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1.
Christophe?T.?Arendt Patricia?Tischendorf Julian?L.?Wichmann Michael?Messerli Lucas?J?rg Niklas?Ehl Robin?F.?Gohmann Simon?Wildermuth Thomas?J.?Vogl Ralf?W.?Bauer
Objectives
We investigated the potential reduction of patient exposure during invasive coronary angiography (ICA) if the procedure had only been directed to the vessel with at least one ≥ 50% stenosis as described in the CT report.Methods
Dose reports of 61 patients referred to ICA because of at least one ≥ 50% stenosis on coronary CT angiography (CCTA) were included. Dose–area product (DAP) was documented separately for left (LCA) and right coronary arteries (RCA) by summing up the single DAP for each angiographic projection. The study population was subdivided as follows: coronary intervention of LCA (group 1) or RCA (group 2) only, or of both vessels (group 3), or further bypass grafting (group 4), or no further intervention (group 5).Results
57.4% of the study population could have benefitted from reduced exposure if catheterization had been directly guided to the vessel of interest as described on CCTA. Mean relative DAP reductions were as follows: group 1 (n = 18), 11.2%; group 2 (n = 2), 40.3%; group 3 (n = 10), 0%; group 4 (n = 3), 0%; group 5 (n = 28), 28.8%.Conclusions
Directing ICA to the vessel with stenosis as described on CCTA would reduce intraprocedural patient exposure substantially, especially for patients with single-vessel stenosis.Key points
? Patients with CAD can benefit from decreased radiation exposure during coronary angiography. ? ICA should be directed solely to significant stenoses as described on CCTA. ? Severely calcified plaques remain a limitation of CCTA leading to unnecessary ICA referrals.2.
Objectives
To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE).Methods
We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined.Results
The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05).Conclusions
Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE.Key Points
? Repeat CCTA can provide information regarding the progression of coronary atherosclerosis. ? Coronary atherosclerosis progression at CCTA is independently associated with MACE. ? CCTA findings could serve as incremental predictors of MACE.3.
Objectives
To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience.Methods
Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure.Results
One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %.Conclusions
Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS.Key points
? ED Coronary CTA using advanced systems is associated with low radiation exposure. ? Negative coronary CTA is associated with low rates of MACE. ? CTA in ED patients enables short median time to discharge home. ? CTA strategy is characterized by few downstream tests including unnecessary ICA.4.
Objectives
To validate a method for performing myocardial segmentation based on coronary anatomy using coronary CT angiography (CCTA).Methods
Coronary artery-based myocardial segmentation (CAMS) was developed for use with CCTA. To validate and compare this method with the conventional American Heart Association (AHA) classification, a single coronary occlusion model was prepared and validated using six pigs. The unstained occluded coronary territories of the specimens and corresponding arterial territories from CAMS and AHA segmentations were compared using slice-by-slice matching and 100 virtual myocardial columns.Results
CAMS more precisely predicted ischaemic area than the AHA method, as indicated by 95% versus 76% (p?<?0.001) of the percentage of matched columns (defined as percentage of matched columns of segmentation method divided by number of unstained columns in the specimen). According to the subgroup analyses, CAMS demonstrated a higher percentage of matched columns than the AHA method in the left anterior descending artery (100% vs. 77%; p?<?0.001) and mid- (99% vs. 83%; p?=?0.046) and apical-level territories of the left ventricle (90% vs. 52%; p?=?0.011).Conclusions
CAMS is a feasible method for identifying the corresponding myocardial territories of the coronary arteries using CCTA.Key Points
? CAMS is a feasible method for identifying corresponding coronary territory using CTA ? CAMS is more accurate in predicting coronary territory than the AHA method ? The AHA method may underestimate the ischaemic territory of LAD stenosis5.
Amir Imanzadeh Elizabeth George Takeshi Kondo Shinichi Takase Makoto Amanuma Frank J. Rybicki Kanako K. Kumamaru 《Japanese journal of radiology》2016,34(2):140-147
Purpose
To evaluate the role of coronary artery calcium scoring (CACS) and/or coronary CT angiography (CCTA) in asymptomatic elderly patients with high pretest probability for coronary artery disease (CAD).Materials and methods
Forty-eight consecutive asymptomatic elderly (>65 years) subjects who had a high pretest probability and underwent CACS/CCTA were included. Each CCTA was evaluated for adequacy for assessment of coronary stenosis. Significant stenosis (>50 % diameter narrowing) was assessed on evaluable CT images and by invasive catheter angiography (ICA).Results
All subjects were men with mean CACS of 880 ± 1779. Among those with low (0–99), intermediate (100–399), and high (400–999) CACS, ICA-verified significant stenosis was present in 8 % (1/13), 23 % (2/13), and 67 % (8/12), respectively. Among those with very high CACS (≥1000) (n = 10), 90 % of CCTAs were not evaluable for stenosis.Conclusion
In asymptomatic elderly subjects with high pretest probability, CACS followed by CCTA may be considered for those with intermediate to high CACS.6.
