utilization in acute stroke is low and further information should be collected on which patient groups would gain the most benefit from acute MR imaging. Our continuous work is aimed at that goal. .
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Affiliation(s)
- Máté Magyar
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - Adrienn Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
| | - Luca Nóra Nyilas
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - István Biró
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - Rudolf Lajos Kozák
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - Gyula Gyebnár
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - Gábor Rudas
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
| | - Pál Maurovich Horvat
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Budapest
| | - Dániel Bereczki
- Semmelweis Egyetem, Általános Orvostudományi Kar, Neurológiai Klinika, Budapest
| | - Péter Barsi
- Semmelweis Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Klinika, Neuroradiológia Tanszék, Budapest
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Baskaran L, Neo YP, Lee JK, Yoon YE, Jiang Y, Al'Aref SJ, van Rosendael AR, Han D, Lin FY, Nakanishi R, Maurovich Horvat P, Tan SY, Villines TC, Bittencourt MS, Shaw LJ. Evaluating the Coronary Artery Disease Consortium Model and the Coronary Artery Calcium Score in Predicting Obstructive Coronary Artery Disease in a Symptomatic Mixed Asian Cohort. J Am Heart Assoc 2022; 11:e022697. [PMID: 35411790 PMCID: PMC9238474 DOI: 10.1161/jaha.121.022697] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The utility of a given pretest probability score in predicting obstructive coronary artery disease (CAD) is population dependent. Previous studies investigating the additive value of coronary artery calcium (CAC) on pretest probability scores were predominantly limited to Western populations. This retrospective study seeks to evaluate the CAD Consortium (CAD2) model in a mixed Asian cohort within Singapore with stable chest pain and to evaluate the incremental value of CAC in predicting obstructive CAD. Methods and Results Patients who underwent cardiac computed tomography and had chest pain were included. The CAD2 clinical model comprised of age, sex, symptom typicality, diabetes, hypertension, hyperlipidemia, and smoking status and was compared with the CAD2 extended model that added CAC to assess the incremental value of CAC scoring, as well as to the corresponding locally calibrated local assessment of the heart models. A total of 522 patients were analyzed (mean age 54±11 years, 43.1% female). The CAD2 clinical model obtained an area under the curve of 0.718 (95% CI, 0.668–0.767). The inclusion of CAC score improved the area under the curve to 0.896 (95% CI, 0.867–0.925) in the CAD2 models and from 0.767 (95% CI, 0.721–0.814) to 0.926 (95% CI, 0.900–0.951) in the local assessment of the heart models. The locally calibrated local assessment of the heart models showed better discriminative performance than the corresponding CAD2 models (P<0.05 for all). Conclusions The CAD2 model was validated in a symptomatic mixed Asian cohort and local calibration further improved performance. CAC scoring provided significant incremental value in predicting obstructive CAD.
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Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Yu Pei Neo
- Duke-National University of Singapore Singapore
| | | | | | - Yilin Jiang
- Department of Cardiology National Heart Centre Singapore
| | - Subhi J Al'Aref
- Division of Cardiology Department of Medicine University of Arkansas for Medical Sciences Little Rock AR
| | | | - Donghee Han
- Department of Imaging Cedars-Sinai Medical Center Los Angeles CA
| | - Fay Y Lin
- Department of Radiology New York-Presbyterian Hospital and Weill Cornell Medicine New York NY
| | - Rine Nakanishi
- Department of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo Japan
| | | | - Swee Yaw Tan
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Todd C Villines
- Division of Cardiovascular Medicine University of Virginia Health System Charlottesville VA
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research University Hospital University of Sao Paulo School of Medicine Sao Paulo Brazil
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute Mount Sinai School of Medicine New York NY
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Whitaker J, Karády J, Karim R, Tobon-Gomez C, Fastl T, Razeghi O, O'Neill L, Decroocq M, Williams S, Corrado C, Mukherjee RK, Sim I, O'Hare D, Kotadia I, Kolossváry M, Merkely B, Littvay L, Tarnoki AD, Tarnoki DL, Voros S, Razavi R, O'Neill M, Rajani R, Maurovich Horvat P, Niederer S. Standardised computed tomographic assessment of left atrial morphology and tissue thickness in humans. Int J Cardiol Heart Vasc 2021; 32:100694. [PMID: 33392384 PMCID: PMC7772783 DOI: 10.1016/j.ijcha.2020.100694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
