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Chadha RM. CT coronary angiography: Is it the new standard in coronary assessment for liver transplant candidates? Int J Cardiol 2024; 406:131999. [PMID: 38574999 DOI: 10.1016/j.ijcard.2024.131999] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
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Oikonomou EK, Antonopoulos AS, Schottlander D, Marwan M, Mathers C, Tomlins P, Siddique M, Klüner LV, Shirodaria C, Mavrogiannis MC, Thomas S, Fava A, Deanfield J, Channon KM, Neubauer S, Desai MY, Achenbach S, Antoniades C. Standardized measurement of coronary inflammation using cardiovascular computed tomography: integration in clinical care as a prognostic medical device. Cardiovasc Res 2021; 117:2677-2690. [PMID: 34450625 DOI: 10.1093/cvr/cvab286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS Coronary computed tomography angiography (CCTA) is a first-line modality in the investigation of suspected coronary artery disease (CAD). Mapping of perivascular fat attenuation index (FAI) on routine CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which integrates standardized FAI mapping together with clinical risk factors and plaque metrics to provide individualized cardiovascular risk prediction. METHODS AND RESULTS The study included 3912 consecutive patients undergoing CCTA as part of clinical care in the USA (n = 2040) and Europe (n = 1872). These cohorts were used to generate age-specific nomograms and percentile curves as reference maps for the standardized interpretation of FAI. The first output of CaRi-Heart® is the FAI-Score of each coronary artery, which provides a measure of coronary inflammation adjusted for technical, biological, and anatomical characteristics. FAI-Score is then incorporated into a risk prediction algorithm together with clinical risk factors and CCTA-derived coronary plaque metrics to generate the CaRi-Heart® Risk that predicts the likelihood of a fatal cardiac event at 8 years. CaRi-Heart® Risk was trained in the US population and its performance was validated externally in the European population. It improved risk discrimination over a clinical risk factor-based model [Δ(C-statistic) of 0.085, P = 0.01 in the US Cohort and 0.149, P < 0.001 in the European cohort] and had a consistent net clinical benefit on decision curve analysis above a baseline traditional risk factor-based model across the spectrum of cardiac risk. CONCLUSION Mapping of perivascular FAI on CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which allows standardized measurement of coronary inflammation by calculating the FAI-Score of each coronary artery. The CaRi-Heart® device provides a reliable prediction of the patient's absolute risk for a fatal cardiac event by incorporating traditional cardiovascular risk factors along with comprehensive CCTA coronary plaque and perivascular adipose tissue phenotyping. This integration advances the prognostic utility of CCTA for individual patients and paves the way for its use as a dual diagnostic and prognostic tool among patients referred for CCTA.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - David Schottlander
- Caristo Diagnostics, 1st Floor, New Barclay House, 234 Botley Rd, OX2 0HP, Oxford, UK
| | - Mohammad Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximilianspl 2, 91054 Erlangen, Germany
| | - Chris Mathers
- Caristo Diagnostics, 1st Floor, New Barclay House, 234 Botley Rd, OX2 0HP, Oxford, UK
| | - Pete Tomlins
- Caristo Diagnostics, 1st Floor, New Barclay House, 234 Botley Rd, OX2 0HP, Oxford, UK
| | - Muhammad Siddique
- Caristo Diagnostics, 1st Floor, New Barclay House, 234 Botley Rd, OX2 0HP, Oxford, UK
| | - Laura V Klüner
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - Cheerag Shirodaria
- Caristo Diagnostics, 1st Floor, New Barclay House, 234 Botley Rd, OX2 0HP, Oxford, UK
| | - Michail C Mavrogiannis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - Sheena Thomas
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - Agostina Fava
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH44195, USA
| | - John Deanfield
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BTUK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- National Institute of Health Research (NIHR), Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- National Institute of Health Research (NIHR), Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH44195, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximilianspl 2, 91054 Erlangen, Germany
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
- National Institute of Health Research (NIHR), Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX39DU, Oxford UK
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Ehrman RR, Malik AN, Smith RK, Kalarikkal Z, Huang A, King RM, Green RD, O'Neil BJ, Sherwin RL. Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism. Intern Emerg Med 2021; 16:2251-2259. [PMID: 33742340 DOI: 10.1007/s11739-021-02703-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Pulmonary embolism (PE) remains a diagnostic challenge in emergency medicine. Clinical decision aids (CDAs) like the Pulmonary Embolism Rule-Out Criteria (PERC) are sensitive but poorly specific; serial CDA use may improve specificity. The goal of this before-and-after study was to determine if serial use of existing CDAs in a novel diagnostic algorithm safely decreases the use of CT pulmonary angiograms (CTPA). This was a retrospective before-and-after study conducted at an urban ED with 105,000 annual visits. Our algorithm uses PERC, Wells' score, and D-dimer in series, before moving to CTPA. The algorithm was introduced in January, 2017. Use of CDAs and D-dimer in the 24 months pre- and 12 months post-intervention were obtained by chart review. The algorithm's effect on CTPA ordering was assessed by comparing volume 5 years pre- and 3 years post-intervention, adjusted for ED volume. Mean CTPAs per 1000 adult ED visits was 11.1 in the 5 pre-intervention years and 9.9 in the 3 post-intervention years (p < 0.0001). Use of PERC, Wells' score and D-dimer increased from 1.1%, 1.1%, and 28% to 8.8% (p = 0.0002) 8.1% (p = 0.0005), and 35% (p = 0.0066), respectively. Pre-intervention, there were six potentially missed PEs compared to three in the post-intervention period. Introduction of our serial CDA diagnostic algorithm was associated with increased use of CDAs and D-dimer and reduced CTPA rate without an apparent increase in the number of missed PEs. Prospective validation is needed to confirm these results.
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Affiliation(s)
- Robert Russell Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA.
| | - Adrienne Nicole Malik
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Reid Kenneth Smith
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Zeid Kalarikkal
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Andrew Huang
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Ryan Michael King
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Rubin David Green
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Brian James O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Detroit Receiving Hospital, Detroit, USA
| | - Robert Leigh Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
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Alshumrani G, Al bshabshe A, Mousa WF. Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients. Medicine (Baltimore) 2021; 100:e26213. [PMID: 34087898 PMCID: PMC8183708 DOI: 10.1097/md.0000000000026213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.
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Affiliation(s)
| | - Ali Al bshabshe
- Department of Medicine (Adult Critical Care Division), College of Medicine, King Khalid University, Abha
| | - Wesam Faried Mousa
- Department of Critical Care, Khamis General Hospital, Khamis Mushyet, Saudi Arabia
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Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Shaw LJ, Blankstein R, Bax JJ, Ferencik M, Bittencourt MS, Min JK, Berman DS, Leipsic J, Villines TC, Dey D, Al'Aref S, Williams MC, Lin F, Baskaran L, Litt H, Litmanovich D, Cury R, Gianni U, van den Hoogen I, R van Rosendael A, Budoff M, Chang HJ, E Hecht H, Feuchtner G, Ahmadi A, Ghoshajra BB, Newby D, Chandrashekhar YS, Narula J. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. J Cardiovasc Comput Tomogr 2021; 15:93-109. [PMID: 33303383 DOI: 10.1016/j.jcct.2020.11.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
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Affiliation(s)
- Leslee J Shaw
- Weill Cornell School of Medicine, New York, NY, USA.
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - James K Min
- Weill Cornell School of Medicine; Cleerly, Inc. (started in 2020), New York, NY, USA
| | - Daniel S Berman
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Fay Lin
- Weill Cornell School of Medicine, New York, NY, USA
| | | | - Harold Litt
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Litmanovich
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, FL, USA
| | | | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | - Amir Ahmadi
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - David Newby
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, NY, USA
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Abstract
PURPOSE OF REVIEW This article describes how imaging can be used by physicians in diagnosing, determining prognosis, and making appropriate treatment decisions in a timely manner in patients with acute stroke. RECENT FINDINGS Advances in acute stroke treatment, including the use of endovascular thrombectomy in patients with large vessel occlusion and, more recently, of IV thrombolysis in an extended time window, have resulted in a paradigm shift in how imaging is used in patients with acute stroke. This paradigm shift, combined with the understanding that "time is brain," means that imaging must be fast, reliable, and available around the clock for physicians to make appropriate clinical decisions. CT has therefore become the primary imaging modality of choice. Recognition of a large vessel occlusion using CT angiography has become essential in identifying patients for endovascular thrombectomy, and techniques such as imaging collaterals on CT angiography or measuring blood flow to predict tissue fate using CT perfusion have become useful tools in selecting patients for acute stroke therapy. Understanding the use of these imaging modalities and techniques in dealing with an emergency such as acute stroke has therefore become more important than ever for physicians treating patients with acute stroke. SUMMARY Imaging the brain and the blood vessels supplying it using modern tools and techniques is a key step in understanding the pathophysiology of acute stroke and making appropriate and timely clinical decisions.
