The utility of cardiac CT beyond the assessment of suspected coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Kakouros, N. [Johns Hopkins Hospital, Baltimore, MD (United States); Giles, J.; Crundwell, N.B. [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom); McWilliams, E.T.M., E-mail: eric.mcwilliams@esht.nhs.uk [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom)

2012-07-15

Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

The utility of cardiac CT beyond the assessment of suspected coronary artery disease

International Nuclear Information System (INIS)

Kakouros, N.; Giles, J.; Crundwell, N.B.; McWilliams, E.T.M.

2012-01-01

Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

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Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

2015-07-15

To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

Coronary CT angiography: Diagnostic value and clinical challenges.

Science.gov (United States)

Sabarudin, Akmal; Sun, Zhonghua

2013-12-26

Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

Detection of aneurysms in subarachnoidal hemorrhage - CT-angiography versus digital subtraction angiography

International Nuclear Information System (INIS)

Roehnert, W.; Haenig, V.; Hietschold, V.; Abolmaali, N.

1998-01-01

Purpose: The value of CT-angiography (CT-A) for the visualization of intracranial aneurysms was more closely defined by comparison with digital subtraction angiography (DSA). Methods: Over a period of 18 months a total of 106 patients in whom a subarachnoidal hemorrhage had been detected on native CT were examined in parallel by spiral CT and DSA. CT-angiography was performed under standardized parameters and included processing with 3D surface reconstructions. Results: In 64 patients (60.4%) at total of 72 aneurysms were detected. In four cases (6.2%) there were two and in two cases (3.1%) even three aneurysms. The findings of DSA and CTA agreed in 98 cases (92.5%). In four patients (3.8%) a false negative results was obtained in CTA and the initial DSA. Conclusions: Digital subtraction angiography must still be considered as the gold standard in the diagnosis of cerebral aneurysms. On account of its excellent spatial delineation of aneurysms and possibilities for exact measurements, CT-angiography represents a valuable, supplementary method - in some cases also an alternative method - to digital subtraction angiography. (orig.) [de

Automatic selection of optimal cardiac-phase in coronary CT angiography. Its clinical usefulness for patients with atrial fibrillation

International Nuclear Information System (INIS)

Matsumoto, Ryota; Narita, Hiroshi; Anno, Hirofumi; Ida, Yoshihiro; Sanda, Yoshihiro; Katada, Kazuhiro; Motoyama, Sadako; Sarai, Masayoshi; Tsuyuki, Masaharu

2008-01-01

The optimal cardiac phases for coronary CT angiography (CTA) are end-systole and mid-diastole, in which cardiac movement is slow. In conventional methods, these cardiac phases are determined by visual selection. We have compared the images in the optimal cardiac phases that were selected by the conventional method and cardiac-phase search software (Phase Navi), and examined the clinical usefulness of Phase Navi in patients with atrial fibrillation. The subjects were 38 patients (regular rhythm: 20, atrial fibrillation: 18). The continuity scores of patients with regular rhythm (Phase Navi, conventional methods) were 2.4±0.3-2.5±0.3 in end-systole and 2.4±0.5-2.4±0.4 in mid-diastole. The scores of patients with atrial fibrillation (Phase Navi, conventional methods) were 2.3±0.4-2.3±0.4 in end-systole, and 2.2±0.5-2.1±0.6 in mid-diastole. Because the continuity scores of the optimal images from Phase Navi were similar to those from the conventional method, Phase Navi had clinical usefulness in patients with atrial fibrillation. (author)

Dose reduction strategies for cardiac CT

International Nuclear Information System (INIS)

Midgley, S.M.; Einsiedel, P.; Langenberg, F.; Lui, E.

2010-01-01

Full text: Recent advances in CT technology have produced brighter X-ray sources. gantries capable of increased rotation speeds, faster scintil lation materials arranged into multiple rows of detectors, and associated advances in 3D reconstruction methods. These innovations have allowed multi-detector CT to be turned to the diagnosis of cardiac abnormalities and compliment traditional imaging techniques such as coronary angiography. This study examines the cardiac imaging solution offered by the Siemens Somatom Definition Dual Source 64 slice CT scanner. Our dose reduction strategies involve optimising the data acquisition protocols according to diagnostic task, patient size and heart rate. The relationship between scan parameters, image quality and patient dose is examined and verified against measurements with phantoms representing the standard size patient. The dose reduction strategies are reviewed with reference to survey results of patient dose. Some cases allow the insertion of shielding to protect radiosensitive organs, and results are presented to quantify the dose saving.

Latest techniques in head and neck CT angiography

International Nuclear Information System (INIS)

Schuknecht, B.

2004-01-01

Continuous evolution of multi row CT is increasingly making CT angiography a viable imaging modality for assessment of the supraaortic and intracranial vessels as an anatomically and functionally coherent vascular system. Extended non-invasive examinations with reduced contrast volume have become feasible with the availability of 16 and 64 row MDCT scanners. Prerequisites to obtain high resolution CT angiographies of the head and neck vessels with superior detail include the administration of low contrast volume, high contrast density (400 mg I/ml) contrast media, adequate timing and data acquisition, optimal flow rate (4 ml/s) and saline flushing. Non-invasiveness, delineation of vessel calcification, virtual independence from hemodynamic conditions, and the ability to provide quantification without needing to correct for magnification are all attributes that favour CT angiography over digital subtraction angiography and to some extent even magnetic resonance angiography as an alternative non-invasive technique. CT angiography is established as a modality of choice for the assessment of patients with acute stroke and chronic steno-occlusive disease. CT angiography may indicate the presence of extra- or intracranial acute vessel occlusion and dissection, predisposing atherosclerotic steno-occlusive disease and thus indicate thrombo-embolism or local appositional thrombosis as the principle pathogenic factor. CT angiography is used to assess anatomy, and to depict the presence, location and extent of calcified and non-calcified plaque as a cause of high grade stenosis. Despite relatively limited sensitivity CT angiography is indicated for suspected or confirmed aneurysms that demand further verification of their presence, geometry, or relationship to parent artery branches and osseous anatomic landmarks. Low volume high density contrast media have substantially increased the ability of CT angiography to depict small aneurysms, small branches, and collateral vessels

Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

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Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B. [Papworth Hospital, Cambridge (United Kingdom); Screaton, Nicholas J. [Papworth Hospital, Cambridge (United Kingdom); Papworth Hospital NHS Trust, Diagnostic Centre, Department of Radiology, Papworth Everard, Cambridgeshire (United Kingdom)

2009-11-15

The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. (orig.)

Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

International Nuclear Information System (INIS)

Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B.; Screaton, Nicholas J.

2009-01-01

The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. (orig.)

Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

Energy Technology Data Exchange (ETDEWEB)

Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

2014-07-01

Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

Automatic coronary artery calcium scoring in cardiac CT angiography using paired convolutional neural networks.

Science.gov (United States)

Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; van Hamersvelt, Robbert W; Viergever, Max A; Išgum, Ivana

2016-12-01

The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. CAC is clinically quantified in cardiac calcium scoring CT (CSCT), but it has been shown that cardiac CT angiography (CCTA) may also be used for this purpose. We present a method for automatic CAC quantification in CCTA. This method uses supervised learning to directly identify and quantify CAC without a need for coronary artery extraction commonly used in existing methods. The study included cardiac CT exams of 250 patients for whom both a CCTA and a CSCT scan were available. To restrict the volume-of-interest for analysis, a bounding box around the heart is automatically determined. The bounding box detection algorithm employs a combination of three ConvNets, where each detects the heart in a different orthogonal plane (axial, sagittal, coronal). These ConvNets were trained using 50 cardiac CT exams. In the remaining 200 exams, a reference standard for CAC was defined in CSCT and CCTA. Out of these, 100 CCTA scans were used for training, and the remaining 100 for evaluation of a voxel classification method for CAC identification. The method uses ConvPairs, pairs of convolutional neural networks (ConvNets). The first ConvNet in a pair identifies voxels likely to be CAC, thereby discarding the majority of non-CAC-like voxels such as lung and fatty tissue. The identified CAC-like voxels are further classified by the second ConvNet in the pair, which distinguishes between CAC and CAC-like negatives. Given the different task of each ConvNet, they share their architecture, but not their weights. Input patches are either 2.5D or 3D. The ConvNets are purely convolutional, i.e. no pooling layers are present and fully connected layers are implemented as convolutions, thereby allowing efficient voxel classification. The performance of individual 2.5D and 3D ConvPairs with input sizes of 15 and 25 voxels, as well as the performance of ensembles of these Conv

Anomalous origin of coronary artery: the role of multislice CT Angiography: a case report and literature review

Energy Technology Data Exchange (ETDEWEB)

Rabelo, Daniel Rocha; Barros, Marcio Vinicius Lins; Nunes, Maria do Carmo Pereira; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil)

2012-07-15

Anomalous origin of coronary arteries is a relatively rare entity and can present different clinical forms. Recently, CT angiography of the coronary arteries have demonstrated an important role in the diagnosis and management of these anomalies. We present the case of a young female without significant comorbidities who presented with cardiopulmonary arrest, being revived by a team of customer service mobile emergency. After completion of multislice CT angiography of the coronary arteries was observed anomalous origin of left main coronary artery in the right coronary artery, no signs of extrinsic compression. Patient received a defibrillator and had an uneventful follow-up performed. Multislice CT angiography is minimally invasive diagnostic methods to detect the origin and trajectory of the coronary arteries, allowing an alternative to cardiac catheterization for evaluation of patients with anomalous origin of coronary arteries. (author)

Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

International Nuclear Information System (INIS)

Hwang, Jae-Yeon; Choo, Ki Seok; Choi, Yoon Young; Kim, Jin Hyeok; Ryu, Hwaseong; Kim, Yong-Woo; Jeon, Ung Bae; Nam, Kyung Jin; Han, Junhee

2017-01-01

Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups. (orig.)

Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

Energy Technology Data Exchange (ETDEWEB)

Hwang, Jae-Yeon [Pusan National University Yangsan Hospital, Department of Radiology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Choo, Ki Seok; Choi, Yoon Young; Kim, Jin Hyeok; Ryu, Hwaseong; Kim, Yong-Woo; Jeon, Ung Bae; Nam, Kyung Jin [Pusan National University Yangsan Hospital, Department of Radiology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Han, Junhee [Pusan National University Yangsan Hospital, Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of)

2017-05-15

Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups. (orig.)

CT Angiography in the Diagnosis of Brain Death

International Nuclear Information System (INIS)

Sawicki, Marcin; Bohatyrewicz, Romuald; Walecka, Anna; Sołek-Pastuszka, Joanna; Rowiński, Olgierd; Walecki, Jerzy

2014-01-01

Summary Brain death is defined as the irreversible cessation of functioning of the entire brain, including the brainstem. Brain death is principally established using clinical criteria including coma, absence of brainstem reflexes and loss of central drive to breathe assessed with apnea test. In situations in which clinical testing cannot be performed or when uncertainty exists about the reliability of its parts due to confounding conditions ancillary tests (i.a. imaging studies) may be useful. The objective of ancillary tests in the diagnosis of brain death is to demonstrate the absence of cerebral electrical activity (EEG and evoked potentials) or cerebral circulatory arrest. In clinical practice catheter cerebral angiography, perfusion scintigraphy, transcranial Doppler sonography, CT angiography and MR angiography are used. Other methods, like perfusion CT, xenon CT, MR spectroscopy, diffusion weighted MRI and functional MRI are being studied as potentially useful in the diagnosis of brain death. CT angiography has recently attracted attention as a promising alternative to catheter angiography – a reference test in the diagnosis of brain death. Since 1998 several major studies were published and national guidelines were introduced in several countries (e.g. in France, Austria, Switzerland, the Netherlands and Canada). This paper reviews technique, characteristic findings and criteria for the diagnosis of cerebral circulatory arrest in CT angiography

CT and MR angiography

International Nuclear Information System (INIS)

Bert, A.L.; Marshal, G.

1995-01-01

CT-angiography is a new vessel imaging technique based on the volumetric scanning of the region of interst during the first pass of IV bolus injection of contrast medium. MR-angiography is a titally noninvasive technique. The differentiation of flowing blood from the adjecent stationary tissues is based on the detection of blood motion. The flowing blood is highlighted with white light. CT- and MR-angiographic techniques are used to establish% stenoses and occlusions in intracranial arteries; aneurisms; trombosis of intracranial veins and venous angioma; diseases of neck vessels, thoracic vessels, abdominal vessels. Blood flow direction in cirrotic patients with portal hypertension can be determined in the portal vein, as well as the presence of thrombosis

Cardiac 82rubidium PET/CT: initial European experience

International Nuclear Information System (INIS)

Groves, Ashley M.; Dickson, John C.; Kayani, Irfan; Endozo, Raymondo; Blanchard, Patty; Shastry, Manu; Prvulovich, Elizabeth; Waddington, Wendy A.; Ben-Haim, Simona; Bomanji, Jamshed B.; Ell, Peter J.; Speechly-Dick, Marie-Elsya; McEwan, Jean R.

2007-01-01

Myocardial perfusion with PET/CT has advantages over conventional SPECT. We describe our initial European experience using 82 Rubidium-PET/CT, as part of a clinical myocardial perfusion service. We studied the first 100 patients (64 male; 36 female, mean age = 60: SD +/-12.5y, mean body mass index = 30: SD +/-6.9kg/m 2 ) who underwent 82 Rubidium cardiac PET/CT in our institution. Thirty patients had recently undergone coronary angiography. Patients underwent imaging during adenosine infusion and at rest. Images were acquired over 5 minutes using a GE-PET/CT instrument. Image quality was described as good, adequate or inadequate. Images were reported patient-by-patient by a minimum of five nuclear medicine physicians. A segment-by-segment analysis (17-segment model) was also performed. Image quality was good in 77%, adequate 23% and inadequate 0%. There was no statistical difference in image quality between obese and non-obese patients (Fisher's exact test, p = 0.2864). 59% had normal perfusion studies, 29% had inducible ischaemia, 12% had myocardial infarction (11% with super added ischaemia). There was reduced 82 Rubidium uptake in 132/1700 segments during stress. There was reduced 82 Rubidium uptake at rest in 42/1700 segments. The 82 Rubidium PET/CT findings were consistent with the angiographic findings in 28/30 cases. We show that, even from initial use of 82 Rubidium, it is possible to perform myocardial perfusion studies quickly with good image quality, even in the obese. The PET findings correlated well in the third of the cases where angiography was available. As such, 82 Rubidium cardiac PET/CT is likely to be an exciting addition to the European nuclear physician/ cardiologist's radionuclide imaging arsenal. (orig.)

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study.

Science.gov (United States)

Grabherr, Silke; Heinemann, Axel; Vogel, Hermann; Rutty, Guy; Morgan, Bruno; Woźniak, Krzysztof; Dedouit, Fabrice; Fischer, Florian; Lochner, Stefanie; Wittig, Holger; Guglielmi, Giuseppe; Eplinius, Franziska; Michaud, Katarzyna; Palmiere, Cristian; Chevallier, Christine; Mangin, Patrice; Grimm, Jochen M

2018-05-01

Purpose To determine if postmortem computed tomography (CT) and postmortem CT angiography help to detect more lesions than autopsy in postmortem examinations, to evaluate the strengths and weaknesses of each method, and to define their indications. Materials and Methods Postmortem CT angiography was performed on 500 human corpses and followed by conventional autopsy. Nine centers were involved. All CT images were read by an experienced team including one forensic pathologist and one radiologist, blinded to the autopsy results. All findings were recorded for each method and categorized by anatomic structure (bone, organ parenchyma, soft tissue, and vascular) and relative importance in the forensic case (essential, useful, and unimportant). Results Among 18 654 findings, autopsies helped to identify 61.3% (11 433 of 18 654), postmortem CT helped to identify 76.0% (14 179 of 18 654), and postmortem CT angiography helped to identify 89.9% (16 780 of 18 654; P < .001). Postmortem CT angiography was superior to autopsy, especially at helping to identify essential skeletal lesions (96.1% [625 of 650] vs 65.4% [425 of 650], respectively; P < .001) and vascular lesions (93.5% [938 of 1003] vs 65.3% [655 of 1003], respectively; P < .001). Among the forensically essential findings, 23.4% (1029 of 4393) were not detected at autopsy, while only 9.7% (428 of 4393) were missed at postmortem CT angiography (P < .001). The best results were obtained when postmortem CT angiography was combined with autopsy. Conclusion Postmortem CT and postmortem CT angiography and autopsy each detect important lesions not detected by the other method. More lesions were identified by combining postmortem CT angiography and autopsy, which may increase the quality of postmortem diagnosis. Online supplemental material is available for this article.

Radiological evaluation with Doppler sonography and multidetector CT angiography in congenital hepatic arteriovenous malformation in a newborn

Energy Technology Data Exchange (ETDEWEB)

Adaletli, Ibrahim; Kurugoglu, Sebuh; Kilic, Fahrettin [Istanbul University, Department of Radiology, Cerrahpasa Medical Faculty (Turkey); Senyuz, Osman F. [Istanbul University, Department of Paediatric Surgery, Cerrahpasa Medical Faculty (Turkey); Dervisoglu, Sergulen [Istanbul University, Department of Pathology, Cerrahpasa Medical Faculty (Turkey)

2006-11-15

Although hepatic arteriovenous malformations are rarely reported, they frequently have life-threatening complications such as cardiac failure and are associated with a high mortality rate. Consequently, accurate prenatal and early postnatal diagnosis is important and therapeutic procedures depend on the imaging features. We report the early postnatal sonographic, Doppler sonographic, multidetector CT and CT angiography findings of a congenital hepatic arteriovenous malformation in a newborn. (orig.)

Radiological evaluation with Doppler sonography and multidetector CT angiography in congenital hepatic arteriovenous malformation in a newborn

International Nuclear Information System (INIS)

Adaletli, Ibrahim; Kurugoglu, Sebuh; Kilic, Fahrettin; Senyuz, Osman F.; Dervisoglu, Sergulen

2006-01-01

Although hepatic arteriovenous malformations are rarely reported, they frequently have life-threatening complications such as cardiac failure and are associated with a high mortality rate. Consequently, accurate prenatal and early postnatal diagnosis is important and therapeutic procedures depend on the imaging features. We report the early postnatal sonographic, Doppler sonographic, multidetector CT and CT angiography findings of a congenital hepatic arteriovenous malformation in a newborn. (orig.)

Current but not past smoking increases the risk of cardiac events: Insights from coronary computed tomographic angiography

NARCIS (Netherlands)

R. Nakanishi (Rine); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); H. Gransar (Heidi); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor Y.); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); R.C. Cury (Ricardo); A. Delago (Augustin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); F.Y. Lin (Fay); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); A. Dunning (Allison); J.K. Min (James)

2015-01-01

textabstractAims We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA). Methods and results We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588

CT coronary angiography: examination technique, clinical results, and outlook on future developments

International Nuclear Information System (INIS)

Dewey, M.; Hamm, B.

