Long-term evaluation of a selective retrograde coronary venous perfusion model in pigs (Sus scrofa domestica).

The lack of suitable target vessels remains a challenge for aortocoronary bypass grafting in end-stage coronary heart disease. This study aimed to investigate the arterialization of cardiac veins as an alternative myocardial revascularization strategy in an experimental long-term model in pigs. Selective retrograde perfusion of a coronary vein (aorta to coronary vein bypass, retrobypass) before ligation of the ramus interventricularis paraconalis (equivalent to the left anterior descending artery in humans) was performed in 20 German Landrace pigs (Sus scrofa domestica). Retroperfusion of the left anterior descending vein was performed in 10 pigs (RP+) but not in the other 10 (RP-), and the vena cordis magna was ligated (L+) in 5 pigs in each of these groups but left open (L-) in the remaining animals. Hemodynamic performance (for example, cardiac output) was significantly better in the group that underwent selective retroperfusion with proximal ligation of vena cordis magna (RP+L+; 4.1 L/min) compared with the other groups (RP+L-, 2.5 L/min; RP-L+, 2.2 L/min; RP-L-, 1.9 L/min). Long-term survival was significantly better in RP+L+ pigs (112±16 d) than in all other groups. Histologic follow-up studies showed significantly less necrosis in the RP+L+ group compared with all other groups. Venous retroperfusion is an effective technique to achieve long-term survival after acute occlusion of the left anterior descending artery in a pig model. In this model, proximal ligation of vena cordis magna is essential.

Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience.

OBJECTIVE: We evaluated radiation exposure and image quality of a new coronary CT angiography protocol, high-pitch spiral acquisition, using dual source CT (DSCT). MATERIAL AND METHODS: Coronary CTAwas performed in 25 consecutive patients with a stable heart rate of 60 bpm or less after premedication, using 2 x 128 0.6-mm sections, 38.4-mm collimation width and 0.28-s rotation time. Tube settings were 100 kV/320 mAs and 120 kV/400 mAs for patients below and above 100-kg weight, respectively. Data acquisition was prospectively ECG-triggered at 60% of the R-R interval using a pitch of 3.2 (3.4 for the last 10 patients). Images were reconstructed with 75-ms temporal resolution, 0.6-mm slice thickness and 0.3-mm increment. Image quality was evaluated using a four-point scale (1 = excellent, 4 = unevaluable). RESULTS: Mean range of data acquisition was 113 +/- 22 mm, mean duration was 268 +/- 23 ms. Of 363 coronary artery segments, 327 had an image quality score of 1, and only 2 segments were rated as "unevaluable". Mean dose-length product (DLP) was 71 +/- 23 mGy cm, mean effective dose was 1.0 +/- 0.3 mSv (range 0.78-2.1 mSv). For 21 patients with a body weight below 100 kg, mean DLP was 63 +/- 5 mGy cm (0.88 +/- 0.07 mSv; range 0.78-0.97 mSv). CONCLUSION: Prospectively ECGtriggered high-pitch spiral CT acquisition provides high and stable image quality at very low radiation dose.

Cardiac spiral dual-source CT with high pitch: a feasibility study.

Increase of pitch in spiral CT decreases data acquisition time; dual-source CT (DSCT) systems provide improved temporal resolution. We evaluated the combination of these two features. Measurements were performed using a commercial DSCT system equipped with prototype software allowing pitch factors from p = 0.35 to 3.0. We measured slice sensitivity profiles as a function of pitch to assess spatial resolution in the z-direction and the contrast of structures moved periodically to measure temporal resolution. Additionally we derived modulation transfer functions to provide objective parameters; both spatial and temporal resolution were essentially unchanged even at high pitch. CT of the cardiac region of three pigs was performed at p = 3.0. In vivo CT images confirmed good image quality; direct comparison with standard low-pitch phase-correlated CT image datasets showed no significant difference. For a normalized z-axis acquisition of 12 cm, the corresponding effective dose value was 2.0 mSv for the high-pitch CT protocol. We conclude that spiral DSCT imaging with a pitch of 3.0 can provide unimpaired image quality with respect to spatial and temporal resolution. Applications to cardiac and thoracic imaging with effective dose below 1 mSv are possible.