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Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, Emery MS, Sengupta PP, Sharma S, Martinez MW, La Gerche A. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13:2635-2652. [PMID: 33303102 PMCID: PMC7598679 DOI: 10.1016/j.jcmg.2020.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.
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Affiliation(s)
- Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory School of Medicine, Atlanta, Georgia, USA
| | - Michael D Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Meagan M Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amer M Johri
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael S Emery
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University Hospital, London, United Kingdom
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health, Morristown, New Jersey, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Warin Fresse K, Isorni MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Cardiac computed tomography angiography in the paediatric population: Expert consensus from the Filiale de cardiologie pédiatrique et congénitale (FCPC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV). Arch Cardiovasc Dis 2020; 113:579-586. [PMID: 32522436 DOI: 10.1016/j.acvd.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pédiatrique congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
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Affiliation(s)
- Karine Warin Fresse
- Imagerie cardiovasculaire fédération des cardiopathies congénitales, CHU de Nantes HGRL, 44093 Nantes, France
| | - Marc Antoine Isorni
- Unité de radiologie diagnostique et thérapeutique, hôpital Marie-Lannelongue, 92350 Le Plessis Robinson, France
| | - Jean Nicolas Dacher
- Cardiac MR/CT Unit, University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, 76183 Rouen, France
| | - François Pontana
- Inserm UMR 1011, Department of Cardiovascular Radiology, EGID (European Genomic Institute for Diabetes), université de Lille, Institut Cœur-Poumon, Institut Pasteur de Lille, CHU de Lille, FR3508, 59000 Lille, France
| | - Guillaume Gorincour
- Image(2), institut méditerranéen d'imagerie médicale appliquée à la gynecologie, grossesse et enfance, 13008 Marseille, France
| | - Nathalie Boddaert
- Paediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, 75743 Paris, France
| | - Alexis Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU La Timone, Marseille, France
| | - Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes (M3C), hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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Papachristidis A, Vaughan GF, Denny SJ, Akbari T, Avornyo E, Griffiths T, Saunders E, Byrne J, Monaghan MJ, Al Fakih K. Comparison of NICE and ESC proposed strategies on new onset chest pain and the contemporary clinical utility of pretest probability risk score. Open Heart 2020; 7:e001081. [PMID: 32467136 PMCID: PMC7259870 DOI: 10.1136/openhrt-2019-001081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/02/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Patients with de novo chest pain are usually investigated non-invasively. The new UK-National Institute for Health and Care Excellence (NICE) guidelines recommend CT coronary angiography (CTCA) for all patients, while European Society of Cardiology (ESC) recommends functional tests. We sought to compare the clinical utility and perform a cost analysis of these recommendations in two UK centres with different primary investigative strategies. METHODSRESULTS We compared two groups of patients, group A (n=667) and group B (n=654), with new onset chest pain in two neighbouring National Health Service hospitals, each primarily following either ESC (group A) or NICE (group B) guidance. We assessed the clinical utility of each strategy, including progression to invasive coronary angiography (ICA) and revascularisation. We present a retrospective cost analysis in the context of UK tariff for stress echo (£176), CTCA (£220) and ICA (£1001). Finally, we sought to identify predictors of revascularisation in the whole population.Baseline characteristics in both groups were similar. The progression to ICA was comparable (9.9% vs 12.0%, p=0.377), with similar requirement for revascularisation (4.0% vs 5.0%.; p=0.532). The average cost of investigations per investigated patient was lower in group A (£279.66 vs £325.77), saving £46.11 per patient. The ESC recommended risk score (RS) was found to be the only predictor of revascularisation (OR 1.05, 95% CI 1.04 to 1.06; p<0.001). CONCLUSION Both NICE and ESC-proposed strategies led to similar rates of ICA and need for revascularisation in discrete, but similar groups of patients. The SE-first approach had a lower overall cost by £46.11 per patient, and the ESC RS was the only variable correlated to revascularisation.
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Affiliation(s)
- Alexandros Papachristidis
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
- Cardiovascular Division, King's College London, London, United Kingdom
| | | | - Sarah J Denny
- Cardiology, Lewisham and Greenwich NHS Trust, London, UK
| | - Tamim Akbari
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Edith Avornyo
- Cardiology, Lewisham and Greenwich NHS Trust, London, UK
| | - Tracey Griffiths
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma Saunders
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Byrne
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark J Monaghan
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
- Cardiovascular Division, King's College London, London, United Kingdom
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11
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Abstract
To evaluate the utility of echocardiography (echo) in the diagnosis of persistent fifth aortic arch (PFAA), a very rare congenital aortic arch anomaly, and to compare echo and computed tomography angiography (CTA) imaging findings to improve our understanding of this anomaly.Data on the clinical diagnosis, imaging findings, and clinical management of PFAA were retrospectively analyzed in 10 suspected cases of PFAA admitted to our hospital between January 2012 and February 2017. We compared echo as a first line examination modality, and CTA and surgery results as the gold standard. Weinberg's classification was used to classify the type of PFAA.All patients (100%) received echo examination, eight patients (80%) received CTA examination, and four patients (40%) received sternotomy surgery; all recovered well after surgery. According to Weinberg's classification, 2, 6, and 2 cases (20%, 60%, and 20%) were classified as Type A, B, and C, respectively. Echo was able to diagnose 5 cases of PFAA (1 Type A case and 4 Type B cases) in the first instance. The diagnostic conformance rate of echo was 62.5% after comparisons with CTA and surgery results.The clinical manifestation of PFAA was atypical, and its diagnosis depended primarily on medical imaging. Echo has a relatively high diagnostic accuracy for PFAA, which is very valuable for its early detection.
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Affiliation(s)
- Haiyan Yang
- Department of Ultrasound, Children's Hospital of Chongqing
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Key Laboratory of Biomedical Engineering, Chongqing
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Xu Zhu
- Department of Ultrasound, Children's Hospital of Chongqing
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Chun Wu
- Department of Cardiothoracic Surgery
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Xiaodong Zhao
- Department of Pediatric Research Institute
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Xiaojuan Ji
- Department of Ultrasound, Children's Hospital of Chongqing
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
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12
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Ren Z, Zhang X, Hu Z, Li D, Liu Z, Wei D, Jia Y, Yu N, Yu Y, Lei Y, Chen X, Guo C, Ren Z, He T. Application of Adaptive Statistical Iterative Reconstruction-V With Combination of 80 kV for Reducing Radiation Dose and Improving Image Quality in Renal Computed Tomography Angiography for Slim Patients. Acad Radiol 2019; 26:e324-e332. [PMID: 30655053 DOI: 10.1016/j.acra.2018.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/03/2018] [Revised: 12/23/2018] [Accepted: 12/24/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To explore the application of adaptive statistical iterative reconstruction-V (ASIR-V) with combination of 80 kV for reducing radiation dose and improving image quality in renal computed tomography angiography (CTA) for slim patients compared with traditional filtered back projection (FBP) reconstruction using 120 kV. METHODS Eighty patients for renal CTA were prospectively enrolled and randomly divided into group A and group B. Group A used 120 kV and 600 mgI/kg contrast agent and FBP reconstruction, while group B used 80 kV and 350 mgI/kg contrast agent and both FBP and ASIR-V reconstruction from 10%ASIR-V to 100%ASIR-V with 10%ASIR-V interval. The CT values and SD values of the right renal artery and left renal artery were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a five-point criterion. The contrast agent, volumetric CT dose index (CTDIvol), and dose length product in both groups were recorded and the effective radiation dose was calculated. RESULTS There were no significant difference in patient characteristics between two groups (p > 0.05). The CTDIvol, dose length product and effective radiation dose in group B were 59.0%, 65.0%, and 65.1% lower than those in group A, respectively (all p < 0.05), and the contrast agent in group B was 42.2% lower than that in group A (p < 0.05). In group B, with the increase of ASIR-V percentage, CT values showed no significant difference, SD values decreased gradually, SNR values and CNR values increased gradually. The CT values showed no statistically significant difference (p > 0.05) between two groups with different reconstructions. The SD values with 40%ASIR-V to 100%ASIR-V reconstruction in group B was significantly lower(p < 0.5), while the SNR values with 50% ASIR-V to 100% ASIR-V reconstruction and CNR values with 70%ASIR-V to 100%ASIR-V were significantly higher than those of group A with FBP reconstruction (p < 0.5). Two radiologists had excellent consistency in subjective scores of image quality for renal CTA (kappa >0.75, p < 0.05). The subjective scores with 60% ASIR-V to 90% ASIR-V in group B were significantly higher than those of FBP in group A (p < 0.5), of which 70%ASIR-V reconstruction obtained the highest subjective score for renal CTA. CONCLUSION ASIR-V with combination of 80 kV can significantly reduce effective radiation dose (about 65.1%) and contrast agent (about 42.2%) and improve image quality in renal CTA for slim patients compared with traditional FBP reconstruction using 120 kV, and the 70% ASIR-V was the best reconstruction algorithm in 80 kV renal CTA. ADVANCES IN KNOWLEDGE Using 80 kV with combination of ASIR-V can significantly reduce radiation dose and contrast agent dose as well as improve image quality in renal CTA for thin patients when compared with FBP using 120 kV.