2007-01-01

Multislice computed tomography (MSCT) after intravenous contrast agent administration enables visualization of the coronary arteries with high spatial resolution (voxel sizes down to 0.5 x 0.35 x 0.35 mm3) and a short scan time. Magnetic resonance imaging (MRI) is also intensively studied with respect to the noninvasive detection of coronary artery stenosis and thus the detection of coronary artery disease (CAD) without radiation exposure but is not equal to MSCT at present. This article provides an overview of the historical development of CT coronary angiography from 4-slice CT to 16-slice CT and 64-slice CT. A crucial aspect of this development is the improvement in image quality resulting from shorter breath-hold periods and the reduced gantry rotation time. Other techniques that appear to considerably improve image quality and accuracy and make CT independent of patient heart rates are multisegment reconstruction and dual-source CT. Sublingual nitroglycerin as well as oral or intravenous betablocker administration should be considered in relation to the diagnostic question to be answered and the patient's heart rate. In the studies available CT coronary angiography with at least 12 simultaneous detector rows has a sensitivity of 96.9 % and a specificity of 75.3 % at the patient level. Especially the negative predictive value of CT (94.6 %) emphasizes the idea that this technique may reliably exclude CAD in patients with intermediate pretest likelihood. In the near future, 256-slice CT will allow examination of the entire heart during one heartbeat or even 4D CT scanning with simultaneous assessment of myocardial perfusion. Automatic or semiautomatic software tools will assume a central place in detecting and quantifying coronary artery stenoses and plaques as well as in the analysis of cardiac function in the clinical setting over the next years. Prior to its routine clinical use, the cost-effectiveness of CT coronary angiography must be determined and the

Clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease

International Nuclear Information System (INIS)

Tian Xinhua; Liu Jianhua; Gong Tingting; Geng Lili; Sun Yong

2011-01-01

Objective: To investigate the clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease, and to evaluate the relationship of the image quality and radiation dose between prospective ECG-gated and retrospective ECG-gated cardiac CT angiography (CTA). Methods: Sixty patients who doubt congenital heart disease underwent cardiac CTA, and they were randomly divided into two groups. Thirty patients in group A underwent prospective ECG-gated cardiac CTA, and thirty patients in group B underwent retrospective ECG-gated cardiac CTA. Then the homogeneous enhancement of vascular structures, stair-step artifact, overall image quality and radiation dose were evaluated. Results: The homogeneous enhancement of vascular structures were 2.8±0.3 and 2.7±0.6, respectively, in two groups; and there was no statistical significance (P>0.05). The stair-step artifact were 3.0±0.9 and 3.1±0.9, respectively, in two groups; and there was also no statistical significance (P>0.05). The overall image quality were 3.0±0.8 and 3.1±0.9, respectively, in two group; and there was statistical significance (P>0.05). However, the effective dose were (5.24±0.52) mSv and (16.68±1.49) mSv, respectively, in two groups; and there was statistical significance (P<0.001). Conclusion: Compared with retrospective ECG-gated cardiac CTA, prospective ECG-gated cardiac CTA can reduce radiation dose about 68.6% , while maintaining the image quality which could be made diagnosis. (authors)

DNA double-strand breaks as potential indicators for the biological effects of ionising radiation exposure from cardiac CT and conventional coronary angiography: a randomised, controlled study

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Geisel, Dominik; Zimmermann, Elke; Rief, Matthias; Greupner, Johannes; Hamm, Bernd [Charite Medical School, Department of Radiology, Berlin (Germany); Laule, Michael; Knebel, Fabian [Charite Medical School, Department of Cardiology, Berlin (Germany); Dewey, Marc [Charite Medical School, Department of Radiology, Berlin (Germany); Charite, Institut fuer Radiologie, Berlin (Germany)

2012-08-15

To prospectively compare induced DNA double-strand breaks by cardiac computed tomography (CT) and conventional coronary angiography (CCA). 56 patients with suspected coronary artery disease were randomised to undergo either CCA or cardiac CT. DNA double-strand breaks were assessed in fluorescence microscopy of blood lymphocytes as indicators of the biological effects of radiation exposure. Radiation doses were estimated using dose-length product (DLP) and dose-area product (DAP) with conversion factors for CT and CCA, respectively. On average there were 0.12 {+-} 0.06 induced double-strand breaks per lymphocyte for CT and 0.29 {+-} 0.18 for diagnostic CCA (P < 0.001). This relative biological effect of ionising radiation from CCA was 1.9 times higher (P < 0.001) than the effective dose estimated by conversion factors would have suggested. The correlation between the biological effects and the estimated radiation doses was excellent for CT (r = 0.951, P < 0.001) and moderate to good for CCA (r = 0.862, P < 0.001). One day after radiation, a complete repair of double-strand breaks to background levels was found in both groups. Conversion factors may underestimate the relative biological effects of ionising radiation from CCA. DNA double-strand break assessment may provide a strategy for individualised assessments of radiation. (orig.)

Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

International Nuclear Information System (INIS)

Hyare, Harpreet; Desigan, Sharmini; Nicholl, Helen; Guiney, Michael J.; Brookes, Jocelyn A.; Lees, William R.

2006-01-01

Purpose: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. Materials and methods: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. Results: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. Conclusion: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients

Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial.

Science.gov (United States)

Uretsky, Seth; Argulian, Edgar; Supariwala, Azhar; Agarwal, Shiv K; El-Hayek, Georges; Chavez, Patricia; Awan, Hira; Jagarlamudi, Ashadevi; Puppala, Siva P; Cohen, Randy; Rozanski, Alan

2017-08-01

Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain. The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA. There were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.).

Time-resolved CT angiography in aortic dissection

International Nuclear Information System (INIS)

Meinel, Felix G.; Nikolaou, Konstantin; Weidenhagen, Rolf; Hellbach, Katharina; Helck, Andreas; Bamberg, Fabian; Reiser, Maximilian F.; Sommer, Wieland H.

2012-01-01

Objectives: We performed this study to assess feasibility and additional diagnostic value of time-resolved CT angiography of the entire aorta in patients with aortic dissection. Materials and methods: 14 consecutive patients with known or suspected aortic dissection (aged 60 ± 9 years) referred for aortic CT angiography were scanned on a dual-source CT scanner (Somatom Definition Flash; Siemens, Forchheim, Germany) using a shuttle mode for multiphasic image acquisition (range 48 cm, time resolution 6 s, 6 phases, 100 kV, 110 mAs/rot). Effective radiation doses were calculated from recorded dose length products. For all phases, CT densities were measured in the aortic lumen and renal parenchyma. From the multiphasic data, 3 phases corresponding to a triphasic standard CT protocol, served as a reference and were compared against findings from the time-resolved datasets. Results: Mean effective radiation dose was 27.7 ± 3.5 mSv. CT density of the true lumen peaked at 355 ± 53 HU. Compared to the simulated triphasic protocol, time-resolved CT angiography added diagnostic information regarding a number of important findings: the enhancement delay between true and false lumen (n = 14); the degree of membrane oscillation (n = 14); the perfusion delay in arteries originating from the false lumen (n = 9). Other additional information included true lumen collapse (n = 4), quantitative assessment of renal perfusion asymmetry (n = 2), and dynamic occlusion of aortic branches (n = 2). In 3/14 patients (21%), these additional findings of the multiphasic protocol altered patient management. Conclusions: Multiphasic, time-resolved CT angiography covering the entire aorta is feasible at a reasonable effective radiation dose and adds significant diagnostic information with therapeutic consequences in patients with aortic dissection.

Comparison between angiography and CT scan in the urologic field

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Fujioka, Toshio; Takao, Masaya; Odajima, Kunio; Nakamura, Hiroshi

1988-02-01

Seventy-five consecutive patients with urological diseases were examined preoperatively by means of computerized tomography and renal angiography. Classification of the diseases were 53 renal diseases which included renal cell carcinoma, sarcoma, cyst, renal bleeding, arteriovenous fistula, trauma, hydronephrosis and tuberculosis, 11 vesical diseases which included bladder tumor and endometriosis, 9 adrenal diseases which included primary aldosteronism, Cushing syndrome, pheochromocytoma, and metastatic tumor, and 1 case of intra-abdominal testes. For renal diseases, both angiography and CT were useful imaging tools. For vesical diseases, CT was a more useful imaging method but, for adrenal diseases, angiography was superior to CT. CT offers certain advantages over conventional techniques but, in the near future, it may be replaced by MRI. On the contrary, angiography will remain popular for a long time, because angiography is the only way to show which vessels feed organs.

18F-FDG-PET/CT Angiography for the Diagnosis of Infective Endocarditis.

Science.gov (United States)

Roque, A; Pizzi, M N; Cuéllar-Calàbria, H; Aguadé-Bruix, S

2017-02-01

This article reviews the current imaging role of 18 F-fluordeoxyglucose positron emission computed tomography ( 18 F-FDG-PET/CT) combined with cardiac CT angiography (CTA) in infective endocarditis and discusses the strengths and limitations of this technique. The diagnosis of infective endocarditis affecting prosthetic valves and intracardiac devices is challenging because echocardiography and, therefore, the modified Duke criteria have well-recognized limitations in this clinical scenario. The high sensitivity of 18 F-FDG-PET/CT for the detection of infection associated with the accurate definition of structural damage by gated cardiac CTA in a combined technique (PET/CTA) has provided a significant increase in diagnostic sensitivity for the detection of IE. PET/CTA has proven to be a useful diagnostic tool in patients with suspected infective endocarditis. The additional information provided by this technique improves diagnostic performance in prosthetic valve endocarditis when it is used in combination with the Duke criteria. The findings obtained in PET/CTA studies have been included as a major criterion in the recently updated diagnostic algorithm in infective endocarditis guidelines.

Spontaneous rectus sheath hematoma: The utility of CT angiography

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Antonio Pierro, MD

2018-04-01

Full Text Available We described the utility of computed tomography (CT angiography in detection of bleeding vessels for a rapid percutaneous arterial embolization of the spontaneous rectus sheath hematoma. A 70-year-old woman comes to our attention with acute abdominal pain and a low hemoglobin level. An unenhanced CT was performed demonstrating a large rectus sheath hematoma. A conservative management was initially established. Despite this therapy, the abdominal pain increased together with a further decrease of hemoglobin values. A CT angiography was then performed, demonstrating an active bleeding within the hematoma and addressing the patient to a rapid percutaneous arterial embolization. Keywords: Rectus sheath hematoma, Acute abdomen, Arterial embolization, CT angiography, Active bleeding

Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging.

Science.gov (United States)

von Spiczak, Jochen; Manka, Robert; Gotschy, Alexander; Oebel, Sabrina; Kozerke, Sebastian; Hamada, Sandra; Alkadhi, Hatem

2018-04-01

The purpose of this work was to develop a framework for 3D fusion of CT coronary angiography (CTCA) and whole-heart dynamic 3D cardiac magnetic resonance perfusion (3D-CMR-Perf) image data-correlating coronary artery stenoses to stress-induced myocardial perfusion deficits for the assessment of coronary artery disease (CAD). Twenty-three patients who underwent CTCA and 3D-CMR-Perf for various indications were included retrospectively. For CTCA, image quality and coronary diameter stenoses > 50% were documented. For 3D-CMR-Perf, image quality and stress-induced perfusion deficits were noted. A software framework was developed to allow for 3D image fusion of both datasets. Computation steps included: (1) fully automated segmentation of coronary arteries and heart contours from CT; (2) manual segmentation of the left ventricle in 3D-CMR-Perf images; (3) semi-automatic co-registration of CT/CMR datasets; (4) projection of the 3D-CMR-Perf values on the CT left ventricle. 3D fusion analysis was compared to separate inspection of CTCA and 3D-CMR-Perf data. CT and CMR scans resulted in an image quality being rated as good to excellent (mean scores 3.5 ± 0.5 and 3.7 ± 0.4, respectively, scale 1-4). 3D-fusion was feasible in all 23 patients, and perfusion deficits could be correlated to culprit coronary lesions in all but one case (22/23 = 96%). Compared to separate analysis of CT and CMR data, coronary supply territories of 3D-CMR-Perf perfusion deficits were refined in two cases (2/23 = 9%), and the relevance of stenoses in CTCA was re-judged in four cases (4/23 = 17%). In conclusion, 3D fusion of CTCA/3D-CMR-Perf facilitates anatomic correlation of coronary lesions and stress-induced myocardial perfusion deficits thereby helping to refine diagnostic assessment of CAD.

Strategies to reduce radiation dose in cardiac PET/CT

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Wu, Tung Hsin; Wu, Nien-Yun [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Wang, Shyh-Jen [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (China); Wu, Jay [Institute of Radiological science, Central Taiwan University of Science and Technology, Taichung, Taiwan (China); Mok, Greta S.P. [Department of Electrical and Electronics Engineering, Faculty of Science and Technology, University of Macau, Macau (China); Yang, Ching-Ching, E-mail: g39220003@yahoo.com.tw [Department of Radiological Technology, Tzu Chi College of Technology, 880, Sec.2, Chien-kuo Rd. Hualien 970, Taiwan (China); Huang, Tzung-Chi, E-mail: tzungchi.huang@mail.cmu.edu.tw [Department of Biomedical Imaging and Radiological Science, China Medical University, No.91 Hsueh-Shih Road, Taichung 40402, Taiwan (China)

2011-08-21

Background: Our aim was to investigate CT dose reduction strategies on a hybrid PET/CT scanner for cardiac applications. Materials: Image quality and dose estimation of different CT scanning protocols for CT coronary angiography (CTCA), and CT-based attenuation correction for PET imaging were investigated. Fifteen patients underwent CTCA, perfusion PET imaging at rest and under stress, and FDG PET for myocardial viability. These patients were divided into three groups based on the CTCA technique performed: retrospectively gated helical (RGH), ECG tube current modulation (ETCM), and prospective gated axial (PGA) acquisitions. All emission images were corrected for photon attenuation using CT images obtained by default setting and an ultra-low dose CT (ULDCT) scan. Results: Radiation dose in RGH technique was 22.2{+-}4.0 mSv. It was reduced to 10.95{+-}0.82 and 4.13{+-}0.31 mSv using ETCM and PGA techniques, respectively. Radiation dose in CT transmission scan was reduced by 96.5% (from 4.53{+-}0.5 to 0.16{+-}0.01 mSv) when applying ULDCT as compared to the default CT. No significant difference in terms of image quality was found among various protocols. Conclusion: The proposed CT scanning strategies, i.e. ETCM or PGA for CTCA and ULDCT for PET attenuation correction, could reduce radiation dose up to 47% without degrading imaging quality in an integrated cardiac PET/CT coronary artery examination.

Electron-beam CT coronary angiography in the patients with high heart rate arrhythmia or pacemaker

International Nuclear Information System (INIS)

Dong Zhi; Zhu Jiemin; Liu Zhe; Liu Junbo; Li Youjie; Qi Ji

2006-01-01

Objective: To report the clinical applicability of coronary angiography for patients with high heart rate, arrhythmia or cardiac pacing using the new-generation of electron-beam CT (e-Speed). Methods: EBCT (GE e-Speed) coronary angiography was performed in 36 eases (male 27, female 9, mean age 58), including the heart rate more than 90 bpm in 20 patients, frequent ectopic beats in 11 cases, implantation of cardiac pacemaker in 4 patients and the unacceptable MSCT image quality due to variability of interscan heart rate (from 82 bpm to 104 bpm) in 1 case. After volume data set was acquired using spiral mode with prospective ECG-gating, the reconstructions of MIP, CPR, VR and Cine were performed. The VR quality was evaluated using a five-point scale. Results: The quality of coronary imaging in all of 36 cases were acceptable. The total visualization rate of coronary artery branches was 80.0%. Left main, left anterior artery and right coronary artery were visualized in all patients and in 94.3% of all cases circumflex artery were visible. Conclusion: EBCT (e-Speed) is applicable in noninvasive coronary angiography for patients with high heart rate, arrhythmia or implanted cardiac pacemaker', and this examination can obtain satisfied diagnosis. (authors)

Combined CT Angiography and CT Venography in Thromboembolic disease: clinical impact

International Nuclear Information System (INIS)

Bouzas, R.; Migueles, Y.; Gomez, S.; Mallo, R.; Garcia-Tejedor, J. L.; Diaz Vega, M. J.

2002-01-01

Combined CT Venography and Pulmonary Angiography was described in 1998 as a tool for diagnostic Thromboembolic Disease. The purpose is to relate our own experience with this technique in a population with suspected pulmonary embolism. 46 consecutive patients with suspected pulmonary embolism underwent combined CT Venography after Pulmonary CT Angiography to depict Deep Venous Thrombosis (DVT). CT Venography where obtained with a 3 minutes delay from injection, without additional intravenous contrast, from upper abdomen to fibular head. A prospective study from emergency reports where used. The reports where aimed by nine different radiologist at diary emergency room (images where not retrospective review). We report if a pulmonary embolus or deep venous thrombus or another alternative diagnostic where done. An endo luminal thrombus in any pulmonary arteries was assessed as a positive study for PE. A Thrombus in the leg veins or in an abdominal vein without diminished size of vein was assessed as an acute DVT. In those patients with a CT negative to Thromboembolic Disease was the clinician who decide if more proves where needed. Those patients without evidence in CT of Thromboembolic Disease where asked for symptoms related to the episode in a 3 months period after initial CT. Patients free of symptoms for 3 months without anticoagulation therapy where considered true negative for CT. CT shows Thromboembolic Disease in 23 of 46 patients. 21PE, 14 DVT 2 of 14 patients with DVT don't show PE, CT excluded thromboembolic disease in 23 patients and in 15 of those patients an alternative diagnostic was shown. In 22 of those 23 patients CT excluded correctly Thromboembolic Disease. One patient result in a false negative CT, Pulmonary Angiography of that patient shows us a subsegmentary embolus. (Author) 9 refs

Spiral CT-angiography of the aorta

NARCIS (Netherlands)

Balm, R.; Eikelboom, B. C.; van Leeuwen, M. S.; Noordzij, J.

1994-01-01

AIMS: To determine whether the new technique of CT-angiography was accurate in displaying the complex anatomy of the aorta and its major branches. METHODS: Seventeen patients with a variety of aortic pathology were examined. Using a spiral CT-scanner a volumetric scan was made during injection of

Diagnosis of clinical staging of bladder cancer by CT and angiography

International Nuclear Information System (INIS)

Kobayashi, Isao; Igawa, Mikio; Ohnishi, Yoshio; Nakano, Hiroshi; Nihira, Hiromi; Mori, Masaki; Okada, Mitsuo.

1984-01-01

The preoperative staging of bladder cancer is of fundamental importance for prognostic evaluation and surgical indication. We studied the accuracy of computed tomography (CT) and angiography in defining the extent of local invasion in 16 patients with surgically proven carcinoma of the bladder. The overall accuracy of CT and angiographic staging in these cases was 75 % and 50 % respectively. In low stage, the accuracy was 90 % in CT and 70 % in angiography. In high stage, the accuracy was 50 % in CT and 16.7 % in angiography. Our results seems to indicate lower accuracy in high stage bladder cancer compared with other research. Data from a much larger series are required to ascertain whether the additional information provided by CT and angiography will produce any improvement in patient management. (author)

Gallbladder visualization on CT shortly after angiography with ioxaglate

International Nuclear Information System (INIS)

Tajima, H.; Kaizu, T.; Ichikawa, T.; Kumazaki, T.

1994-01-01

Thirty-five patients underwent CT examination 15 to 30 min after abdominal angiography with ioxaglate. The gallbladder was visualized in 12 patients in the absence of clinical evidence of renal impairment. Gallbladder opacification on CT examinations shortly after angiography shows that the hepatobiliary tract is important in the excretion of ioxaglate. (orig.)

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

International Nuclear Information System (INIS)

Lee, Hwa Yeon; Song, In Sup; Yoo, Seung Min; Rho, Ji Young; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun; White, Charles S.

2011-01-01

Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

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Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

2011-05-15

Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

Estimating Effective Dose of Radiation From Pediatric Cardiac CT Angiography Using a 64-MDCT Scanner: New Conversion Factors Relating Dose-Length Product to Effective Dose.

Science.gov (United States)

Trattner, Sigal; Chelliah, Anjali; Prinsen, Peter; Ruzal-Shapiro, Carrie B; Xu, Yanping; Jambawalikar, Sachin; Amurao, Maxwell; Einstein, Andrew J

2017-03-01

The purpose of this study is to determine the conversion factors that enable accurate estimation of the effective dose (ED) used for cardiac 64-MDCT angiography performed for children. Anthropomorphic phantoms representative of 1- and 10-year-old children, with 50 metal oxide semiconductor field-effect transistor dosimeters placed in organs, underwent scanning performed using a 64-MDCT scanner with different routine clinical cardiac scan modes and x-ray tube potentials. Organ doses were used to calculate the ED on the basis of weighting factors published in 1991 in International Commission on Radiological Protection (ICRP) publication 60 and in 2007 in ICRP publication 103. The EDs and the scanner-reported dose-length products were used to determine conversion factors for each scan mode. The effect of infant heart rate on the ED and the conversion factors was also assessed. The mean conversion factors calculated using the current definition of ED that appeared in ICRP publication 103 were as follows: 0.099 mSv · mGy -1 · cm -1 , for the 1-year-old phantom, and 0.049 mSv · mGy -1 · cm -1 , for the 10-year-old phantom. These conversion factors were a mean of 37% higher than the corresponding conversion factors calculated using the older definition of ED that appeared in ICRP publication 60. Varying the heart rate did not influence the ED or the conversion factors. Conversion factors determined using the definition of ED in ICRP publication 103 and cardiac, rather than chest, scan coverage suggest that the radiation doses that children receive from cardiac CT performed using a contemporary 64-MDCT scanner are higher than the radiation doses previously reported when older chest conversion factors were used. Additional up-to-date pediatric cardiac CT conversion factors are required for use with other contemporary CT scanners and patients of different age ranges.

Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

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Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

2014-10-15

CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Chua, A. E.; Ridley, L. J.

2008-01-01

Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2 x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x 2 = 3.5, P=0.6) and (x 2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

Digital subtraction angiography in cardiac diseases

International Nuclear Information System (INIS)

Choi, Deuk Lin; Kim, Ki Jeong

1986-01-01

DSA was done in 133 examinations of 128 patients during 2 years consist of 9 examination of IV DSA and 124 examination of selective cardiac DSA after cardiac catheterization. Open heart surgery was performed in 90 patients and 12 patients showed discrepancy between pre-and post operative diagnosis, showing a total 86.7% of diagnostic accuracy with DSA. We experienced the significant reduction in dose of contrast media, 30-40% of dose of conventional cardiac angiography. It is concluded that DSA is useful in the evaluation of septal defects, valvular disease and other congenital heart disease. DSA is an accurate simple and safe method in evaluating of cardiac diseases.

