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1.
Eur Radiol ; 2024 May 04.
Article in English | MEDLINE | ID: mdl-38703188

ABSTRACT

OBJECTIVES: To compare the repeatability and interrelation of various late gadolinium enhancement (LGE) assessment techniques for monitoring fibrotic changes in myocarditis follow-up. MATERIALS AND METHODS: LGE extent change between baseline and 3-month cardiovascular magnetic resonance (CMR) was compared in patients with acute myocarditis using the full width at half maximum (FWHM), gray-scale thresholds at 5 and 6 standard deviations (SD5 and SD6), visual assessment with threshold (VAT) and full manual (FM) techniques. In addition, visual presence score (VPS), visual transmurality score (VTS), and a simplified visual change score (VCS) were assessed. Intraclass-correlation (ICC) was used to evaluate repeatability, and methods were compared using Spearman's correlation. RESULTS: Forty-seven patients (38 male, median age: 27 [IQR: 21; 38] years) were included. LGE extent change differed among quantitative techniques (p < 0.01), with variability in the proportion of patients showing LGE change during follow-up (FWHM: 62%, SD5: 74%, SD6: 66%, VAT: 43%, FM: 60%, VPS: 53%, VTS: 77%, VCS: 89%). Repeatability was highest with FWHM (ICC: 0.97) and lowest with SD5 (ICC: 0.89). Semiquantitative scoring had slightly lower values (VPS ICC: 0.81; VTS ICC: 0.71). VCS repeatability was excellent (ICC: 0.93). VPS and VTS correlated with quantitative techniques, while VCS was positively associated with VPS, VTS, VAT, and FM, but not with FWHM, SD5, and SD6. CONCLUSION: FWHM offers the least observer-dependent LGE follow-up after myocarditis. VPS, VTS, and VCS are practical alternatives, showing reliable correlations with quantitative methods. Classification of patients exhibiting either stable or changing LGE relies on the assessment technique. CLINICAL RELEVANCE STATEMENT: This study shows that LGE monitoring in myocarditis is technique-dependent; the FWHM method yields the most consistent fibrotic tracking results, with scoring-based techniques as reliable alternatives. KEY POINTS: Recognition of fibrotic changes during myocarditis follow-up is significantly influenced by the choice of the quantification technique employed. The FWHM technique ensures highly repeatable tracking of myocarditis-related LGE changes. Segment-based visual scoring and the simplified visual change score offer practical, reproducible alternatives in resource-limited settings.

2.
JACC Case Rep ; 29(1): 102151, 2024 Jan 03.
Article in English | MEDLINE | ID: mdl-38223269

ABSTRACT

Acute chest pain and dyspnea often raise coronary disease suspicion. When echocardiography and cardiac computed tomography findings appear normal, alternative diagnoses should be explored. We present a case initially suggestive of myocarditis but later revealed as coronary dissection by cardiac magnetic resonance. This case emphasizes the role of advanced imaging in atypical cardiac presentations.

3.
Int J Cardiovasc Imaging ; 39(6): 1169-1178, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36826613

ABSTRACT

PURPOSE: Numerous electrocardiogram (ECG) abnormalities and late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR) have been related to poor prognosis in acute myocarditis. We evaluated whether ECG parameters are associated with the distribution and dynamic of LGE along the course of myocarditis. METHODS: Fifty-one patients with CMR confirmed acute myocarditis were included who underwent CMR with LGE and 12-lead ECG at baseline and 3-month follow-up at our institution. The association between the presence, regional distribution and change of ECG parameters and LGE was investigated using linear regression analysis. LGE was quantified as visual presence score (VPS) and visual transmurality score (VTS). RESULTS: Among many ECG parameters only > 1 mm ST-elevation (STE) was associated with VPS and VTS at baseline (ß = 3.08 [95%CI: 1.75; 4.41], p = < 0.001 and ß = 5.40 [95%CI: 1.92; 8.88], p = 0.004; respectively). STE was most frequent in lateral and inferior ECG-leads (48% and 31%) and it was associated with VPS and VTS in these localizations (p < 0.05 all), however no association between anterior-septal STE and LGE could be confirmed. At follow-up the regression of STE was associated with the regression of VPS and VTS in univariate analysis (ß=-1.49 [95%CI: -2.41; -0.57], p = 0.003 and ß=-4.87 [95%CI: -7.18; -2.56], p = 0.001, respectively), which remained significant for VTS using a multivariate model (ß=-2.39 [95%CI: -3.32; -0.47], p = 0.019). CONCLUSION: Although we demonstrated some promising associations between STE and LGE, the usability of ECG to estimate the territorial involvement and dynamical changes of LGE along the course of myocarditis is generally limited and cardiac magnetic resonance should be considered for this purpose.


