RESUMO
PURPOSE: The aim of this pilot study was to prospectively evaluate the first integrated positron emission tomography (PET)/dual-energy computed tomography (DECT) system performance in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: In this single-center, prospective trial, consecutive patients with NSCLC referred for a PET study between May 2017 and June 2018 were enrolled. All patients received contrast-enhanced imaging on a clinical PET/DECT system. Data analysis included PET-based standard uptake values (SUVmax) and DECT-based iodine densities of tumor masses, lymph nodes, and distant metastases. Results were analyzed using correlation tests and receiver operating characteristics curves. RESULTS: The study population was composed of 21 patients (median age 62 y, 14 male patients). A moderate positive correlation was found between iodine density values (2.2 mg/mL) and SUVmax (10.5) in tumor masses (ρ=0.53, P<0.01). Iodine density values (2.3 mg/mL) and SUVmax (5.4) of lymph node metastases showed a weak positive correlation (ρ=0.23, P=0.14). In addition, iodine quantification analysis provided no added value in differentiating between pathologic and nonpathologic lymph nodes with an area under the curve (AUC) of 0.55 using PET-based SUVmax as the reference standard. A weak positive correlation was observed between iodine density (2.2 mg/mL) and SUVmax in distant metastases (14.9, ρ=0.23, P=0.52). CONCLUSIONS: The application of an integrated PET/DECT system in lung cancer might provide additional insights in the assessment of tumor masses. However, the added value of iodine density quantification for the evaluation of lymph nodes and distant metastases seems limited.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Linfonodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities. METHODS: Metrix Matrix is an efficient cloud-based system for tracking value-added work. A password-protected home page contains links to web-based forms created using Google Forms, with collected data populating Google Sheets spreadsheets. Value-added work metrics selected for tracking included interdisciplinary conferences, hospital committee meetings, consulting on nonbilled outside studies, and practice-based quality improvement. Over a period of 4 months, value-added work data were collected for all clinical attending faculty members in a university-based radiology department (n = 39). Time required for data entry was analyzed for 2 faculty members over the same time period. RESULTS: Thirty-nine faculty members (equivalent to 36.4 full-time equivalents) reported a total of 1,223.5 hours of value-added work time (VAWT). A formula was used to calculate "value-added RVUs" (vRVUs) from VAWT. VAWT amounted to 5,793.6 vRVUs or 6.0% of total work performed (vRVUs plus work RVUs [wRVUs]). Were vRVUs considered equivalent to wRVUs for staffing purposes, this would require an additional 2.3 full-time equivalents, on the basis of average wRVU calculations. Mean data entry time was 56.1 seconds per day per faculty member. CONCLUSIONS: As health care reimbursement evolves with an emphasis on value-based medicine, it is imperative that radiologists demonstrate the value they add to patient care beyond wRVUs. This free and easy-to-use cloud-based system allows the efficient quantification of value-added work activities.
Assuntos
Computação em Nuvem , Eficiência Organizacional , Radiologistas/estatística & dados numéricos , Escalas de Valor Relativo , Carga de Trabalho/estatística & dados numéricos , HumanosAssuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Adulto , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Hematemese , Hemoptise , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To use suitable objective methods of analysis to assess the influence of the combination of an integrated-circuit computed tomographic (CT) detector and iterative reconstruction (IR) algorithms on the visualization of small (≤3-mm) coronary artery stents. MATERIALS AND METHODS: By using a moving heart phantom, 18 data sets obtained from three coronary artery stents with small diameters were investigated. A second-generation dual-source CT system equipped with an integrated-circuit detector was used. Images were reconstructed with filtered back-projection (FBP) and IR at a section thickness of 0.75 mm (FBP75 and IR75, respectively) and IR at a section thickness of 0.50 mm (IR50). Multirow intensity profiles in Hounsfield units were modeled by using a sum-of-Gaussians fit to analyze in-plane image characteristics. Out-of-plane image characteristics were analyzed with z upslope of multicolumn intensity profiles in Hounsfield units. Statistical analysis was conducted with one-way analysis of variance and the Student t test. RESULTS: Independent of stent diameter and heart rate, IR75 resulted in significantly increased xy sharpness, signal-to-noise ratio, and contrast-to-noise ratio, as well as decreased blurring and noise compared with FBP75 (eg, 2.25-mm stent, 0 beats per minute; xy sharpness, 278.2 vs 252.3; signal-to-noise ratio, 46.6 vs 33.5; contrast-to-noise ratio, 26.0 vs 16.8; blurring, 1.4 vs 1.5; noise, 15.4 vs 21.2; all P < .001). In the z direction, the upslopes were substantially higher in the IR50 reconstructions (2.25-mm stent: IR50, 94.0; IR75, 53.1; and FBP75, 48.1; P < .001). CONCLUSION: The implementation of an integrated-circuit CT detector provides substantially sharper out-of-plane resolution of coronary artery stents at 0.5-mm section thickness, while the use of iterative image reconstruction mostly improves in-plane stent visualization.