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Affiliation(s)
- Zhanli Ren
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000; Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China; The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xirong Zhang
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Zhijun Hu
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Dou Li
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Zhentang Liu
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Donghong Wei
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Yongjun Jia
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Nan Yu
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Yong Yu
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Yuxin Lei
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Xiaoxia Chen
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Changyi Guo
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Zhanliang Ren
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000.
| | - Taiping He
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000.
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13
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Kim J, Goo BS, Cho YS, Youn TJ, Choi DJ, Dhanantwari A, Vembar M, Chun EJ. Diagnostic performance and image quality of iterative model-based reconstruction of coronary CT angiography using 100 kVp for heavily calcified coronary vessels. PLoS One 2019; 14:e0222315. [PMID: 31504074 PMCID: PMC6736300 DOI: 10.1371/journal.pone.0222315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic performance and image quality of an iterative model-based reconstruction (IMR) using a 100-kVp protocol for the assessment of heavily calcified coronary vessels, compared to those of filtered back projection (FBP) and hybrid iterative technique (iDose4), and also compared to those of IMR with standard 120 kVp protocol. METHODS Among patients with Agatston scores ≥ 400 who had undergone both coronary CT angiography (CCTA) and invasive coronary angiography (ICA), age- and sex-matched patients with body mass index < 30 were retrospectively enrolled from CCTA with low-kVp protocol (100 kVp, n = 30) and with standard-kVp protocol (120 kVp, n = 30). Image data were all reconstructed with FBP, iDose4, and IMR. In each dataset, the objective and subjective image quality, and diagnostic accuracy (> 50% in luminal reduction as compared with ICA) were assessed. RESULTS IMR showed better objective and subjective image quality than FBP and iDose4 in both 100 kVp and 120 kVp groups (all p < 0.05). IMR showed a significantly improved all diagnostic performance compared with FBP (p < 0.05). Compared with iDose4, IMR significantly improved positive predictive value (85.0% vs. 80.5%; p < 0.05). There was no significant difference in image quality and diagnostic performance using IMR between the 100 kVp and 120 kVp groups. CONCLUSIONS 100 kVp IMR may be useful for the assessment of heavily calcified coronary vessels, providing better diagnostic performance than FBP or iDose4 at the same dose, while maintaining similar diagnostic accuracy to 120 kVp IMR.
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Affiliation(s)
- Junwoo Kim
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Bon Seung Goo
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Dong Jun Choi
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Amar Dhanantwari
- CT/AMI Clinical Science, Philips Healthcare, Highland Heights, OH, United States of America
| | - Mani Vembar
- CT/AMI Clinical Science, Philips Healthcare, Highland Heights, OH, United States of America
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea
- * E-mail:
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14
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Chen K, Zhang X, Li D, Chen H, Zhang Z, Chen L. A noninvasive and highly sensitive approach for the assessment of coronary collateral circulation by 192-slice third-generation dual-source computed tomography. Medicine (Baltimore) 2019; 98:e17014. [PMID: 31567938 PMCID: PMC6756702 DOI: 10.1097/md.0000000000017014] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).Eight hundred patients (450 men and 350 women, mean age: 56 ± 11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ± 3.7 days (Range: 1-15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91-0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ± 0.04 mSv (range, 0.35-0.43 mSv).The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.
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Affiliation(s)
- Kebin Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Xiaoge Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Daling Li
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Honglei Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Zhixu Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Lei Chen
- Department of Lab Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
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Zhang XH, Liang HM. Systematic review with network meta-analysis: Diagnostic values of ultrasonography, computed tomography, and magnetic resonance imaging in patients with ischemic stroke. Medicine (Baltimore) 2019; 98:e16360. [PMID: 31348236 PMCID: PMC6709059 DOI: 10.1097/md.0000000000016360] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Ischemic stroke is a foremost cause for disability and death worldwide. This study is conducted in order to compare the diagnostic values between transcranial Doppler ultrasound (ultrasonography), computed tomography (CT), and magnetic resonance imaging (MRI) in patients suffering from ischemic stroke by performing a network meta-analysis. METHODS We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the seven different imaging methods. These imaging techniques include ultrasonography, computed tomography (traditional CT, computed tomography angiography [CTA], computed tomography perfusion [CTP]), and MRI (traditional MRI, diffusion-weighted imaging [DWI], magnetic resonance angiography), in order to properly diagnose ischemic stroke patients. RESULTS Thirteen eligible diagnostic trials were enrolled into this network meta-analysis. The results of the traditional meta-analysis showed that among CT methods, CTP showed higher sensitivity, NPV, and accuracy; among MRI methods, DWI had relatively higher sensitivity, NPV, and accuracy. The results of network meta-analysis showed that DWI had relatively higher sensitivity, NPV, and accuracy when compared with traditional CT, CTA, magnetic resonance angiography and traditional MRI. CTP showed higher SUCRA among CT methods while DWI showed higher SUCRA among MRI methods. A cluster analysis revealed that DWI had the highest diagnostic value in terms of sensitivity, PPV, NPV, and accuracy amongst the aforementioned seven imaging techniques. CONCLUSION This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
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Affiliation(s)
| | - Hui-Min Liang
- Department of Neurology, Huaihe Hospital of Henan University, Kaifeng, P. R. China
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16
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Wang SQ, Ren FY, Wang JH, Ren ZH, Jin ZG, Xu Y, Li ZH, Ding QJ, Zhong C. Diagnostic value of multislice spiral computed tomography (CT) combined with CT angiography for intra-abdominal undescended testis secondary seminomas. Cancer Imaging 2019; 19:24. [PMID: 31097025 PMCID: PMC6521511 DOI: 10.1186/s40644-019-0210-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/29/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To discuss the diagnostic value of multislice spiral tomography (CT) combined with CT angiography (CTA) technology in intra-abdominal undescended testis secondary seminoma cases. METHODS We retrospectively analyzed the CT and CTA imaging features of CT and CTA findings of nine patients with an intra-abdominal undescended testis secondary seminoma. RESULTS The tumors in all nine patients were mainly solid, and the average CT value was 38.4 ± 3.4 HU. Low-density areas of various sizes were visible in the tumors, and calcifications were detected in two patients. The tumors in eight patients had a complete capsule, which pressed on the surrounding structures. In one patient, the tumor had an incomplete capsule, which invaded the surrounding structures. Some of the solid tumors showed progressive and slight enhancement on the CT-enhanced scans. The values in the arterial phase, venous phase, and delayed phase were 46.3 ± 5.1 (40-55 HU), 57.3 ± 7.3HU (48-68 HU), and 65.1 ± 7.2HU (56-77 HU), respectively, with an average increase rate of 27.0 ± 7.2 HU. No enhancement was found in low-density areas on the CTA scans, and the supply arteries of the tumors in the nine patients all originated from the abdominal aortic wall 2-3 cm below the renal ostia. These arteries became thickened and tortuous when near the tumors, and there were no branching vessels. In eight patients, the supply arteries of the tumors originated from the posterior tumor and ended inside the tumor, and they originated from anterior of the tumor in one patient. Testicular venous drainage was detected in three patients, and lymph node metastasis in the abdominal aorta detected in two cases. CONCLUSION An intra-abdominal undescended testis secondary seminoma exhibits a characteristic appearance on CT. CTA shows a three-dimensional testicular vascular pedicle sign of a seminoma. A combination of CT and CTA can improve the diagnostic accuracy of an intra-abdominal undescended testis secondary seminoma.
