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Spagnolo P, Giglio M, Di Marco D, Cannaò PM, Agricola E, Della Bella PE, Monti CB, Sardanelli F. Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT. Eur Radiol 2020; 31:1236-1244. [PMID: 32886202 PMCID: PMC7880950 DOI: 10.1007/s00330-020-07172-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 03/14/2020] [Revised: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
Objectives The current reference standard for diagnosing LAA thrombi is transesophageal echocardiography (TEE), a semi-invasive technique. We aimed to devise an optimal protocol for cardiac computed tomography (CCT) in diagnosing left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), using TEE as reference standard. Methods Two hundred sixty consecutive patients referred for radiofrequency ablation for AF were prospectively enrolled. All patients underwent CCT and TEE within 2 hours. The CCT protocol included one standard angiographic phase and three delayed acquisitions at 1-, 3-, and 6-min after contrast injection. Thrombi were defined as persisting defects at 6-min delayed acquisition. Results TEE demonstrated spontaneous contrast in 52 (20%) patients and thrombus in 10 (4%). In 63 patients (24%), CCT demonstrated LAA early filling defects at angiographic phase. Among them, 15 (6%) had a persistent defect at 1-min, 12 (5%) at 3-min, and 10 (4%) at 6-min. All 10 thrombi diagnosed on TEE were correctly identified by delayed CCT, without any false positives. For all phases, sensitivity and negative predictive were 100%. Specificity increased from 79% for the angiographic phase to 100% at 6-min. Positive predictive value increased from 16% to 100%. Estimated radiation exposure was 2.08 ± 0.76 mSv (mean ± standard deviation) for the angiographic phase and 0.45 ± 0.23 mSv for each delayed phase. Conclusion A CCT protocol adding a 6-min delayed phase to the angiographic phase can be considered optimized for the diagnosis of LAA thrombi, with a low radiation dose. Key Points • In patients with persistent atrial fibrillation referred for ablation procedures, a cardiac CT examination comprising an angiographic-phase acquisition and, in case of filling defects, a 6-min delayed phase may help reduce the need for transesophageal echocardiography. • Cardiac CT would provide morphological and volumetric data, along with the potential to exclude the presence of thrombi in the left atrial appendage.
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Affiliation(s)
- Pietro Spagnolo
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Manuela Giglio
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Daniela Di Marco
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola M Cannaò
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Eustachio Agricola
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo E Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Francesco Sardanelli
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Petrini M, Alì M, Cannaò PM, Zambelli D, Cozzi A, Codari M, Malavazos AE, Secchi F, Sardanelli F. Epicardial adipose tissue volume in patients with coronary artery disease or non-ischaemic dilated cardiomyopathy: evaluation with cardiac magnetic resonance imaging. Clin Radiol 2018; 74:81.e1-81.e7. [PMID: 30336943 DOI: 10.1016/j.crad.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/09/2017] [Accepted: 09/19/2018] [Indexed: 12/12/2022]
Abstract
AIM To compare the amount of epicardial adipose tissue (EAT) in patients with coronary artery disease (CAD) or non-ischaemic dilated cardiomyopathy (NIDCM) with that in patients with negative cardiac magnetic resonance imaging (CMR). MATERIALS AND METHODS One hundred and fifty patients (median age 57 years, interquartile range [IQR] 46-66 years) who underwent CMR were evaluated retrospectively: 50 with CAD, 50 with NIDCM, and 50 with negative CMR. For each patient, the EAT mass index (EATMI) to body surface area, end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), ejection fraction (EF) for both ventricles, and left ventricle (LV) mass index were estimated. Intra and inter-reader reproducibility was tested in a random subset of 30 patients, 10 for each group. Mann-Whitney U test, Kruskal-Wallis test, Spearman's correlation, and Bland-Altman statistics were used. RESULTS The EATMI in CAD patients (median 15.7 g/m2, IQR 8.3-25.7) or in NIDCM patients (15.9 g/m2, 11.5-18.1) was significantly higher than that in negative CMR patients (9.1 g/m2, 6-12; p<0.001 both). No significant difference was found between CAD and NIDCM patients (p=1.000). A correlation between EATMI and LV mass index was found in NIDCM patients (r=0.455, p=0.002). Intra- and inter-reader reproducibility were up to 80% and 72%, respectively. CONCLUSION Patients with NIDCM or CAD exhibited an increased EATMI in comparison to negative CMR patients. CMR can be used to estimate EAT with good reproducibility.