Cardiac cone-beam CT

International Nuclear Information System (INIS)

Manzke, Robert

2005-01-01

This doctoral thesis addresses imaging of the heart with retrospectively gated helical cone-beam computed tomography (CT). A thorough review of the CT reconstruction literature is presented in combination with a historic overview of cardiac CT imaging and a brief introduction to other cardiac imaging modalities. The thesis includes a comprehensive chapter about the theory of CT reconstruction, familiarizing the reader with the problem of cone-beam reconstruction. The anatomic and dynamic properties of the heart are outlined and techniques to derive the gating information are reviewed. With the extended cardiac reconstruction (ECR) framework, a new approach is presented for the heart-rate-adaptive gated helical cardiac cone-beam CT reconstruction. Reconstruction assessment criteria such as the temporal resolution, the homogeneity in terms of the cardiac phase, and the smoothness at cycle-to-cycle transitions are developed. Several reconstruction optimization approaches are described: An approach for the heart-rate-adaptive optimization of the temporal resolution is presented. Streak artifacts at cycle-to-cycle transitions can be minimized by using an improved cardiac weighting scheme. The optimal quiescent cardiac phase for the reconstruction can be determined automatically with the motion map technique. Results for all optimization procedures applied to ECR are presented and discussed based on patient and phantom data. The ECR algorithm is analyzed for larger detector arrays of future cone-beam systems throughout an extensive simulation study based on a four-dimensional cardiac CT phantom. The results of the scientific work are summarized and an outlook proposing future directions is given. The presented thesis is available for public download at www.cardiac-ct.net

Prediction of parent artery of anterior communicating artery aneurysm on CT angiography

International Nuclear Information System (INIS)

Chung, Jin Young; Han, Tae Il; Kim, Dae Hong; Han, Hyun Young; Kim, Hyun Jung; Song, Mun Kab

1999-01-01

To determine whether CT angiography can predict the parent artery of an anterior communicating aneurysm on the basis of characteristics of the aneurysm and precommunication anterior cerebral artery. Eighteen patients with anterior communication aneurysm were studied prospectively using CT angiography and conventional angiography. The parent artery of an aneurysm was predicted by evaluating aneurysm neck location, direction of aneurysm projection, and size of the precommunicating anterior cerebral artery, as seen on CT angiography. A somatom Plus-4 spiral CT scanner was used and shaded-surface display three-dimensional images were constructed. Aneurysm neck was located near the parent artery in 12 cases(66.7%), and aneurysm projection was against the parent artery in 11 cases(61.1%). The parent artery of the anterior cerebral artery was larger in 15 cases(83.3%), including ten cases of hypoplasia or agenesis of the contralateral anterior cerebral artery. In 17 of 18 aneurysms(94.4%) the parent artery seen on DSA was correctly predicted by CT angiography. The parent artery of an anterior communicating aneurysm can be predicted by evaluating aneurysm neck location, direction of aneurysm projection, and precommunicating anterior cerebral artery, as seen on CT angiography

Comparison of spiral CT angiography with conventional digital subtraction angiography in the evaluation of renal transplant donors: a pilot study

International Nuclear Information System (INIS)

Chu, C.; Young, N.; Lau, H.

2001-01-01

Conventional digital subtraction renal arteriography (IA-DSA) has been traditionally used as the preoperative imaging modality for assessment of renal vascular anatomy for renal transplant donors. This study evaluates the potential use of spiral CT angiography in replacing IA-DSA in the preoperative assessment of this group of patients. Seven patients underwent both spiral CT angiography and IA-DSA between October 1997 and April 1998. It is concluded that spiral CT angiography can demonstrate the number, length and location of renal arteries and it is suggested that spiral CT angiography can potentially replace IA-DSA in the preoperative assessment of renal donors. Copyright (2001) Blackwell Science Pty Ltd

The clinical application studies of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations

International Nuclear Information System (INIS)

Gao Sijia; Zhang Mengwei; Liu Xiping; Zh Yushen; Liu Jinghong; Wang Zhonghui; Zang Peizhuo; Shi Qiang; Wang Qiang; Liang Chuansheng; Xu Ke

2009-01-01

Background and purpose: To explore the value of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations. Methods: Seventeen patients with initial MR and clinical findings suggestive of spinal vascular diseases underwent CT spinal angiography. Among these, 14 patients took DSA examination within 1 week after CT scan, 7 patients underwent surgical treatment, and 6 patients underwent vascular intervention embolotheraphy. CT protocol: TOSHIBA Aquilion 64 Slice CT scanner, 0.5 mm thickness, 0.5 s/r, 120 kV and 350 mA, positioned at the aortic arch level, and applied with 'sure start' technique with CT threshold of 180 Hu. Contrast agent Iohexol (370 mg I/ml) was injected at 6 ml/s velocity with total volume of 80 ml. The post-processing procedures included MPR, CPR, MIP, VR, etc. Among the 17 patients, four patients underwent fast dynamic contrast-enhanced 3D MR angiography imaging. CT spinal angiography and three-dimensional contrast-enhanced MR angiography (3D CE-MRA) images were compared and evaluated with DSA and operation results based on disease type, lesion range, feeding arteries, fistulas, draining veins of vascular malformation by three experienced neuroradiologists independently, using double blind method. The data were analyzed using SPSS analytic software with χ 2 -test. We compared the results with DSA and operation results. Results: The statistical analysis of the diagnostic results by the three experienced neuroradiologists had no statistical difference (P > 0.05). All of the 17 patients showed clearly the abnormality of spinal cord vessels and the range of lesions by CT spinal angiography. Among them, one patient was diagnosed as arteriovenous fistulas (AVF) by MRI and CT spinal angiography, which was verified by surgical operation. DSA of the same patient, however, did not visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT spinal angiography could only show AVM not AVF. The

The clinical application studies of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations

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Gao Sijia [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China)], E-mail: scarlettgao@126.com; Zhang Mengwei; Liu Xiping; Zh Yushen; Liu Jinghong; Wang Zhonghui [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Zang Peizhuo [Department of Neurosurgery, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Shi Qiang; Wang Qiang [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Liang Chuansheng [Department of Neurosurgery, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Xu Ke [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China)

2009-07-15

Background and purpose: To explore the value of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations. Methods: Seventeen patients with initial MR and clinical findings suggestive of spinal vascular diseases underwent CT spinal angiography. Among these, 14 patients took DSA examination within 1 week after CT scan, 7 patients underwent surgical treatment, and 6 patients underwent vascular intervention embolotheraphy. CT protocol: TOSHIBA Aquilion 64 Slice CT scanner, 0.5 mm thickness, 0.5 s/r, 120 kV and 350 mA, positioned at the aortic arch level, and applied with 'sure start' technique with CT threshold of 180 Hu. Contrast agent Iohexol (370 mg I/ml) was injected at 6 ml/s velocity with total volume of 80 ml. The post-processing procedures included MPR, CPR, MIP, VR, etc. Among the 17 patients, four patients underwent fast dynamic contrast-enhanced 3D MR angiography imaging. CT spinal angiography and three-dimensional contrast-enhanced MR angiography (3D CE-MRA) images were compared and evaluated with DSA and operation results based on disease type, lesion range, feeding arteries, fistulas, draining veins of vascular malformation by three experienced neuroradiologists independently, using double blind method. The data were analyzed using SPSS analytic software with {chi}{sup 2}-test. We compared the results with DSA and operation results. Results: The statistical analysis of the diagnostic results by the three experienced neuroradiologists had no statistical difference (P > 0.05). All of the 17 patients showed clearly the abnormality of spinal cord vessels and the range of lesions by CT spinal angiography. Among them, one patient was diagnosed as arteriovenous fistulas (AVF) by MRI and CT spinal angiography, which was verified by surgical operation. DSA of the same patient, however, did not visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT spinal angiography could only show

Vascular imaging with spiral CT. The way to CY angiography

International Nuclear Information System (INIS)

Prokop, M.; Schaefer, C.; Kalender, W.A.; Polacin, A.; Galanski, M.

1993-01-01

Spiral CT is a technique that allows for high-quality two-dimensional angiographic projections and 3D imaging of vascular structures. The authors present the technical and methodological principles of the technique, including scan parameters and parameters of contrast application for various clinical imaging tasks. They present their experience with over 150 clinical cases using spiral CT angiography. Suitable applications of this technique include cogenital anomalies, aneurysms, dissections, stenoses, thrombi and vascular tumor involvement. Given a problem-adapted examination technique, pathologic changes in vessels of as little as 2 mm can be visualized. In some cases with complex vascular anatomy, spiral CT angiography can be superior to arterial angiography. (orig.) [de

Angiography-based C-arm CT for the assessment of extrahepatic shunting before radioembolization

International Nuclear Information System (INIS)

Heusner, Till Alexander; Hahn, S.; Forsting, M.; Antoch, G.; Hamami, M.E.; Poeppel, T.; Bockisch, A.; Ertle, J.; Hilgard, P.

2010-01-01

Purpose: to retrospectively assess the accuracy of angiography-based C-arm CT for the detection of extrahepatic shunting before SIRT. Materials and methods: 30 patients (mean age: 64 ± 12 years) with hypervascularized hepatic tumors underwent hepatic angiography, coil embolization of gastrointestinal collaterals and 99mTc-macroaggregated albumin (MAA) SPECT/CT before SIRT. Before MAA injection via a microcatheter from the intended treatment position, an angiography and angiography-based C-arm CT (XperCT trademark, Philips Healthcare) were acquired. Angiographies and XperCT trademark were performed from 48 microcatheter positions followed by MAA injections and MAA-SPECT/CT. MAA-SPECT/CT served as the reference standard for determining the accuracy of hepatic arteriography and C-arm CT for the detection of extrahepatic shunting. Results: MAA-SPECT/CT revealed extrahepatic shunting in 5 patients (17%). Hepatic arteriography yielded a true negative in 22 (73%), a false negative in 5 (17%), and an unclear result in 3 patients (10%). C-arm CT yielded a true positive in 3 (10%), true negative in 24 (80%), false positive in 1 (3%), and false negative in 2 patients (7%). The specificity and the NPV of hepatic arteriography for the detection of extrahepatic shunting were 88% and 81%, respectively. For C-arm CT the sensitivity, specificity, PPV, NPV, and accuracy for the detection of extrahepatic shunting were 60%, 96%, 75%, 92%, and 90%, respectively. Conclusion: C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies. (orig.)

Early evaluation of coronary artery bypass grafts: CT or selective angiography

International Nuclear Information System (INIS)

Wilson, P.C.; Gutierrez, O.; Moss, A.

1984-01-01

A prospective study was performed in 27 patients to compare the value of computed tomography and selective angiography in assessing coronary artery graft patency in the early post-operative period. The sensitivity of CT to graft patency was 85% with no falsely patent determinations. Dynamic CT was not found useful in predicting graft stenosis. There were no complications associated with CT studies, and two related to selective angiography. It is concluded that CT is the procedure of choice for graft evaluation in the early post-operative period; but that angiography is mandatory for the assessment of late symptom recurrence. A review is made of the results described in previous series. (orig.)

A LabVIEW Platform for Preclinical Imaging Using Digital Subtraction Angiography and Micro-CT.

Science.gov (United States)

Badea, Cristian T; Hedlund, Laurence W; Johnson, G Allan

2013-01-01

CT and digital subtraction angiography (DSA) are ubiquitous in the clinic. Their preclinical equivalents are valuable imaging methods for studying disease models and treatment. We have developed a dual source/detector X-ray imaging system that we have used for both micro-CT and DSA studies in rodents. The control of such a complex imaging system requires substantial software development for which we use the graphical language LabVIEW (National Instruments, Austin, TX, USA). This paper focuses on a LabVIEW platform that we have developed to enable anatomical and functional imaging with micro-CT and DSA. Our LabVIEW applications integrate and control all the elements of our system including a dual source/detector X-ray system, a mechanical ventilator, a physiological monitor, and a power microinjector for the vascular delivery of X-ray contrast agents. Various applications allow cardiac- and respiratory-gated acquisitions for both DSA and micro-CT studies. Our results illustrate the application of DSA for cardiopulmonary studies and vascular imaging of the liver and coronary arteries. We also show how DSA can be used for functional imaging of the kidney. Finally, the power of 4D micro-CT imaging using both prospective and retrospective gating is shown for cardiac imaging.

Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT.

Science.gov (United States)

Ng, Ming Yen; Karimzad, Yasser; Menezes, Ravi J; Wintersperger, Bernd J; Li, Qin; Forero, Julian; Paul, Narinder S; Nguyen, Elsie T

2016-10-01

To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. • Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient experience.

Imaging in cardiac mass lesions

International Nuclear Information System (INIS)

Mundinger, A.; Gruber, H.P.; Dinkel, E.; Geibel, A.; Beck, A.; Wimmer, B.; Schlosser, V.

1992-01-01

In 26 patients with cardiac mass lesions confirmed by surgery, diagnostic imaging was performed preoperatively by means of two-dimensional echocardiography (26 patients), angiography (12 patients), correlative computed tomography (CT, 8 patients), and magnetic resonance imaging (MRI, 3 patients). Two-dimensional echocardiography correctly identified the cardiac masses in all patients. Angiography missed two of 12 cardiac masses; CT missed one of eight. MRI identified three of three cardiac masses. Although the sensitivity of two-dimensional echocardiography was high (100%), all methods lacked specificity. None of the methods allowed differentiation between myxoma (n=13) and thrombus (n=7). Malignancy of the lesions was successfully predicted by noninvasive imaging methods in all six patients. However, CT and MRI provided additional information concerning cardiac mural infiltration, pericardial involvement, and extracardiac tumor extension, and should be integrated within a preoperative imaging strategy. Thus two-dimensional echocardiography is the method of choice for primary assessment of patients with suspected cardiac masses. Further preoperative imaging by CT or MRI can be limited to patients with malignancies suspected on the grounds of pericardial effusion or other clinical results. (author)

Transient Global Amnesia following Neural and Cardiac Angiography May Be Related to Ischemia

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Hongzhou Duan

2016-01-01

Full Text Available Introduction. Transient global amnesia (TGA following angiography is rare, and the pathogenesis has not been illustrated clearly till now. The aim of this research is to explore the pathogenesis of TGA following angiography by analyzing our data and reviewing the literature. Methods. We retrospectively studied 20836 cases with angiography in our hospital between 2007 and 2015 and found 9 cases with TGA following angiography. The data of these 9 cases were analyzed. Results. We found all 9 cases with TGA following neural angiography (5 in 4360 or cardiac angiography (4 in 8817 and no case with TGA following peripheral angiography (0 in 7659. Statistical difference was found when comparing the neural and cardiac angiography group with peripheral group (p=0.022. Two cases with TGA were confirmed with small acute infarctions in hippocampus after angiography. This might be related to the microemboli which were rushed into vertebral artery following blood flow during neural angiography or cardiac angiography. There was no statistical difference when comparing the different approaches for angiography (p=0.82 and different contrast agents (p=0.619. Conclusion. Based on the positive findings of imaging study and our analysis, we speculate that ischemia in the medial temporal lobe with the involvement of the hippocampus might be an important reason of TGA following angiography.

Gallbladder visualization on CT shortly after abdominal angiography with iodixanol

International Nuclear Information System (INIS)

Tajima, Hiroyuki; Murakami, Ryusuke; Goto, Shinsuke; Aoyama, Toshiya; Kaizu, Toshihide; Ichikawa, Taro; Kumazaki, Tatsuo; Onda, Masahiko

1996-01-01

Fifteen patients underwent CT examination shortly after abdominal angiography with iodixanol. Gallbladder opacification was observed in 13 patients in the absence of clinical evidence of renal impairment. Among them, 2 patients showed a strong opacification on CT. There was no significant relationship between visualization of the gallbladder and the total dose of contrast medium. Gallbladder opacification on CT examination shortly after angiography shows that the hepatobiliary tract is important in the excretion of iodixanol. (author)

Post-mortem CT-coronary angiography

DEFF Research Database (Denmark)

Pøhlsgaard, Camilla; Leth, Peter Mygind

2007-01-01

post-mortem coronary angiography and computerized tomography.  We describe how to prepare and inject the contrast medium, and how to establish a CT-protocol that optimizes spatial resolution, low contrast resolution and noise level. Testing of the method on 6 hearts, showed that the lumen...

Evaluation of spinal cord vessels using multi-slice CT angiography

International Nuclear Information System (INIS)

Chen Shuang; Zhu Ruijiang; Feng Xiaoyuan

2006-01-01

Objective: To evaluate the value of Multi-slice spiral CT angiography for spinal cord vessels. Methods: 11 adult subjects with suspected of myelopathy were performed with Multi-slice spiral CT angiography, An iodine contrast agent was injected at 3.5 ml/s, for total 100 ml. The parameters were axial 16 slice mode, 0.625 mm slice thickness, 0.8 s rotation, delay time depending on smartprep(15-25 s), multi-phase scan. The coronal and sagittal MPR and SSD were generated on a workstation compared with spinal digital subtraction angiography (DSA) to analyze normal or abnormal spinal cord vessels. Results: Normal findings at spinal CTA and digital subtraction angiography in six adult normal subjects and spinal cord vascular malformations (1 intradural extramedullary AVF, 4 dural AVFs) in five cases, Recognizable intradural vessels corresponding to anterior median (midline) veins and/or anterior spinal arteries were show in six adult normal subjects. Abnormal intradural vessels were detected in all five spinal cord vascular malformation with CT angiography, in comparison with digital subtraction angiography these vessels were primarily enlarged veins of the coronal venous plexus on the cord surface, radiculomedullary-dural arteries could not be clearly shown in four dural AVF, only one anterior spinal artery was detected in one patient with intradural medullary AVF, which direct shunt between anterior spinal artery and perimedullary vein with tortuous draining vessel. Conclusion: Multi-slice CT angiography is able to visualize the normal or abnormal spinal cord vessels. It could be used as a noninvasive method to screen the spinal cord vascular disease. (authors)

Radiological findings of dissecting aneurysm -a correlative study of CT with angiography-

International Nuclear Information System (INIS)

Bae, Tae Yeong; Park, Jae Hyung; Kim, Seung Hyup; Han, Man Chung

1987-01-01

This study comprised 16 patients with aortic dissecting aneurysm who were admitted to Seoul National University Hospital from May 1984 to January 1987. CT findings in 16 cases of aortic dissecting aneurysm were correlated with angiographic findings retrospectively. The results were analysed. 1. Number of male was 11 and that of female was 5. Male patients in fifties were most common and 4 in number. 13 patients had hypertension or history of hypertension among 14 patients. There were one case of Marfan's syndrome, preeclampsia and Takayasu's arteritis respectively. 2. There were 5 cases of DeBakey type I, 1 case of type II and 9 cases of types III dissecting aneurysm. Type III was most common. 3. CT confirmed as superior vena cava which was not identified whether it was superior vena cava or unopacified false lumen by angiography in one case. Regarding distal extent, authors defined A whose extent was proximal to diaphragm and B beyond it for convenience sake. There was one false negative case in CT among 16 cases which was diagnosed as dissecting aneurysm type IIIB by angiography and confirmed as type III surgically. One case was diagnosed as type IB by CT and as type IIIB by angiography and confirmed as type I surgically. Extent was more accurate in CT than angiography. One case was diagnosed as type II by CT but misdiagnosed as right atrial tumor by angiography. 4. Diagnostic sensitivities of CT and angiography in this study were 94% (15/16) respectively. CT was more advantageous in hemothorax, hemopericardium, hemomediastinum, unopacified false lumen, aortic wall calcification and getting information about mediastinum. In angiography aortic regurgitation and tear site and involvement of abdominal vessels could be observed

Radiological findings of dissecting aneurysm -a correlative study of CT with angiography-

Energy Technology Data Exchange (ETDEWEB)

Bae, Tae Yeong; Park, Jae Hyung; Kim, Seung Hyup; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

1987-06-15

This study comprised 16 patients with aortic dissecting aneurysm who were admitted to Seoul National University Hospital from May 1984 to January 1987. CT findings in 16 cases of aortic dissecting aneurysm were correlated with angiographic findings retrospectively. The results were analysed. 1. Number of male was 11 and that of female was 5. Male patients in fifties were most common and 4 in number. 13 patients had hypertension or history of hypertension among 14 patients. There were one case of Marfan's syndrome, preeclampsia and Takayasu's arteritis respectively. 2. There were 5 cases of DeBakey type I, 1 case of type II and 9 cases of types III dissecting aneurysm. Type III was most common. 3. CT confirmed as superior vena cava which was not identified whether it was superior vena cava or unopacified false lumen by angiography in one case. Regarding distal extent, authors defined A whose extent was proximal to diaphragm and B beyond it for convenience sake. There was one false negative case in CT among 16 cases which was diagnosed as dissecting aneurysm type IIIB by angiography and confirmed as type III surgically. One case was diagnosed as type IB by CT and as type IIIB by angiography and confirmed as type I surgically. Extent was more accurate in CT than angiography. One case was diagnosed as type II by CT but misdiagnosed as right atrial tumor by angiography. 4. Diagnostic sensitivities of CT and angiography in this study were 94% (15/16) respectively. CT was more advantageous in hemothorax, hemopericardium, hemomediastinum, unopacified false lumen, aortic wall calcification and getting information about mediastinum. In angiography aortic regurgitation and tear site and involvement of abdominal vessels could be observed.

Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography.

Science.gov (United States)

Rana, A K; Turner, H E; Deans, K A

2013-01-01

Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks. Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis. 15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA. The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable.

Automated selection of the optimal cardiac phase for single-beat coronary CT angiography reconstruction

International Nuclear Information System (INIS)

Stassi, D.; Ma, H.; Schmidt, T. G.; Dutta, S.; Soderman, A.; Pazzani, D.; Gros, E.; Okerlund, D.

