Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT.

OBJECTIVES: The current reference standard for diagnosing LAA thrombi is transesophageal echocardiography (TEE), a semi-invasive technique. We aimed to devise an optimal protocol for cardiac computed tomography (CCT) in diagnosing left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), using TEE as reference standard. METHODS: Two hundred sixty consecutive patients referred for radiofrequency ablation for AF were prospectively enrolled. All patients underwent CCT and TEE within 2 hours. The CCT protocol included one standard angiographic phase and three delayed acquisitions at 1-, 3-, and 6-min after contrast injection. Thrombi were defined as persisting defects at 6-min delayed acquisition. RESULTS: TEE demonstrated spontaneous contrast in 52 (20%) patients and thrombus in 10 (4%). In 63 patients (24%), CCT demonstrated LAA early filling defects at angiographic phase. Among them, 15 (6%) had a persistent defect at 1-min, 12 (5%) at 3-min, and 10 (4%) at 6-min. All 10 thrombi diagnosed on TEE were correctly identified by delayed CCT, without any false positives. For all phases, sensitivity and negative predictive were 100%. Specificity increased from 79% for the angiographic phase to 100% at 6-min. Positive predictive value increased from 16% to 100%. Estimated radiation exposure was 2.08 ± 0.76 mSv (mean ± standard deviation) for the angiographic phase and 0.45 ± 0.23 mSv for each delayed phase. CONCLUSION: A CCT protocol adding a 6-min delayed phase to the angiographic phase can be considered optimized for the diagnosis of LAA thrombi, with a low radiation dose. KEY POINTS: • In patients with persistent atrial fibrillation referred for ablation procedures, a cardiac CT examination comprising an angiographic-phase acquisition and, in case of filling defects, a 6-min delayed phase may help reduce the need for transesophageal echocardiography. • Cardiac CT would provide morphological and volumetric data, along with the potential to exclude the presence of thrombi in the left atrial appendage.

Pulmonary Insufficiency: Advantage of Pulmonary Regurgitation Volume Versus Pulmonary Regurgitation Fraction in a Congenital Heart Disease Mixed Population.

OBJECTIVE: The objective of this study was to compare the use of pulmonary regurgitation volume (PRV) or indexed PRV (PRVi) with that of pulmonary regurgitation fraction (PRF) in the assessment of patients with pulmonary regurgitation (PR) undergoing cardiac magnetic resonance (CMR) imaging. MATERIALS AND METHODS: CMR of 176 patients with PR were retrospectively evaluated. Their right ventricular diastolic (end-diastolic volume index [EDVi]) and systolic (end-systolic volume index) volume indexes, stroke volume, and ejection fraction were obtained from cine CMR sequences, whereas phase-contrast flow sequences were analyzed to obtain PRV, PRVi, and PRF. Patients were divided into subgroups, according to underlying pathology and according to PR severity. Correlations between PRV or PRF and RV parameters were studied through Spearman ρ, both in the main group and subgroups. Follow-up examinations were analyzed, and correlations between PRV or PRF from the first CMR examination and volume data from the second were calculated. RESULTS: Tetralogy of Fallot was the main setting of PR (98/179). Overall, EDVi strongly correlates with PRV (ρ=0.592, P<0.001) than with PRF (ρ=0.522, P<0.001), and end-systolic volume index strongly correlates with PRV (ρ=0.454, P<0.001) and PRF (ρ=0.406, P <0.001). As regards subgroup analysis, in moderate or severe PR patients, EDVi strongly correlates (P=0.043) with PRV (ρ=0.499, P<0.001) than with PRF (ρ=0.317, P<0.001). Follow-up EDVi correlates with PRV (ρ=0.450, P=0.031), but not with PRF. CONCLUSIONS: Especially when assessing moderate to severe PR, PRV and PRVi may be better indicators of right ventricular dysfunction than PRF. Moreover, PRV may be a predictor of worsening RV dilation.

An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator.

OBJECTIVES: To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). METHODS: We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). RESULTS: 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three-12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. CONCLUSIONS: A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. KEY POINTS: • Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers. • No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers. • Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic. • All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic. • Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.

Strain of ascending aorta on cardiac magnetic resonance in 1027 patients: Relation with age, gender, and cardiovascular disease.