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Affiliation(s)
- M Petrini
- Post-graduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milan, Italy
| | - M Alì
- Integrative Biomedical Research Program, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - P M Cannaò
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - D Zambelli
- Università degli Studi di Milano, Corso di Laurea in Medicina e Chirurgia, Via Festa del Perdono 7, 20122 Milan, Italy
| | - A Cozzi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Via Vanvitelli 32, 20129, Milan, Italy
| | - M Codari
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - A E Malavazos
- High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - F Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
| | - F Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
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Scarabello M, Codari M, Secchi F, Cannaò PM, Alì M, Di Leo G, Sardanelli F. Strain of ascending aorta on cardiac magnetic resonance in 1027 patients: Relation with age, gender, and cardiovascular disease. Eur J Radiol 2018; 99:34-39. [PMID: 29362149 DOI: 10.1016/j.ejrad.2017.12.002] [Citation(s) in RCA: 2] [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: 07/20/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate ascending aortic strain (AAS) with cardiac magnetic resonance (CMR) in a large consecutive series of patients with different types of cardiovascular disease (CVD). METHODS Two-dimensional phase-contrast gradient-echo sequences of the ascending aorta were retrospectively reviewed in 1027 patients (726 males, 301 females). Aortic lumen area was segmented using a semi-automatic approach to calculate AAS values. Subgroup analysis was performed for patients with normal CMR, tetralogy of Fallot (ToF), and ischemic heart disease (IHD). Multivariate and post-hoc analyses were performed to evaluate the effect of age, gender, and CVD on AAS values. Shapiro-Wilk, three- and two-way ANOVA, Mann-Whitney U, and Spearman correlation statistics were used. RESULTS Multivariate analysis showed significant differences in AAS among decades of age (p<0.001), genders (p=0.006) and CVD subgroups (p<0.001) without interaction among these factors. A gender-related difference (higher AAS in females) was significant in ToF (p=0.008), while an AAS reduction during aging was observed in all CVD subgroups. Post-hoc analysis showed a significantly lower AAS in ToF and IHD patients compared to subjects with normal CMR (p<0.001). CONCLUSION Differences in age, gender, and CVD independently affect AAS. The lower AAS observed in ToF fosters its assessment during follow-up in adulthood. Future studies on causes and clinical implications of a higher AAS in females affected by ToF are warranted.
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Affiliation(s)
- Marco Scarabello
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Marina Codari
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
| | - Paola M Cannaò
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Marco Alì
- PhD Course in Integrative Biomedical Research, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milano, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Italy
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Varga-Szemes A, Muscogiuri G, Schoepf UJ, Wichmann JL, Suranyi P, De Cecco CN, Cannaò PM, Renker M, Mangold S, Fox MA, Ruzsics B. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method. Eur Radiol 2015; 26:1503-11. [PMID: 26267520 DOI: 10.1007/s00330-015-3952-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 03/17/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. METHODS Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. RESULTS Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17%; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM mesurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. CONCLUSIONS Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. KEY POINTS • Threshold-based left ventricular segmentation provides time-efficient assessment of left ventricular parameters • The threshold-based method can discriminate between blood and papillary muscles • This method provides improved accuracy compared to aortic flow measurements as a reference.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Giuseppe Muscogiuri
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Paola M Cannaò
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Scuola di Specializzazione in Radiodiagnostica, University of Milan, Milan, Italy
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Mary A Fox
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Balazs Ruzsics
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Varga-Szemes A, van der Geest RJ, Spottiswoode BS, Suranyi P, Ruzsics B, De Cecco CN, Muscogiuri G, Cannaò PM, Fox MA, Wichmann JL, Vliegenthart R, Schoepf UJ. Myocardial Late Gadolinium Enhancement: Accuracy of T1 Mapping-based Synthetic Inversion-Recovery Imaging. Radiology 2015; 278:374-82. [PMID: 26230908 DOI: 10.1148/radiol.2015150162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare the accuracy of detection and quantification of myocardial late gadolinium enhancement (LGE) with a synthetic inversion-recovery (IR) approach with that of conventional IR techniques. MATERIALS AND METHODS This prospective study was approved by the institutional review board and compliant with HIPAA. All patients gave written informed consent. Between June and November 2014, 43 patients (25 men; mean age, 54 years ± 16) suspected of having previous myocardial infarction underwent magnetic resonance (MR) imaging, including