Assuntos
Vasos Coronários , Processamento de Imagem Assistida por Computador , Stents , Tomografia Computadorizada por Raios X , Algoritmos , Imagens de Fantasmas , Desenho de PróteseRESUMO
BACKGROUND: Many computed tomography (CT) parameters have been proposed as potential predictors of outcome in acute pulmonary embolism. We sought to summarize available evidence on the predictive value of CT severity parameters for short-term clinical outcome in pulmonary embolism. METHODS: We searched PubMed and EMBASE through February 2014 for studies that reported on the association between CT parameters of acute pulmonary embolism severity and short-term (≤6 months) clinical outcome. Risk estimates for quantitative parameters of right ventricular (RV) dysfunction (abnormally increased RV/left ventricular [LV] diameter ratio on transverse sections and 4-chamber views), qualitative parameters of RV dysfunction (abnormal septal morphology and contrast reflux), thrombus load, and central thrombus location were derived using random effect regression analysis. Meta-regression analysis was performed to quantify and explain study heterogeneity. RESULTS: A total of 49 studies with 13,162 patients with acute pulmonary embolism (median age of 61 years, 55.1% were women) who underwent diagnostic CT imaging were included in the analysis. An abnormally increased RV/LV diameter ratio measured on transverse sections was associated with an approximately 2.5-fold risk for all-cause mortality (pooled odds ratio [OR], 2.5; 95% confidence interval [CI], 1.8-3.5) and adverse outcome (OR, 2.3; 95% CI, 1.6-3.4) and a 5-fold risk for pulmonary embolism-related mortality (OR, 5.0; 95% CI, 2.7-9.2). Thrombus load (OR, 1.6, 95% CI, 0.7-3.9; P = .2896) and central location (OR, 1.7; 95% CI, 0.7-4.2; P = .2609) were not predictive for all-cause mortality, although both were associated with adverse clinical outcome. CONCLUSIONS: Across all end points, the RV/LV diameter ratio on transverse CT sections has the strongest predictive value and most robust evidence base for adverse clinical outcomes in patients with acute pulmonary embolism.
Assuntos
Causas de Morte , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Distribuição por Idade , Idoso , Intervalos de Confiança , Medicina Baseada em Evidências , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Análise de Sobrevida , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/epidemiologiaAssuntos
Teste de Esforço/métodos , Cardiopatias/diagnóstico por imagem , Cardiopatias/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Lesões por Radiação/epidemiologia , Teste de Esforço/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Medição de Risco/métodos , Fatores de Risco , Processos EstocásticosRESUMO
The respiratory and the cardiovascular systems are intimately connected. Because of the high degree of morphological and functional interaction, pathophysiological processes in one compartment are likely to induce adaptive changes in the other. Computed tomography (CT) plays a central role in the diagnostic work up of both thoracic and cardiac disorders. Historically, these two systems have been evaluated separately; however, CT technology has evolved remarkably over recent decades. Up-to-date advanced imaging strategies allow for a combined assessment of the cardiopulmonary unit. Besides improved techniques of electrocardiogram (ECG)-synchronization for obtaining both morphological and functional information, latest advances of dual-source CT (DSCT) have shown great promise for even more comprehensive integrated cardiothoracic imaging.
Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Torácicas/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doenças Cardiovasculares/fisiopatologia , Eletrocardiografia/métodos , Humanos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Doenças Torácicas/fisiopatologia , Tomografia Computadorizada por Raios X/tendênciasRESUMO
OBJECTIVE: The objective of our study was to evaluate the reproducibility of noncalcified coronary artery plaque burden quantification from coronary CT angiography (CTA) across different commercial analysis platforms. MATERIALS AND METHODS: For this study, 47 patients (36 men, 11 women; mean age ± SD, 62 ± 13 years) with noncalcified plaques on coronary CTA were included. Automated quantification of noncalcified coronary artery plaque volume was performed on identical datasets using three commercially available image analysis software platforms (software platforms 1-3). Identical tissue attenuation ranges between 0 and 50 HU for low-attenuation plaques and 50-130 HU for medium-attenuation plaques were consistently applied. Log volume data were compared with the Pearson correlation coefficient and Bland-Altman analysis. RESULTS: Differences in plaque volume measurements on intraplatform repeat measurements were statistically insignificant (p = 0.923). At the low-attenuation threshold, software platform 3 had significantly higher log volumes (p < 0.001) than both software platforms 1 and 2 and software platform 1 had significantly higher log volumes than software platform 2 (p < 0.001). The results at the medium-attenuation level were identical except that the log volumes for software platforms 1 and 2 were not significantly different (p > 0.05) in the left anterior descending artery and left circumflex artery. The Pearson correlation coefficient was found to be 0.677 (p < 0.001; 95% CI, 0.608-0.735) between software platforms 1 and 2, 0.672 (p < 0.001; 95% CI, 0.603-0.732) between software platforms 1 and 3, and 0.550 (p < 0.001; 95% CI, 0.463-0.627) between software platforms 2 and 3. CONCLUSION: Currently available noncalcified plaque quantification software provides good intraplatform reproducibility but poor interplatform reproducibility. Serial or comparative assessments require evaluation using the same software. Industry standards should be developed to enable reproducible assessments across manufacturers.
Assuntos
Angiografia Coronária/métodos , Doença das Coronárias/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , SoftwareRESUMO
OBJECTIVES: This study evaluated the performance of a novel automated software tool for epicardial fat volume (EFV) quantification compared to a standard manual technique at coronary CT angiography (cCTA). METHODS: cCTA data sets of 70 patients (58.6 ± 12.9 years, 33 men) were retrospectively analysed using two different post-processing software applications. Observer 1 performed a manual single-plane pericardial border definition and EFVM segmentation (manual approach). Two observers used a software program with fully automated 3D pericardial border definition and EFVA calculation (automated approach). EFV and time required for measuring EFV (including software processing time and manual optimization time) for each method were recorded. Intraobserver and interobserver reliability was assessed on the prototype software measurements. T test, Spearman's rho, and Bland-Altman plots were used for statistical analysis. RESULTS: The final EFVA (with manual border optimization) was strongly correlated with the manual axial segmentation measurement (60.9 ± 33.2 mL vs. 65.8 ± 37.0 mL, rho = 0.970, P < 0.001). A mean of 3.9 ± 1.9 manual border edits were performed to optimize the automated process. The software prototype required significantly less time to perform the measurements (135.6 ± 24.6 s vs. 314.3 ± 76.3 s, P < 0.001) and showed high reliability (ICC > 0.9). CONCLUSIONS: Automated EFVA quantification is an accurate and time-saving method for quantification of EFV compared to established manual axial segmentation methods. KEY POINTS: ⢠Manual epicardial fat volume quantification correlates with risk factors but is time-consuming. ⢠The novel software prototype automates measurement of epicardial fat volume with good accuracy. ⢠This novel approach is less time-consuming and could be incorporated into clinical workflow.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Design de SoftwareRESUMO
OBJECTIVE: We sought to use cardiac CT angiography (CTA) to longitudinally examine the relationship between changes in aortic stiffness and of the atherosclerotic burden over time. MATERIALS AND METHODS: One hundred sixty-four patients with suspected coronary artery disease underwent two retrospectively ECG-gated cardiac CTA studies an average of 12 ± 10 months apart. Arterial stiffness was represented by the aortic distensibility index (ADI) and atherosclerosis by segment involvement score (SIS) (defined as the number of coronary artery segments per patient displaying atherosclerotic plaque). Changes in ADI and SIS between the studies were compared using linear and logistic regression accounting for differences in clinical and demographic baseline characteristics. RESULTS: Age (p = 0.004), time between studies (p = 0.02), and increase in SIS (p < 0.001) were associated with a decrease in ADI on univariate analysis. Increase in SIS remained a significant independent predictor of decreased ADI on both multivariate logistic regression (with change in ADI represented categorically) and multivariate linear regression (both p < 0.001). CONCLUSION: On longitudinal evaluation with cardiac CTA, the progression of aortic stiffness is associated with the progression of coronary atherosclerosis. Although outcome studies are needed, a comprehensive assessment of vascular health with cardiac CTA, including both indexes of arterial stiffness and atherosclerotic burden, may improve risk stratification and therapy monitoring.
Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Rigidez Vascular , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Progressão da Doença , Feminino , Humanos , Iohexol/análogos & derivados , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos RetrospectivosRESUMO
PURPOSE: To investigate whether coronary artery calcium (CAC) scoring performed on three different workstations generates comparable and thus vendor-independent results. MATERIALS AND METHODS: Institutional review board and Federal Office for Radiation Protection approval were received, as was each patient's written informed consent. Fifty-nine patients (37 men, 22 women; mean age, 57 years±3 [standard deviation]) underwent CAC scoring with use of 64-section multidetector computed tomography (CT) with retrospective electrocardiographic gating (one examination per patient). Data sets were created at 10% increments of the R-R interval from 40%-80%. Two experienced observers in consensus calculated Agatston and volume scores for all data sets by using the calcium scoring software of three different workstations. Comparative analysis of CAC scores between the workstations was performed by using regression analysis, Spearman rank correlation (rs), and the Kruskal-Wallis test. RESULTS: Each workstation produced different absolute numeric results for Agatston and volume scores. However, statistical analysis revealed excellent correlation between the workstations, with highest correlation at 60% of the R-R interval (minimal rs=0.998; maximal rs=0.999) for both scoring methods. No significant differences were detected for Agatston and volume score results between the software platforms. At analysis of individual reconstruction intervals, each workstation demonstrated the same score variability, with the consequence that 12 of 59 patients were assigned to divergent cardiac risk groups by using at least one of the workstations. CONCLUSION: While mere numeric values might be different, commercially available software platforms produce comparable CAC scoring results, which suggests a vendor-independence of the method; however, none of the analyzed software platforms appears to provide a distinct advantage for risk stratification, as the variability of CAC scores depending on the reconstruction interval persists across platforms.
Assuntos
Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X/normas , Técnicas de Imagem de Sincronização Cardíaca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Estatísticas não ParamétricasRESUMO
PURPOSE: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. METHODS AND MATERIALS: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel "shuttle" mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. RESULTS: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. CONCLUSION: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.
Assuntos
Adenosina , Dor no Peito/diagnóstico por imagem , Angiografia Coronária/métodos , Teste de Esforço/métodos , Imagem de Perfusão do Miocárdio/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Idoso , Sistemas Computacionais , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , VasodilatadoresRESUMO
PURPOSE: To assess the interobserver variability of 4 radiologists with different levels of experience in the evaluation of 64-slice coronary computed tomographic angiography (cCTA). MATERIALS AND METHODS: Two board-certified radiologists with 10 and 8 years of experience in reading cCTA and 2 radiology residents, 1 with 3 years of experience in reading cCTA and 1 with experience in reading general computed tomographic scans but without dedicated cCTA training, participated in the study. All the observers independently analyzed 50 cCTA studies for signs of coronary artery disease (stenosis of 0%, ≤49%, 50% to 74%, 75% to 99%, or 100%). Diagnostic accuracy of the 4 readers for stenosis detection on cCTA was compared with that of conventional angiography on a per-segment and per-patient basis. No patients, vessels, or segments were excluded from analysis. RESULTS: On a per-segment basis, correlation between cCTA and invasive coronary angiography was good for readers with more than 10 (r=0.75), more than 8 (r=0.75), and more than 3 (r=0.73) years of cCTA experience. The correlation coefficient was poor (r=0.39) for the untrained reader. Sensitivity was not significantly (P=0.56) different between observers with more than 8 and more than 10 years of experience but was significantly (P>0.05) lower for the reader with less than 3 years experience and for the untrained reader. However, we found no significant difference in overall diagnostic accuracy on a per-patient (P=0.86) and on a per-segment level (P=0.72) among the 4 readers. CONCLUSION: The level of experience significantly influences the sensitivity of coronary artery stenosis detection at cCTA, and thus highlights the need for dedicated training in cCTA interpretation.