OBJECTIVES: To evaluate ascending aortic strain (AAS) with cardiac magnetic resonance (CMR) in a large consecutive series of patients with different types of cardiovascular disease (CVD). METHODS: Two-dimensional phase-contrast gradient-echo sequences of the ascending aorta were retrospectively reviewed in 1027 patients (726 males, 301 females). Aortic lumen area was segmented using a semi-automatic approach to calculate AAS values. Subgroup analysis was performed for patients with normal CMR, tetralogy of Fallot (ToF), and ischemic heart disease (IHD). Multivariate and post-hoc analyses were performed to evaluate the effect of age, gender, and CVD on AAS values. Shapiro-Wilk, three- and two-way ANOVA, Mann-Whitney U, and Spearman correlation statistics were used. RESULTS: Multivariate analysis showed significant differences in AAS among decades of age (p<0.001), genders (p=0.006) and CVD subgroups (p<0.001) without interaction among these factors. A gender-related difference (higher AAS in females) was significant in ToF (p=0.008), while an AAS reduction during aging was observed in all CVD subgroups. Post-hoc analysis showed a significantly lower AAS in ToF and IHD patients compared to subjects with normal CMR (p<0.001). CONCLUSION: Differences in age, gender, and CVD independently affect AAS. The lower AAS observed in ToF fosters its assessment during follow-up in adulthood. Future studies on causes and clinical implications of a higher AAS in females affected by ToF are warranted.

Technical Feasibility of a Combined Noncontrast Magnetic Resonance Protocol for Preoperative Transcatheter Aortic Valve Replacement Evaluation.

PURPOSE: The aim of this study was to prospectively evaluate the technical feasibility of a noncontrast magnetic resonance angiography (MRA) protocol using investigational prototype self-navigated 3D (SN3D) radial whole-heart and quiescent-interval single-shot (QISS) pulse sequences regarding their potential in planning transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS: Five patients (76±7 y) with severe aortic valve stenosis and prior computed tomographic angiography (CTA) for TAVR planning and 10 healthy volunteers (28±6 y) underwent noncontrast MRA on a 1.5 T system. A SN3D whole-heart acquisition was used to assess the aortic root anatomy. Evaluation of the aortoiliac access route was performed with both SN3D and QISS. Measurements were compared among SN3D, QISS, and CTA using a paired t test or 1-way analysis of variance. Image quality ratings and contrast-to-noise ratios (CNR) were analyzed using Mann-Whitney U tests. Interobserver agreement was evaluated using Cohen's κ. RESULTS: The combined SN3D and QISS protocol provided a 10.1±1.6-minute acquisition time. TAVR-relevant evaluation was technically feasible in healthy volunteers. All measurements showed good agreement with CTA in patients (all P>0.098). SN3D and QISS produced similar image quality both in volunteers and in patients (all P>0.122). There was no difference in qualitative ratings between MRA and CTA (all P>0.119). Interobserver agreement was good for MRA (κ=0.71 to 0.76) and excellent for CTA (κ=0.82 to 0.84). Thoracic SN3D provided a similar CNR compared with CTA (P=0.117). CTA yielded higher CNR in the abdominopelvic region compared with QISS (P=0.006). CONCLUSIONS: A noncontrast MRA protocol combining SN3D and QISS acquisitions for the assessment of cardiac and vascular access route anatomy has technical feasibility for TAVR planning.

Biventricular Heart Remodeling After Percutaneous or Surgical Pulmonary Valve Implantation: Evaluation by Cardiac Magnetic Resonance.

PURPOSE: The aim of this study was to evaluate the impact of percutaneous pulmonary valve implantation (PPVI) and surgical pulmonary valve replacement (SPVR) on biventricular and pulmonary valve function using cardiac magnetic resonance. MATERIALS AND METHODS: Thirty-five patients aged 20±8 years (mean±SD) underwent PPVI, whereas 16 patients aged 30±11 years underwent SPVR. Cardiac magnetic resonance examinations were performed before and after the procedures with an average follow-up interval of 10 months. Cine steady-state free precession sequences for cardiac function and phase-contrast sequences for pulmonary flow were performed. The right ventricle (RV) and left ventricle (LV) functions were evaluated using a dedicated software. RESULTS: The RV end-diastolic volume index (mL/m) decreased significantly after PPVI and SPVR, from 74 to 64 (P=0.030) and from 137 to 83 (P=0.001), respectively. The RV ejection fraction increased significantly after SPVR, from 47% to 53% (P=0.038). The LV end-diastolic volume index increased significantly after PPVI, from 66 to 76 mL/m (P<0.001). The LV stroke volume index increased significantly after PPVI, from 34 to 43 mL/m (P=0.004). The analysis of bivariate correlations showed that in patients undergoing SPVR the RV changes after the procedure were positively correlated to LV changes in terms of end-systolic volume index (r=0587; P=0.017) and ejection fraction (r=0.681; P=0.004). CONCLUSIONS: A RV volumetric reduction and a positive effect on ventricular-ventricular interaction were observed after both PPVI and SPVR. After PPVI, a positive volumetric LV remodeling was found. No LV remodeling was found after SPVR. After both procedures, the replaced pulmonary valve functioned well.