Subject(s)
Myocarditis , Humans , Myocarditis/pathology , Contrast Media , Gadolinium , Magnetic Resonance Imaging, Cine/methods , Predictive Value of Tests , Electrocardiography/methods , Arrhythmias, Cardiac
4.
Eur Radiol ; 33(1): 339-347, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35984513

ABSTRACT

OBJECTIVES: In patients of advanced age, the feasibility of myocardial ischemia testing might be limited by age-related comorbidities and falling compliance abilities. Therefore, we aimed to test the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population as compared to reference standard fractional flow reserve (FFR). METHODS: Fifty-six patients at age 75 years or older (mean age 79 ± 4 years, 35 male) underwent 3D CMR perfusion imaging and invasive coronary angiography with FFR in 5 centers using the same study protocol. The diagnostic accuracy of CMR was compared to a control group of 360 patients aged below 75 years (mean age 61 ± 9 years, 262 male). The percentage of myocardial ischemic burden (MIB) relative to myocardial scar burden was further analyzed using semi-automated software. RESULTS: Sensitivity, specificity, and positive and negative predictive values of 3D perfusion CMR deemed similar for both age groups in the detection of hemodynamically relevant (FFR < 0.8) stenosis (≥ 75 years: 86%, 83%, 92%, and 75%; < 75 years: 87%, 80%, 82%, and 85%; p > 0.05 all). While MIB was larger in the elderly patients (15% ± 17% vs. 9% ± 13%), the diagnostic accuracy of 3D CMR perfusion was high in both elderly and non-elderly populations to predict pathological FFR (AUC: 0.906 and 0.866). CONCLUSIONS: 3D CMR perfusion has excellent diagnostic accuracy for the detection of hemodynamically relevant coronary stenosis, independent of patient age. KEY POINTS: • The increasing prevalence of coronary artery disease in elderly populations is accompanied with a larger ischemic burden of the myocardium as compared to younger individuals. • 3D cardiac magnetic resonance perfusion imaging predicts pathological fractional flow reserve in elderly patients aged ≥ 75 years with high diagnostic accuracy. • Ischemia testing with 3D CMR perfusion imaging has similarly high accuracy in the elderly as in younger patients and it might be particularly useful when other non-invasive techniques are limited by aging-related comorbidities and falling compliance abilities.


Subject(s)
Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Myocardial Perfusion Imaging , Humans , Male , Aged , Aged, 80 and over , Middle Aged , Coronary Artery Disease/diagnosis , Myocardial Perfusion Imaging/methods , Severity of Illness Index , Coronary Angiography/methods , Predictive Value of Tests , Perfusion , Magnetic Resonance Spectroscopy
5.
JACC Case Rep ; 4(17): 1115-1118, 2022 Sep 07.
Article in English | MEDLINE | ID: mdl-36124157

ABSTRACT

We present the case of a patient who presented with palpitations and was found to have atrioventricular re-entrant tachycardia with unusually elevated cardiac biomarkers. A coronary computed tomographic angiography showed a myocardial left anterior descending artery bridge; an accessory pathway was ablated, and cardiac magnetic resonance revealed anteroseptal myocardial infarction resulting from hypoperfusion during tachycardia caused by the left anterior descending artery myocardial bridge. (Level of Difficulty: Intermediate.).

6.
BMC Cardiovasc Disord ; 22(1): 226, 2022 05 18.
Article in English | MEDLINE | ID: mdl-35585495

ABSTRACT

BACKGROUND: The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. METHODS: 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. RESULTS: Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). CONCLUSION: Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available.


Subject(s)
Cicatrix , Myocardial Infarction , Aged , Cicatrix/diagnostic imaging , Cicatrix/etiology , Cicatrix/pathology , Follow-Up Studies , Humans , Magnetic Resonance Imaging, Cine/methods , Magnetic Resonance Spectroscopy , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/pathology , Myocardium/pathology , Retrospective Studies , Ventricular Function, Left
7.
Br J Radiol ; 95(1133): 20210966, 2022 May 01.
Article in English | MEDLINE | ID: mdl-35195448