Respiratory phase-correlated micro-CT imaging of free-breathing rodents.

We provide a dedicated phase-correlated imaging procedure for respiratory gating in micro-CT imaging with automatic detection of the optimal data window providing the least amount of motion blurring. A rawdata-based motion function (kymogram) was used for synchronization purposes and for identification of the optimal data window used for phase-correlated image reconstruction. Measurements were performed on a dual-source micro-CT scanner. Projection data were acquired over ten rotations for multi-segment phase-correlated reconstruction. Visual assessment was performed on datasets of ten free-breathing subjects. The kymogram approach provided a reliable synchronization signal for phase-correlated image reconstruction. Also, it allowed for the identification of phase intervals of increased and decreased motion and the corresponding detection of the optimal reconstruction phase. Phase-correlated images showed a strong improvement with respect to motion blurring compared to standard image reconstruction. A reconstruction for the calculated optimal data window provided the least amount of motion blurring and even allowed for the assessment of small structures in the lung. The dedicated retrospective phase-correlated image reconstruction procedure for respiratory gating is a feasible approach for motion-free imaging. A subject-specific optimal reconstruction phase can minimize motion blurring and further improve image quality.

Technical note: raw data-based approach to identify the optimal reconstruction phase in coronary computed tomography angiography.

For coronary computed tomography (CT) angiography, the reconstruction phase finally used has to be iteratively adapted to the patient-specific heart motion to provide optimal image quality and therewith to improve the diagnostic value. The purpose was to provide an automatically raw data-based identification of the patient-specific optimal reconstruction phase for cardiac computed tomography imaging. We validated our method by a visual assessment of 65 patient data sets. In 52% of all cases, the highest correlation of the computed and the visually identified optimal reconstruction phase was ensured. In 30% of the cases, our method provided a higher image quality compared with the results obtained in routine clinical work. Our identification of the optimal reconstruction phase is a reliable method and can improve the medical workflow by providing optimal image quality with the initial image reconstruction, making multiple time-consuming image reconstructions obsolete.

Real-time determination of the optimal reconstruction phase to control ECG pulsing in spiral cardiac CT.

The reconstruction phase providing optimal image quality in coronary CT angiography is dependent on the heart rate but additionally displays substantial patient-dependent variation. The purpose of this study was to provide online identification of the patient-specific optimal reconstruction phase during CT coronary angiography data acquisition and to allow adaptation of tube current modulation for the individual patient. A raw data-based cardiac motion signal (kymogram) was used for the detection of the optimal reconstruction phase. The individual motion curve of each patient was correlated with dedicated template curves to reduce signal noise. Data sets of 90 consecutive patients were used for validation purposes. The reliability of our approach increased with scan time and provided highest correlation with the visually identified optimal reconstruction phase already after half of the total scan time indicated by a difference value of 13.2% and 8.2%, respectively. A high correlation of the computed and the visually identified optimal reconstruction phase was assured in most cases providing a dose reduction of 36% compared to conventional TCM application for a confidence interval of 80%. Our method is a fully automatic computer-assisted approach identifying the optimal reconstruction phase with high reliability while online capability can be ensured. We conclude that our method can identify cardiac phases providing highest image quality already during CT scanning. Reduction of the tube current by a patient-specific optimization providing a minimal dose level is the major benefit for the patients.

Cardiac phase-correlated image reconstruction and advanced image processing in pulmonary CT imaging.