Virtual unenhanced imaging of the liver with third-generation dual-source dual-energy CT and advanced modeled iterative reconstruction.

OBJECTIVES: To compare image quality and diagnostic accuracy for the detection of liver lesions of virtual unenhanced (VU) images based on third-generation dual-source dual- energy computed tomography (DECT) compared to conventional unenhanced (CU) images. METHODS: Thirty patients underwent triphasic abdominal CT consisting of single-energy CU (120kV, 147 ref.mAs) and dual-energy CT arterial and portal-venous phase acquisitions (100/Sn150kV, 180/90 ref.mAs). VU images were generated from arterial (AVU) and portal venous (PVU) phases. CU, AVU and PVU datasets were reconstructed. Quantitative image quality analysis was performed and two abdominal radiologists independently analyzed all datasets to evaluate image quality and identify liver lesions. Radiation dose was recorded and potential radiation dose reduction was estimated. RESULTS: Image quality was rated diagnostic in 100% of the VU datasets. The mean subjective image quality of the CU datasets was higher than that of VU images (p<0.0001). No significant difference was observed in the mean attenuation values of the liver parenchyma (p>0.99) and hypoattenuating liver lesions (p≥0.21) between CU, AVU and PVU. However, a significant reduction in the attenuation values of calcified lesions (p<0.0001), metallic clips (p<0.0001) and gallstones (p≤0.047) was observed in the AVU and PVU images compared with CU images. A total of 122 liver lesions were found in 25 patients. VU images were more sensitive than CU images for detection of small hypoattenuating liver lesions (≤1cm). However, CU images were more sensitive than VU for calcified liver lesions. The mean radiation dose reduction achievable by avoiding the unenhanced acquisition was 32.9%±1.1% (p<0.01). CONCLUSIONS: Third-generation DSCT VU images of the liver provide diagnostic image quality and improve small (≤1cm) liver lesion detection; however calcified liver lesions can be missed due to complete subtraction.

Semiautomated Global Quantification of Left Ventricular Myocardial Perfusion at Stress Dynamic CT:: Diagnostic Accuracy for Detection of Territorial Myocardial Perfusion Deficits Compared to Visual Assessment.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic accuracy of semiautomated global quantification of left ventricular myocardial perfusion derived from stress dynamic computed tomography myocardial perfusion imaging (CTMPI) for detection of territorial perfusion deficits (PD). MATERIALS AND METHODS: Dynamic CTMPI datasets of 71 patients were analyzed using semiautomated volume-based software to calculate global myocardial blood flow (MBF), myocardial blood volume, and volume transfer constant. Optimal cutoff values to assess the diagnostic accuracy of these parameters for detection of one- to three-vessel territories with PD in comparison to visual analysis were calculated. RESULTS: Nonsignificant differences (P = 0.694) were found for average global MBF in patients without PD and single-territorial PD. Significant differences were found for mean global MBF in patients with PD in two (P < 0.0058) and three territories (P < 0.0003). Calculated optimal thresholds for global MBF and myocardial blood volume resulted in a sensitivity, specificity, and negative predictive value of 100% for detection of three-vessel territory PD. For detection of ≥2 territories with PD, global MBF was superior to other parameters (sensitivity 81.3%, specificity 90.9%, and negative predictive value 94.3%). CONCLUSIONS: Semiautomated global quantification of left ventricular MBF during stress dynamic CTMPI shows high diagnostic accuracy for detection of ≥2 vessel territories with PD, facilitating identification of patients with multi-territorial myocardial PD.

Approaches to ultra-low radiation dose coronary artery calcium scoring based on 3rd generation dual-source CT: A phantom study.