Objectives
To evaluate image quality, coronary evaluability and radiation exposure of coronary CT angiography (CCTA) performed with whole-heart coverage cardiac-CT in patients with atrial fibrillation (AF).Materials and methods
We prospectively enrolled 164 patients with AF who underwent a clinically indicated CCTA with a 16-cm z-axis coverage scanner. In all patients CCTA was performed using prospective ECG-triggering with targeted RR interval. We evaluated image quality, coronary evaluability and effective dose (ED). Patients were divided in two subgroups based on heart rate (HR) during imaging. Group 1: 64 patients with low HR (<75 bpm), group 2: 100 patients with high HR (≥75 bpm). Written informed consent was obtained from all patients and the institutional ethics committee approved the study protocol.Results
In a segment-based analysis, coronary evaluability was 98.4 % (2,577/2,620 segments) in the whole population, without significant differences between groups (1,013/1,024 (98.9 %) and 1,565/1,596 (98.1 %), for groups 1 and 2, respectively, p=0.15). Mean ED was similar in both groups (3.8±1.9 mSv and 3.9±2.1 mSv in groups 1 and 2, respectively, p=0.75)Conclusions
The whole-heart-coverage scanner could evaluate coronary arteries with high image quality and without increase in radiation exposure in AF patients, even in the high HR group.Key points
? Last-generation CT scanner improves coronary artery assessment in AF patients. ? The new CT scanner enables low radiation exposure in AF patients. ? Diagnostic ICA maybe avoided in AF patients with suspected CAD. ? Whole-heart coverage CT scanner enables low radiation exposure in AF patients.7.
Purpose
To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients.Methods
We retrospectively analyzed 76 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography. Prospectively ECG-triggered acquisition was performed with automated tube voltage selection (ATVS). Patients were dichotomized based on body mass index in groups A (<30 kg/m2, n?=?37) and B (≥30 kg/m2, n?=?39) and based on tube voltage in groups C (<120 kV, n?=?46) and D (120 kV, n?=?30). Coronary arteries were assessed for significant stenoses (≥50 % luminal narrowing) and diagnostic accuracy was calculated.Results
Per-patient overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 96.9 %, 95.5 %, 93.9 %, 97.7 % and 96.1 %, respectively. Sensitivity and NPV were lower in groups B and D compared to groups A and C, but no statistically significant differences were observed (group A vs. B: sensitivity, 100.0 % vs. 93.3 %, p?=?0.9493; NPV, 100 % vs. 95.5 %, p?=?0.9812; group C vs. D: sensitivity, 100.0 % vs. 92.3 %, p?=?0.8462; NPV, 100.0 % vs. 94.1 %, p?=?0.8285).Conclusion
CCTA using 3rd-generation DSCT and (ATVS) provides high diagnostic accuracy in both non-obese and obese patients.Key Points
? Coronary CTA provides high diagnostic accuracy in non-obese and obese patients. ? Diagnostic accuracy between obese and non-obese patients showed no significant difference.? <120 kV studies were performed in 44 % of obese patients. ? Current radiation dose-saving approaches can be applied independent of body habitus.8.
Fabian Plank Philipp Burghard Guy Friedrich Wolfgang Dichtl Agnes Mayr Andrea Klauser Florian Wolf Gudrun Feuchtner 《European radiology》2016,26(11):3781-3789
Objective
To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization.Methods
160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8).Results
210 coronary segments were included (59 % positive). MLA of ≤1.8 mm2 was identified as the optimal cut-off (c?=?0.97, p?<?0.001; 95 % CI 0.94–0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm2 sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c?=?0.92; p?<?0.001; 95 % CI 0.88–95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c?=?0.89; 95 % CI 0.84–93, c?=?0.87; 95 % CI 0.82–92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c?=?0.74 (95 % CI 0.67–81), and for LL/MLA and LL/MLD ratio c?=?0.90 and c?=?0.84.Conclusions
MLA ≤1.8 mm2 and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis.Key Points
? Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. ? Absolute lumen area and diameter rather than %stenosis predict functional relevance. ? Lumen area <1.8 mm 2 and diameter <1.2 mm are the most accurate cut-offs. ? Quantitative parameters are helpful for decision-making in terms of patient management.9.