ABSTRACT

OBJECTIVES: Late gadolinium enhancement with fixed short inversion time (LGEshort) provides excellent tissue contrast with dark scar and bright blood pool and does not need prior myocardial nulling. We hypothesize better visibility of ischemic scars and equal visibility of non-ischemic LGE in LGEshort compared to clinically established LGE (LGEstandard). METHODS: LGEshort and LGEstandard were retrospectively evaluated in 179 patients (3043 segments) with suspected or known coronary artery disease by four blinded readers (reader A: most experienced - D: least experienced). The amount of ischemic and non-ischemic LGE as well as visibility (4: very good - 1: poor) of ischemic LGE was visually assessed. RESULTS: All readers detected more infarcted segments in LGEshort compared to LGEstandard (378 segments reported as infarcted; A:p = 0.5, B:p = 0.8, C,D:p = 0.03). Scar visibility was scored higher in LGEshort by all readers (A,B:p = 0.03; C,D:p = 0.02), especially for subendocardial infarcts (A,B:p = 0.04, C,D:p = 0.02). Less experienced readers detected significantly more infarcted papillary muscles (C:p = 0.02, D:p = 0.03) in a shorter reading time in LGEshort (C:p = 0.04, D:p = 0.02). Non-ischemic LGE was equally visible in both sequences (A:p = 0.9, B:p = 0.8, C,D:p = 0.6). CONCLUSIONS: LGEshort detects more ischemic LGE with improved scar visibility compared to LGEstandard, independent of experience level. The visibility of non-ischemic LGE is equivalent to LGEstandard. Less experienced readers can diagnose ischemic and non-ischemic LGE faster in LGEshort. ADVANCES IN KNOWLEDGE: LGEshort with its maximal operational simplicity can be used for visualization of all types of fibrosis - ischemic and non-ischemic - instead of LGEstandard, independent of experience level.


Subject(s)
Cardiomyopathies , Gadolinium , Cicatrix/diagnostic imaging , Contrast Media , Fibrosis , Humans , Image Enhancement , Ischemia , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Myocardium/pathology , Predictive Value of Tests , Retrospective Studies
8.
Eur J Cardiothorac Surg ; 61(2): 459-466, 2022 Jan 24.
Article in English | MEDLINE | ID: mdl-34410332

ABSTRACT

OBJECTIVES: Computed tomography angiography (CTA) is broadly used for long-term follow-up of graft patency after coronary artery bypass graft surgery (CABG). However, its clinical value in the early postoperative setting has not been established yet. We evaluated the benefit of adding CTA to the routine clinical work-up after CABG on patient management. METHODS: A total of 305 consecutive patients (269 males, median age 68 years) underwent CABG and postoperative CTA with a median of 6 days after surgery. Graft patency and additional imaging findings were assessed and their influence on diagnosis and clinical management was evaluated. RESULTS: Graft occlusion or high-grade stenosis was found in 15% of the patients. Additional findings were reported in 44% of the patients, including pericardial (2%) and pleural effusion (27%), large pneumothorax (11%), pulmonary infection (4%), cardiac or vascular thrombus (2%), pulmonary embolism (2%), sternal dehiscence (1%) and additional incidental findings requiring follow-up (6%). CT findings initiated new diagnostic and/or therapeutic measures in 15% of the patients, 47% of those with diseased grafts and 19% of patients with non-graft-related findings. No adverse events related to CTA were documented. CONCLUSIONS: Early routine postoperative assessment of CABG with CTA reveals both cardiac and non-cardiac findings with a high frequency, affecting clinical management in a substantial proportion of patients.


Subject(s)
Computed Tomography Angiography , Graft Occlusion, Vascular , Aged , Coronary Angiography/methods , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Humans , Male , Tomography, X-Ray Computed/methods , Vascular Patency
9.
Radiol Cardiothorac Imaging ; 4(6): e220109, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36601458