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Affiliation(s)
- Si-qi Wang
- Department of Radiology, The Affiliated Hospital of Medical school, Ningbo University, Zhejiang, 315020 China
- Medicine School of Ningbo University, Zhejiang, 315020 China
| | - Fang-yuan Ren
- Department of Radiology, The Affiliated Hospital of Medical school, Ningbo University, Zhejiang, 315020 China
| | - Jian-hua Wang
- Department of Radiology, The Affiliated Hospital of Medical school, Ningbo University, Zhejiang, 315020 China
| | - Zhi-hao Ren
- Medicine School of Ningbo University, Zhejiang, 315020 China
| | | | - Yu Xu
- Department of Radiology, The Affiliated Hospital of Medical school, Ningbo University, Zhejiang, 315020 China
| | - Zhen-hui Li
- Yunnan Cancer Hospital, Kunming, 650118 Yunnan Province China
| | - Qian-jiang Ding
- Medicine School of Ningbo University, Zhejiang, 315020 China
| | - Chao Zhong
- Department of Radiology, The Affiliated Hospital of Medical school, Ningbo University, Zhejiang, 315020 China
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Matsumoto H, Watanabe S, Kyo E, Tsuji T, Ando Y, Otaki Y, Cadet S, Gransar H, Berman DS, Slomka P, Tamarappoo BK, Dey D. Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound. Eur Radiol 2019; 29:6129-6139. [PMID: 31028446 DOI: 10.1007/s00330-019-06219-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 02/27/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We sought to evaluate the accuracy of standardized total plaque volume (TPV) measurement and low-density non-calcified plaque (LDNCP) assessment from coronary CT angiography (CTA) in comparison with intravascular ultrasound (IVUS). METHODS We analyzed 118 plaques without extensive calcifications from 77 consecutive patients who underwent CTA prior to IVUS. CTA TPV was measured with semi-automated software comparing both scan-specific (automatically derived from scan) and fixed attenuation thresholds. From CTA, %LDNCP was calculated voxels below multiple LDNCP thresholds (30, 45, 60, 75, and 90 Hounsfield units [HU]) within the plaque. On IVUS, the lipid-rich component was identified by echo attenuation, and its size was measured using attenuation score (summed score ∕ analysis length) based on attenuation arc (1 = < 90°; 2 = 90-180°; 3 = 180-270°; 4 = 270-360°) every 1 mm. RESULTS TPV was highly correlated between CTA using scan-specific thresholds and IVUS (r = 0.943, p < 0.001), with no significant difference (2.6 mm3, p = 0.270). These relationships persisted for calcification patterns (maximal IVUS calcium arc of 0°, < 90°, or ≥ 90°). The fixed thresholds underestimated TPV (- 22.0 mm3, p < 0.001) and had an inferior correlation with IVUS (p < 0.001) compared with scan-specific thresholds. A 45-HU cutoff yielded the best diagnostic performance for identification of lipid-rich component, with an area under the curve of 0.878 vs. 0.840 for < 30 HU (p = 0.023), and corresponding %LDNCP resulted in the strongest correlation with the lipid-rich component size (r = 0.691, p < 0.001). CONCLUSIONS Standardized noninvasive plaque quantification from CTA using scan-specific thresholds correlates highly with IVUS. Use of a < 45-HU threshold for LDNCP quantification improves lipid-rich plaque assessment from CTA. KEY POINTS • Standardized scan-specific threshold-based plaque quantification from coronary CT angiography provides an accurate total plaque volume measurement compared with intravascular ultrasound. • Attenuation histogram-based low-density non-calcified plaque quantification can improve lipid-rich plaque assessment from coronary CT angiography.
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Affiliation(s)
- Hidenari Matsumoto
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
| | - Satoshi Watanabe
- Department of Cardiology, Kusatsu Heart Center, Kusatsu, Shiga, Japan
| | - Eisho Kyo
- Department of Cardiology, Kusatsu Heart Center, Kusatsu, Shiga, Japan
| | - Takafumi Tsuji
- Department of Cardiology, Kusatsu Heart Center, Kusatsu, Shiga, Japan
| | - Yosuke Ando
- Department of Cardiology, Kusatsu Heart Center, Kusatsu, Shiga, Japan
| | - Yuka Otaki
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Piotr Slomka
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Balaji K Tamarappoo
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Soc Echocardiogr 2019; 32:683-707. [PMID: 31010608 DOI: 10.1016/j.echo.2019.02.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Laura Mauri
- American College of Cardiology representative
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Alhailiy AB, Ekpo EU, Ryan EA, Kench PL, Brennan PC, McEntee MF. DIAGNOSTIC REFERENCE LEVELS FOR CARDIAC CT ANGIOGRAPHY IN AUSTRALIA. Radiat Prot Dosimetry 2018; 182:525-531. [PMID: 30032302 DOI: 10.1093/rpd/ncy112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
This study aims to assess patient radiation dose from cardiac computed tomography angiography (CCTA) with the aim of proposing a national diagnostic reference levels (NDRLs) for CCTA procedures in Australia. A questionnaire was used to retrospectively gather baseline information related to CCTA scanning and patient parameters in CT centres across the country. The 75th percentile of both volumetric CT dose index (CTDIvol) and dose length-product (DLP) was used as DRL values for CCTA. A DRL for CT calcium scoring test was also determined. NDRLs were compared with international published data. Data sets of 338 patients from nine CT centres were used for analysis. The CCTA DRL for the CTDIvol and the DLP were 22 mGy and 268 mGy cm, respectively. The CT calcium scoring test DRL for DLP was 137 mGy cm. The DRL values for CCTA in Australia have been recommended for the first time. DRLs are lower than those in most published studies due to the implementation of dose-saving technologies such as prospective ECG-gated mode and iterative reconstruction algorithms. Considerable variations remain in patient doses between hospitals for the most frequently used CCTA protocols, indicating the potential for DRLs to prompt dose optimisation strategies in CT facilities.
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Affiliation(s)
- Ali B Alhailiy
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Ernest U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Elaine A Ryan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Peter L Kench
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Patrick C Brennan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
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Alhailiy AB, Kench PL, McEntee MF, Brennan PC, Ryan EA. ESTABLISHING DIAGNOSTIC REFERENCE LEVELS FOR CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY IN SAUDI ARABIA. Radiat Prot Dosimetry 2018; 181:129-134. [PMID: 29351655 DOI: 10.1093/rpd/ncx306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
Cardiac computed tomography angiography (CCTA) is a commonly used diagnostic imaging tool for cardiovascular disease. Despite constant improvements to imaging technologies, the radiation dose to patients remains a concern when using this procedure. Diagnostic reference levels (DRLs) are used as a trigger to identify and alert individual facilities that are using high doses during CT. This study aims to assess patient radiation dose and establish new national DRLs (NDRL) associated with CCTA in Saudi clinical practices. A structured booklet survey was designed for recording patient and scanning protocols during CCTA procedures. The data were collected retrospectively from the participating centres. NDRLs for CCTA were defined as the 75th and 25th of volumetric CT dose index (CTDIvol) and dose length product (DLP). Specific DRLs based on two main ECG-gating modes were also proposed. Data sets related to 197 CCTAs with a mean weight of 77 kg were analysed in detail. The DRL values for CTDIvol and DLP for prospective gating mode and retrospective gating mode were 29 and 62 mGy and 393 and 1057 mGy cm, respectively. NDRLs for CCTA in Saudi Arabia are comparable or slightly lower than European DRLs due to the current use of dose-saving technology. There are major variations in patient doses during CCTA due to differences in CT scanners, scanning modes and departmental CCTA protocols.