2016-01-01

Purpose: Reconstructing a low-motion cardiac phase is expected to improve coronary artery visualization in coronary computed tomography angiography (CCTA) exams. This study developed an automated algorithm for selecting the optimal cardiac phase for CCTA reconstruction. The algorithm uses prospectively gated, single-beat, multiphase data made possible by wide cone-beam imaging. The proposed algorithm differs from previous approaches because the optimal phase is identified based on vessel image quality (IQ) directly, compared to previous approaches that included motion estimation and interphase processing. Because there is no processing of interphase information, the algorithm can be applied to any sampling of image phases, making it suited for prospectively gated studies where only a subset of phases are available. Methods: An automated algorithm was developed to select the optimal phase based on quantitative IQ metrics. For each reconstructed slice at each reconstructed phase, an image quality metric was calculated based on measures of circularity and edge strength of through-plane vessels. The image quality metric was aggregated across slices, while a metric of vessel-location consistency was used to ignore slices that did not contain through-plane vessels. The algorithm performance was evaluated using two observer studies. Fourteen single-beat cardiac CT exams (Revolution CT, GE Healthcare, Chalfont St. Giles, UK) reconstructed at 2% intervals were evaluated for best systolic (1), diastolic (6), or systolic and diastolic phases (7) by three readers and the algorithm. Pairwise inter-reader and reader-algorithm agreement was evaluated using the mean absolute difference (MAD) and concordance correlation coefficient (CCC) between the reader and algorithm-selected phases. A reader-consensus best phase was determined and compared to the algorithm selected phase. In cases where the algorithm and consensus best phases differed by more than 2%, IQ was scored by three

First results of spiral CT angiography in the evaluation of carotid artery stenosis

International Nuclear Information System (INIS)

Link, J.; Mueller-Huelsbeck, S.; Brossmann, J.; Grabener, M.; Voss, C.; Heller, M.

1995-01-01

To determine the value of spiral CT angiography in Maximum Intensity Projection (MIP)-technique for evaluation of carotid artery stenosis. A comparison of the MIP technique with intraarterial DSA was done in 24 patients with 40 stenoses. Quantification of stenosis was determined according to the NASCET study: mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%). Totally the correlation of spiral CT angiography with DSA was 80% (r=0.93; p=0.0001). In the moderate stenosis group (r=1; p=0.1573), severe stenosis group (r=0.89; p=0.002) and the occlusion group (r=1; p=0.0009) there was a good correlation with DSA. In the mild stenosis group (r=0.55; p=0.0704) correlation of spiral CT angiography with DSA was poor. Spiral CT angiography allows an excellent delineation of calcifications. Tandem lesions and collateral flow cannot be shown with spiral CT angiography. (orig./MG) [de

Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography

International Nuclear Information System (INIS)

Efstathopoulos, E P; Kelekis, N L; Pantos, I; Brountzos, E; Argentos, S; Grebac, J; Ziaka, D; Seimenis, I; Katritsis, D G

2009-01-01

Computed tomography (CT) coronary angiography has been widely used since the introduction of 64-slice scanners and dual-source CT technology, but high radiation doses have been reported. Prospective ECG-gating using a 'step-and-shoot' axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. Radiation doses were estimated for 25 patients scanned with either prospective or retrospective ECG-gating. Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring. It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECG-gating (3.2 ± 0.6 mSv versus 13.4 ± 2.7 mSv). Consequently, the radiogenic fatal cancer risk for the patient is much lower with prospective gating (0.0176% versus 0.0737%). No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments. Therefore, prospective ECG-gating using a 'step-and-shoot' protocol that covers the cardiac anatomy in two axial acquisitions effectively reduces radiation doses in 256-slice CT coronary angiography without compromising image quality.

16-slice multi-detector row CT coronary angiography: image quality and optimization of the image reconstruction window

International Nuclear Information System (INIS)

Kim, Yoo Kyung; Shim, Sung Shine; Lim, Soo Mee; Hwang, Ji Young; Kim, Yoon Kyung

2005-01-01

The purpose of this experiment is to investigate the image quality of CT coronary angiography using a 16-slice multi-detector row CT and to determine the optimal image reconstruction window. CT coronary angiography was obtained in 36 nonsymptomatic volunteers using a 16-slice multi-detector row CT (SOMATOM Sensation, Siemens Medical System). The mean heart rates were 70 beats per minute (bpm) or less in 18 persons and more than 70 bpm in 18 persons. Eleven data sets were obtained for each patient (reconstructed at 30%-80% of the cardiac cycle with an increment of 5%). Image quality of the eight coronary segments [left main coronary artery (LM), proximal and middle segments of left anterior descending artery (p-LAD, m-LAN) and left circumflex coronary artery (p-LCx, m-LCx) and proximal, middle and distal segments of right coronary artery (p-RCA, m-RCA, d-RCA)] was assessed. The optimal reconstruction windows in the cardiac cycle for the best image quality were 60-70% for the segments of the LM, LAD, and LC arteries in two groups (bpm 70) and 55-65% (bpm 70) for the segments of the RCA. On the best dataset for each coronary segment, the following diagnostic image quality was achieved in the two groups: LM: 100%, 83%; p-LAD: 100%, 88% m-LAD: 100%, 72%; p-LCx: 100%, 72%; m-LCx: 100%, 72%; p-RCA: 94%, 72%; m-RCA: 61%, 50%; d-RCA: 100%, 80%. The 16 slice multi-detector row CT scan provided visualization of the coronary arteries with high resolution. Especially in the group with a mean heart rate of 70 bpm or less, all the coronary segments except the RCA showed diagnostic image quality. Optimal image quality was achieved with a 60-70% trigger delay for all coronary arterial segments, but the best images of RCA were achieved in the earlier cardiac phase in the patients with a mean heart rate of more than 70 bpm

Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model.

Science.gov (United States)

Rosow, David E; Sahani, Dushyant; Strobel, Oliver; Kalva, Sanjeeva; Mino-Kenudson, Mari; Holalkere, Nagaraj S; Alsfasser, Guido; Saini, Sanjay; Lee, Susanna I; Mueller, Peter R; Fernández-del Castillo, Carlos; Warshaw, Andrew L; Thayer, Sarah P

2005-12-01

Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings--compared with pathologic diagnoses-- predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia.

Dual energy cardiac CT.

Science.gov (United States)

Carrascosa, Patricia; Deviggiano, Alejandro; Rodriguez-Granillo, Gastón

2017-06-01

Conventional single energy CT suffers from technical limitations related to the polychromatic nature of X-rays. Dual energy cardiac CT (DECT) shows promise to attenuate and even overcome some of these limitations, and might broaden the scope of patients eligible for cardiac CT towards the inclusion of higher risk patients. This might be achieved as a result of both safety (contrast reduction) and physiopathological (myocardial perfusion and characterization) issues. In this article, we will review the main clinical cardiac applications of DECT, that can be summarized in two core aspects: coronary artery evaluation, and myocardial evaluation.

Cardiac CT

International Nuclear Information System (INIS)

Dewey, Marc

2011-01-01

Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

Cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

2011-07-01

Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

Science.gov (United States)

Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

2017-08-01

Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: Prospective, multicentre cohort study

NARCIS (Netherlands)

C.J.J. Van Asch (Charlotte J.J.); B.K. Velthuis (Birgitta K.); G.J.E. Rinkel (Gabriël J.E.); A. Algra (Ale); G.A.P. de Kort (G. A P); T.D. Witkamp (Theo); J.C.M. De Ridder (Johanna C.M.); K.M. Van Nieuwenhuizen (Koen M.); F.-E. De Leeuw (Frank-Erik); W.J. Schonewille (Wouter); P.L.M. de Kort (Paul); D.W.J. Dippel (Diederik); T.W.M. Raaymakers (Theodora W.M.); J. Hofmeijer; M.J.H. Wermer (Marieke); H. Kerkhoff (Henk); K. Jellema (Korné); I.M. Bronner (Irene M.); M.J.M. Remmers (Michel ); H.P. Bienfait (Henri); R.J.G.M. Witjes (Ron J.G.M.); J.P. Greving (Jacoba); C.J.M. Klijn (Catharina J.M.); H.F. de Leeuw (Frank); H.B. Boogaarts; E.J. van Dijk (Ewoud); W.J. Schonewille; W.M.J. Pellikaan; C. Puppels-De Waard; P.L.M. De Kort; J.P. Peluso; J. van Tuijl (Jordie); J. Hofmeijer; F.B.M. Joosten (Frank); D.W.J. Dippel (Diederik); L. Khajeh (Ladbon); T.W.M. Raaijmakers; M.J. Wermer; M.A.A. van Walderveen (Marianne); H. Kerkhoff; E. Zock; K. Jellema (Korné); G.J. Lycklama à Nijeholt (Geert); I.M. Bronner; M.J.M. Remmers; R.J.G.M. Witjes; H.P. Bienfait; K.E. Droogh-Greve; R. Donders (Rogier); V.I.H. Kwa; T.H.C.M.L. Schreuder (Tobien H. C. M. L.); C.L. Franke (Cees); J.S. Straver; C. Jansen; S.L.M. Bakker (Stef); C.C. Pleiter (C.); M.C. Visser; C.J.J. Van Asch; B.K. Velthuis (Birgitta); G.J.E. Rinkel (Gabriel); K.M. Van Nieuwenhuizen; C.J.M. Klijn (Catharina J.M.)

2015-01-01

textabstractStudy question What are the diagnostic yield and accuracy of early computed tomography (CT) angiography followed by magnetic resonance imaging/angiography (MRI/MRA) and digital subtraction angiography (DSA) in patients with non-traumatic intracerebral haemorrhage? Methods This

3D-CT angiography. Intracranial arterial lesions

Energy Technology Data Exchange (ETDEWEB)

Asato, Mikio; Tong, X.Q.; Tamura, Shozo [Miyazaki Medical Coll., Kiyotake (Japan)] [and others

1997-06-01

Since its introduction, three dimensional CT angiography (3D-CTA) on spiral (helical) CT has played an important role in clinical imaging. Initially it was reported to be useful in depicting aortic abnormalities, afterwards the merit in detecting intracranial aneurysm by 3D-CTA was also described. We have investigated the usefullness of 3D-CTA in detecting patients of intracranial aneurysm as well as arterio-venous malformation (AVM), Moyamoya disease and stenosis of middle cerebral artery, meanwhile the MR angiography (MRA) and digital subtraction angiography (DSA) examination of these patients were also studied as comparison to the 3D-CTA results. The sensitivity and specificity on investigating intracranial aneurysm were similar with other reports so far. 3D-CTA was possible to identify the feeding artery, nidus and draining vein of AVM, although DSA showed higher detectability. Occlusion of internal carotid artery and post-operative anastomosis in Moyamoya disease were all demonstrated by 3D-CTA, however the Moyamoya collaterals were shown better on MRA. 3D-CTA revealed the site of stenosis of middle cerebral artery in all of our cases, but in general maximum intensity projection (MIP) images can provide more exact information about the degree of stenosis. Five years has passed since the emergence of spiral CT and utilizing of 3D-CTA in clinical applications. With the development of hard and soft ware in the near future, it is possible to delineate more small vessels by 3D-CTA. We predict that 3D-CTA would be widely used for detecting vasculature of the whole body, and may take the place of conventional angiography in many cases. (author)

Subcutaneous Tissue Thickness is an Independent Predictor of Image Noise in Cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Staniak, Henrique Lane; Sharovsky, Rodolfo [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Pereira, Alexandre Costa [Hospital das Clínicas - Universidade de São Paulo, São Paulo, SP (Brazil); Castro, Cláudio Campi de; Benseñor, Isabela M.; Lotufo, Paulo A. [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP (Brazil); Bittencourt, Márcio Sommer, E-mail: msbittencourt@mail.harvard.edu [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil)

2014-01-15

Few data on the definition of simple robust parameters to predict image noise in cardiac computed tomography (CT) exist. To evaluate the value of a simple measure of subcutaneous tissue as a predictor of image noise in cardiac CT. 86 patients underwent prospective ECG-gated coronary computed tomographic angiography (CTA) and coronary calcium scoring (CAC) with 120 kV and 150 mA. The image quality was objectively measured by the image noise in the aorta in the cardiac CTA, and low noise was defined as noise < 30HU. The chest anteroposterior diameter and lateral width, the image noise in the aorta and the skin-sternum (SS) thickness were measured as predictors of cardiac CTA noise. The association of the predictors and image noise was performed by using Pearson correlation. The mean radiation dose was 3.5 ± 1.5 mSv. The mean image noise in CT was 36.3 ± 8.5 HU, and the mean image noise in non-contrast scan was 17.7 ± 4.4 HU. All predictors were independently associated with cardiac CTA noise. The best predictors were SS thickness, with a correlation of 0.70 (p < 0.001), and noise in the non-contrast images, with a correlation of 0.73 (p < 0.001). When evaluating the ability to predict low image noise, the areas under the ROC curve for the non-contrast noise and for the SS thickness were 0.837 and 0.864, respectively. Both SS thickness and CAC noise are simple accurate predictors of cardiac CTA image noise. Those parameters can be incorporated in standard CT protocols to adequately adjust radiation exposure.

Subcutaneous Tissue Thickness is an Independent Predictor of Image Noise in Cardiac CT

International Nuclear Information System (INIS)

Staniak, Henrique Lane; Sharovsky, Rodolfo; Pereira, Alexandre Costa; Castro, Cláudio Campi de; Benseñor, Isabela M.; Lotufo, Paulo A.; Bittencourt, Márcio Sommer

2014-01-01

Few data on the definition of simple robust parameters to predict image noise in cardiac computed tomography (CT) exist. To evaluate the value of a simple measure of subcutaneous tissue as a predictor of image noise in cardiac CT. 86 patients underwent prospective ECG-gated coronary computed tomographic angiography (CTA) and coronary calcium scoring (CAC) with 120 kV and 150 mA. The image quality was objectively measured by the image noise in the aorta in the cardiac CTA, and low noise was defined as noise < 30HU. The chest anteroposterior diameter and lateral width, the image noise in the aorta and the skin-sternum (SS) thickness were measured as predictors of cardiac CTA noise. The association of the predictors and image noise was performed by using Pearson correlation. The mean radiation dose was 3.5 ± 1.5 mSv. The mean image noise in CT was 36.3 ± 8.5 HU, and the mean image noise in non-contrast scan was 17.7 ± 4.4 HU. All predictors were independently associated with cardiac CTA noise. The best predictors were SS thickness, with a correlation of 0.70 (p < 0.001), and noise in the non-contrast images, with a correlation of 0.73 (p < 0.001). When evaluating the ability to predict low image noise, the areas under the ROC curve for the non-contrast noise and for the SS thickness were 0.837 and 0.864, respectively. Both SS thickness and CAC noise are simple accurate predictors of cardiac CTA image noise. Those parameters can be incorporated in standard CT protocols to adequately adjust radiation exposure

Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients

Energy Technology Data Exchange (ETDEWEB)

Özgen, Ali, E-mail: draliozgen@hotmail.com [Yeditepe University Hospital, Department of Radiology (Turkey); Sanioğlu, Soner [Yeditepe University Hospital, Department of Cardiovascular Surgery (Turkey); Bingöl, Uğur Anıl [Yeditepe University Hospital, Department of Plastic Surgery (Turkey)

2016-08-15

PurposeTo image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).Materials and MethodsThree cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatinine levels were followed for possible CIN.ResultsIntra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention.ConclusionIntra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.

Assessment of hepatic arterial variation using multidetector helical CT-angiography

International Nuclear Information System (INIS)

Lee, Dong Hoon; Lee, Jun Woo; Jun, Woong Bae; Lee, Suk Hong

2001-01-01

To evaluate the anatomy of the hepatic artery and normal variants using oblique thick-slab maximal intensity projection (MIP) 3-D CT angiography and multidetector helical CT technology. In 70 patients, axial three-phase CT together with multidetector helical CT and a nonionic contrast agent was used to evaluate liver disease. During the early arterial phase, the parameters were as follow: slice thickness, 2.5 mm; table speed, 15 mm/rotation, pitch, 6; contrast material, 4 ml/sec; total 120 ml. Using the MIP technique and an Advantage window voxtal 3.03 system (GE), the images obtained were reconstructed as 3D angiograms. In each case, the arterial anatomy and its variants were recorded. A typical anatomy was found in 53 cases (75.7%). Common variants were a left hepatic artery arising from the left gastric artery(8 cases, 11.4 %) and a right hepatic artery arising from the superior mesenteric artery(3 cases, 4.3%). Other variant cases were right hepatic artery arising from the gastroduodenal artery(2 cases, 2.9%), a proper hepatic artery arising from the left gastric artery (1 case, 1.4%), a hepatomesenteric trunk (1 case), a hepatogastric/splenomesenteric trunk(1 case), and a celiomesenteric trunk (1 case). 3-D hepatic angiography using multidetector helical CT technology is non-invasive and as accurate as conventional angiography for the evaluation of hepatic arterial anatomy. It is thus considered that 3-D CT angiography is very helpful for the evaluation of hepatic arterial anatomy prior to liver surgery such as transplantation or the treatment of hepatocellular carinoma

The Efficacy of Iopamidol (Pamiray 370) in Aortic and Extremity CT Angiography

International Nuclear Information System (INIS)

Lee, Yoo Jin; Lee, Jong Min; Lee, Hui Joong; Park, Ji Won

2010-01-01

To evaluate the clinical safety and radiological feasibility of a domestic iopamidol-based contrast media (Pamiray 370) during an aortic and extremity CT angiography. Between August and December of 2008, 100 patients (M:F=51:49; mean age, 59 years) underwent an aortic and extremity CT angiography using Pamiray 370 based with informed consent. All changes in vital signs, clinical symptoms, and adverse reactions to the contrast media were monitored. Two radiologists assessed the image quality of the CT angiography. A statistical comparison was conducted using an independent t-test and a Mann-Whitney test based on the 100-patient group studied using Optiray 350. The contrast enhancement of the descending aorta in the arterial phase showed a statistically greater efficacy (p<0.001) of Pamiray 370 compared to Optiray 350, which was the routine contrast media for CT angiography for our institute. Adverse reaction signs were evident in 3%(3/100) of the subjects. All of them showed mild and transient reactions such as vomiting (n=2) and coughing (n=1), with no medical treatment required. Contrast media related symptoms including dizziness (n=7), nausea (n=3), headaches (n=2), and injection site pain (n=1), were noted in 12%(12/100). The clinical efficacy of Pamiray 370 was acceptable for the aortic and extremity CT angiography, in terms of clinical safety, tolerance, and image quality

Correlation of 64 row MDCT, echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease

International Nuclear Information System (INIS)

Chandrashekhar, Guruprasadh; Sodhi, Kushaljit Singh; Saxena, Akshay Kumar; Rohit, Manoj Kumar; Khandelwal, Niranjan

2012-01-01

Objective: To study the correlation of low-dose 64-row multi-detector computed tomography (MDCT) with echocardiography and cardiac catheterization angiography (CCA) in the assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease (CCHD). Materials and methods: This prospective study included 105 children (74 males, 31 females) with CCHD, in the age group of 2 months to 20 years, who underwent 64-row MDCT examination (low-dose CT protocol), echocardiography and CCA for the assessment of pulmonary arteries, including visualization, presence of confluence, stenosis and collaterals. Statistical analysis was performed using the non-parametric statistical analysis test to evaluate the concordance or discordance between echocardiography, MDCT and CCA. Results: 64-row MDCT detected significantly more main and branch pulmonary arteries, patent pulmonary confluences, and more cases of pulmonary artery stenosis. CCA detected more major aorto-pulmonary collaterals than MDCT, whereas echocardiography failed to identify these major aorto-pulmonary collaterals. The effective CT radiation dose to patients less than 2 years of age was in the range of 0.7–2.5 mSv, where as the dose in patients more than 2 years of age ranged from that of 2.1 to 4.2 mSv, which is much less than the radiation dose reported in cardiac catheterization angiography. Conclusion: In cases where cardiac MRI cannot be performed, or is not sufficiently informative, low-dose 64-row MDCT correlates well with CCA and can provide adequate information about pulmonary arterial anatomy in children with cyanotic congenital heart disease, and can replace invasive cardiac catheterization angiography with markedly reduced radiation dosage to the patient.

Hepatic arterial supply in 1297 CT-angiographies; Die arterielle Leberversorgung in 1297 CT-Angiografien

Energy Technology Data Exchange (ETDEWEB)

Loeschner, C.; Kausche, S.; Teichgraeber, U. [Jena University Hospital, Jena (Germany). Dept. of Radiology; Nagel, S.N. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology

2015-04-15

Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2%), followed by type V in 114 patients (8.8%) and type III in 83 patients (6.4%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n=10). Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification.

New cardiac cameras: single-photon emission CT and PET.

Science.gov (United States)

Slomka, Piotr J; Berman, Daniel S; Germano, Guido

2014-07-01

measurements for this tracer. The availability of high-end CT component in most PET/CT configurations enables hybrid multimodality cardiac imaging protocols with calcium scoring or CT angiography or both. Copyright © 2014. Published by Elsevier Inc.

Quantification of coronary artery stenoses. Comparison of 64-slice and dual source CT angiography with cardiac catheterization

International Nuclear Information System (INIS)

Busch, Stephanie; Nikolaou, K.; Johnson, T.; Rist, C.; Knez, A.; Reiser, M.; Becker, C.