AIMS Left atrial (LA) remodelling is a common feature of many cardiovascular pathologies and is a sensitive marker of adverse cardiovascular outcomes. The aim of this study was to establish normal ranges for LA parameters derived from coronary computed tomographic angiography (CCTA) imaging using a standardised image processing pipeline to establish normal ranges in a previously described cohort. METHODS CCTA imaging from 193 subjects recruited to the Budapest GLOBAL twin study was analysed. Indexed LA cavity volume (LACVi), LA surface area (LASAi), wall thickness and LA tissue volume (LATVi) were calculated. Wall thickness maps were combined into an atlas. Indexed LA parameters were compared with clinical variables to identify early markers of pathological remodelling. RESULTS LACVi is similar between sexes (31 ml/m2 v 30 ml/m2) and increased in hypertension (33 ml/m2 v 29 ml/m2, p = 0.009). LASAi is greater in females than males (47.8 ml/m2 v 45.8 ml/m2 male, p = 0.031). Median LAWT was 1.45 mm. LAWT was lowest at the inferior portion of the posterior LA wall (1.14 mm) and greatest in the septum (median = 2.0 mm) (p < 0.001). Conditions known to predispose to the development of AF were not associated with differences in tissue thickness. CONCLUSIONS The reported LACVi, LASAi, LATVi and tissue thickness derived from CCTA may serve as reference values for this age group and clinical characteristics for future studies. Increased LASAi in females in the absence of differences in LACVi or LATVi may indicate differential LA shape changes between the sexes. AF predisposing conditions, other than sex, were not associated with detectable changes in LAWT.Clinical trial registration:http://www.ClinicalTrials.gov/NCT01738828.
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Key Words
- AF, atrial fibrillation
- BSA, body surface area
- CCTA, cardiac computed tomography
- Computed tomography (CT)
- DZ, dizygotic
- LA, left atrium
- LAA, left atrial appendage
- LACV, left atrial cavity volume
- LASA, left atrial surface area
- LATV, left atrial tissue volume
- LAWT, left atrial wall thickness
- Left atrium
- MZ, monozygotic
- PV, pulmonary vein
- Tissue thickness
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Affiliation(s)
- John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Júlia Karády
- Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Catalina Tobon-Gomez
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Thomas Fastl
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Louisa O'Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Marie Decroocq
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Steven Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Rahul K. Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Daniel O'Hare
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Levente Littvay
- Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Adam D. Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
- Hungarian Twin Registry, Budapest, Hungary
| | - David L. Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
- Hungarian Twin Registry, Budapest, Hungary
| | - Szilard Voros
- Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
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Soós P, Merkely B, Horvat PM, Zima E, Schauerte P. Determinants and Effects of Electrical Stimulation of the Inferior Interatrial Parasympathetic Plexus During Atrial Fibrillation. J Cardiovasc Electrophysiol 2005; 16:1362-7. [PMID: 16403070 DOI: 10.1111/j.1540-8167.2005.00248.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Catheter stimulation of the inferior interatrial ganglionated parasympathetic plexus decreases the ventricular rate during atrial fibrillation (AF) in humans. However, the relatively high stimulation voltages might prevent implementation of neurostimulation in chronic implantable devices. From myocardial electrostimulation it is known that the required impulse energy and charge is lowest at the chronaxie time. In order to lower energy requirements for cardiac neurostimulation, the present study evaluates the impulse-strength versus impulse-duration relationship for a neurostimulation lead that was implanted into the inferior interatrial ganglionated plexus. METHODS AND RESULTS In nine dogs, permanent epicardial bipolar screw-in electrodes were fixed in the inferior interatrial ganglionated plexus. AF was maintained via rapid atrial pacing. During AF, neural stimulation was performed at various frequencies (1-100 Hz), impulse durations (0.05-2 msec), and voltages (0.02-11.5 V). There was a linear correlation between R-R interval lengthening and stimulus voltage (R = 0.99; P < 0.001) and a bell-shaped relationship between stimulation frequency and negative dromotropic effect with maximum rate slowing at 30-50 Hz. The rheobase for a 50% R-R interval prolongation during AF was 1.81 V and 2.72 V for high-grade AVB yielding a chronaxie time of 0.14 msec and 0.18 msec, respectively. The impulse energy (charge) at the chronaxie time was 4-6 microJ (6-8 microC). CONCLUSIONS Cardiac neurostimulation follows a chronaxie/rheobase behavior. Energy, charge, and voltage values needed to achieve significant negative dromotropic effects are within the limits of conventional cardiac pacemaker outputs, which may allow implementation of neurostimulation capabilities in current pacemaker technology.
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Affiliation(s)
- Pál Soós
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
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