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Affiliation(s)
- Ali B Alhailiy
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, New South Wales, Australia
- Faculty of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Peter L Kench
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, New South Wales, Australia
| | - Mark F McEntee
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, New South Wales, Australia
| | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, New South Wales, Australia
| | - Elaine A Ryan
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, New South Wales, Australia
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Adamson PD, Newby DE, Hill CL, Coles A, Douglas PS, Fordyce CB. Comparison of International Guidelines for Assessment of Suspected Stable Angina: Insights From the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging 2018; 11:1301-1310. [PMID: 30190030 PMCID: PMC6130226 DOI: 10.1016/j.jcmg.2018.06.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to compare the performance of major guidelines for the assessment of stable chest pain including risk-based (American College of Cardiology/American Heart Association and European Society of Cardiology) and symptom-focused (National Institute for Health and Care Excellence) strategies. BACKGROUND Although noninvasive testing is not recommended in low-risk individuals with stable chest pain, guidelines recommend differing approaches to defining low-risk patients. METHODS Patient-level data were obtained from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) and SCOT-HEART (Scottish Computed Tomography of the Heart) trials. Pre-test probability was determined and patients dichotomized into low-risk and intermediate-high-risk groups according to each guideline's definitions. The primary endpoint was obstructive coronary artery disease on coronary computed tomography angiography. Secondary endpoints were coronary revascularization at 90 days and cardiovascular death or nonfatal myocardial infarction up to 3 years. RESULTS In total, 13,773 patients were included of whom 6,160 had coronary computed tomography angiography. The proportions of patients identified as low risk by the American College of Cardiology/American Heart Association, European Society of Cardiology, and National Institute for Health and Care Excellence guidelines, respectively, were 2.5%, 2.5%, and 10.0% within PROMISE, and 14.0%, 19.8%, and 38.4% within SCOT-HEART. All guidelines identified lower rates of obstructive coronary artery disease in low- versus intermediate-high-risk patients with a negative predictive value of ≥0.90. Compared with low-risk groups, all intermediate-high-risk groups had greater risks of coronary revascularization (odds ratio [OR]: 2.2 to 24.1) and clinical outcomes (OR: 1.84 to 5.8). CONCLUSIONS Compared with risk-based guidelines, symptom-focused assessment identifies a larger group of low-risk chest pain patients potentially deriving limited benefit from noninvasive testing. (Scottish Computed Tomography of the Heart Trial [SCOT-HEART]; NCT01149590; Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
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Affiliation(s)
- Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Adrian Coles
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Dane B, Patel H, O'Donnell T, Girvin F, Brusca-Augello G, Alpert JB, Niu B, Attia M, Babb J, Ko JP. Image Quality on Dual-energy CTPA Virtual Monoenergetic Images: Quantitative and Qualitative Assessment. Acad Radiol 2018; 25:1075-1086. [PMID: 29398436 DOI: 10.1016/j.acra.2017.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast. MATERIALS AND METHODS The study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50-60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40-150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P <.05 was considered significant. RESULTS Region of interest mean CT number increased as keV decreased, with 40 keV having the highest value (P < .001). Mean SNR was highest for 40-60 keV (P <.05) (14.5-14.7) and was higher (P <.05) than all remaining energies (90-150 keV) for all vessel regions combined. Contrast to noise ratio was highest for 40 keV (P <.001) and decreased as keV increased. SNR was highest at 60 and 70 keV, only slightly higher than 40-50 keV (P <.05). Reader scores for 40-50 keV were greater than other energies and weighted-average images (P <.05). CONCLUSIONS Kiloelectron volt images of 40-50 keV from the second-generation algorithm optimize attenuation on dual-energy CTPA and can potentially aid in interpretation and avoiding nondiagnostic examinations.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016.
| | - Hersh Patel
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Francis Girvin
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Jeffrey B Alpert
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Bowen Niu
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - James Babb
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
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Abstract
The aim of this study was to compare image quality of low tube voltage cerebral computed tomography angiography (CTA) reconstructed with knowledge-based iterative model reconstruction (IMR), filtered back projection (FBP), and hybrid iterative reconstruction (HIR).A total of 101 patients with suspected cerebrovascular diseases were enrolled and randomized into 2 groups, 100 kVp tube voltage (n = 53) and reduced tube voltage (80 kVp) (n = 48). Computed tomography data were reconstructed with IMR, FBP, and HIR algorithms. The image noise, vascular attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured and calculated. Two blinded radiologists independently evaluated image quality based on diagnostic confidence on a 3-point scale. Quantitative and qualitative assessments were compared between different groups and reconstruction subgroups.Vascular attenuation was higher in the reduced tube voltage group than in 100-kVp tube voltage group, but showed no significant difference within each group. In both groups, the image noise, vascular SNR, and CNR were significantly improved by IMR as compared with FBP and HIR. Inter-group comparison indicated that IMR with reduced tube voltage showed better image quality with lower image noise and higher vascular SNR and CNR than FBP and HIR at 100 kVp, but slightly inferior to IMR at 100 kVp. IMR also yields the best qualitative image quality, and improves the diagnostic confidence of atherosclerosis and aneurysm. Compared with the standard 120-kVp protocol (1.86mSv), the radiation doses of 100 kVp (1.13mSv) and 80 kVp (0.56mSv) were 39% and 70% less, respectively.The quantitative and qualitative image quality obtained by IMR was superior to that obtained by FBP and HIR for low tube voltage cerebral CTA.
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Affiliation(s)
- Xinrui Wang
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chengcheng Zhu
- From the Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA
| | - Jing Li
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Andrew J. Degnan
- From the Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Tao Jiang
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianping Lu
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Sabel BO, Plum JL, Czihal M, Lottspeich C, Schönleben F, Gäbel G, Schinner R, Schoeppe F, Meinel FG. Structured Reporting of CT Angiography Runoff Examinations of the Lower Extremities. Eur J Vasc Endovasc Surg 2018; 55:679-687. [PMID: 29627139 DOI: 10.1016/j.ejvs.2018.01.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/27/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim was to evaluate the effect of structured reporting of computed tomography angiography (CTA) runoff studies on clarity, completeness, clinical relevance, usefulness of the radiology reports, further testing, and therapy in patients with known or suspected peripheral arterial disease. METHODS Conventional reports (CRs) and structured reports (SRs) were generated for 52 patients who had been examined with a CTA runoff examination of the lower extremities. The sample size was based on power calculations with a power of 95% and a significance level of .007 (adjusted for multiple testing). CRs were dictated in a free text form; SRs contained a consistent ordering of observations with standardised subheadings. CRs were compared with SRs. Two vascular medicine specialists and two vascular surgeons rated the reports regarding their satisfaction with clarity, completeness, clinical relevance, and usefulness as well as overall satisfaction. Additionally, they made hypothetical decisions on further testing and therapy. Median ratings were compared using the Wilcoxon signed rank test and generalised linear mixed effects models. RESULTS SRs received higher ratings for satisfaction with clarity (median rating 9.0 vs. 7.0, p < .0001) and completeness (median rating 9.0 vs. 7.5, p < .0001) and were judged to be of greater clinical relevance (median rating 9.0 vs. 8.0, p < .0001) and usefulness (median rating 9.0 vs. 8.0, p < .0001). Overall satisfaction was also higher for SRs (median rating 9.0 vs. 7.0, p < .0001) than CRs. There were no significant differences in further testing or therapy. CONCLUSION Referring clinicians perceive SRs of CTA runoff examinations of the lower extremities as offering superior clarity, completeness, clinical relevance, and usefulness than CRs. Structured reporting does not appear to alter further testing or therapy in patients with known or suspected peripheral arterial disease.
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Affiliation(s)
- Bastian O Sabel
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Jessica L Plum
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Christian Lottspeich
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Frank Schönleben
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Gabor Gäbel
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Germany
| | | | - Felix G Meinel
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, Rostock University Medical Centre, Rostock, Germany
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Ge C, Zhao W, Guo H, Sun Z, Zhang W, Li X, Yang X, Zhang J, Wang D, Xiang Y, Mao J, Zhang W, Guo H, Zhang Y, Chen J. Comparison of the clinical efficacy of craniotomy and craniopuncture therapy for the early stage of moderate volume spontaneous intracerebral haemorrhage in basal ganglia: Using the CTA spot sign as an entry criterion. Clin Neurol Neurosurg 2018; 169:41-48. [PMID: 29625339 DOI: 10.1016/j.clineuro.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/21/2018] [Accepted: 04/01/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Surgical treatment is widely used for haematoma removal in spontaneous intracerebral haemorrhage (ICH) patients, but there is controversy about the selection of surgical methods. The CT angiography (CTA) spot sign has been proven to be a promising factor predicting haematoma expansion and is recommended as an entry criterion for haemostatic therapy in patients with ICH. This trial was designed to evaluate the clinical efficacy of two surgical methods (haematoma removal by craniotomy and craniopuncture combined with urokinase infusion) for patients in the early stage (≤6h from symptom onset) of spontaneous ICH with a moderate haematoma volume (30 ml - 60 ml). PATIENTS AND METHODS From January 2012 to July 2017, 196 eligible patients treated in our institution were enrolled according to the inclusion criteria. The patients were divided into the CTA spot sign positive type and CTA spot sign negative type according to the presence or absence of the CTA spot sign. For each type, the patients were randomly assigned to two groups, i.e., the craniotomy group, in which patients underwent craniotomy with haematoma removal, and the craniopuncture group, in which patients underwent minimally invasive craniopuncture combined with urokinase infusion therapy. Neurological function was evaluated with the Scandinavian Stroke Scale (SSS) at day 14. The disability level and the activities of daily living were assessed using a modified Rankin Scale (mRS) and Barthel Index (BI) at day 90. Case fatalities were recorded at day 14 and 90. Complications were recorded during hospitalization. RESULTS For the CTA spot sign positive type, the craniotomy group had a higher SSS than that in the craniopuncture group (P < 0.05) at day 14. The rebleeding rate was higher in the craniopuncture group than that in the craniotomy group (P < 0.05) during hospitalization. The craniotomy group had a lower mRS than that in the craniopuncture group (P < 0.01) and had a higher BI than that in the craniopuncture group (P < 0.05) at day 90. There was no statistically significant difference in the fatality rate between the two groups. For the CTA spot sign negative type, there were no significant differences in the SSS, mRS, BI, fatality rate and complication rate between the two groups. CONCLUSION ICH can be divided into the CTA spot sign positive and negative type according to the presence or absence of the CTA spot sign. For the CTA spot sign positive type, patients can benefit from craniotomy with haematoma removal, which can reduce the postoperative rebleeding rate and improve the prognosis. For the CTA spot sign negative type, both craniotomy and craniopuncture are applicable. Considering simple procedure and minor surgical injury, craniopuncture can be a more reasonable choice.