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Idoso , Distribuição de Qui-Quadrado , Competência Clínica , Meios de Contraste , Angiografia Coronária , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The performance of dual-energy CT (DECT) for the detection of myocardial blood volume deficits has not systematically been compared with single-energy CT (SCT) spectra. OBJECTIVE: We evaluated the accuracy for detection of myocardial blood volume deficits in DECT and SCT compared with 99m-Tc-Sestamibi-SPECT (single-photon emission CT) during rest and stress. METHODS: 47 patients underwent rest/stress SPECT myocardial perfusion imaging and cardiac DECT on a dual-source CT scanner. The A- and B-tubes were operated with 140 kV and 80 kV/100 kV, respectively. DECT raw data were reconstructed by (1) only using high-energy (140 kV) CT spectra, (2) only using low-energy (80 kV/100 kV) CT spectra, (3) merging data (30% low- and 70% high-energy CT spectra), and (4) DECT-based iodine maps. Two independent, blinded observers analyzed all CT data according to each of the 4 reconstruction strategies for myocardial blood volume deficits. RESULTS: Specificity and positive predictive values were relatively similar between the 4 reconstruction strategies, with highest specificity (98%) of SCT datasets based on 140 kV for mixed perfusion deficits seen on SPECT. DECT iodine maps showed highest sensitivity, negative predictive value, and accuracy of 91%, 97%, and 93%, respectively, for mixed perfusion deficits. Analysis with receiver operating characteristics showed highest area under the curve values (0.84-0.93) with the use of DECT iodine maps in the detection of purely fixed and mixed perfusion deficits. CONCLUSION: DECT iodine maps show superior performance for the detection of fixed and mixed perfusion deficits compared with SCT spectra.
Assuntos
Volume Sanguíneo , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
OBJECTIVES: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume measurements, to predict adverse outcomes in patients with acute pulmonary embolism (PE). BACKGROUND: Three-dimensional ventricular volume measurements based on chest CT have become feasible for routine clinical application; however, their prognostic role in patients with acute PE has not been assessed. METHODS: We evaluated 260 patients with acute PE for the following CT signs of RV dysfunction obtained on routine chest CT: abnormal position of the interventricular septum, inferior vena cava contrast reflux, right ventricle diameter (RVD) to left ventricle diameter (LVD) ratio on axial sections and 4-chamber (4-CH) views, and 3-dimensional right ventricle volume (RVV) to left ventricle volume (LVV) ratio. Comorbidities and fatal and nonfatal adverse outcomes according to the MAPPET-3 (Management Strategies and Prognosis in Pulmonary Embolism Trial-3) criteria within 30 days were recorded. RESULTS: Fifty-seven patients (21.9%) had adverse outcomes, including 20 patients (7.7%) who died within 30 days. An RVD(axial)/LVD(axial) ratio >1.0 was not predictive for adverse outcomes. On multivariate analysis (adjusting for comorbidities), abnormal position of the interventricular septum (hazard ratio [HR]: 2.07; p = 0.007), inferior vena cava contrast reflux (HR: 2.57; p = 0.001), RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 2.51; p = 0.009), and RVV/LVV ratio >1.2 (HR: 4.04; p < 0.001) were predictive of adverse outcomes, whereas RVD(4-CH)/LVD(4-CH) ratio >1.0 (HR: 3.68; p = 0.039) and RVV/LVV ratio >1.2 (HR: 6.49; p = 0.005) were predictive of 30-day death. CONCLUSIONS: Three-dimensional ventricular volume measurement on chest CT is a predictor of early death in patients with acute PE, independent of clinical risk factors and comorbidities. Abnormal position of the interventricular septum, inferior vena cava contrast reflux, and RVD(4-CH)/LVD(4-CH) ratio are predictive of adverse outcomes, whereas RVD(axial)/LVD(axial) ratio >1.0 is not.