OBJECTIVES: To investigate to what extent 3rd generation dual-source computed tomography (DSCT) can reduce radiation dose in coronary artery calcium scoring. METHODS: Image acquisition was performed using a stationary calcification phantom. Prospectively electrocardiogram (ECG)-triggered 120 kV sequential, and 120 and Sn100 kV ultra-high pitch (UHP) acquisitions were performed with different tube currents (80, 60, 40, 20 mA). Images were reconstructed using filtered back projection (FBP) and 3rd generation iterative reconstruction (IR). Contrast-to-noise ratio (CNR), Agatston score, calcium volume, and radiation dose were assessed. For statistical analysis Friedman tests and Wilcoxon rank sum tests were used. RESULTS: Even at reduced tube currents, the three acquisition techniques did not show significant differences in Agatston score (p=0.4) or calcium volume (p=0.08) with FBP reconstruction. Calcium volumes were significantly lower for 3rd generation IR compared to FBP reconstructions (p<0.01). CTDIvol for the 120 kV sequential, 120 and Sn100 kV UHP acquisitions at 80 and 20 mA were 1.2-0.37, 0.48-0.17, and 0.07-0.02 mGy, respectively. CONCLUSION: 3rd generation DSCT enabled a reduction of tube current in both the sequential and UHP acquisitions without significantly affecting coronary calcium scoring. Tin filtered 100 kV scanning may allow accurate quantification of calcium score without correction of the HU threshold.

Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study.

PURPOSE: To evaluate the impact of an advanced monoenergetic (ME) reconstruction algorithm on CT coronary stent imaging in a phantom model. MATERIALS AND METHODS: Three stents with lumen diameters of 2.25, 3.0 and 3.5 mm were examined with a third-generation dual-source dual-energy CT (DECT). Tube potential was set at 90/Sn150 kV for DE and 70, 90 or 120 kV for single-energy (SE) acquisitions and advanced modelled iterative reconstruction was used. Overall, 23 reconstructions were evaluated for each stent including three SE acquisitions and ten advanced and standard ME images with virtual photon energies from 40 to 130 keV, respectively. In-stent luminal diameter was measured and compared to nominal lumen diameter to determine stent lumen visibility. Contrast-to-noise ratio was calculated. RESULTS: Advanced ME reconstructions substantially increased lumen visibility in comparison to SE for stents ≤3 mm. 130 keV images produced the best mean lumen visibility: 86 % for the 2.25 mm stent (82 % for standard ME and 64 % for SE) and 82 % for the 3.0 mm stent (77 % for standard ME and 69 % for SE). Mean DLP for SE 120 kV and DE acquisitions were 114.4 ± 9.8 and 58.9 ± 2.2 mGy × cm, respectively. CONCLUSION: DECT with advanced ME reconstructions improves the in-lumen visibility of small stents in comparison with standard ME and SE imaging. KEY POINTS: • An advanced image-based monoenergetic reconstruction algorithm improves lumen visualization in stents ≤3.0 mm. • Application of high keV reconstructions significantly improves in-stent lumen visualization. • DECT acquisition resulted in 49 % radiation dose reduction compared with 120 kV SE.

Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method.

OBJECTIVES: To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. METHODS: Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. RESULTS: Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17%; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM mesurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. CONCLUSIONS: Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. KEY POINTS: • Threshold-based left ventricular segmentation provides time-efficient assessment of left ventricular parameters • The threshold-based method can discriminate between blood and papillary muscles • This method provides improved accuracy compared to aortic flow measurements as a reference.

Myocardial Late Gadolinium Enhancement: Accuracy of T1 Mapping-based Synthetic Inversion-Recovery Imaging.