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Affiliation(s)
- Chunyan Ge
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wangmiao Zhao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Zhaosheng Sun
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wanzeng Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Xiaowei Li
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Xuehui Yang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jinrong Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Dongxin Wang
- Department of Radiology, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Yi Xiang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jianhui Mao
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Wenchao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Hao Guo
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Yazhao Zhang
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
| | - Jianchao Chen
- Department of Neurosurgery, Harrison International Peace Hospital (Hengshui People's Hospital) Affiliated to Hebei Medical University, Postal address: No. 180, East Renmin Road, Hengshui City, Hebei Province, China.
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Pang CL, Pilkington N, Wei Y, Peters J, Roobottom C, Hyde C. A methodology review on the incremental prognostic value of computed tomography biomarkers in addition to Framingham risk score in predicting cardiovascular disease: the use of association, discrimination and reclassification. BMC Cardiovasc Disord 2018; 18:39. [PMID: 29466951 PMCID: PMC5822603 DOI: 10.1186/s12872-018-0777-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/20/2017] [Accepted: 02/14/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Computed tomography (CT) biomarkers claim to improve cardiovascular risk stratification. This review focuses on significant differences in incremental measures between adequate and inadequate reporting practise. METHODS Studies included were those that used Framingham Risk Score as a baseline and described the incremental value of adding calcium score or CT coronary angiogram in predicting cardiovascular risk. Searches of MEDLINE, EMBASE, Web of Science and Cochrane Central were performed with no language restriction. RESULTS Thirty five studies consisting of 206,663 patients (men = 118,114, 55.1%) were included. The baseline Framingham Risk Score included the 1998, 2002 and 2008 iterations. Selective reporting, inconsistent reference groupings and thresholds were found. Twelve studies (34.3%) had major and 23 (65.7%) had minor alterations and the respective Δ AUC were significantly different (p = 0.015). When the baseline model performed well, the Δ AUC was relatively lower with the addition of a CT biomarker (Spearman coefficient = - 0.46, p < 0.0001; n = 33; 76 pairs of data). Other factors that influenced AUC performance included exploration of data analysis, calibration, validation, multivariable and AUC documentation (all p < 0.05). Most studies (68.7%) that reported categorical NRI (n = 16; 46 pairs of data) subjectively drew strong conclusions along with other poor reporting practices. However, no significant difference in values of NRI was found between adequate and inadequate reporting. CONCLUSIONS The widespread practice of poor reporting particularly association, discrimination, reclassification, calibration and validation undermines the claimed incremental value of CT biomarkers over the Framingham Risk Score alone. Inadequate reporting of discrimination inflates effect estimate, however, that is not necessarily the case for reclassification.
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Affiliation(s)
- Chun Lap Pang
- University of Plymouth, Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Tamar Science Park, Research Way, Plymouth, PL6 8BU UK
- Plymouth Hospitals NHS Trust, Derriford Hospital, Imaging Department, Derriford Rd, Plymouth, PL6 8DH UK
- Primary Care Plymouth, Room N9, ITTC Building, Davy Road, Plymouth Science Park, Derriford, Plymouth, Devon PL6 8BX UK
| | - Nicola Pilkington
- Plymouth Hospitals NHS Trust, Derriford Hospital, Department of Anaesthetics, Derriford Rd, Plymouth, PL6 8DH UK
| | - Yinghui Wei
- University of Plymouth, School of Computing, Electronics and Mathematics, Plymouth, PL4 8AA UK
| | - Jaime Peters
- University of Exeter, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Carl Roobottom
- University of Plymouth, Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Tamar Science Park, Research Way, Plymouth, PL6 8BU UK
- Plymouth Hospitals NHS Trust, Derriford Hospital, Imaging Department, Derriford Rd, Plymouth, PL6 8DH UK
| | - Chris Hyde
- University of Exeter, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
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Nielsen JM, Mortensen J. [The choice of diagnostic modality for acute pulmonary embolism]. Ugeskr Laeger 2018; 180:V05170391. [PMID: 29493500] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The diagnosis of pulmonary embolism (PE) relies on clinical assessment, D-dimer test and diagnostic imaging. Modern CT pulmonary angiography (CTPA), ventilation/perfusion single-photon emission computed tomography (SPECT) and SPECT/CT are rather equal in terms of sensitivity, specificity and inconclusive results for the diagnosis of PE, outper-forming planar lung scintigraphy. Furthermore, SPECT/CT and CTPA can both provide important information regarding differential diagnoses. Thus, the choice of primary diag-nostic modality relies on local expertise, availability and special circumstances like radiation dose, contraindications and the clinical urgency.
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Adamson PD, Fordyce CB, McAllister DA, Udelson JE, Douglas PS, Newby DE. Identification of patients with stable chest pain deriving minimal value from coronary computed tomography angiography: An external validation of the PROMISE minimal-risk tool. Int J Cardiol 2018; 252:31-34. [PMID: 29249436 PMCID: PMC5761719 DOI: 10.1016/j.ijcard.2017.09.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) minimal-risk tool was recently developed to identify patients with suspected stable angina at very low risk of coronary artery disease (CAD) and clinical events. We assessed the external validity of this tool within the context of the Scottish Computed Tomography of the HEART (SCOT-HEART) multicenter randomised controlled trial of patients with suspected stable angina due to coronary disease. METHODS The minimal-risk tool was applied to 1764 patients with complete imaging and follow-up data. External validity was compared with the guideline-endorsed CAD Consortium (CADC) risk score and determined through tests of model discrimination and calibration. RESULTS A total of 531 (30.1%, mean age 52.4years, female 62.0%) patients were classified as minimal-risk. Compared to the remainder of the validation cohort, this group had lower estimated pre-test probability of coronary disease according to the CADC model (30.0% vs 47.0%, p<0.001). The PROMISE minimal-risk tool improved discrimination compared with the CADC model (c-statistic 0.785 vs 0.730, p<0.001) and was improved further following re-estimation of covariate coefficients (c-statistic 0.805, p<0.001). Model calibration was initially poor (χ2 197.6, Hosmer-Lemeshow [HL] p<0.001), with significant overestimation of probability of minimal risk, but improved significantly following revision of the PROMISE minimal-risk intercept and covariate coefficients (χ2 5.6, HL p=0.692). CONCLUSION AND RELEVANCE Despite overestimating the probability of minimal-risk, the PROMISE minimal-risk tool outperforms the CADC model with regards to prognostic discrimination in patients with suspected stable angina, and may assist clinicians in decisions regarding non-invasive testing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01149590.
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Affiliation(s)
- Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Christopher B Fordyce
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - James E Udelson
- The CardioVascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA, United States
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ, Schoepf UJ, Shaw LJ, Stillman AE, White CS, Woodard PK, Leipsic JA. Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovasc Imaging 2017; 9:1099-1113. [PMID: 27609151 DOI: 10.1016/j.jcmg.2016.05.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/29/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022]
Abstract
The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.
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Suntharalingam S, Mikat C, Stenzel E, Erfanian Y, Wetter A, Schlosser T, Forsting M, Nassenstein K. Submillisievert standard-pitch CT pulmonary angiography with ultra-low dose contrast media administration: A comparison to standard CT imaging. PLoS One 2017; 12:e0186694. [PMID: 29045463 PMCID: PMC5646863 DOI: 10.1371/journal.pone.0186694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/19/2017] [Accepted: 10/05/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the image quality and radiation dose of submillisievert standard-pitch CT pulmonary angiography (CTPA) with ultra-low dose contrast media administration in comparison to standard CTPA. Materials and methods Hundred patients (56 females, 44 males, mean age 69.6±15.4 years; median BMI: 26.6, IQR: 5.9) with suspected pulmonary embolism were examined with two different protocols (n = 50 each, group A: 80 kVp, ref. mAs 115, 25 ml of contrast medium; group B: 100 kVp, ref. mAs 150, 60 ml of contrast medium) using a dual-source CT equipped with automated exposure control. Objective and subjective image qualities, radiation exposure as well as the frequency of pulmonary embolism were evaluated. Results There was no significant difference in subjective image quality scores between two groups regarding pulmonary arteries (p = 0.776), whereby the interobserver agreement was excellent (group A: k = 0.9; group B k = 1.0). Objective image analysis revealed that signal intensities (SI), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the pulmonary arteries were equal or significantly higher in group B. There was no significant difference in the frequency of pulmonary embolism (p = 0.65). Using the low dose and low contrast media protocol resulted in a radiation dose reduction by 71.8% (2.4 vs. 0.7 mSv; p<0.001). Conclusions This 80 kVp standard pitch CTPA protocol with 25 ml contrast agent volume can obtain sufficient image quality to exclude or diagnose pulmonary emboli while reducing radiation dose by approximately 71%.