Assuntos
Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Doença Aguda , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/fisiopatologiaRESUMO
PURPOSE: To use coronary computed tomographic (CT) angiography to compare the prevalence, extent, and composition of coronary atherosclerotic lesions in African American and white patients with acute chest pain. MATERIALS AND METHODS: The institutional review board waived the requirement for informed consent for this retrospective, HIPAA-compliant matched-cohort study. The authors analyzed the CT angiographic data of 301 patients (150 consecutive African American patients; 151 white control patients; mean age, 55 years ± 11 [standard deviation]; 33% male) with acute chest pain. Each coronary artery segment was evaluated for presence of atherosclerotic plaque, plaque composition (calcified, noncalcified, or mixed), and stenosis. In addition, the noncalcified plaque volume was quantified by using a threshold-based automated algorithm. The presence and extent of atherosclerotic plaque were compared between the groups by using univariate and multivariate regression analyses. RESULTS: While there was no significant difference between the African American and white patients with respect to presence of any plaque (118 [79%] of 150 vs 112 [74%] of 151 patients, respectively; P = .36) or presence of stenosis (26 [17%] vs 37 [24%] patients, respectively; P = .13), the African American patients had a significantly higher prevalence (96 [64%] vs 62 [41%] patients, respectively; P < .001) and volume (median volume, 2.2 vs 1.4 mL, respectively; P < .001) of noncalcified plaque, independent of diabetes and other cardiovascular risk factors (odds ratio, 2.45; 95% confidence interval: 1.52, 4.04). In contrast, the African American patients had a lower prevalence of calcified plaque (39 [26%] vs 68 [45%] white patients, P = .001). CONCLUSION: Study results suggest that atherosclerotic plaque burden and composition, as measured by using coronary CT angiography, differ between African American and white patients, with relatively more noncalcified disease in African Americans and more calcified disease in white individuals. Further research is warranted to determine whether CT plaque characterization can improve cardiac risk prediction in African Americans.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Dor no Peito/diagnóstico por imagem , Dor no Peito/etnologia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etnologia , Tomografia Computadorizada por Raios X , População Branca/estatística & dados numéricos , Doença Aguda , Distribuição de Qui-Quadrado , Meios de Contraste , Feminino , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Prevalência , Interpretação de Imagem Radiográfica Assistida por Computador , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Estatísticas não ParamétricasRESUMO
OBJECTIVE: Over the last decade, rapid technologic evolution in CT has resulted in improved spatial and temporal resolution and acquisition speed, enabling cardiothoracic CT angiography to become a viable and effective noninvasive alternative in the diagnostic algorithm. These new technologic advances have imposed new challenges for the optimization of contrast medium delivery and image acquisition strategies. CONCLUSION: Thorough understanding of contrast medium dynamics is essential for the design of effective acquisition and injection protocols. This article provides an overview of the fundamentals affecting contrast enhancement, emphasizing the modifications to contrast material delivery protocols required to optimize cardiothoracic CT angiography.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Angiografia Coronária/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste/farmacocinética , Humanos , Intensificação de Imagem Radiográfica/métodosRESUMO
PURPOSE: To evaluate the effect of a computer-aided detection (CAD) algorithm on the performance of novice readers for detection of pulmonary embolism (PE) at CT pulmonary angiography (CTPA). MATERIALS AND METHODS: We included CTPA examinations of 79 patients (50 female, 52 ± 18 years). Studies were evaluated by two independent inexperienced readers who marked all vessels containing PE. After 3 months all studies were reevaluated by the same two readers, this time aided by CAD prototype. A consensus read by three expert radiologists served as the reference standard. Statistical analysis used χ(2) and McNemar testing. RESULTS: Expert consensus revealed 119 PEs in 32 studies. For PE detection, the sensitivity of CAD alone was 78%. Inexperienced readers' initial interpretations had an average per-PE sensitivity of 50%, which improved to 71% (p < 0.001) with CAD as a second reader. False positives increased from 0.18 to 0.25 per study (p = 0.03). Per-study, the readers initially detected 27/32 positive studies (84%); with CAD this number increased to 29.5 studies (92%; p = 0.125). CONCLUSION: Our results suggest that CAD significantly improves the sensitivity of PE detection for inexperienced readers with a small but appreciable increase in the rate of false positives.