contrast material-enhanced LGE imaging and T1 mapping. Synthetic magnitude and phase-sensitive IR images were generated on the basis of T1 maps. Images were assessed by two readers. Differences in the per-patient and per-segment LGE detection rates between the synthetic and conventional techniques were analyzed with the McNemar test, and the accuracy of LGE quantification was calculated with the paired t test and Bland-Altman statistics. Interreader agreement for the detection and quantification of LGE was analyzed with κ and Bland-Altman statistics, respectively. RESULTS Seventeen of the 43 patients (39%) had LGE patterns consistent with myocardial infarction. The sensitivity and specificity of synthetic magnitude and phase-sensitive IR techniques in the detection of LGE were 90% and 95%, respectively, with patient-based analysis and 94% and 99%, respectively, with segment-based analysis. The area of LGE measured with synthetic IR techniques showed excellent agreement with that of conventional techniques (4.35 cm(2) ± 1.88 and 4.14 cm(2)± 1.62 for synthetic magnitude and phase-sensitive IR, respectively, compared with 4.25 cm(2) ± 1.92 and 4.22 cm(2) ± 1.86 for conventional magnitude and phase-sensitive IR, respectively; P > .05). Interreader agreement was excellent for the detection (κ > 0.81) and quantification (bias range, -0.34 to 0.40; P > .05) of LGE. CONCLUSION The accuracy of the T1 map-based synthetic IR approach in the detection and quantification of myocardial LGE in patients with previous myocardial infarction was similar to that of conventional IR techniques. The use of T1 mapping to derive synthetic LGE images may reduce imaging times and operator dependence in future T1 mapping protocols with full left ventricular coverage.
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Affiliation(s)
- Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Rob J van der Geest
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Bruce S Spottiswoode
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Pal Suranyi
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Balazs Ruzsics
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Carlo N De Cecco
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Giuseppe Muscogiuri
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Paola M Cannaò
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Mary A Fox
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Julian L Wichmann
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - Rozemarijn Vliegenthart
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (A.V.S., P.S., C.N.D.C., G.M., P.M.C., M.A.F., J.L.W., R.V., U.J.S.), and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29245-2260; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.); Siemens Medical Solutions, Chicago, Ill (B.S.S.); and Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom (B.R.)
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Cannaò PM, Schoepf UJ, Muscogiuri G, Wichmann JL, Fuller SR, Secchi F, Varga-Szemes A, De Cecco CN. Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. Eur J Radiol 2015; 84:2401-10. [PMID: 25779223 DOI: 10.1016/j.ejrad.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.
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Affiliation(s)
- Paola M Cannaò
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Scuola di Specializzazione di Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Giuseppe Muscogiuri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Julian L Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen R Fuller
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
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Leonardi S, Arena A, Bruno ME, Cannaò PM, D'Anneo RW, Falagiani P, Gammeri E, Mistrello G, Nicolini A, Ricciardi L, Valenti G, Longo R, La Rosa M. Olea sublingual allergoid immunotherapy administered with two different treatment regimens. Allergy Asthma Proc 2010; 31:e25-9. [PMID: 20406589 DOI: 10.2500/aap.2010.31.3316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sublingual immunotherapy (SLIT) with monomeric carbamylated allergoid administered in accordance with the standard regimen has proven to be effective and safe. Achieving clinical benefit, however, requires a lengthy period of time so it is not very suitable for short-lasting allergies. We thus performed this study to compare an administration protocol starting in the coseasonal period (with a 4-day build-up phase) with a precoseasonal scheme to verify if the former regimen provides the same benefit in a shorter period of time. The prospective, randomized, drug therapy-controlled study was conducted in 33 rhinitic patients monosensitized to Olea with or without asthma. Ten patients were assigned to the coseasonal therapy with 5000 allergic units (AU)/week for 6 weeks, 11 to the precoseasonal therapy with 3000 AU/week for 10 weeks, and 12 to drug therapy. They were treated from April or May to June 2008. A visual analog scale (VAS) was performed at baseline and after treatment to assess the well being of the patients. Drug consumption was evaluated by means of a monthly diary. There was greater VAS improvement in both the SLIT groups versus the controls, but it was statistically significant only in the coseasonal group (p < 0.01). Furthermore, there was a reduction in the rescue medication only in the coseasonal SLIT (p < 0.05 versus drug therapy). One mild adverse event was observed. The allergoid SLIT was shown to be effective and safe in Olea allergy in particular when a coseasonal regimen was used.
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