Stefan B. Puchner Maros Ferencik Pal Maurovich-Horvat Masataka Nakano Fumiyuki Otsuka Hans-Ulrich Kauczor Renu Virmani Udo Hoffmann Christopher L. Schlett 《European radiology》2015,25(1):15-23
Objectives
To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.Methods and materials
CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.Results
Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78?±?2.29 vs. 3.39?±?1.68 FBP; 5.92?±?1.87 vs. 3.43?±?1.62 ASIR; 6.40?±?1.55 vs. 3.49?±?1.50 MBIR; all p?<?0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p?=?0.01). MBIR increased sensitivity for detection of LCP by CCTA.Conclusion
Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.Key Points
? A low attenuation plaque area is associated with the presence of lipid-core plaque ? MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque ? The benefit of MBIR is mainly due to increased sensitivity at high specificities ? Semiautomated CCTA assessment can detect vulnerable plaques non-invasively10.
Valeria Cantoni Roberta Green Wanda Acampa Mario Petretta Domenico Bonaduce Marco Salvatore Alberto Cuocolo 《Journal of nuclear cardiology》2016,23(2):185-197
Background
We conducted a meta-analysis to compare the long-term prognostic value of stress single-photon emission computed tomography myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) for adverse cardiovascular events in subjects with suspected or known coronary artery disease.Methods and Results
We searched PubMed, Cochrane, Web of Science, and Scopus database between January 2000 and December 2014 for stress MPI and CCTA studies that followed up ≥ 100 subjects for ≥ 2.5 years and provided the unadjusted and/or adjusted hazard ratio (HR) at Cox regression analysis. Summary risk estimates for abnormal perfusion at MPI or ≥ 50% coronary stenosis at CCTA were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. We identified 21 eligible articles (10 MPI and 11 CCTA) including 25,258 participants (13,484 in MPI and 11,774 in CCTA studies) with suspected or known coronary artery disease. Among the included publications, 8 MPI and 8 CCTA studies reported the HR for the occurrence of hard events (death and nonfatal myocardial infarction). The pooled HR was comparable for MPI and CCTA studies. The HR for the occurrence of a combined endpoint including revascularization as event was reported in 4 MPI and 6 CCTA studies. The pooled HR was higher for CCTA compared to MPI (P < .05) also when only MPI and CCTA studies with limited representation of prior CAD were considered.Conclusions
The long-term prognostic value of MPI and CCTA for the occurrence of hard events is similar. However, the association between event-free survival and CCTA is higher than MPI when coronary revascularization is included in the endpoint.11.
Objectives
The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR).Materials and methods
Twenty-one patients who underwent coronary CTA and invasive FFR were retrospectively identified. Ischemia was defined as invasive FFR ≤0.80. Using a work-in-progress computational fluid dynamics algorithm, CTA-FFR was computed with BP measured before CTA, and simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg respectively. Correlation between CTA-FFR and invasive FFR was assessed using Pearson test. The repeated measuring test was used for multiple comparisons of CTA-FFR values by simulated BP inputs.Results
Twenty-nine vessels (14 with invasive FFR?≤0.80) were assessed. The average CTA-FFR for measured BP (134?±?20/73?±?12 mmHg) was 0.77?±?0.12. Correlation between CTA-FFR by measured BP and invasive FFR was good (r?=?0.735, P?<?0.001). For simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg, the CTA-FFR increased: 0.69?±?0.13, 0.73?±?0.12, 0.75?±?0.12, 0.77?±?0.11, 0.79?±?0.11, and 0.81?±?0.10 respectively (P?<?0.05).Conclusion
Measurement of the BP just before CTA is preferred for accurate CTA-FFR simulation. BP variations in the common range slightly affect CTA-FFR. However, inaccurate BP assumptions differing from the patient-specific BP could cause misinterpretation of borderline significant lesions.Key Points
? The blood pressure (BP) affects the CTA-FFR computation. ? Measured BP before CT examination is preferable for accurate CTA-FFR simulation. ? Inaccurate BP assumptions can cause misinterpretation of borderline significant lesions.12.