Image quality in pulmonary CT imaging is commonly degraded by cardiac motion artifacts. Phase-correlated image reconstruction algorithms known from cardiac imaging can reduce motion artifacts but increase image noise and conventionally require a concurrently acquired ECG signal for synchronization. Techniques are presented to overcome these limitations. Based on standard and phase-correlated images that are reconstructed using a raw data-derived synchronization signal, image-merging and temporal-filtering techniques are proposed that combine the input images automatically or interactively. The performance of the approaches is evaluated in patient and phantom datasets. In the automatic approach, areas of strong motion and static areas were well detected, providing an optimal combination of standard and phase-correlated images with no visible border between the merged regions. Image noise in the non-moving regions was reduced to the noise level of the standard reconstruction. The application of the interactive filtering allowed for an optimal adaptation of image noise and motion artifacts. Noise content after interactive filtering decreased with increasing temporal filter width used. We conclude that a combination of our motion-free merging approach and a dedicated interactive filtering procedure can highly improve pulmonary imaging with respect to motion artifacts and image noise.

Modulation transfer function-based assessment of temporal resolution: validation for single- and dual-source CT.

The purpose of this study was to determine a manufacturer-independent quality assurance measurement for temporal resolution with a three-dimensional cardiac motion robot; validation was with single-source (SS) and dual-source (DS) computed tomography (CT). Image acquisition was performed by using standard cardiac protocols. Image contrast-based modulation transfer function (MTF) was assessed as function of time. For motion frequency of 60 beats per minute, MTF slightly decreased by 14% and 6% for SS CT and DS CT, respectively. For higher frequencies, a stronger decrease of MTF (eg, by 50% [SS CT] and 18% [DS CT] at 120 beats per minute) was detected. Effect of manufacturer's adaptive bisegment algorithm for SS CT and corresponding resonance effects of rotation time and heart rate were quantified. The robot-based approach is a reproducible, objective way to assess temporal resolution; it allows practical measurement of temporal resolution and comparison of CT scanners and protocols.

Validation of a raw data-based synchronization signal (kymogram) for phase-correlated cardiac image reconstruction.

Phase-correlated reconstruction is commonly used in computed tomography (CT)-based cardiac imaging. Alternatively to the commonly used ECG, the raw data-based kymogram function can be used as a synchronization signal. We used raw data of 100 consecutive patient exams to compare the performance of kymogram function to the ECG signal. For objective validation the correlation of the ECG and the kymogram was assessed. Additionally, we performed a double-blinded comparison of ECG-based and kymogram-based phase-correlated images. The two synchronization signals showed good correlation indicated by a mean difference in the detected heart rate of negligible 0.2 bpm. The mean image quality score was 2.0 points for kymogram-correlated images and 2.3 points for ECG-correlated images, respectively (3: best; 0: worst). The kymogram and the ECG provided images adequate for diagnosis for 93 and 97 patients, respectively. For 50% of the datasets the kymogram provided an equivalent or even higher image quality compared with the ECG signal. We conclude that an acceptable image quality can be assured in most cases by the kymogram. Improvements of image quality by the kymogram function were observed in a noticeable number of cases. The kymogram can serve as a backup solution when an ECG is not available or lacking in quality.

Rawdata-based detection of the optimal reconstruction phase in ECG-gated cardiac image reconstruction.

In order to achieve diagnostically useful CT (computed tomography) images of the moving heart, the standard image reconstruction has to be modified to a phase-correlated reconstruction, which considers the motion phase of the heart and generates a quasi-static image in one defined motion phase. For that purpose a synchronization signal is needed, typically a concurrent ECG recording. Commonly, the reconstruction phase is adapted by the user to the patient-specific heart motion to improve the image quality and thus the diagnostic value. The purpose of our work is to automatically identify the optimal reconstruction phase for cardiac CT imaging with respect to motion artifacts. We provide a solution for a patient- and heart rate-independent detection of the optimal phase in the cardiac cycle which shows a minimum of cardiac movement. We validated our method by the correlation with the reconstruction phase selected visually on the basis of ECG-triggering and used for the medical diagnosis. The mean difference between both reconstruction phases was 12.5% with respect to a whole cardiac motion cycle indicating a high correlation. Additionally, reconstructed cardiac images are shown which confirm the results expressed by the correlation measurement and in some cases even indicating an improvement using the proposed method.