ABSTRACT

Purpose: To compare three-dimensional (3D) whole-heart MRI with isotropic submillimeter resolution with standard two-dimensional (2D) cine MRI in measuring the bilayered myocardium in left ventricular noncompaction (LVNC). Materials and Methods: Twenty-four patients with LVNC (mean age, 42 years ± 16 [SD]) were retrospectively enrolled between October 2011 and July 2020. Compacted myocardium (CM) and noncompacted myocardium (NCM) were measured in long axis (Petersen approach) and short axis (Jacquier approach) at 3D whole-heart and 2D cine MRI by two independent readers. Image quality (1 = excellent, 2 = adequate, 3 = nondiagnostic), considering discrimination between NCM and CM and CM and adjacent tissue, was evaluated. Pearson, Spearman, and intraclass correlation tests were used as statistical tests. Results: In long-axis measurements, the correlation between both sequences was moderate to strong for CM (Pearson, 0.66-0.79; Spearman, 0.61-0.68) and strong to very strong for NCM (Pearson, 0.90-0.97; Spearman, 0.77-0.91). Intraclass correlation coefficient (ICC) in 3D whole-heart MRI was 0.90 (95% CI: 0.78, 0.95) for CM and 0.94 (95% CI: 0.84, 0.97) for NCM, while ICC in 2D cine MRI was 0.77 (95% CI: 0.55, 0.89) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. Short-axis CM and NCM measurements had a strong to very strong correlation between both sequences (Pearson, 0.86-0.98; Spearman, 0.82-0.98). ICC in 3D whole-heart MRI was 0.96 (95% CI: 0.94, 0.99) for CM and 0.98 (95% CI: 0.97, 0.99) for NCM, while ICC in 2D cine MRI was 0.82 (95% CI: 0.63, 0.92) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. 3D whole-heart MRI demonstrated higher image quality than did 2D cine MRI (P < .001). Conclusion: 3D whole-heart MRI revealed higher image quality, with better structure discrimination and interobserver agreement in LVNC measurements, compared with standard 2D cine images.Keywords: MR Imaging, Cardiac, Cardiovascular Magnetic Resonance, Left Ventricular Noncompaction, Free-breathing Imaging Technique Supplemental material is available for this article. © RSNA, 2022See also the commentary by Jensen and Petersen in this issue.

13.
Eur Radiol ; 30(4): 1997-2009, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31844958

ABSTRACT

OBJECTIVE: To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study. MATERIALS AND METHODS: From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB). RESULTS: We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13). CONCLUSION: We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations. KEY POINTS: • Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.


Subject(s)
Computed Tomography Angiography/methods , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Coronary Vessels/diagnostic imaging , Female , Humans , Male , Middle Aged , Pilot Projects , Reproducibility of Results
14.
J Cardiovasc Comput Tomogr ; 13(2): 128-133, 2019.
Article in English | MEDLINE | ID: mdl-30528167

ABSTRACT

BACKGROUND: We sought to compare quantitative coronary CT angiography (CTA) assessment versus standard clinical reading to identify heart transplanted (HTX) patients with progressive coronary wall thickening. METHODS: 35 patients (23 males, age 58 [IQR: 50;61] years) underwent 256-slice coronary CTA at one year and two years after HTX to rule out cardiac allograft vasculopathy (CAV). In addition to the standard clinical read, we quantified total vessel wall volume in all coronaries up to 2-mm luminal diameter. Fixed threshold settings were used to assess calcified (>350 HU) and non-calcified vessel wall components with high- (131-350 HU), intermediate- (75-130 HU) and low-attenuation (<75 HU). RESULTS: Total lumen volume did not change between baseline and follow-up studies (p = 0.59). Total vessel wall volume showed significant increase (464 [IQR: 338; 570] vs. 563 [IQR: 345; 717] mm3, p < 0.001). The volume of high-, intermediate and low-attenuation non-calcified wall components showed progression (332 [IQR: 217;425] vs. 385 [IQR: 238;489], 40 [IQR: 12;48] vs. 59 [IQR: 16;83] and 18 [IQR: 4;21] vs. 46 [IQR: 6;41] mm3, respectively, p < 0.05 all), while calcified volume did not change between baseline and follow-up CTAs (72 [IQR: 16;127] vs. 72 [IQR: 29;102] mm3, p = 0.73). Quantitative analysis identified more patients with progressive coronary wall thickening (≥10% cut-off) than standard clinical read (11 vs. 22, p = 0.01). CONCLUSION: Quantitative coronary wall assessment is feasible with coronary CTA in HTX patients. Coronary wall thickening within the first two years after HTX is mainly attributable to non-calcified lesion components and might be an early sign of CAV.