Aimin Ding Guoqing Qiu Wensheng Lin Ling Hu Guangliang Lu Xiang Long Xin Hong Yaohua Chen Xiaoping Luo Qinqin Tang Dongqin Deng 《Japanese journal of radiology》2016,34(12):795-808
Purpose
Fractional flow reserve based on coronary computed tomographic angiography (CCTA; FFRCT) can evaluate functional severity in coronary artery disease (CAD). This study investigated the diagnostic value of FFRCT for determining CAD severity.Materials and methods
Medline, Cochrane, EMBASE, and Google Scholar databases were searched until June 16, 2016 using the following search terms: fractional flow reserve, coronary computed tomography angiography, myocardial ischemia. Randomized controlled trials, two-arm prospective studies, and retrospective studies were included in the analysis.Results
Twenty-one studies were included with a total of 2216 subjects and 2798 vessels. FFRCT, sensitivity per-vessel and per-patient were ≥82% and specificity was ≥73% for diagnosis of ischemia. FFRCT had better diagnostic accuracy and discrimination than CCTA.Conclusion
This study indicates that FFRCT may be a good tool for screening and diagnosing of myocardial ischemia in patients with CAD.13.
Objectives
Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT).Methods
We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard.Results
We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P?<?0.0001).Conclusions
Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions.Key Points
? Computed tomography angiography tends to overestimate stenosis in calcified coronary artery. ? Dual-energy CT enables us to suppress calcification of coronary artery lesions. ? Calcification-suppressed material density imaging reduces false-positive diagnosis of calcified lesion.14.
Xiaoyi?Chen Huilin?Zhao Zhensen?Chen Huiyu?Qiao Yuanyuan?Cui Dongye?Li Zechen?Zhou Le?He Rui?Li Chun?Yuan Xihai?Zhao
Purpose
Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA.Methods
Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images.Results
In total, 166 carotid arteries from 125 patients (mean age 61.0 ± 10.5 years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%–49%, 50%–69%, 70%–99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r = 0.767, P < 0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR) = 2.459, 95% confidence interval (CI) 1.896–3.189, P < 0.001].Conclusion
Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA.15.
Objectives
To compare the incremental diagnostic value of targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) fusion to conventional 14-cores biopsy.Patients and Methods
Uni-institutional, institutional review board (IRB) approved prospective blinded study comparing TRUS-guided random and targeted biopsy using mpMRI-TRUS fusion, in 100 consecutive men. We included men with clinical-laboratorial suspicious for prostate cancer and Likert score ≥ 3 mp-MRI. Patients previously diagnosed with prostate cancer were excluded. All patients were submitted to 14-cores TRUS-guided biopsy (mpMRI data operator-blinded), followed by targeted biopsy using mpMRI-TRUS fusion.Results
There was an overall increase in cancer detection rate, from 56% with random technique to 62% combining targeted biopsy using mpMRI-TRUS fusion; incremental diagnosis was even more relevant for clinically significant lesions (Gleason ≥ 7), diagnosing 10% more clinically significant lesions with fusion biopsy technique. Diagnosis upgrade occurred in 5 patients that would have negative results in random biopsies and had clinically significant tumours with the combined technique, and in 5 patients who had the diagnosis of significant tumours after fusion biopsy and clinically insignificant tumours in random biopsies(p=0.0010).Conclusions
Targeted biopsy using mpMRI-TRUS fusion has incremental diagnostic value in comparison to conventional random biopsy, better detecting clinically significant prostate cancers.Key Points
? mpMRI-TRUS targeted biopsy increases overall cancer detection rate, but not statistically significant.? mpMRI-TRUS targeted biopsy actually improves the diagnosis of clinically significant PCa.? There was no evidence to acquire the mpMRI-TRUS fusion cores alone.16.
Objectives
To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery.Methods
Between October 2010–June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADCmean were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis.Results
CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADCmean did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%.Conclusions
TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome.Key Points
? Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC. ? Best cut-off for predicting pathological PR was ΔTV reduction of 73 %. ? Early-MRI ADC mean measurements did not correlate with treatment outcome.17.