2007-01-01

Until now stenoses of the coronary arteries have been evaluated visually with CT angiography. Therefore, the results were highly dependent on subjective factors inherent in the examiner. New software tools for semiquantitative analysis (CT-QCA, quantitative coronary assessment) might be adequate to improve the diagnostic accuracy und reproducibility. CTAs of 20 patients were analyzed. Ten patients each were evaluated using 64-slice CT (64SCT) and dual source CT (DSCT) (Somatom Sensation 64 and Somatom Definition, Siemens Medical Solutions, Forchheim), respectively. Two radiologists independently evaluated the data visually and with the help of a software tool (Syngo Circulation, Siemens Medical Solutions, Forchheim). The results of the quantitative assessment of the invasive heart catheterization served as the reference standard. Sensitivity and specificity as well as the correlation coefficient, the systematic error, and the interobserver agreement (kappa) were determined. In each of both patient groups 12 stenoses were detected. For the detection of stenoses >75%, sensitivity and specificity for the visual evaluation using the 64SCT were 100% and 90%, and with the CT-QCA both were 100%. For the DSCT sensitivity and specificity were 100% for both the visual and semiautomated evaluation. The Bland-Altman plot of the results of the 64SCT showed an overestimation of 3.3% (±62.7%/56.2%) compared to the heart catheterization. The results of the DSCT exhibited an overestimation of 6.2% (±33.1%/19.8%). The interobserver agreement of the CT-QCA and the visual evaluation showed a kappa value of 0.75 and for DSCT of 1.0. The results showed a good correlation of grading stenosis between the software-assisted evaluation and the results of the coronary catheter angiography. The promising results of the DSCT are due to a superior temporal resolution compared to the 64SCT. Confirmation of these data by trials in larger patient collectives is warranted. (orig.) [de

Assessment of anemia during CT pulmonary angiography

International Nuclear Information System (INIS)

Jung, Caroline; Groth, Michael; Bley, Thorsten A.; Henes, Frank O.; Treszl, András; Adam, Gerhard; Bannas, Peter

2012-01-01

Objectives: Anemia is associated with increased mortality in patients with acute symptomatic pulmonary embolism (PE). The purpose of this study was to evaluate the feasibility of Hounsfield unit (HU) measurements on the single unenhanced trigger slice of pulmonary CT angiography scans for diagnosis of anemia. Material and Methods: 150 consecutive patients (median age 64 ± 16 years) with suspected PE underwent pulmonary CT angiography. Two radiologists, blinded to laboratory results, performed HU measurements in the single unenhanced trigger scan independently by region-based analysis (ROI). HU values from ascending and descending aorta and the calculated mean of both were correlated with serum hemoglobin levels. Inter- and intraobserver variability was determined for HU measurements, and ROC analysis was performed for diagnosis of anemia. Calculated linear models were used to assess formulas for estimation of hemoglobin levels from HU measurements. Results: HU measurements revealed high intra- and interrater reliability (ICC > 0.981 and ICC > 0.965, respectively). Calculated mean HU values showed a strong correlation with serum hemoglobin levels (r = 0.734), which allowed generation of different formulas for calculation of hemoglobin levels from HU measurements. ROC analyses confirmed a high sensitivity (80.4 for men; 91.3 for women) and specificity (84.0 for men; 84.9 for women) for diagnosing anemia. Conclusion: Diagnosis of anemia and quantification of hemoglobin levels upon a single unenhanced trigger scan of pulmonary CT angiography is feasible. We suggest disclosing the anemic state in the radiological report, independent of the presence of PE, since anemia carries increased risks of morbidity and mortality.

Assessment of anemia during CT pulmonary angiography

Energy Technology Data Exchange (ETDEWEB)

Jung, Caroline, E-mail: cjung@uke.de [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Groth, Michael; Bley, Thorsten A.; Henes, Frank O. [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Treszl, András [Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Adam, Gerhard; Bannas, Peter [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany)

2012-12-15

Objectives: Anemia is associated with increased mortality in patients with acute symptomatic pulmonary embolism (PE). The purpose of this study was to evaluate the feasibility of Hounsfield unit (HU) measurements on the single unenhanced trigger slice of pulmonary CT angiography scans for diagnosis of anemia. Material and Methods: 150 consecutive patients (median age 64 ± 16 years) with suspected PE underwent pulmonary CT angiography. Two radiologists, blinded to laboratory results, performed HU measurements in the single unenhanced trigger scan independently by region-based analysis (ROI). HU values from ascending and descending aorta and the calculated mean of both were correlated with serum hemoglobin levels. Inter- and intraobserver variability was determined for HU measurements, and ROC analysis was performed for diagnosis of anemia. Calculated linear models were used to assess formulas for estimation of hemoglobin levels from HU measurements. Results: HU measurements revealed high intra- and interrater reliability (ICC > 0.981 and ICC > 0.965, respectively). Calculated mean HU values showed a strong correlation with serum hemoglobin levels (r = 0.734), which allowed generation of different formulas for calculation of hemoglobin levels from HU measurements. ROC analyses confirmed a high sensitivity (80.4 for men; 91.3 for women) and specificity (84.0 for men; 84.9 for women) for diagnosing anemia. Conclusion: Diagnosis of anemia and quantification of hemoglobin levels upon a single unenhanced trigger scan of pulmonary CT angiography is feasible. We suggest disclosing the anemic state in the radiological report, independent of the presence of PE, since anemia carries increased risks of morbidity and mortality.

Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

International Nuclear Information System (INIS)

Becker, Hans-Christoph; Johnson, Thorsten

2012-01-01

Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

Directory of Open Access Journals (Sweden)

Marwa Sayed Meshaal

Full Text Available Infective endocarditis (IE is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs. These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention.The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%. Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32% had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%. The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.Routine brain CT/CTA resulted in changes in the treatment plan in a significant

Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

Energy Technology Data Exchange (ETDEWEB)

Schlett, Christopher L. [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Nance, John W. Jr. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); O’Brien, Terrence X. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (United States); Ebersberger, Ullrich [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich (Germany); Headden, Gary F. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bamberg, Fabian [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich (Germany); Department of Radiology, University of Tuebingen (Germany)

2014-07-15

Highlights: • Patients developing UAP had overall more atherosclerosis as patients without any events. • Patients developing MACE had only more mixed plaque as those developing UAP. • Different atherosclerotic plaque components by CTA carry different prognostic value. - Abstract: Objective: CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). Methods: We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Results: Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. Conclusion: The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.

The value of 3D-CT angiography and duplex sonography in comparison to arteriography in carotid artery stenoses

International Nuclear Information System (INIS)

Link, J.; Mueller-Huelsbeck, S.; Wesner, F.; Hoepfner, M.; Schwarzenberg, H.; Heller, M.

1997-01-01

To determine the value of 3D-CT angiography, duplex sonography in comparison to selective digital subtraction angiography for evaluation of carotid artery stenoses. Methods: 30 patients with 51 stenoses of carotid artery underwent 3D-CT angiography, duplex sonography and angiography. Quantification of stenosis was determined according to the NASCET study and categorized into mild (0-29%), moderate (30-69%), severe (70-99%) and occluded (100%). Results: The agreement of 3D-CT angiography with intraarterial digital subtraction angiography (DSA) was 62% (r=0.89; p [de

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

International Nuclear Information System (INIS)

Garcarek, Jerzy; Kurcz, Jacek; Guziński, Maciej; Banasik, Mirosław; Miś, Marcin; Gołębiowski, Tomasz

2015-01-01

High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages. Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1–2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6–8 mL of Iodixanol (320 mg/mL) diluted with saline to 18–24 mL was administered at a speed of 4–5 mL/s. Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of

Radiation Dose and Image Quality from Coronary Angiography in 320-Detecor Row CT

International Nuclear Information System (INIS)

Thanomphudsa, J.; Krisanachinda, A.; Tumkosit, M.

2012-01-01

Introduction: Coronary Computed Tomography Angiography examinations are increasing rapidly. New Computed Tomography has been developed to improve image quality with the patient dose reduction. The purpose of this study is to evaluate radiation dose and image quality of Coronary Computed Tomography Angiography in patients using 320-detector row CT. Methods: Forty-one patients referred for cardiac CT examinations at King Chulalongkorn Memorial Hospital were included in this study. All coronary computed tomographic angiography (CCTA) examinations were performed on the 320-detector row CT, Toshiba Aquilion One. Scanning protocol was investigated on dose estimates and image quality. Patients were scanned base on heart rate (HR) by HR 75 bpm use retrospective with dose modulation. Scanning parameters, kVp, mAs, HR, BMI, CTDIvol(mGy) and DLP(mGy.cm), were recorded to study the factors affecting the image quality and patient dose. And mA and kVp setting depend on BMI of the patient. Effective dose is calculated from DLP using specific conversion factor. The image quality was evaluated in 4 vessels by two radiologists. Noise assessment was also studied quantitatively. Results: The patient effective dose in prospective gating 70-80% was 3.6 ± 0.9 mSv, prospective gating 30-80% (1R-R) was 6.3 ± 1.9 mSv, and 30-80% (2R-R) was 10.8 ± 1.8 mSv and in retrospective with tube current modulation was 12.1± 7.7 mSv. Image noise was highest in PGT 70-80% 1R-R and decreased in RGT with tube current modulation, PGT 30-80% 1R-R and lowest in PGT 30-80% 2 R-R. And overall qualitative image quality was mostly good to excellent score. Discussion: The heart rate, heart rate variability and disease of the patient are affecting in the radiation dose and image quality so the suitable acquisition protocol used could be necessary. the effective dose and the image noise for the image quality. (author)

Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

International Nuclear Information System (INIS)

Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun

1999-01-01

To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery

Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events

DEFF Research Database (Denmark)

Chen, Marcus Y.; Rochitte, Carlos E.; Arbab-Zadeh, Armin

2017-01-01

Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial p...

Influence of technical parameters on epicardial fat volume quantification at cardiac CT.

Science.gov (United States)

Bucher, Andreas M; Joseph Schoepf, U; Krazinski, Aleksander W; Silverman, Justin; Spearman, James V; De Cecco, Carlo N; Meinel, Felix G; Vogl, Thomas J; Geyer, Lucas L

2015-06-01

To systematically analyze the influence of technical parameters on quantification of epicardial fat volume (EATV) at cardiac CT. 153 routine cardiac CT data sets were analyzed using three-dimensional pericardial border delineation. Three image series were reconstructed per patient: (a) CTAD: coronary CT angiography (CTA), diastolic phase; (b) CTAS: coronary CTA, systolic phase; (c) CaScD: non-contrast CT, diastolic phase. EATV was calculated using three different upper thresholds (-15HU, -30 HU, -45HU). Repeated measures ANOVA, Spearman's rho, and Bland Altman plots were used. Mean EATV differed between all three image series at a -30HU threshold (CTAD 87.2 ± 38.5 ml, CTAS 90.9 ± 37.7 ml, CaScD 130.7 ± 49.5 ml, PEATV of diastolic and systolic CTA reconstructions did not differ significantly (P=0.225). Mean EATV for contrast enhanced CTA at a -15HU threshold (CTAD15 102.4 ± 43.6 ml, CTAS15 105.3 ± 42.3 ml) could be approximated most closely by non-contrast CT at -45HU threshold (CaScD45 105.3 ± 40.8 ml). The correlation was excellent: CTAS15-CTAD15, rho=0.943; CTAD15-CaScD45, rho=0.905; CTAS15-CaScD45, rho=0.924; each PEATV can differ substantially between contrast enhanced and non-contrast CT studies, which can be reconciled by threshold modification. Heart cycle phase does not significantly influence EATV measurements. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Diagnosis of arterial sequestration using multidetector CT angiography

Energy Technology Data Exchange (ETDEWEB)

Yu Hong, E-mail: yuhong.2002@hotmail.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003 (China); Li Huimin, E-mail: lihuiminphd@163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003 (China)

2010-11-15

Background: Arterial sequestration is a rare congenital disorder. The diagnostic evaluation of this condition using multidetector computerized tomography (MDCT) has not been described previously. The purpose of this study was to describe the characteristic features of this disorder and to assess the use of MDCT in visualizing the characteristic anatomic features. Methods: We retrospectively reviewed the records of seven patients with anomalous systemic blood supply to left lower lobe of the lung. All the patients had undergone MDCT angiography. To evaluate the lung parenchyma, bronchial branching pattern, and vascular anatomy, four series of images were systematically reconstructed as follows: contiguous transverse CT scans viewed at mediastinal and pulmonary window settings, oblique coronal and sagittal maximum intensity projections (MIP), multiplanar reconstruction (MPR), and three-dimensional volume-rendered images (VR) of airway and thoracic vascular structures. Results: All 7 cases had isolated and tortuous arterial anatomy from the descending thoracic aorta to the basal segment of the left lower lobe; however, variable distribution of branches was observed. Characteristic findings of anomalous systemic arterial (ASA) supply were distinct from those seen in other pulmonary sequestration syndromes and were well visualized by the use of noninvasive MDCT. Conclusion: Complex CT findings allow clear imaging of arterial sequestration and the ASA blood supply; MDCT angiography has demonstrated its value and accuracy in diagnosing this condition, obviating the use of digital subtraction angiography and magnetic resonance angiography for the diagnosis of arterial sequestration.

Diagnosis of arterial sequestration using multidetector CT angiography

International Nuclear Information System (INIS)

Yu Hong; Li Huimin; Liu Shiyuan; Xiao Xiangsheng

2010-01-01

Background: Arterial sequestration is a rare congenital disorder. The diagnostic evaluation of this condition using multidetector computerized tomography (MDCT) has not been described previously. The purpose of this study was to describe the characteristic features of this disorder and to assess the use of MDCT in visualizing the characteristic anatomic features. Methods: We retrospectively reviewed the records of seven patients with anomalous systemic blood supply to left lower lobe of the lung. All the patients had undergone MDCT angiography. To evaluate the lung parenchyma, bronchial branching pattern, and vascular anatomy, four series of images were systematically reconstructed as follows: contiguous transverse CT scans viewed at mediastinal and pulmonary window settings, oblique coronal and sagittal maximum intensity projections (MIP), multiplanar reconstruction (MPR), and three-dimensional volume-rendered images (VR) of airway and thoracic vascular structures. Results: All 7 cases had isolated and tortuous arterial anatomy from the descending thoracic aorta to the basal segment of the left lower lobe; however, variable distribution of branches was observed. Characteristic findings of anomalous systemic arterial (ASA) supply were distinct from those seen in other pulmonary sequestration syndromes and were well visualized by the use of noninvasive MDCT. Conclusion: Complex CT findings allow clear imaging of arterial sequestration and the ASA blood supply; MDCT angiography has demonstrated its value and accuracy in diagnosing this condition, obviating the use of digital subtraction angiography and magnetic resonance angiography for the diagnosis of arterial sequestration.

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

Energy Technology Data Exchange (ETDEWEB)

Kang, Koung Mi; Choi, Sang Il; Chun, Eun Ju; Kim, Jeong A; Youn, Tae Jin; Choi, Dong Ju [Seoul National University Bundang Hospital, Sungnam (Korea, Republic of)

2012-01-15

We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test). Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test. Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively. Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.

Timing-Invariant CT Angiography Derived from CT Perfusion Imaging in Acute Stroke : A Diagnostic Performance Study

NARCIS (Netherlands)

Smith, E. J.; Vonken, E. -J.; Meijer, F. J. A.; Dankbaar, J. W.; Horsch, A. D.; van Ginneken, B.; Velthuis, B.; van der Schaaf, I.; Prokop, M.

2015-01-01

BACKGROUND AND PURPOSE: Timing-invariant (or delay-insensitive) CT angiography derived from CT perfusion data may obviate a separate cranial CTA in acute stroke, thus enhancing patient safety by reducing total examination time, radiation dose, and volume of contrast material. We assessed the

Early detection of lung cancer using ultra-low-dose computed tomography in coronary CT angiography scans among patients with suspected coronary heart disease.

Science.gov (United States)

Zanon, Matheus; Pacini, Gabriel Sartori; de Souza, Vinicius Valério Silveiro; Marchiori, Edson; Meirelles, Gustavo Souza Portes; Szarf, Gilberto; Torres, Felipe Soares; Hochhegger, Bruno

2017-12-01

To assess whether an additional chest ultra-low-dose CT scan to the coronary CT angiography protocol can be used for lung cancer screening among patients with suspected coronary artery disease. 175 patients underwent coronary CT angiography for assessment of coronary artery disease, additionally undergoing ultra-low-dose CT screening to early diagnosis of lung cancer in the same scanner (80kVp and 15mAs). Patients presenting pulmonary nodules were followed-up for two years, repeating low-dose CTs in intervals of 3, 6, or 12 months based on nodule size and growth rate in accordance with National Comprehensive Cancer Network guidelines. Ultra-low-dose CT identified 71 patients with solitary pulmonary nodules (41%), with a mean diameter of 5.50±4.00mm. Twenty-eight were >6mm, and in 79% (n=22) of these cases they were false positive findings, further confirmed by follow-up (n=20), resection (n=1), or biopsy (n=1). Lung cancer was detected in six patients due to CT screening (diagnostic yield: 3%). Among these, four cases could not be detected in the cardiac field of view. Most patients were in early stages of the disease. Two patients diagnosed at advanced stages died due to cancer complications. The addition of the ultra-low-dose CT scan represented a radiation dose increment of 1.22±0.53% (effective dose, 0.11±0.03mSv). Lung cancer might be detected using additional ultra-low-dose protocols in coronary CT angiography scans among patients with suspected coronary artery disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Application of digital subtraction angiography in disease of large cardiac vessel

Energy Technology Data Exchange (ETDEWEB)

Arisawa, Jun; Sone, Shusuke; Morimoto, Shizuo; Ikezoe, Junpei; Higashibara, Tokuro; Hanayama, Masayuki

1983-06-01

Digital subtraction angiography (DSA) was performed in 31 cases of disease of large cardiac vessel. DSA was useful for the diagnosis of aortic aneurysm and malformation of large vessels, follow-up after A-C bypass operation and Blalock's shunt operation for tetralogy of Fallot and as an adjuvant modality in cardiac catheterization.

Application of digital subtraction angiography in disease of large cardiac vessel

International Nuclear Information System (INIS)

Arisawa, Jun; Sone, Shusuke; Morimoto, Shizuo; Ikezoe, Junpei; Higashibara, Tokuro; Hanayama, Masayuki

1983-01-01

Digital subtraction angiography (DSA) was performed in 31 cases of disease of large cardiac vessel. DSA was useful for the diagnosis of aortic aneurysm and malformation of large vessels, follow-up after A-C bypass operation and Blalock's shunt operation for tetralogy of Fallot and as an adjuvant modality in cardiac catheterization. (Chiba, N.)

CT coronary angiography: Influence of different cardiac reconstruction intervals on image quality and diagnostic accuracy

Energy Technology Data Exchange (ETDEWEB)

Dewey, Marc [Department of Radiology, Charite Medical School, Humboldt-Universitaet zu Berlin (Germany)], E-mail: marc.dewey@charite.de; Teige, Florian [Department of Radiology, Charite Medical School, Humboldt-Universitaet zu Berlin (Germany); Rutsch, Wolfgang [Department of Cardiology, Charite Medical School, Humboldt-Universitaet zu Berlin (Germany)], E-mail: wolfgang.rutsch@charite.de; Schink, Tania [Department of Medical Biometry, Charite Medical School, Humboldt-Universitaet zu Berlin (Germany)], E-mail: peter.martus@charite.de; Hamm, Bernd [Department of Radiology, Charite Medical School, Humboldt-Universitaet zu Berlin (Germany)

2008-07-15

Purpose: To prospectively analyze image quality and diagnostic accuracy of different reconstruction intervals of coronary angiography using multislice computed tomography (MSCT). Materials and methods: For each of 47 patients, 10 ECG-gated MSCT reconstructions were generated throughout the RR interval from 0 to 90%, resulting in altogether 470 datasets. These datasets were randomly analyzed for image quality and accuracy and compared with conventional angiography. Statistical comparison of intervals was performed using nonparametric analysis for repeated measurements to account for clustering of arteries within patients. Results: Image reconstruction intervals centered at 80, 70, and 40% of the RR interval resulted (in that order) in the best overall image quality for all four main coronary vessels. Eighty percent reconstructions also yielded the highest diagnostic accuracy of all intervals. The combination of the three best intervals (80, 70, and 40%) significantly reduced the nondiagnostic rate as compared with 80% alone (p = 0.005). However, the optimal reconstruction interval combination achieved significantly improved specificities and nondiagnostic rates (p < 0.05). The optimal combination consisted of 1.7 {+-} 0.9 reconstruction intervals on average. In approximately half of the patients (49%, 23/47) a single reconstruction was optimal. In 18 (38%), 3 (6%), and 3 (6%) patients one, two, and three additional reconstruction intervals were required, respectively, to achieve optimal quality. In 28% of the patients the optimal combination consisted of reconstructions other than the three best intervals (80, 70, and 40%). Conclusion: Multiple image reconstruction intervals are essential to ensure high image quality and accuracy of CT coronary angiography.

Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

Energy Technology Data Exchange (ETDEWEB)

Pugliese, Francesca; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Mollet, Nico R.A.; deFeyter, Pim J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Runza, Giuseppe [University of Palermo, Department of Radiology, Palermo (Italy); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy); Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Malagutti, Patrizia [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); University of Ferrara, Department of Cardiology, Ferrara (Italy); Cademartiri, Filippo [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy)

2006-03-15

Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as {>=} 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

International Nuclear Information System (INIS)

Pugliese, Francesca; Krestin, Gabriel P.; Mollet, Nico R.A.; DeFeyter, Pim J.; Runza, Giuseppe; Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo; Malagutti, Patrizia; Cademartiri, Filippo

2006-01-01

Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)

2014-09-15

Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

Analysis of the cardiac motion in myocardial infarction by the ECG-synchronized CT

International Nuclear Information System (INIS)

Watanabe, Shigeru; Shimizu, Masahiko; Yoshida, Hideo; Morooka, Nobuhiro; Shukuya, Masaki

1981-01-01

The cardiac motion in patients with myocardial infarction was analyzed by the ECG-synchronized computed tomography (CT). For ECG synchronization, the ECG gating method and the data sorting method were used. By the ECG gating method, the gated cardiac images during 0.1 msec intervals at end-diastolic and the end-systolic phases were obtained. By the data sorting method, phasic CT images were reconstructed retrospectively by selecting appropriate data from a series of consecutive scans taken with simultaneous continuous ECG recordings. Six normal subjects and eight patients with myocardial infarction were studied by the ECG gating method, and 14 normal subjects and 25 patients with myocardial infarction were studied by the data sorting method. The end-diastolic and the end-systolic pictures at mid left ventricular level were superimposed and the cardiac borders were traced for the analysis (Fig. 4). Then the cardiac cross-sectional areas at each cardiac phase (40 msec) were calculated, and a cardiac area curve was obtained by plotting them consecutively. The cross-sectional images were divided into right anterior, right posterior, left anterior and left posterior segments. Cardiac area curves of the each segment were also obtained for further analysis. From these curves, the changing ratio of cardiac areas (maximum area - minimum area/maximum area) and the maximum area velocity in systole and diastole were calculated. On the images and the cardiac area curves in myocardial infarction patients, abnormal myocardial movements such as partial akinesis, hypokinesis or paradoxical movement were apparent asd the area of abnormal motions corresponded well with the location of infarction determined by ECG, RI scanning and angiography. A decrease of the changing ratio and the velocity in the infarction area were shown (Fig. 6, 7) and the functional disturbances were suggested during not only systole but diastole also. (author)

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

OpenAIRE

Rosow, David E.; Sahani, Dushyant; Strobel, Oliver; Kalva, Sanjeeva; Mino-Kenudson, Mari; Holalkere, Nagaraj S.; Alsfasser, Guido; Saini, Sanjay; Lee, Susanna I.; Mueller, Peter R.; Castillo, Carlos Fernández-del; Warshaw, Andrew L.; Thayer, Sarah P.

2005-01-01

Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly f...

Appearance and impact of post-operative intracranial clips and coils on whole-brain CT angiography and perfusion

International Nuclear Information System (INIS)

Roach, Cayce J.; Russell, Cheryl L.; Hanson, Eric H.; Bluett, Brent; Orrison, William W.

2012-01-01

Background: To evaluate the effect of vascular clips and endovascular coils placed for intracranial aneurysms and arteriovenous malformations on whole-brain computed tomography (CT) angiography and perfusion. Methods: A 320-detector row dynamic volume CT system imaged 11 patients following surgical placement of vascular clips or endovascular coils. The extent of clip and coil subtraction by automated software was evaluated using CT digital subtraction angiography and CT perfusion. Impact on CT perfusion values by retained intracranial devices was compared to age- and gender-matched controls. Results: Clip and coil subtraction on CT angiography was graded as good in 8 and moderate in 3 cases. A residual neck and additional aneurysm were noted in 1 of 11 patients. Post-procedural axial slice level CT perfusion values decreased in reliability with increasing proximity to the metallic devices secondary to beam hardening. However, the intracranial devices did not affect axial slice level CTP values of cerebral blood volume, cerebral blood flow and mean transit time outside of the level of the device. Time to peak values was globally decreased outside of the immediate vascular intervention region. Conclusions: Advances in CT technology have provided clinically useful subtraction of intracranial clips and coils. While CT perfusion values were altered in device subtraction areas and within beam hardening artifact areas; they can provide valuable postoperative information on whole-brain hemodynamics. In selected cases, the combination of CT angiography and whole-brain CT perfusion can offer an alternative to conventional angiography that is a more invasive option.

Dual-source CT cardiac imaging: initial experience

International Nuclear Information System (INIS)

Johnson, Thorsten R.C.; Nikolaou, Konstantin; Wintersperger, Bernd J.; Rist, Carsten; Buhmann, Sonja; Reiser, Maximilian F.; Becker, Christoph R.; Leber, Alexander W.; Ziegler, Franz von; Knez, Andreas

2006-01-01

The relation of heart rate and image quality in the depiction of coronary arteries, heart valves and myocardium was assessed on a dual-source computed tomography system (DSCT). Coronary CT angiography was performed on a DSCT (Somatom Definition, Siemens) with high concentration contrast media (Iopromide, Ultravist 370, Schering) in 24 patients with heart rates between 44 and 92 beats per minute. Images were reconstructed over the whole cardiac cycle in 10% steps. Two readers independently assessed the image quality with regard to the diagnostic evaluation of right and left coronary artery, heart valves and left ventricular myocardium for the assessment of vessel wall changes, coronary stenoses, valve morphology and function and ventricular function on a three point grading scale. The image quality ratings at the optimal reconstruction interval were 1.24±0.42 for the right and 1.09±0.27 for the left coronary artery. A reconstruction of diagnostic systolic and diastolic images is possible for a wide range of heart rates, allowing also a functional evaluation of valves and myocardium. Dual-source CT offers very robust diagnostic image quality in a wide range of heart rates. The high temporal resolution now also makes a functional evaluation of the heart valves and myocardium possible. (orig.)

The influence factors in image quality of multi-slice spiral CT coronary angiography (MSCTA)

International Nuclear Information System (INIS)

Zeng Huiliang; Zhu Xinjin; Liang Jianhao; Zhong Yingze; Chen Xueguang; Ou Weiqian; Wen Haomao; Li Peiwen

2007-01-01

Objective: To evaluate the influence of heart rate on image quality of multi-slice spiral CT coronary angiography(MSCTA) and the optimization of image reconstruction windows. Methods: Retrospectively ECG-gated MSCT coronary angiography were performed in 67 cases. The cases were divided into four groups by heart rate, groupl with heart rate less than 60 beats per minute(bpm), group 2 with heart rate 61-70 bpm, group 3 with heart rate 71-80 bpm and group 4 with heart rate over 81 bpm. The impact of heart rate on image quality of MSCTA and the optimization of image reconstruction windows were evaluated. Results: 4 coronary (RCA,LM,LAD,LCX) segments were analyzed in each patients with regard to image quality. 86.7%(112/128) of the coronary segments were sufficient for analysis in patients with heart rate less than 60 bpm,62.5%(55/88) with 61-70 bpm,40%(8/20) with 71-80 bpm and 12.5%(2/16) with heart rate over 81 bpm, respectively. There were statistically significances between every coronary segments of group 1 and 2, group 3 and 4 (P<0.05). All coronary segments of group 1 were optimally visualized on the image reconstructed at 75% image reconstruction window of' cardiac cycle; 89.5% cases at 75% in group 2; for group 3.55% of coronary artery were best presented at 75% image reconstruction window, 45% of coronary artery at 45%; All coronary segments of group 4 were optimally visualized on the image reconstructed at 45% image reconstruction window. Conclusion: Image quality of MSCT coronary angiography is highly dependent on heart rate. Coronary artery is usually best shown at 75% image reconstruction window of cardiac cycle for those with heart rate less than 70 bpm. 30%-90% image reconstruction should be performed when heart rate is over 71 bpm. (authors)

Low-dose celiac CT angiography with fixed current-time product

International Nuclear Information System (INIS)

Yu Hong; Li Huimin; Li Xiaolin; Zhu Shiqiang; Zhang Jiaming; Wang Xiangming; Zou Xiaofeng

2009-01-01

Objective: To characterize the feasibility of low-dose CT angiography on 16-slice multi-slice computed tomography (16-MSCT), and its relationship to the noise in the pre-contrast image and enhancement value. Methods: Forty-three consecutive patients (male 21, female 22, mean age 59 years, median age 56 years) underwent abdominal 16-MSCT (Toshiba Aquilion 16) with constant scanning parameters including 120 kVp, a 0.5-second gantry rotation time, a pitch of 0.938: 1, and 16 x 1-mm detector collimation. The mA was set at 200 in the pre-contrast scan and 160 in the contrast-enhanced scan. The arterial phase images were retrospectively reconstructed with 1-mm slice thickness, 0.8 mm interval. The pre-contrast noise was defined as the standard deviation (SD) of the aorta at the level of right posterior crura of diaphragm. The enhancement of aorta was also measured at level of celiac artery. The volume rendering of CT angiography was made and classified into three grades (excellent, good, bad). Receiver operating characteristic curve (ROC) was used to evaluate the relationship between the image quality of CT angiography and noise in the pre-contrast image and enhancement value. Results: Twenty-five cases had the aorta enhancement between 300.0-400.0 HU. The sensitivity and specificity of excellent CTA image was 75% and 62%, respectively when the SD was 12.00. Eighteen cases had the aorta enhancement more than 400.0 HU. The sensitivity and specificity of excellent CTA image was all 100% when the SD was 12.25, and 100% and 75%, respectively when the SD was 13.35. The area under curve of CTA image quality and enhancement in receiver-operated characteristic analysis was 0.907. The enhancement was more than 356.7 HU when the sensitivity and specificity of excellent CTA image was 100% and 60%, respectively, and 389.8 HU when 78% and 80%. When the enhancement was more than 442.4 HU, the specificity of excellent CTA image was 100%. Conclusions: MSCT angiography with low radiation

Cardiac CT and cardiac MRI - competitive or complementary for nuclear cardiology

International Nuclear Information System (INIS)

Moshage, W.

2004-01-01

In summary, cardiac computed tomography (CT) and cardiac magnetic resonance (MR) are two different technologies with distinct imaging properties that gain increasing importance in clinical cardiology. Even though images may look similar, the areas of application of CT and MR are quite different. Clinical applications of cardiac CT focus on on-invasive imaging of the coronary arteries. In this respect, the higher spatial resolution of cardiac CT constitutes a significant advantage as compared to MR and clinical results are superior. Clinical applications of cardiac MR, next to morphologic imaging of the heart, are most frequently found in the context of intra-and pericardial masses, complex congenital anomalies, and the assessment of left ventricular function (dobutamine) and perfusion (adenosine) under stress. The evaluation of the size and localization of myocardial necrosis, scars, and fibrosis gains increasing importance, for example in the workup of myocardial infarction, but also myocarditis and cardiomyopathies. In this respect, magnetic resonance imaging partly constitutes an alternative to nuclear medicine methods. Due to the lack of ionizing radiation and a relatively high spatial resolution, an increase of MR diagnostic procedures at the expense of nuclear medicine can be expected. (orig.)

The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion.

Science.gov (United States)

Pontone, Gianluca; Muscogiuri, Giuseppe; Andreini, Daniele; Guaricci, Andrea I; Guglielmo, Marco; Mushtaq, Saima; Baggiano, Andrea; Conte, Edoardo; Beltrama, Virginia; Annoni, Andrea; Formenti, Alberto; Mancini, Elisabetta; Rabbat, Mark G; Pepi, Mauro

2016-12-01

The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR). Invasive FFR is considered the gold standard for the evaluation of functionally relevant CAD. Therefore, an urgent need for non-invasive techniques that evaluate both the functional and morphological severity of CAD is growing. Coronary computed tomography angiography (CCTA) has emerged as a unique non-invasive technique providing coronary artery anatomic imaging. More recently, the evaluation of FFR with CCTA (FFR CT ) has demonstrated high diagnostic performance compared to invasive FFR. Additionally, stress myocardial computed tomography perfusion (CTP) represents a novel tool for the diagnosis of ischemia with high diagnostic accuracy. Compared to nuclear imaging and cardiac magnetic resonance imaging, both FFR CT and stress-CTP, allow us to integrate the anatomical evaluation of coronary arteries with the functional relevance of coronary artery lesions having the potential to revolutionize the diagnostic paradigm of suspected CAD. FFR CT and stress-CTP could be assimilated in diagnostic pathways of patients with stable CAD and will likely result in a decrease of invasive diagnostic procedures and costs. The current review evaluates the technical aspects and clinical experience of FFR CT and stress-CTP in the evaluation of functionally relevant CAD discussing the strengths and weaknesses of each approach.

Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: A meta-analysis

International Nuclear Information System (INIS)

Sun Zhonghua; Almutairi, Abdulrahman Marzouq D.

2010-01-01

Purpose: The aim of this study was to perform a meta-analysis of the diagnostic accuracy of 64-slice CT angiography for the detection of coronary in-stent restenosis in patients treated with coronary stents when compared to conventional coronary angiography. Materials and methods: A search of PUBMED/MEDLINE, ProQuest and Cochrane library databases for English literature was performed. Only studies comparing 64-slice CT angiography with conventional coronary angiography for the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model. Results: Fourteen studies met selection criteria for inclusion in the analysis. The mean value of assessable stents was 89%. Prevalence of in-stent restenosis following coronary stenting was 20% among these studies. Pooled estimates of the sensitivity and specificity of overall 64-slice CT angiography for the detection of coronary in-stent restenosis was 90% (95% CI: 86%, 94%) and 91% (95% CI: 90%, 93%), respectively, based on the evaluation of assessable stents. Diagnostic value of 64-slice CT angiography was found to decrease significantly when the analysis was performed with inclusion of nonassessable segments in five studies, with pooled sensitivity and specificity being 79% (95% CI: 68%, 88%) and 81% (95% CI: 77%, 84%). Stent diameter is the main factor affecting the diagnostic value of 64-slice CT angiography. Conclusion: Our results showed that 64-slice CT angiography has high diagnostic value (both sensitivity and specificity) for detection of coronary in-stent restenosis based on assessable segments when compared to conventional coronary angiography.

Liver hydatid cyst ruptured into the thorax: CT angiography findings of a case

International Nuclear Information System (INIS)

Kara, K.; Ors, F.; Bozlar, U.; Tasar, M.

2012-01-01

Full text: Introduction: Intrathoracic rupture of hepatic hydatid cyst is a rare but severe condition causing a spectrum of lesions to the pleura, lung parenchyma, and bronchi. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. Objectives and tasks: In this report we aimed to present computed tomography (CT) angiography findings of a case with liver hydatid cyst ruptured into the thorax. The patient underwent CT angiography examination with suspicion of pulmonary embolism. Materials and methods: A 71-year-old female patient admitted to our emergency department with complaints of severe and persistent cough. Basal region of the right hemithorax could not get breath sounds on physical examination. Chest radiography revealed the presence of consolidation-effusion. The patient was treated with antibiotherapy for pneumonia and parapneumonic effusion. Because of the clinical symptoms and chest radiograph findings persisted the patient underwent CT angiography examination with suspicion of pulmonary embolism. Results: On CT angiography images pulmonary artery and its branches were normal. There were subtotal collapse in the right middle and lower lung lobes and complicated cystic lesion that has air densities in the basal interlobar space. Another thick walled complicated cystic lesion with multiple septations and air densities was detected in the right posterior liver lobe. The right hemidiaphragm was interrupted and the right liver lobe partially herniated into the thorax cavity. Serologic tests were positive for Echinococcus granulosus and there were prior therapy history for liver cyst hydatid. The diagnostic aspiration findings were consistent with hydatid cyst lesion. Conclusion: In patients with hepatic hydatid cyst associated with persistent and severe cough, thoracic rupture of the cyst should be considered in differential diagnosis. CT angiography is fast, non-invasive and effective method in the detection of

Renal computed angiography. Part I: Renal CT arteriography in hypertension

International Nuclear Information System (INIS)

Al-Amin, M.; Hadjidekov, V.

2012-01-01

Visualization of renal vasculature is needed in several clinical condition among which hypertension is dominant. CT angiography now day replaces catheter angiography as non-invasive method. The goal of this study is to present initial authors experience in visualization of renal arteries using 64 MDCT and to evaluated the utility in hypertensive patients. MDCT assures excellent assessment of renal arteries conditions. Multiplanar reconstruction and allow better delineation in tortuous vessels course and anatomic variants. (authors)

Practical textbook of cardiac CT and MRI

Energy Technology Data Exchange (ETDEWEB)

Lim, Tae-Hwan (ed.) [ASAN Medical Center, Seoul (Korea, Republic of). Dept. of Radiology

2015-04-01

Guide to the interpretation of cardiac CT and MRI for the purposes of diagnosis, treatment planning, and follow-up. Emphasis on applications in a wide range of real clinical situations. Numerous informative illustrations. Summarizing sections permitting rapid retrieval of information. QR codes allowing access to references, additional figures, and motion pictures from the internet. This up-to-date textbook comprehensively reviews all aspects of cardiac CT and MRI and demonstrates the value of these techniques in clinical practice. A wide range of applications are considered, including imaging of atherosclerotic and non-atherosclerotic coronary artery disease, coronary revascularization, ischemic heart disease, non-ischemic cardiomyopathy, valvular heart disease, cardiac tumors, and pericardial disease. The numerous high-quality images illustrate how to interpret cardiac CT and MRI correctly for the purposes of diagnosis, treatment planning, and follow-up. Helpful summarizing sections in every chapter will facilitate rapid retrieval of information. This book will be of great value to radiologists and cardiologists seeking a reliable guide to the optimal use of cardiac CT and MRI in real clinical situations.

Practical textbook of cardiac CT and MRI

International Nuclear Information System (INIS)

Lim, Tae-Hwan

2015-01-01

Guide to the interpretation of cardiac CT and MRI for the purposes of diagnosis, treatment planning, and follow-up. Emphasis on applications in a wide range of real clinical situations. Numerous informative illustrations. Summarizing sections permitting rapid retrieval of information. QR codes allowing access to references, additional figures, and motion pictures from the internet. This up-to-date textbook comprehensively reviews all aspects of cardiac CT and MRI and demonstrates the value of these techniques in clinical practice. A wide range of applications are considered, including imaging of atherosclerotic and non-atherosclerotic coronary artery disease, coronary revascularization, ischemic heart disease, non-ischemic cardiomyopathy, valvular heart disease, cardiac tumors, and pericardial disease. The numerous high-quality images illustrate how to interpret cardiac CT and MRI correctly for the purposes of diagnosis, treatment planning, and follow-up. Helpful summarizing sections in every chapter will facilitate rapid retrieval of information. This book will be of great value to radiologists and cardiologists seeking a reliable guide to the optimal use of cardiac CT and MRI in real clinical situations.

Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography

International Nuclear Information System (INIS)

Young, N.; Kingston, R.J.; Markson, G.; Dorsch, N.W.C.; McMahon, J.

2001-01-01

The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms. (orig.)

Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR

Energy Technology Data Exchange (ETDEWEB)

Maffei, Erica; Seitun, Sara [Giovanni XXIII Hospital, Cardiovascular Radiology Unit, Monastier di Treviso (Italy); Messalli, Giancarlo; Catalano, Onofrio [SDN Foundation - IRCCS, Naples (Italy); Martini, Chiara; Cademartiri, Filippo [Giovanni XXIII Hospital, Cardiovascular Radiology Unit, Monastier di Treviso (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Nieman, Koen; Rossi, Alexia; Mollet, Nico R. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Guaricci, Andrea I. [Azienda Ospedaliero-Universitaria di Foggia, Department of Cardiology, Foggia (Italy); Tedeschi, Carlo [Ospedale San Gennaro, Department of Cardiology, Naples (Italy)

2012-05-15

To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software. CT and MR images showed good agreement: LV EF (Ejection Fraction) (52 {+-} 14% for CT vs. 52 {+-} 14% for MR; r = 0.73; p > 0.05); RV EF (47 {+-} 12% for CT vs. 47 {+-} 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 {+-} 21 ml/m{sup 2} for CT vs. 76 {+-} 25 ml/m{sup 2} for MR; r = 0.59; p > 0.05); RV EDV (84 {+-} 25 ml/m{sup 2} for CT vs. 80 {+-} 23 ml/m{sup 2} for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 {+-} 19 ml/m{sup 2} for CT vs. 38 {+-} 23 ml/m{sup 2} for MR; r = 0.76; p > 0.05); RV ESV (46 {+-} 21 ml/m{sup 2} for CT vs. 43 {+-} 18 ml/m{sup 2} for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. Cardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. circle Cardiac-CT is able to provide Left and Right Ventricular function. circle Cardiac-CT is accurate as MR for LV and RV volume assessment. (orig.)

Catheter Angiography

Medline Plus

Full Text Available ... is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, ... tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of ...

Coronary CT in Acute Cardiac Care

NARCIS (Netherlands)

A. Dedic (Admir)

2016-01-01

markdownabstractCoronary CT angiography is a well-established diagnostic modality for stable angina pectoris. It provides an angiographic, non-invasive alternative for the diagnosis of coronary artery disease, exceeding in the ability to exclude important coronary artery disease. Having the ability

Catheter Angiography

Medline Plus

Full Text Available ... is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a ... tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a ...

Catheter Angiography

Medline Plus

Full Text Available ... using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin plastic ... called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes it ...

Spiral CT angiography of renal arteries: comparison with angiography

International Nuclear Information System (INIS)

Wittenberg, G.; Kenn, W.; Tschammler, A.; Sandstede, J.; Hahn, D.