Subject(s)
Computed Tomography Angiography , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Heart Transplantation/adverse effects , Multidetector Computed Tomography , Coronary Artery Disease/etiology , Feasibility Studies , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Treatment Outcome
15.
AJR Am J Roentgenol ; 210(2): 314-319, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29091000

ABSTRACT

OBJECTIVE: Cardiac allograft vasculopathy (CAV) is among the top causes of death 1 year after heart transplantation (HTx). Coronary CT angiography (CTA) is a potential alternative to invasive imaging in the diagnosis of CAV. However, the higher heart rate (HR) of HTx recipients prompts the use of retrospective ECG-gating, which is associated with higher radiation dose, a major concern in this patient population. Therefore, we sought to evaluate the feasibility and image quality of low-radiation-dose prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND METHODS: In total, 1270 coronary segments were evaluated in 50 HTx recipients and 50 matched control subjects who did not undergo HTx. The control subjects were selected from our clinical database and were matched for age, sex, body mass index, HR, and coronary dominance. Scans were performed using 256-MDCT with prospective ECG-triggering. The degree of motion artifacts was evaluated on a per-segment basis on a 4-point Likert-type scale. RESULTS: The median HR was 74.0 beats/min (interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0 beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p = 0.58). In the HTx group, more segments had diagnostic image quality compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p < 0.001). The mean effective radiation dose was low in both groups (3.7 mSv [IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the control group; p = 0.24). CONCLUSION: Prospectively ECG-triggered coronary CTA examinations of HTx recipients yielded diagnostic image quality with low radiation dose. Coronary CTA is a promising noninvasive alternative to routine catheterization during follow-up of HTx recipients to diagnose CAV.


Subject(s)
Cardiac-Gated Imaging Techniques/methods , Computed Tomography Angiography/methods , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Heart Transplantation , Postoperative Complications/diagnostic imaging , Artifacts , Case-Control Studies , Contrast Media , Female , Humans , Iopamidol/analogs & derivatives , Male , Middle Aged , Radiation Dosage , Radiographic Image Interpretation, Computer-Assisted , Retrospective Studies
16.
J Cardiovasc Comput Tomogr ; 11(6): 449-454, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28941999

ABSTRACT

BACKGROUND: Structured reporting in cardiac imaging is strongly encouraged to improve quality through consistency. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) was recently introduced to facilitate interdisciplinary communication of coronary CT angiography (CTA) results. We aimed to assess the agreement between manual and automated CAD-RADS classification using a structured reporting platform. METHODS: Five readers prospectively interpreted 500 coronary CT angiographies using a structured reporting platform that automatically calculates the CAD-RADS score based on stenosis and plaque parameters manually entered by the reader. In addition, all readers manually assessed CAD-RADS blinded to the automatically derived results, which was used as the reference standard. We evaluated factors influencing reader performance including CAD-RADS training, clinical load, time of the day and level of expertise. RESULTS: Total agreement between manual and automated classification was 80.2%. Agreement in stenosis categories was 86.7%, whereas the agreement in modifiers was 95.8% for "N", 96.8% for "S", 95.6% for "V" and 99.4% for "G". Agreement for V improved after CAD-RADS training (p = 0.047). Time of the day and clinical load did not influence reader performance (p > 0.05 both). Less experienced readers had a higher total agreement as compared to more experienced readers (87.0% vs 78.0%, respectively; p = 0.011). CONCLUSIONS: Even though automated CAD-RADS classification uses data filled in by the readers, it outperforms manual classification by preventing human errors. Structured reporting platforms with automated calculation of the CAD-RADS score might improve data quality and support standardization of clinical decision making.


Subject(s)
Computed Tomography Angiography , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Electronic Health Records , Multidetector Computed Tomography , Radiographic Image Interpretation, Computer-Assisted , Aged , Algorithms , Automation , Coronary Artery Disease/pathology , Coronary Stenosis/pathology , Coronary Vessels/pathology , Female , Humans , Male , Middle Aged , Observer Variation , Plaque, Atherosclerotic , Predictive Value of Tests , Prognosis , Prospective Studies , Reproducibility of Results , Severity of Illness Index
17.
Eur Radiol ; 27(11): 4538-4543, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28540480

ABSTRACT

OBJECTIVES: Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA. METHODS: Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol. RESULTS: 2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034). CONCLUSIONS: Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA. KEY POINTS: • Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.


Subject(s)
Computed Tomography Angiography/methods , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Iopamidol/analogs & derivatives , Contrast Media/administration & dosage , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Injections, Intravenous , Iopamidol/administration & dosage , Male , Middle Aged , Prospective Studies , Single-Blind Method
18.
Eur J Radiol ; 87: 83-89, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28065380