Stefanie Mangold Julian L. Wichmann U. Joseph Schoepf Sheldon E. Litwin Christian Canstein Akos Varga-Szemes Giuseppe Muscogiuri Stephen R. Fuller Andrew C. Stubenrauch Konstantin Nikolaou Carlo N. De Cecco 《European radiology》2016,26(9):2937-2946
Objectives
To evaluate the image quality of coronary CT angiography (CCTA) in obese patients using a 3rd generation, dual-source CT scanner.Methods
We retrospectively evaluated 102 overweight and obese patients who had undergone CCTA. Studies were performed with 3rd generation dual-source CT, prospectively ECG-triggered acquisition at 120 kV, and automated tube current modulation. Advanced modeled iterative reconstruction was used. Patients were divided into three BMI groups: 1)25–29.9 kg/m2; 2)30–39.9 kg/m2; 3)?≥?40 kg/m2. Vascular attenuation in the coronary arteries was measured. Contrast-to-noise ratio (CNR) was calculated. Image quality was subjectively evaluated using five-point scales.Results
Image quality was considered diagnostic in 97.6 % of examinations. CNR was consistently adequate in all groups but decreased for groups 2 and 3 in comparison to group 1 as well as for group 3 compared to group 2 (p?=?0.001, respectively). Subjective image quality was significantly higher in group 1 compared to group 3 (attenuation proximal: 4.8?±?0.4 vs. 4.4?±?0.6, p?=?0.011; attenuation distal: 4.5?±?0.7 vs. 4.0?±?0.8, p?=?0.019; noise: 4.7?±?0.6 vs. 3.8?±?0.7, p?<?0.001). The mean effective dose was 9.5?±?3.9 mSv for group 1, 11.4?±?4.7 mSv for group 2 and 14.0?±?6.4 mSv for group 3.Conclusion
Diagnostic image quality can be routinely obtained at CCTA in obese patients with 3rd generation DSCT at 120 kV.Key Points
? Diagnostic CCTA can be routinely performed in obese patients with 3 rd generation DSCT.? 120-kV tube voltage allows diagnostic image quality in patients with BMI?>?40 kg/m 2 .? 80-ml contrast medium can be administered without significant decline in vascular attenuation.18.
Amanda Formosa Denise May Santos Daniel Marcuzzi Andrew A. Common Vikramaditya Prabhudesai 《Cardiovascular and interventional radiology》2016,39(4):606-610
Purpose
Catheter-directed computed tomography angiography (CCTA) has been shown to reduce the contrast volumes required in conventional CTA, thus minimizing the risk of contrast-induced nephropathy (CIN).Materials and Methods
A retrospective analysis was performed on cases where CCTA was used to assess access vessels prior to transfemoral aortic valve implantation (TAVI, n = 53), abdominal aortic aneurysm assessment for endovascular aneurysm repair (EVAR, n = 11), and peripheral vascular disease (PVD, n = 24).Results
We show that CCTA can image vasculature with adequate diagnostic detail to allow assessment of lower extremity disease, anatomic suitability for EVAR, as well as potential contraindications to TAVI. Average contrast volumes for pre-TAVI, pre-EVAR, and PVD cases were 7, 11, and 28 mL, respectively.Conclusion
This study validates the use of CCTA in obtaining diagnostic images of the abdominal and pelvic vessels and in imaging lower extremity vasculature.19.
Objectives
Indications for pulmonary valve replacement (PVR) in patients with pulmonary regurgitation (PR) after repaired tetralogy of Fallot (rToF) are debated. We aimed to compare right (RV) and left ventricular (LV) kinetic energy (KE) measured by 4D-flow magnetic resonance imaging (MRI) in patients to controls, to further understand the pathophysiological effects of PR.Methods
Fifteen patients with rToF with PR > 20% and 14 controls underwent MRI. Ventricular volumes and KE were quantified from cine MRI and 4D-flow, respectively. Lagrangian coherent structures were used to discriminate KE in the PR. Restrictive RV physiology was defined as end-diastolic forward flow.Results
LV systolic peak KE was lower in rToF, 2.8 ± 1.1 mJ, compared to healthy volunteers, 4.8 ± 1.1 mJ, p < 0.0001. RV diastolic peak KE was higher in rToF (7.7 ± 4.3 mJ vs 3.1 ± 1.3 mJ, p = 0.0001) and the difference most pronounced in patients with non-restrictive RV physiology. KE was primarily located in the PR volume at the time of diastolic peak KE, 64 ± 17%.Conclusion
This is the first study showing disturbed KE in patients with rToF and PR, in both the RV and LV. The role of KE as a potential early marker of ventricular dysfunction to guide intervention needs to be addressed in future studies.Key Points
? Kinetic energy (KE) reflects ventricular performance ? KE is a potential marker of ventricular dysfunction in Fallot patients ? KE is disturbed in both ventricles in patients with tetralogy of Fallot ? KE contributes to the understanding of the pathophysiology of pulmonary regurgitation ? Lagrangian coherent structures enable differentiation of ventricular inflows20.