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Affiliation(s)
- Saravanabavaan Suntharalingam
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- * E-mail:
| | - Christian Mikat
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Elena Stenzel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Youssef Erfanian
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Kang D, Hua H, Peng N, Zhao J, Wang Z. Improving Image Quality of Coronary Computed Tomography Angiography Using Patient Weight and Height-Dependent Scan Trigger Threshold. Acad Radiol 2017; 24:462-469. [PMID: 27940232 DOI: 10.1016/j.acra.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES We aim to improve the image quality of coronary computed tomography angiography (CCTA) by using personalized weight and height-dependent scan trigger threshold. MATERIALS AND METHODS This study was divided into two parts. First, we performed and analyzed the 100 scheduled CCTA data, which were acquired by using body mass index-dependent Smart Prep sequence (trigger threshold ranged from 80 Hu to 250 Hu based on body mass index). By identifying the cases of high quality image, a linear regression equation was established to determine the correlation among the Smart Prep threshold, height, and body weight. Furthermore, a quick search table was generated for weight and height-dependent Smart Prep threshold in CCTA scan. Second, to evaluate the effectiveness of the new individual threshold method, an additional 100 consecutive patients were divided into two groups: individualized group (n = 50) with weight and height-dependent threshold and control group (n = 50) with the conventional constant threshold of 150 HU. Image quality was compared between the two groups by measuring the enhancement in coronary artery, aorta, left and right ventricle, and inferior vena cava. By visual inspection, image quality scores were performed to compare between the two groups. RESULTS Regression equation between Smart Prep threshold (K, Hu), height (H, cm), and body weight (BW, kg) was K = 0.811 × H + 1.917 × BW - 99.341. When compared to the control group, the individualized group presented an average overall increase of 12.30% in enhancement in left main coronary artery, 12.94% in proximal right coronary artery, and 10.6% in aorta. Correspondingly, the contrast-to-noise ratios increased by 26.03%, 27.08%, and 23.17%, respectively, and by 633.1% in contrast between aorta and left ventricle. Meanwhile, the individualized group showed an average overall decrease of 22.7% in enhancement of right ventricle and 32.7% in inferior vena cava. There was no significant difference of the image noise between the two groups (P > .05). By visual inspection, the image quality score of the individualized group was higher than that of the control group. CONCLUSION Using personalized weight and height-dependent Smart Prep threshold to adjust scan trigger time can significantly improve the image quality of CCTA.
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Affiliation(s)
- Deqiang Kang
- Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Haiqin Hua
- Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Nan Peng
- Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Jing Zhao
- Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Zhiqun Wang
- Department of Radiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China.
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Budoff MJ, Li D, Kazerooni EA, Thomas GS, Mieres JH, Shaw LJ. Diagnostic Accuracy of Noninvasive 64-row Computed Tomographic Coronary Angiography (CCTA) Compared with Myocardial Perfusion Imaging (MPI): The PICTURE Study, A Prospective Multicenter Trial. Acad Radiol 2017; 24:22-29. [PMID: 27771227 DOI: 10.1016/j.acra.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Although multiple studies have shown excellent accuracy statistics for noninvasive angiography by coronary computed tomographic angiography (CCTA), most studies comparing nuclear imaging to CCTA were performed on patients already referred for cardiac catheterization, introducing referral and selection bias. This prospective trial evaluated the diagnostic accuracy of 64-row CCTA to detect obstructive coronary stenosis compared to myocardial perfusion imaging (MPI), using quantitative coronary angiography (QCA) as a reference standard. MATERIALS AND METHODS Twelve sites prospectively enrolled 230 patients (49% male, 57.8 years) with chest pain. All patients underwent MPI and CCTA (Lightspeed VCT/Visipaque 320, GE Healthcare, Milwaukee, WI, USA) prior to invasive coronary angiography (ICA). All patients were evaluated, and those found to have either an abnormal MPI or CCTA were clinically referred for ICA. CCTAs were graded on a 15-segment American Heart Association model by three blinded readers for presence of obstructive stenosis (>50% or >70%); MPI was graded by two blinded readers using a 17-segment model for estimation of the % myocardium ischemic or with stress defects. ICAs were independently graded for % stenosis by QCA. The efficacies of MPI and CCTA were assessed including all vessel segments for per-patient and per-vessel analyses. RESULTS The prevalence of stenosis ≥50% by ICA was 52.1% (25 of 48). The sensitivity of CCTA was significantly higher than nuclear imaging (92.0% vs 54.5%, P < 0.001), with similar specificity (87.0% vs 78.3%) when obstructive disease was defined as ≥50%. CCTA provided superior sensitivity (92.6% vs 59.3%, P < 0.001) and similar specificity (88.9% vs 81.5%) using QCA stenosis ≥70%. For ≥50% stenosis, the computed tomographic angiography odds ratio for ICA disease was 51.75 (95% CI = 8.50-314.94, P < 0.001). For summed stress score ≥5%, the odds ratio for ICA CAD was 12.73 (95% CI = 2.43-66.55, P < 0.001). Using receiver operating characteristic curve analysis, CCTA was better at classifying obstructive coronary artery disease when compared to MPI (area = 0.85 vs 0.71, P < 0.0001). CONCLUSIONS This study represents one of the first prospective multicenter, controlled clinical trials comparing 64-row CCTA to MPI in the same patients, demonstrating superior diagnostic accuracy of CCTA over myocardial perfusion single photon emission computed tomography (MPS) to reliably detect >50% and >70% stenosis in stable chest pain patients.
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Affiliation(s)
- Matthew J Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California.
| | - Dong Li
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California
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Li X, Chen GZ, Zhao YE, Schoepf UJ, Albrecht MH, Bickford MW, Gu HF, Zhang LJ, Lu GM. Radiation Optimized Dual-source Dual-energy Computed Tomography Pulmonary Angiography: Intra-individual and Inter-individual Comparison. Acad Radiol 2017; 24:13-21. [PMID: 27789203 DOI: 10.1016/j.acra.2016.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to intra-individually and inter-individually compare image quality, radiation dose, and diagnostic accuracy of dual-source dual-energy computed tomography pulmonary angiography (CTPA) protocols in patients with suspected pulmonary embolism (PE). METHODS Thirty-three patients with suspected PE underwent initial and follow-up dual-energy CTPA at 80/Sn140 kVp (group A) or 100/Sn140 kVp (group B), which were assigned based on tube voltages. Subjective and objective CTPA image quality and lung perfusion map image quality were evaluated. Diagnostic accuracies of CTPA and perfusion maps were assessed by two radiologists independently. Effective dose (ED) was calculated and compared. RESULTS Mean computed tomography (CT) values of pulmonary arteries were higher in group A than group B (P = .006). There was no difference in signal-to-noise ratio and contrast-to-noise ratio between the two groups (both P > .05). Interobserver agreement for evaluating subjective image quality of CTPA and color-coded perfusion images was either good (κ = 0.784) or excellent (κ = 0.887). Perfusion defect scores and diagnostic accuracy of CTPA showed no difference between both groups (both P > .05). Effective dose of group A was reduced by 45.8% compared to group B (P < .001). CONCLUSIONS Second-generation dual-source dual-energy CTPA with 80/Sn140 kVp allows for sufficient image quality and diagnostic accuracy for detecting PE while substantially reducing radiation dose.
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Affiliation(s)
- Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew W Bickford
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Hai Feng Gu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
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Carrascosa P, Leipsic JA, Deviggiano A, Capunay C, Vallejos J, Goldsmit A, De Zan MC, Rodriguez-Granillo GA. Virtual Monochromatic Imaging in Patients with Intermediate to High Likelihood of Coronary Artery Disease: Impact of Coronary Calcification. Acad Radiol 2016; 23:1490-1497. [PMID: 27622565 DOI: 10.1016/j.acra.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification. MATERIALS AND METHODS Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population. RESULTS Sixty-seven patients were included. Image quality was significantly lower at 45 keV reconstructions (mean Likert score 45 keV 3.57 ± 0.6, 65 keV 4.07 ± 0.5, and 85 keV 4.09 ± 0.6; P < .0001). Patients with moderate calcification showed a trend toward a significant improvement in the diagnostic performance with 65 keV vs 45 keV reconstructions (45 keV, area under the curve 0.92 [95% confidence interval 0.89-0.95] vs 65 keV, area under the curve 0.96 [95% confidence interval 0.93-0.98], P = .06). The diagnostic performance of DE-CTCA was significantly lower in segments with higher coronary artery calcium scoring compared to segments with none or mild calcification, independent of the energy level applied. CONCLUSIONS In patients with intermediate to high likelihood of CAD, DE-CTCA had a good diagnostic performance, although significantly lower in segments with severe calcification.