ABSTRACT

OBJECTIVE: To assess the impact of iterative model reconstruction (IMR) on calcified plaque quantification as compared to filtered back projection reconstruction (FBP) and hybrid iterative reconstruction (HIR) in coronary computed tomography angiography (CTA). METHODS: Raw image data of 52 patients who underwent 256-slice CTA were reconstructed with IMR, HIR and FBP. We evaluated qualitative, quantitative image quality parameters and quantified calcified and partially calcified plaque volumes using automated software. RESULTS: Overall qualitative image quality significantly improved with HIR as compared to FBP, and further improved with IMR (p<0.01 all). Contrast-to-noise ratios were improved with IMR, compared to HIR and FBP (51.0 [43.5-59.9], 20.3 [16.2-25.9] and 14.0 [11.2-17.7], respectively, all p<0.01) Overall plaque volumes were lowest with IMR and highest with FBP (121.7 [79.3-168.4], 138.7 [90.6-191.7], 147.0 [100.7-183.6]). Similarly, calcified volumes (>130 HU) were decreased with IMR as compared to HIR and FBP (105.9 [62.1-144.6], 110.2 [63.8-166.6], 115.9 [81.7-164.2], respectively, p<0.05 all). High-attenuation non-calcified volumes (90-129 HU) yielded similar values with FBP and HIR (p=0.81), however it was lower with IMR (p < 0.05 both). Intermediate- (30-89 HU) and low-attenuation (<30 HU) non-calcified volumes showed no significant difference (p=0.22 and p=0.67, respectively). CONCLUSIONS: IMR improves image quality of coronary CTA and decreases calcified plaque volumes.


Subject(s)
Computed Tomography Angiography/methods , Coronary Angiography/methods , Plaque, Atherosclerotic/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted/methods , Aged , Algorithms , Female , Humans , Male , Middle Aged , Radiation Dosage , Reproducibility of Results , Tomography, X-Ray Computed/methods
19.
Acta Radiol ; 58(5): 528-536, 2017 May.
Article in English | MEDLINE | ID: mdl-27614067

ABSTRACT

Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.


Subject(s)
Calcinosis/diagnostic imaging , Computed Tomography Angiography/methods , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Aged , Coronary Artery Disease/diagnostic imaging , Female , Humans , Male , Predictive Value of Tests , Reproducibility of Results , Risk Assessment
20.
Eur Radiol ; 27(6): 2419-2425, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27659700

ABSTRACT

OBJECTIVES: Previous studies using transthoracic echocardiography (TTE) observed moderate heritability of aortic root dimensions. Computed tomography angiography (CTA) might provide more accurate heritability estimates. Our primary aim was to assess the heritability of the aortic root with CTA. Our secondary aim was to derive TTE-based heritability and compare this with the CTA-based results. METHODS: In the BUDAPEST-GLOBAL study 198 twin subjects (118 monozygotic, 80 dizygotic; age 56.1 ± 9.4 years; 126 female) underwent CTA and TTE. We assessed the diameter of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, sinotubular junction and ascending aorta. Heritability was assessed using ACDE model (A additive genetic, C common environmental, D dominant genetic, E unique environmental factors). RESULTS: Based on CTA, additive genetic effects were dominant (LVOT: A = 0.67, E = 0.33; annulus: A = 0.76, E = 0.24; sinus of Valsalva: A = 0.83, E = 0.17; sinotubular junction: A = 0.82, E = 0.18; ascending aorta: A = 0.75, E = 0.25). TTE-derived measurements showed moderate to no genetic influence (LVOT: A = 0.38, E = 0.62; annulus: C = 0.47, E = 0.53; sinus of Valsalva: C = 0.63, E = 0.37; sinotubular junction: C = 0.45, E = 0.55; ascending aorta: A = 0.67, E = 0.33). CONCLUSION: CTA-based assessment suggests that aortic root dimensions are predominantly determined by genetic factors. TTE-based measurements showed moderate to no genetic influence. The choice of measurement method has substantial impact on heritability estimates. KEY POINTS: • Aortic root dimensions are determined by genetic and environmental effects. • Transthoracic echocardiography (TTE) demonstrated moderate to no genetic effects on aortic root dimensions. • Computed tomography angiography might provide more accurate heritability estimates compared to TTE. • Three-dimensional imaging techniques are needed to reliably quantify aortic root dimensions.


Subject(s)
Aorta/anatomy & histology , Genetic Determinism , Aorta/diagnostic imaging , Computed Tomography Angiography/methods , Echocardiography/methods , Female , Genotype , Humans , Imaging, Three-Dimensional/methods , Male , Middle Aged , Multidetector Computed Tomography/methods , Multimodal Imaging/methods , Sinus of Valsalva/anatomy & histology , Sinus of Valsalva/diagnostic imaging , Twins, Dizygotic , Twins, Monozygotic
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