PURPOSE: To compare the accuracy of detection and quantification of myocardial late gadolinium enhancement (LGE) with a synthetic inversion-recovery (IR) approach with that of conventional IR techniques. MATERIALS AND METHODS: This prospective study was approved by the institutional review board and compliant with HIPAA. All patients gave written informed consent. Between June and November 2014, 43 patients (25 men; mean age, 54 years ± 16) suspected of having previous myocardial infarction underwent magnetic resonance (MR) imaging, including contrast material-enhanced LGE imaging and T1 mapping. Synthetic magnitude and phase-sensitive IR images were generated on the basis of T1 maps. Images were assessed by two readers. Differences in the per-patient and per-segment LGE detection rates between the synthetic and conventional techniques were analyzed with the McNemar test, and the accuracy of LGE quantification was calculated with the paired t test and Bland-Altman statistics. Interreader agreement for the detection and quantification of LGE was analyzed with κ and Bland-Altman statistics, respectively. RESULTS: Seventeen of the 43 patients (39%) had LGE patterns consistent with myocardial infarction. The sensitivity and specificity of synthetic magnitude and phase-sensitive IR techniques in the detection of LGE were 90% and 95%, respectively, with patient-based analysis and 94% and 99%, respectively, with segment-based analysis. The area of LGE measured with synthetic IR techniques showed excellent agreement with that of conventional techniques (4.35 cm(2) ± 1.88 and 4.14 cm(2)± 1.62 for synthetic magnitude and phase-sensitive IR, respectively, compared with 4.25 cm(2) ± 1.92 and 4.22 cm(2) ± 1.86 for conventional magnitude and phase-sensitive IR, respectively; P > .05). Interreader agreement was excellent for the detection (κ > 0.81) and quantification (bias range, -0.34 to 0.40; P > .05) of LGE. CONCLUSION: The accuracy of the T1 map-based synthetic IR approach in the detection and quantification of myocardial LGE in patients with previous myocardial infarction was similar to that of conventional IR techniques. The use of T1 mapping to derive synthetic LGE images may reduce imaging times and operator dependence in future T1 mapping protocols with full left ventricular coverage.

Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease.

OBJECTIVE: The purpose of this study was to evaluate differences in the diagnostic accuracy of absolute and relative territorial myocardial blood flow (MBF) derived from stress dynamic CT myocardial perfusion imaging (MPI) for the detection of significant coronary artery stenosis. MATERIALS AND METHODS: Dynamic CT MPI and coronary CT angiography (CTA) datasets from a multicenter registry of 137 patients (mean age, 60.9 ± 8.4 years; 88 men) with suspected or known coronary artery disease were retrospectively analyzed. For each coronary territory, absolute MBF and the MBF relative to remote myocardium (MBF ratio) were calculated. Coronary CTA datasets were visually assessed for significant stenosis (≥ 50% luminal narrowing) in consensus by two observers. RESULTS: Significant stenosis was detected in 137 of 411 (33.3%) vessels. Mean absolute MBF and MBF ratio were statistically significantly lower in territories supplied by arteries with stenosis (80.7 ± 33.7 vs 140.0 ± 38.4 mL/100 mL/min and 0.52 vs 0.89, respectively; both p < 0.0001). ROC analysis showed better discrimination by MBF ratio than by absolute MBF (AUC, 0.925 vs 0.882; p = 0.0022) and increased sensitivity (90.7% vs 82.4%; p < 0.04) and specificity (93.1% vs 80.5%; p < 0.03) for MBF ratio and absolute MBF cutoff values of 0.71 or less and 103 mL/100 mL/min or less, respectively. CONCLUSION: In stress dynamic CT MPI, relative MBF provides superior diagnostic accuracy compared with absolute territorial MBF values for coronary CTA-detected significant coronary artery stenosis.

Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging.

Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.

Olea sublingual allergoid immunotherapy administered with two different treatment regimens.

Sublingual immunotherapy (SLIT) with monomeric carbamylated allergoid administered in accordance with the standard regimen has proven to be effective and safe. Achieving clinical benefit, however, requires a lengthy period of time so it is not very suitable for short-lasting allergies. We thus performed this study to compare an administration protocol starting in the coseasonal period (with a 4-day build-up phase) with a precoseasonal scheme to verify if the former regimen provides the same benefit in a shorter period of time. The prospective, randomized, drug therapy-controlled study was conducted in 33 rhinitic patients monosensitized to Olea with or without asthma. Ten patients were assigned to the coseasonal therapy with 5000 allergic units (AU)/week for 6 weeks, 11 to the precoseasonal therapy with 3000 AU/week for 10 weeks, and 12 to drug therapy. They were treated from April or May to June 2008. A visual analog scale (VAS) was performed at baseline and after treatment to assess the well being of the patients. Drug consumption was evaluated by means of a monthly diary. There was greater VAS improvement in both the SLIT groups versus the controls, but it was statistically significant only in the coseasonal group (p < 0.01). Furthermore, there was a reduction in the rescue medication only in the coseasonal SLIT (p < 0.05 versus drug therapy). One mild adverse event was observed. The allergoid SLIT was shown to be effective and safe in Olea allergy in particular when a coseasonal regimen was used.