1999-01-01

A prospective study was carried out to determine the accuracy of spiral CT angiography (CTA) in the detection of renal artery stenosis (RAS). Eighty-two patients with arterial hypertension underwent CTA and digital subtraction angiography (DSA) to exclude RAS. For CTA a contrast medium bolus of 100-150 ml (flow rate 3 ml/s) was injected. A 24 or 40 s CTA was started at the origin of the superior mesenteric artery after a delay time determined by test bolus injection (collimation = 2 mm, pitch = 1/1.5). For stenosis detection transverse images supported by maximum intensity projections (MIP) or multiplanar reconstruction projections were used. Of 197 renal arteries examined (including 33 accessory arteries), 34 RAS were visualized using DSA. With CTA, one hemodynamic RAS was missed and one additional hemodynamic RAS was found. Sensitivity/specificity was calculated to be 94 %/98 %. For hemodynamically relevant RAS (> 50 %) the sensitivity/specificity was 96 %/99 %. CTA additionally depicted five adrenal masses. The high accuracy rate of RAS detection thus allows the use of CTA as a screening method in patients with arterial hypertension to exclude a renovascular cause. (orig.)

Carbon dioxide hepatic arterial DSA and CT angiography in swine model

International Nuclear Information System (INIS)

Tan Huaqiao; Hu Hongjie; Huang Wenxin; Zhang Shizheng; Dong Yonghua; Zhou Dachun

2005-01-01

Objective: To evaluate the imaging findings of carbon dioxide hepatic arterial DSA and CT angiography in normal swine. Methods: In general anaesthesia, hepatic arterial DSA was performed with 10 ml iodinated contrast medium (5 ml/s, 10 ml) in 5 normal swine, and then repeated hepatic arterial CO 2 -DSA was performed with a total of 30-50 ml CO 2 injected by manually operated syringe at the velocity of 5-8 ml/s, followed by CO 2 -CT angiography. All the swine were sacrificed after the procedure, the selective hepatic segments were removed, and pathological examination was carried out. The radiological features of hepatic arterial DSA with iodinated contrast medium and CO 2 and CT angiography with CO 2 were analyzed. The ability of showing the arterio-venous shunt was compared. Results: Hepatic arterio-portal shunt was found in the advanced arterial phase of CO 2 -DSA in three of five swine, which was furthermore demonstrated by CO 2 -CT angiography, but iodinated contrast medium DSA showed no arterio-portal shunt in all swine. The gaseous CO 2 in portal vein was absorbed within 1-3 minutes. No CO 2 shunted into the hepatic vein during CO 2 -DSA and CO 2 -CTA. Histology didn't reveal any abnormal changes caused by CO 2 shunt in the swine liver. Conclusion: (1) Hepatic arterial CO 2 -DSA and CO 2 -CTA can reveal arterio-portal shunt that isn't seen with iodinated contrast medium, the gaseous CO 2 in portal vein was absorbed within 1-3 minutes. (2) The gaseous CO 2 can't shunt into hepatic vein when the hepatic artery is perfused with CO 2 in normal swine. (authors)

Improving best-phase image quality in cardiac CT by motion correction with MAM optimization

Energy Technology Data Exchange (ETDEWEB)

Rohkohl, Christopher; Bruder, Herbert; Stierstorfer, Karl [Siemens AG, Healthcare Sector, Siemensstrasse 1, 91301 Forchheim (Germany); Flohr, Thomas [Siemens AG, Healthcare Sector, Siemensstrasse 1, 91301 Forchheim (Germany); Institute of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

2013-03-15

Purpose: Research in image reconstruction for cardiac CT aims at using motion correction algorithms to improve the image quality of the coronary arteries. The key to those algorithms is motion estimation, which is currently based on 3-D/3-D registration to align the structures of interest in images acquired in multiple heart phases. The need for an extended scan data range covering several heart phases is critical in terms of radiation dose to the patient and limits the clinical potential of the method. Furthermore, literature reports only slight quality improvements of the motion corrected images when compared to the most quiet phase (best-phase) that was actually used for motion estimation. In this paper a motion estimation algorithm is proposed which does not require an extended scan range but works with a short scan data interval, and which markedly improves the best-phase image quality. Methods: Motion estimation is based on the definition of motion artifact metrics (MAM) to quantify motion artifacts in a 3-D reconstructed image volume. The authors use two different MAMs, entropy, and positivity. By adjusting the motion field parameters, the MAM of the resulting motion-compensated reconstruction is optimized using a gradient descent procedure. In this way motion artifacts are minimized. For a fast and practical implementation, only analytical methods are used for motion estimation and compensation. Both the MAM-optimization and a 3-D/3-D registration-based motion estimation algorithm were investigated by means of a computer-simulated vessel with a cardiac motion profile. Image quality was evaluated using normalized cross-correlation (NCC) with the ground truth template and root-mean-square deviation (RMSD). Four coronary CT angiography patient cases were reconstructed to evaluate the clinical performance of the proposed method. Results: For the MAM-approach, the best-phase image quality could be improved for all investigated heart phases, with a maximum

Improving best-phase image quality in cardiac CT by motion correction with MAM optimization

International Nuclear Information System (INIS)

Rohkohl, Christopher; Bruder, Herbert; Stierstorfer, Karl; Flohr, Thomas

2013-01-01

Purpose: Research in image reconstruction for cardiac CT aims at using motion correction algorithms to improve the image quality of the coronary arteries. The key to those algorithms is motion estimation, which is currently based on 3-D/3-D registration to align the structures of interest in images acquired in multiple heart phases. The need for an extended scan data range covering several heart phases is critical in terms of radiation dose to the patient and limits the clinical potential of the method. Furthermore, literature reports only slight quality improvements of the motion corrected images when compared to the most quiet phase (best-phase) that was actually used for motion estimation. In this paper a motion estimation algorithm is proposed which does not require an extended scan range but works with a short scan data interval, and which markedly improves the best-phase image quality. Methods: Motion estimation is based on the definition of motion artifact metrics (MAM) to quantify motion artifacts in a 3-D reconstructed image volume. The authors use two different MAMs, entropy, and positivity. By adjusting the motion field parameters, the MAM of the resulting motion-compensated reconstruction is optimized using a gradient descent procedure. In this way motion artifacts are minimized. For a fast and practical implementation, only analytical methods are used for motion estimation and compensation. Both the MAM-optimization and a 3-D/3-D registration-based motion estimation algorithm were investigated by means of a computer-simulated vessel with a cardiac motion profile. Image quality was evaluated using normalized cross-correlation (NCC) with the ground truth template and root-mean-square deviation (RMSD). Four coronary CT angiography patient cases were reconstructed to evaluate the clinical performance of the proposed method. Results: For the MAM-approach, the best-phase image quality could be improved for all investigated heart phases, with a maximum

Diagnosis of myocardial ischemia combining multiphase postmortem CT-angiography, histology, and postmortem biochemistry.

Science.gov (United States)

Vanhaebost, Jessica; Ducrot, Kewin; de Froidmont, Sébastien; Scarpelli, Maria Pia; Egger, Coraline; Baumann, Pia; Schmit, Gregory; Grabherr, Silke; Palmiere, Cristian

2017-02-01

The aim of this study was to assess whether the identification of pathological myocardial enhancement at multiphase postmortem computed tomography angiography was correlated with increased levels of troponin T and I in postmortem serum from femoral blood as well as morphological findings of myocardial ischemia. We further aimed to investigate whether autopsy cases characterized by increased troponin T and I concentrations as well as morphological findings of myocardial ischemia were also characterized by pathological myocardial enhancement at multiphase postmortem computed tomography angiography. Two different approaches were used. In one, 40 forensic autopsy cases that had pathological enhancement of the myocardium (mean Hounsfield units ≥95) observed at postmortem angiography were retrospectively selected. In the second approach, 40 forensic autopsy cases that had a cause of death attributed to acute myocardial ischemia were retrospectively selected. The preliminary results seem to indicate that the identification of a pathological enhancement of the myocardium at postmortem angiography is associated with the presence of increased levels of cardiac troponins in postmortem serum and morphological findings of ischemia. Analogously, a pathological enhancement of the myocardium at postmortem angiography can be retrospectively found in the great majority of autopsy cases characterized by increased cardiac troponin levels in postmortem serum and morphological findings of myocardial ischemia. Multiphase postmortem computed tomography angiography is a useful tool in the postmortem setting for investigating ischemically damaged myocardium.

CT angiography using electron-beam computed tomography (EBCT). A phantom study

International Nuclear Information System (INIS)

Uchino, Akira; Kato, Akira; Kudo, Sho

1997-01-01

The purpose of this study was to evaluate the accuracy of CT angiography in small vessels using electron-beam computed tomography (EBCT). Vessel phantoms with inner diameters of 8 mm, 6 mm, and 4 mm were prepared with segments of 75%, 50%, and 25% stenosis in each vessel. The vessels were filled with contrast medium (Iopamidol 300 at 1/24 dilution, approximately 380 HU). The EBCT apparatus used was an Imatron C-150. The step volume scan mode was used with slice thicknesses of 1.5 mm and 3.0 mm, scan time of 0.3 sec, and 210 mm field of view. Images with a slice thickness of 1.5 mm were definitely better than those with a slice thickness of 3.0 mm. The quality of maximum intensity projection (MIP) images was quite similar to that of three-dimensional (3D) images. Using the 8 mm vessel phantom, all stenotic segments were accurately visualized on CT angiography. The 50% stenotic segments were accurately estimated in all vessels. However, the 75% stenotic segments were slightly overestimated in smaller vessels, and the 25% stenotic segments were slightly underestimated in smaller vessels. We consider CT angiography using EBCT to be a useful, less invasive diagnostic modality for stenoocclusive lesions. (author)

Usefulness of the Negative Multidetector CT Angiography in Patients with Suspected Pulmonary Embolism

International Nuclear Information System (INIS)

Holguin Holguin, Alfonso Jose; Lombana, Milton; Collazos, Giovanny; Bravo, Hector; Abella Calle, Jose

2012-01-01

Objective: The aim of the study is to evaluate alternative findings in pulmonary CT angiography using MDCT reported as negative in patients with suspected pulmonary embolism. Material and method: Cross sectional study with 178 patients. We recognized other findings reported in pulmonary CT angiography using MDCT whose result was negative. Subsequently these findings were classified into six different categories of clinical relevance and their association with clinical scenario was analyzed. Results: from November 2004 to June 2007 we requested 231 pulmonary CT angiography using MDCT in patients with suspected pulmonary embolism. 217 patients were included in the final analysis. Of these, 39 (185) were positive for pulmonary embolism. The 178 remaining negative studies, 8.43% were normal, 53.37% were classified as category A, 20.79% category B, 14.04% category C; category D 1.12% and 2.25% were not interpretable. The most frequent diagnoses were pneumonia, interstitial lung disease and cardiogenic pulmonary edema. It was less likely to find a normal report whether the study was requested in the hospital department in emergency patients (OR = 0.38 95% 0.16 to 0.88, p = 0.0007). No differences were found in other categories or between patients younger or older than 65 years (p = 0.436). Conclusion: Pulmonary CT angiography as first line imaging tool in patients with suspected pulmonary embolism is useful, offering alternative diagnoses in hospitalized and emergency room patients, regardless of their age and clinical findings.

Budd-Chiari syndrome: dynamic enhancement findings with multi-slice helical CT and CT angiography analysis

International Nuclear Information System (INIS)

Meng Xiaochun; Shan Hong; Zhu Kangshun; Xu Chuan; Zhang Jiansheng; Liu Lingyun; Ye Binbin

2005-01-01

Objective: To investigate the dynamic enhancement regulations of liver and their mechanism in Budd-Chiari syndrome (BCS) by using multi-slice CT and evaluate the value of CT angiography in the diagnosis of BCS. Methods: 28 cases with BCS confirmed by digital subtraction angiography (DSA) were retrospectively analyzed. All patients underwent dynamic enhancement examinations with multi-slice CT within 1 week before DSA. The relevant vessels were reconstructed respectively with MIP, VR and MPR. Compared with the results of DSA, we analyzed the dynamic enhancement regulations of liver in BCS, estimated the value of dynamic enhancement CT exams and CTA techniques in judging the obstruction level and showing collateral vessels. Results: Of all 28 cases, CT correctly showed the obstruction level in 26 cases, and 2 had incorrect results which proved to be membranous obstruction of the inferior vena cava superior to diaphragm. In 22 cases with hepatic vein obstructions, hepatic parenchyma displayed typical patchy enhancement in 19, atypical patchy enhancement in 3.8 cases among these showed benign nodules. Simultaneously, CT showed stenosis and rigidity of portal vein branches in 20, enlargement of hepatic artery in 14, hepatic collateral vessels in 20 out of 22 cases. In 6 cases with simple obstruction of inferior vena cava, hepatic changes were not found. Collateral circulations in or out of liver corresponded to the obstruction level. Conclusion: Dynamic enhancement examinations with multi-slice CT can correctly reflect the hepatic hemodynamic changes. Transverse images, combined with CTA, can explicitly display the obstruction level of vascular lesions and collateral circulations in BCS. (authors)

Cone-beam CT angiography of the thorax. An experimental study

International Nuclear Information System (INIS)

Yoshida, Katsuya; Shimada, Kazuhiro; Tadokoro, Hiroyuki

1999-01-01

The authors recently developed a cone-beam computed tomography (CT) scanner and this report presents their evaluation of its potential for thoracic vascular imaging. An X-ray tube and a video-fluoroscopic system were rotated around the objects and 360 projected images were collected in a 12-s scan. Each image was digitized and a 3 dimensional (D) image (256 x 256 x 256 voxel volume with a voxel dimension of 0.9 x 0.9 x 0.9 mm) was reconstructed. Two different 3D-CT angiographies were investigated in 2 pigs: right atriography and thoracic aortography. Each pig was anesthetized, mechanically ventilated and positioned within the scanner. Contrast agent was infused through the right atrium or the aortic root at a rate of 3 ml/s during the scan. The right atriography scan clearly delineated the anatomy of the pulmonary artery, heart chambers and thoracic aorta. The thoracic aortography scan also clearly delineated the aortic anatomy including the internal thoracic and intercostal arteries. In conclusion, cone-beam CT angiography is potentially useful for thoracic vascular imaging. (author)

CT coronary angiography in patients with atrial fibrillation

International Nuclear Information System (INIS)

Kovacs, A.; Sommer, T.; Leiss, A.; Naehle, P.; Schild, H.; Flacke, S.; Probst, C.; Welz, A.

2005-01-01

Purpose: Reliable visualization of the coronary arteries with multislice spiral CT angiography (MSCTA) in patients with atrial fibrillation (AF) remains a challenge despite retrospective ECG gating. A recently developed new algorithm automatically compensates dynamic changes in the heart rate during the scan, thus reducing misregistration and motion artifacts. The HeartBeat-RT algorithm combines a fixed percent delay determined from the first R wave and the fixed offset delay based on the second R wave in the ECG cycle. The purpose of this study was to find out the optimal reconstruction window in MSCTA in patients with AF for each of the three major coronary arteries during the cardiac cycle. Materials and methods: 20 patients with permanent AF were imaged on a 16-slice scanner (slice collimation: 16 x 0.75 mm; rotation time 0.42 s; 140 kV; 380 mAs; 120 ml Ultravist 370 registered i.v.). The patients had not received any previous drugs for heart frequency regulation. Acquisition was started after bolus tracking of a biphasic bolus of 120 ml Ultravist 370 injected intravenously. Each coronary segment was reconstructed at 0%-90% of the cardiac cycle in increments of 10%. For image analysis we used coronary segments as defined by the American Heart Association. Two blinded independent readers assessed the image quality in terms of visibility and artifacts (five-point rating scale 1=very poor, 2=poor, 3=fair, 4=good and 5=excellent) and the degree of stenosis (five-point rating scale 1=0%, 2=1%-49%, 3=50%-74%, 4=75%-99%, 5=100%) on axial slices, multiplanar reconstructions and three-dimensional volume-rendered images. (orig.)

Quantitative cardiac computed tomography

Energy Technology Data Exchange (ETDEWEB)

Thelen, M.; Dueber, C.; Wolff, P.; Erbel, R.; Hoffmann, T.

1985-06-01

The scope and limitations of quantitative cardiac CT have been evaluated in a series of experimental and clinical studies. The left ventricular muscle mass was estimated by computed tomography in 19 dogs (using volumetric methods, measurements in two axes and planes and reference volume). There was good correlation with anatomical findings. The enddiastolic volume of the left ventricle was estimated in 22 patients with cardiomyopathies; using angiography as a reference, CT led to systematic under-estimation. It is also shown that ECG-triggered magnetic resonance tomography results in improved visualisation and may be expected to improve measurements of cardiac morphology.

Primary cardiac and pericardial tumors, imaging approach

Energy Technology Data Exchange (ETDEWEB)

Yu-Qing Liu, M D [Chinese Academy of Medical Sciences, Beijing, BJ (China). Dept. of Radiology, Fu Wai Hospital and Cardiovascular Inst.

1996-12-31

The incidence of cardiac tumor and its classification was discussed. Imaging study i.e. conventional radiology, echocardiagoaphy (echo), magnetic resonance imaging (MRI), angiography and computed tomography (CT) used also discussed briefly. (8 refs.).

Primary cardiac and pericardial tumors, imaging approach

International Nuclear Information System (INIS)

Yu-Qing Liu, M.D.

1995-01-01

The incidence of cardiac tumor and its classification was discussed. Imaging study i.e. conventional radiology, echocardiagoaphy (echo), magnetic resonance imaging (MRI), angiography and computed tomography (CT) used also discussed briefly. (8 refs.)

Cardiac Computed Tomography (Multidetector CT, or MDCT)

Science.gov (United States)

... Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Computed Tomography (Multidetector CT, or MDCT) Updated:Sep 19,2016 What is Computerized Tomography (CT)? CT is a noninvasive test that uses ...

Development of test bolus tracking method and usefulness in coronary CT angiography

International Nuclear Information System (INIS)

Yamaguchi, Takayoshi; Takahashi, Daichi

2009-01-01

The test bolus tracking (TBT) method is a new injection method of contrast medium that we developed. The TBT method is an injection technique that continuously performs the test bolus injection and the main bolus injection, such that the best acquisition of scan timing and the improvement of examination efficiency can be expected. We compared the TBT method and the test injection method by coronary CT angiography. The results demonstrated that the contrast enhancement of the coronary arteries was high and the variation of the CT value was also small in the TBT method. When the scan timing expected by the TI method and the TBT method were compared, it was different of two seconds or more by the case with 43%. However, the variation of CT value was small for the TBT method in these cases. Therefore, the TBT method is a very useful method for coronary CT angiography (CCTA). (author)

Comparison of diagnostic accuracy of dual-source CT and conventional angiography in detecting congenital heart diseases

International Nuclear Information System (INIS)

Sedaghat, Fariborz; Pouraliakbar, Hamidreza; Motevalli, Marzieh; Karimi, Mohammad Ali; Armand, Sandbad

2014-01-01

Cardiac dual-source computed tomography (DSCT) is primarily used for coronary arteries. There are limited studies about the application of DSCT for congenital heart diseases. The aim of this study was to determine the diagnostic value of DSCT in the cardiac anomalies. The images of DSCTs and conventional angiographies of 36 patients (21 male; mean age: 8.5 month) with congenital heart diseases were reviewed and the parameters of diagnostic value of these methods were compared. Cardiac surgery was the gold standard. A total of 105 cardiac anomalies were diagnosed at surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DSCT were 98.25%, 97.9%, 98.1%, 99.07%, and 98.2%, respectively. The corresponding values of angiography were 95.04%, 98.7%, 97.8%, 98.1%, and 98%, respectively. Only one atrial septal defect (ASD) and two patent ductus arteriosus (PDA) were missed by DSCT. Angiography missed two ASD and two PDA. DSCT also provided important additional findings (n=35) about the intrathoracic or intraabdominal organs. DSCT is a highly accurate diagnostic modality for congenital heart diseases, obviating the need for invasive modalities. Beside its noninvasive nature, the advantage of DSCT over the angiography is its ability to provide detailed anatomical information about the heart, vessels, lungs and intraabdominal organs

Haemodynamic findings on cardiac CT in children with congenital heart disease

International Nuclear Information System (INIS)

Goo, Hyun Woo

2011-01-01

In patients with congenital heart disease, haemodynamic findings demonstrated on cardiac CT might provide useful hints for understanding the haemodynamics of cardiac defects. In contrast to morphological features depicted on cardiac CT, such haemodynamic findings on cardiac CT have not been comprehensively reviewed in patients with congenital heart disease. This article describes normal haemodynamic phenomena of cardiovascular structures and various abnormal haemodynamic findings with their mechanisms and clinical significance on cardiac CT in patients with congenital heart disease. (orig.)

Influence of technical parameters on epicardial fat volume quantification at cardiac CT

International Nuclear Information System (INIS)

Bucher, Andreas M.; Joseph Schoepf, U.; Krazinski, Aleksander W.; Silverman, Justin; Spearman, James V.; De Cecco, Carlo N.; Meinel, Felix G.; Vogl, Thomas J.; Geyer, Lucas L.