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Affiliation(s)
- Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
| | | | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Javier Vallejos
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Alejandro Goldsmit
- Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
| | - Macarena C De Zan
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
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Wu G, Yang J, Zhang T, Morelli JN, Giri S, Li X, Tang W. The diagnostic value of non-contrast enhanced quiescent interval single shot (QISS) magnetic resonance angiography at 3T for lower extremity peripheral arterial disease, in comparison to CT angiography. J Cardiovasc Magn Reson 2016; 18:71. [PMID: 27760564 PMCID: PMC5072342 DOI: 10.1186/s12968-016-0294-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 07/11/2016] [Accepted: 10/07/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD). METHODS 32 consecutive patients (23 male, 9 female, age range 40-81 years, average age 61.97 years) with clinically suspected lower extremity PAD underwent QISS MRA and CTA. 19 of 32 patients underwent Digital Subtraction Angiography (DSA). Image quality of MRA was compared with CTA by two radiologists with 10 and 8 years' experience according to a 4-point scale. The Kappa test was used to determine the intermodality agreement between MRA and CTA in stenosis assessment, and interobserver agreement with each method. Sensitivity and specificity of CTA and MRA in detecting hemodynamically significant stenosis (≥50 %) were compared, with DSA serving as reference standard when available. RESULTS Image quality of QISS MRA was rated 3.70 ± 0.49 by reader 1, and 3.72 ± 0.47 by reader 2, significantly lower than that of CTA (3.80 ± 0.44 and 3.82 ± 0.42, P < 0.001 for both readers). Intermodality agreement between MRA and CTA was excellent for assessment of stenosis (Kappa = 0.923 ± 0.013 for reader 1, 0.930 ± 0.012 for reader 2). Interobserver agreement was 0.936 ± 0.012 for CTA and 0.935 ± 0.011 for MRA. For readers 1 and 2 respectively, the sensitivity of QISS was 94.25 and 93.26 % (versus 90.11 and 89.13 % for CTA, P > 0.05), and specificity of QISS was 96.70 and 97.75 % (versus 96.55 and 96.51 % for CTA, P > 0.05). For heavily calcified segments, sensitivity of QISS (95.83 and 95.83 %) was significantly higher than that of CTA (74.19 and 76.67 %, P < 0.05). CONCLUSION QISS is a reliable alternative to CTA for evaluation of lower extremity PAD, and may be suitable as a first-line screening examination in patients with contraindications to intravenous contrast administration.
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Affiliation(s)
- Gang Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jun Yang
- Department of Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Tianjing Zhang
- Northeast Asia Collaboration, Siemens Healthineers, Beijing, China
| | | | | | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Wenlin Tang
- MR Scientific, SIEMENS Healthcare, Shanghai, China
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Affiliation(s)
- Marianna Porzio
- Dipartimento di Medicina Interna e Specializzazioni Mediche, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Giulia Cernuschi
- Dipartimento di Medicina Interna e Specializzazioni Mediche, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Valentina Vespro
- Dipartimento di Diagnostica per Immagini, UOC di Radiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giorgio Costantino
- Dipartimento di Medicina Interna e Specializzazioni Mediche, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Lewis MA, Pascoal A, Keevil SF, Lewis CA. Selecting a CT scanner for cardiac imaging: the heart of the matter. Br J Radiol 2016; 89:20160376. [PMID: 27302494 PMCID: PMC5124932 DOI: 10.1259/bjr.20160376] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 04/28/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/05/2022] Open
Abstract
Coronary angiography to assess the presence and degree of arterial stenosis is an examination now routinely performed on CT scanners. Although developments in CT technology over recent years have made great strides in improving the diagnostic accuracy of this technique, patients with certain characteristics can still be "difficult to image". The various groups will benefit from different technological enhancements depending on the type of challenge they present. Good temporal and spatial resolution, wide longitudinal (z-axis) detector coverage and high X-ray output are the key requirements of a successful CT coronary angiography (CTCA) scan. The requirement for optimal patient dose is a given. The different scanner models recommended for CTCA all excel in different aspects. The specification data presented here for these scanners and the explanation of the impact of the different features should help in making a more informed decision when selecting a scanner for CTCA.
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Affiliation(s)
- Maria A Lewis
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Pascoal
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen F Keevil
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Cornelius A Lewis
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
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Sechtem U, Greulich S, Ong P. [Recommendations of the ESC guidelines regarding cardiovascular imaging]. Herz 2016; 41:362-70. [PMID: 27388914 DOI: 10.1007/s00059-016-4453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac imaging plays a key role in the diagnosis and risk stratification in the ESC guidelines for the management of patients with stable coronary artery disease. Demonstration of myocardial ischaemia guides the decision which further diagnostic and therapeutic strategy should be followed in these patients. One should, however, not forget that there are no randomised studies supporting this type of management. In patients with a low pretest probability coronary CT angiography is the optimal tool to exclude coronary artery stenoses rapidly and effectively. In the near future, however, better data is needed showing how much cardiac imaging is really necessary and how cost-effective it is in patients with stable coronary artery disease.
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Affiliation(s)
- U Sechtem
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - S Greulich
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - P Ong
- Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
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Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ, Schoepf UJ, Shaw LJ, Stillman AE, White CS, Woodard PK, Leipsic JA. CAD-RADS™: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Am Coll Radiol 2016; 13:1458-1466.e9. [PMID: 27318576 DOI: 10.1016/j.jacr.2016.04.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/24/2016] [Indexed: 02/07/2023]
Abstract
The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States.
| | - Suhny Abbara
- Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States.
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany.
| | - Arthur Agatston
- Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States.
| | - Daniel S Berman
- Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States.
| | | | - Karin E Dill
- 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States.
| | - Jill E Jacobs
- 550 First Avenue, New York, NY, 10016, United States.
| | | | - Geoffrey D Rubin
- 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States.
| | - Frank J Rybicki
- The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada.
| | | | - Leslee J Shaw
- 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States.
| | | | - Charles S White
- University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States.
| | - Pamela K Woodard
- Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States.
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States.
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40
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Hanley M, Ahmed O, Chandra A, Gage KL, Gerhard-Herman MD, Ginsburg M, Gornik HL, Johnson PT, Oliva IB, Ptak T, Steigner ML, Strax R, Rybicki FJ, Dill KE. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation. J Am Coll Radiol 2016; 13:796-800. [PMID: 27209598 DOI: 10.1016/j.jacr.2016.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
Pulmonary arteriovenous malformations are often included in the differential diagnosis of common clinical presentations, including hypoxemia, hemoptysis, brain abscesses, and paradoxical stroke, as well as affecting 30% to 50% of patients with hereditary hemorrhagic telangiectasia (HHT). Various imaging studies are used in the diagnostic and screening settings, which have been reviewed by the ACR Appropriateness Criteria Vascular Imaging Panel. Pulmonary arteriovenous malformation screening in patients with HHT is commonly performed with transthoracic echocardiographic bubble study, followed by CT for positive cases. Although transthoracic echocardiographic bubble studies and radionuclide perfusion detect right-to-left shunts, they do not provide all of the information needed for treatment planning and may remain positive after embolization. Pulmonary angiography is appropriate for preintervention planning but not as an initial test. MR angiography has a potential role in younger patients with HHT who may require lifelong surveillance, despite lower spatial resolution compared with CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- Michael Hanley
- University of Virginia Health System, Charlottesville, Virginia.
| | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California, Society for Vascular Surgery
| | | | | | | | - Heather L Gornik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, American College of Cardiology
| | | | - Isabel B Oliva
- University of Arizona College of Medicine, Tucson, Arizona
| | - Thomas Ptak
- Massachusetts General Hospital, Boston, Massachusetts
| | - Michael L Steigner
- Brigham and Women's Hospital, Boston, Massachusetts, American College of Cardiology
| | | | - Frank J Rybicki
- Ottawa Hospital Research Institute and the Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Achenbach S. CardioPulse: The future of coronary computer tomography angiography. Eur Heart J 2016; 37:661-663. [PMID: 27331220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Stephan Achenbach reviews the history of coronary computer tomography angiography and discusses its further evolution.
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Abstract
UNLABELLED Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease. CLINICAL TRIAL NUMBER NCT01149590, post-results.
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Affiliation(s)
- Alastair J Moss
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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