2015-01-01

Highlights: • Upper threshold levels and contrast enhancement influence epicardial fat volumetry. • Cardiac cycle does not significantly influence epicardial fat volumetry. • Adjustments of upper threshold can lead to comparable volumetry results. - Abstract: Objectives: To systematically analyze the influence of technical parameters on quantification of epicardial fat volume (EATV) at cardiac CT. Methods: 153 routine cardiac CT data sets were analyzed using three-dimensional pericardial border delineation. Three image series were reconstructed per patient: (a) CTA D : coronary CT angiography (CTA), diastolic phase; (b) CTA S : coronary CTA, systolic phase; (c) CaSc D : non-contrast CT, diastolic phase. EATV was calculated using three different upper thresholds (−15HU, −30HU, −45HU). Repeated measures ANOVA, Spearman's rho, and Bland Altman plots were used. Results: Mean EATV differed between all three image series at a −30HU threshold (CTA D 87.2 ± 38.5 ml, CTA S 90.9 ± 37.7 ml, CaSc D 130.7 ± 49.5 ml, P < 0.001). EATV of diastolic and systolic CTA reconstructions did not differ significantly (P = 0.225). Mean EATV for contrast enhanced CTA at a −15HU threshold (CTA D15 102.4 ± 43.6 ml, CTA S15 105.3 ± 42.3 ml) could be approximated most closely by non-contrast CT at −45HU threshold (CaSc D45 105.3 ± 40.8 ml). The correlation was excellent: CTA S15 –CTA D15 , rho = 0.943; CTA D15 –CaSc D45 , rho = 0.905; CTA S15 –CaSc D45 , rho = 0.924; each P < 0.001). Bias values from Bland Altman Analysis were: CTA S15 –CTA D15 , 4.9%; CTA D15 –CaSc D45 , −4.3%; CTA S15 –CaSc D45 , 0.6%. Conclusions: Measured EATV can differ substantially between contrast enhanced and non-contrast CT studies, which can be reconciled by threshold modification. Heart cycle phase does not significantly influence EATV measurements

Influence of technical parameters on epicardial fat volume quantification at cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Bucher, Andreas M. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Joseph Schoepf, U., E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Krazinski, Aleksander W.; Silverman, Justin; Spearman, James V. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); De Cecco, Carlo N. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza” – Polo Pontino, Latina (Italy); Meinel, Felix G. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt (Germany); Geyer, Lucas L. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich (Germany)

2015-06-15

Highlights: • Upper threshold levels and contrast enhancement influence epicardial fat volumetry. • Cardiac cycle does not significantly influence epicardial fat volumetry. • Adjustments of upper threshold can lead to comparable volumetry results. - Abstract: Objectives: To systematically analyze the influence of technical parameters on quantification of epicardial fat volume (EATV) at cardiac CT. Methods: 153 routine cardiac CT data sets were analyzed using three-dimensional pericardial border delineation. Three image series were reconstructed per patient: (a) CTA{sub D}: coronary CT angiography (CTA), diastolic phase; (b) CTA{sub S}: coronary CTA, systolic phase; (c) CaSc{sub D}: non-contrast CT, diastolic phase. EATV was calculated using three different upper thresholds (−15HU, −30HU, −45HU). Repeated measures ANOVA, Spearman's rho, and Bland Altman plots were used. Results: Mean EATV differed between all three image series at a −30HU threshold (CTA{sub D} 87.2 ± 38.5 ml, CTA{sub S} 90.9 ± 37.7 ml, CaSc{sub D} 130.7 ± 49.5 ml, P < 0.001). EATV of diastolic and systolic CTA reconstructions did not differ significantly (P = 0.225). Mean EATV for contrast enhanced CTA at a −15HU threshold (CTA{sub D15} 102.4 ± 43.6 ml, CTA{sub S15} 105.3 ± 42.3 ml) could be approximated most closely by non-contrast CT at −45HU threshold (CaSc{sub D45} 105.3 ± 40.8 ml). The correlation was excellent: CTA{sub S15}–CTA{sub D15}, rho = 0.943; CTA{sub D15}–CaSc{sub D45}, rho = 0.905; CTA{sub S15}–CaSc{sub D45}, rho = 0.924; each P < 0.001). Bias values from Bland Altman Analysis were: CTA{sub S15}–CTA{sub D15}, 4.9%; CTA{sub D15}–CaSc{sub D45}, −4.3%; CTA{sub S15}–CaSc{sub D45}, 0.6%. Conclusions: Measured EATV can differ substantially between contrast enhanced and non-contrast CT studies, which can be reconciled by threshold modification. Heart cycle phase does not significantly influence EATV measurements.

Helical CT for emergency patients with cerebrovascular diseases. Diagnosis of cerebral aneurysms with subarachnoid hemorrhage (SAH) by three-dimensional CT angiography (3D-CTA)

International Nuclear Information System (INIS)

Matsumoto, Masato; Satoh, Naoki; Kobayashi, Touru; Kodama, Namio; Nakano, Masayuki; Watanabe, Youichi; Fujii, Masayuki

1996-01-01

Recently, the usefulness of three-dimensional CT angiography (3D-CTA) using helical CT has been reported. Although 3D-CTA has been applied for neurosurgical diseases, especially for surgical planning, it has not done for emergency patients because of the long time required for image reconstruction and location of a helical CT scanner. We studied emergency patients with SAH, and compared the 3D-CTA with angiography and surgical findings, using TOSHIBA X vigor. Twenty-two patients with SAH were evaluated. The helical CT was performed for 55 seconds with a bolus injection of 90 ml non-ionic, iodinated contrast medium at a rate of 3 ml/sec with a delay of 20 sec. Angiography was carried out immediately after the helical CT. Eighteen of 22 cases were operated on urgently. We were able to create the 3D-CTA in about 7 minutes, and diagnose aneurysms by the 3D-CTA before angiography. The 3D-CTA was able to demonstrate 30 of 31 aneurysms including 9 unruptured aneurysms. An unruptured internal carotid-posterior communicating artery aneurysm 1.3 mm in diameter and associated with a ruptured aneurysm was not detected by either the 3D-CTA or angiography. On the other hand, an unruptured Acom aneurysm 0.8 mm in diameter and associated with a ruptured aneurysm could be detected by the: 3D-CTA, but not by angiography. The 3D-CTA gave us useful information concerning the anatomical relationship of the aneurysm, its neck and parent artery, and the surrounding branches. There were no complications or side effects associated with the helical CT scan. Although the 3D-CTA requires further development of visualization of small arteries less than 1 mm in diameter, such as perforating arteries, subtraction technique of bony structure, and a method for checking cervical arteries, it is useful for diagnosis of emergency patients with SAH and urgent operations. We believe that an operation might be performed by only the 3D-CTA without the angiography in the near future. (author)

Helical CT for emergency patients with cerebrovascular diseases. Diagnosis of cerebral aneurysms with subarachnoid hemorrhage (SAH) by three-dimensional CT angiography (3D-CTA)

Energy Technology Data Exchange (ETDEWEB)

Matsumoto, Masato; Satoh, Naoki; Kobayashi, Touru; Kodama, Namio; Nakano, Masayuki; Watanabe, Youichi; Fujii, Masayuki [Fukushima Medical School (Japan)

1996-05-01

Recently, the usefulness of three-dimensional CT angiography (3D-CTA) using helical CT has been reported. Although 3D-CTA has been applied for neurosurgical diseases, especially for surgical planning, it has not done for emergency patients because of the long time required for image reconstruction and location of a helical CT scanner. We studied emergency patients with SAH, and compared the 3D-CTA with angiography and surgical findings, using TOSHIBA X vigor. Twenty-two patients with SAH were evaluated. The helical CT was performed for 55 seconds with a bolus injection of 90 ml non-ionic, iodinated contrast medium at a rate of 3 ml/sec with a delay of 20 sec. Angiography was carried out immediately after the helical CT. Eighteen of 22 cases were operated on urgently. We were able to create the 3D-CTA in about 7 minutes, and diagnose aneurysms by the 3D-CTA before angiography. The 3D-CTA was able to demonstrate 30 of 31 aneurysms including 9 unruptured aneurysms. An unruptured internal carotid-posterior communicating artery aneurysm 1.3 mm in diameter and associated with a ruptured aneurysm was not detected by either the 3D-CTA or angiography. On the other hand, an unruptured Acom aneurysm 0.8 mm in diameter and associated with a ruptured aneurysm could be detected by the: 3D-CTA, but not by angiography. The 3D-CTA gave us useful information concerning the anatomical relationship of the aneurysm, its neck and parent artery, and the surrounding branches. There were no complications or side effects associated with the helical CT scan. Although the 3D-CTA requires further development of visualization of small arteries less than 1 mm in diameter, such as perforating arteries, subtraction technique of bony structure, and a method for checking cervical arteries, it is useful for diagnosis of emergency patients with SAH and urgent operations. We believe that an operation might be performed by only the 3D-CTA without the angiography in the near future. (author)

Left ventricular functional parameters and geometric patterns in Korean adults on coronary CT angiography with a 320-detector-row CT scanner

Energy Technology Data Exchange (ETDEWEB)

Kang, Eun Ju; Lee, Ki Nam; Cho, Won Jin; Kim, Young Dae [College of Medicine, Dong-A University, Busan (Korea, Republic of); Shin, Kyung Min; Lim, Jae Kwang; Lee, Jong Min [Dept. of Radiology, Kyungpook National University, Daegu (Korea, Republic of)

2017-08-01

To assess the normal reference values of left ventricle (LV) functional parameters in Korean adults on coronary CT angiography (CCTA) with a 320-detector-row CT scanner, and to analyze sex-related differences and correlations with various clinical characteristics. This study retrospectively enrolled 172 subjects (107 men and 65 women; age, 58 ± 10.9 years; body surface area [BSA], 1.75 ± 0.2 m{sup 2}) who underwent CCTA without any prior history of cardiac disease. The following parameters were measured by post-processing the CT data: LV volume, LV functional parameters (ejection fraction, stroke volume, cardiac output, etc.), LV myocardial mass, LV inner diameter, and LV myocardial thickness (including septal wall thickness [SWT], posterior wall thickness [PWT], and relative wall thickness [RWT = 2 × PWT / LV inner diameter]). All of the functional or volumetric parameters were normalized using the BSA. The general characteristics and co-morbidities for the enrolled subjects were recorded, and the correlations between these factors and the LV parameters were then evaluated. The LV myocardial thickness (SWT, 1.08 ± 0.18 cm vs. 0.90 ± 0.17 cm, p < 0.001; PWT, 0.91 ± 0.15 cm vs. 0.78 ± 0.10 cm, p < 0.001; RWT, 0.38 ± 0.08 cm vs. 0.33 ± 0.05 cm, p < 0.001), LV volume (LV end-diastolic volume, 112.9 ± 26.1 mL vs. 98.2 ± 21.0 mL, p < 0.001; LV end-systolic volume, 41.7 ± 14.7 mL vs. 33.7 ± 12.2 mL, p = 0.001) and mass (145.0 ± 29.1 g vs. 107.9 ± 20.0 g, p < 0.001) were significantly greater in men than in women. However, these differences were not significant after normalization using BSA, except for the LV mass (LV mass index, 79.6 ± 14.0 g/m{sup 2} vs. 66.2 ± 11.0 g/m{sup 2},p < 0.001). The cardiac output and ejection fraction were not significantly different between the men and women (cardiac output, 4.3 ± 1.0 L/min vs. 4.2 ± 0.9 L/min, p = 0.452; ejection fraction, 63.4 ± 7.7% vs. 66.4 ± 7.6%, p = 0.079). Most of the LV parameters were

Accuracy of multidetector row computed tomography for the detection of transplant vasculopathy: comparison with invasive coronary angiography and intravascular ultrasound

International Nuclear Information System (INIS)

Carrascosa, P.; Capunay, C.; Carrascosa, J.; Perrone, S.; Deviggiano, A.; Lopez, E.M.; Lev, G.; Garcia, M.J.

2009-01-01

Objective: To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for detection of luminal stenosis and cardiac allograft vasculopathy in comparison with coronary angiography (CA) and intravascular ultrasound (IVUS) respectively. Material and methods: Nineteen cardiac transplant patients scheduled for follow-up CA were included. MDCT coronary angiography was performed using a 16-row CT scanner within 7-14 days after CA and IVUS. Studies were analyzed by independent readers; two observers evaluated the CT datasets for the presence of coronary artery stenosis > 50% and allograft vasculopathy. Results: The sensitivity for detecting > 50% luminal stenosis was 80-88% and specificity, 98-99% and for detection of cardiac allograft vasculopathy, the sensitivity was 91-96% and specificity, 88-91%. Conclusion: In this preliminary series, our results indicate that MDCT coronary angiography was capable of detecting both significant coronary stenosis as well as diffuse intimal proliferation. This non-invasive procedure could be an alternative to CA and IVUS in the surveillance of heart transplant patients. (authors) [es

Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

DEFF Research Database (Denmark)

Dankiewicz, J; Nielsen, N; Annborn, M

2015-01-01

PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...

Prognostic Value of Negative Coronary CT Angiography in Severely Obese Patients Prior to Bariatric Surgery: a Follow-Up After 6 Years.

Science.gov (United States)

Messerli, Michael; Maywald, Céline; Wälti, Stephan; Warschkow, René; Wildermuth, Simon; Alkadhi, Hatem; Leschka, Sebastian; Schiesser, Marc

2017-08-01

This study aims to determine the long-term prognostic value of coronary CT angiography (CCTA) prior to bariatric surgery in severely obese patients with a body mass index (BMI) ≥35 kg/m 2 . Seventy consecutive patients undergoing cardiac CT for coronary assessment prior to bariatric surgery were prospectively included. Images were analysed for the presence of coronary calcification and for non-obstructive (50% stenosis) coronary artery disease (CAD). A median clinical follow-up of 6.1 years in 54 patients was obtained for major adverse cardiovascular events (MACEs), defined as death, non-fatal myocardial infarction or coronary revascularisation. Weight loss and BMI decrease following bariatric surgery were recorded. The median BMI prior to surgery was 46.9 kg/m 2 . The median percentage of excess BMI loss after surgery was 75%. CT showed coronary calcification in 26 (48%) patients, whereas 28 (52%) patients had no calcification. CCTA revealed normal coronaries in 47 (87%) and non-obstructive CAD in 7 (13%) patients. No obstructive CAD was found. All patients successfully underwent bariatric surgery, and no MACE occurred neither perioperatively nor in the follow-up period. The negative predictive value of CCTA was 100% (95% confidence interval of 90.1-100.0%). In severely obese patients, the absence of obstructive CAD in cardiac CT prior to bariatric surgery with subsequently marked weight reduction has strong long-term prognostic implications for ruling out major adverse cardiac events in the postoperative period.

Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD)

International Nuclear Information System (INIS)

Hui, Peter K.T.; Goo, Hyun Woo; Du, Jing; Ip, Janice J.K.; Kanzaki, Suzu; Kim, Young Jin; Kritsaneepaiboon, Supika; Lilyasari, Oktavia; Siripornpitak, Suvipaporn

2017-01-01

With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available. To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study. We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose. Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy circle cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose. This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols. (orig.)

Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD)

Energy Technology Data Exchange (ETDEWEB)

Hui, Peter K.T. [Hong Kong Baptist Hospital, Department of Radiology, Hong Kong, SAR (China); Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Du, Jing [Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Beijing (China); Ip, Janice J.K. [Queen Mary Hospital, Department of Radiology, Hong Kong, SAR (China); Kanzaki, Suzu [National Cerebral and Cardiovascular Center, Department of Radiology, Osaka (Japan); Kim, Young Jin [Yonsei University, Shinchon Severance Hospital, Department of Radiology, Seoul (Korea, Republic of); Kritsaneepaiboon, Supika [Songklanagarind Hospital, Prince of Songkla University, Department of Radiology, Hat Yai (Thailand); Lilyasari, Oktavia [University of Indonesia, National Cardiovascular Center Harapan Kita, Department of Cardiology, Jakarta (Indonesia); Siripornpitak, Suvipaporn [Ramathibodi Hospital, Mahidol University, Department of Radiology, Salaya (Thailand)

2017-07-15

With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available. To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study. We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose. Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy circle cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose. This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols. (orig.)

Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis

Energy Technology Data Exchange (ETDEWEB)

Schlattmann, Peter [University Hospital of Friedrich-Schiller University Jena, Department of Medical Statistics, Informatics and Documentation, Jena (Germany); Schuetz, Georg M. [Freie Universitaet Berlin, Charite, Medical School, Department of Radiology, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, Marc [Freie Universitaet Berlin, Charite, Medical School, Department of Radiology, Humboldt-Universitaet zu Berlin, Berlin (Germany); Charite, Institut fuer Radiologie, Berlin (Germany)

2011-09-15

To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography. We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate. The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8-94.5%) and 87.5% (95% CI, 86.5-88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18-63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with {<=}16 detector rows. It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease. (orig.)

Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis

International Nuclear Information System (INIS)

Schlattmann, Peter; Schuetz, Georg M.; Dewey, Marc

2011-01-01

To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography. We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate. The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8-94.5%) and 87.5% (95% CI, 86.5-88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18-63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with ≤16 detector rows. It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease. (orig.)

Variations in the origins of the thyroid arteries on CT angiography.

Science.gov (United States)

Esen, Kaan; Ozgur, Anil; Balci, Yuksel; Tok, Sermin; Kara, Engin

2018-02-01

To investigate the anatomical variations in the origins of the thyroid arteries on CT angiography images. The presence and the origins of the superior thyroid artery, the inferior thyroid artery, and the thyroidea ima artery were retrospectively evaluated based on carotid CT angiography examinations. The bifurcation level of the common carotid artery with respect to the cervical vertebrae and disc spaces was also determined. A total of 640 patients were included in the study. The right and left superior thyroid arteries arose from the external carotid artery in 413 (64.5%) and 254 (39.7%) patients, from the bifurcation of the common carotid artery in 131 (20.5%) and 148 (23.1%) patients, and from the common carotid artery in 90 (14.1%) and 226 (35.3%) patients, respectively. We could not observe the right and the left superior thyroid arteries in 6 (0.9%) and 12 (1.9%) of the patients, respectively. However, the right and left inferior thyroid arteries were not identified in 14 (2.2%) and 45 (7%) of the patients, respectively. The thyroidea ima artery was detected in 2.3% of the patients. The visualization of thyroid arteries on CT angiography images enables the anatomy of the arterial supply system of the thyroid gland to be explored in a noninvasive manner prior to surgery.

Cerebral angiography with prospective ECG triggering preliminary study of dual-source CT

International Nuclear Information System (INIS)

Xue Yuejun; Qian Nong; Shao Yanhui; Pan Changjie; Rong Weiliang; Xu Yiqun

2012-01-01

Objective: To study the image quality and radiation dose in dual-source CT cerebral angiography with prospective ECG-triggered sequence mode (step-and-shoot, SAS). Methods: A total of forty-three patients with clinically suspected cerebral vascular disease underwent cerebral CT angiography with prospective ECG-triggering (step-and-shoot, SAS). Data acquisition was at 60% R-R interval of the ECG presentation mode. The post-processing included maximum intensity projection (MIP), multiplanar reformation (MPR) and volume rendering (VR). The CTA image quality, radiation dose and rates of excellent images were evaluated. Results: The CTA image quality score was 4.72 ± 0.50 and 97.7% (42/43) patients had excellent CTA images. The average effective dose of SAS-CTA was (0.22 ± 0.01)mSv, which was lower by 76.31% than that of DE-CTA. Conclusions: Prospective ECG-triggering sequence could be used in cerebral angiography with a significant reduction in radiation dose and diagnostic image quality. (authors)

Guideline for appropriate use of cardiac CT in heart disease

International Nuclear Information System (INIS)

Kim, Young Jin; Hong, Yoo Jin; Yong, Hwan Seok; Kim, Sung Mok; Kim, Jeong A; Yang, Dong Hyun

2014-01-01

Heart disease is one of the leading causes of deaths in Korea, along with malignant neoplasms and cerebrovascular diseases. The proper diagnosis and management for patients with suspected heart diseases should be warranted for the public health care. Advances in CT technology have allowed detailed images of the heart to be obtained, which enable evaluations not only of the coronary arteries but also of other cardiac structures. Currently, the latest multi-detector CT machines are widespread around Korea. The appropriate use of cardiac CT may lead to improvements of the physicians' medical performances and to reduce medical costs which eventually contribute to promotions of public health. However, until now, there has been no guidelines regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases.

Cardiac pathologies incidentally detected with non-gated chest CT; Inzidentelle Pathologien des Herzens im Thorax-CT

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Scherer, Axel; Kroepil, P.; Lanzman, R.S.; Moedder, U. [Inst. fuer Radiologie, Universitaetsklinikum Duesseldorf, Heinrich-Heine-Univ. (Germany); Choy, G.; Abbara, S. [Cardiovascular Imaging Section, Massachusetts General Hospital, Harvard Medical School (United States)

2009-12-15

Cardiac imaging using electrocardiogram-gated multi-detector computed tomography (MDCT) permits noninvasive diagnosis of congenital and acquired cardiac pathologies and has thus become increasingly important in the last years. Several studies investigated the incidence and relevance of incidental extracardiac structures within the lungs, mediastinum, chest wall, and abdomen with gated coronary CT. This resulted in the general acceptance of the review of extracardiac structures as a routine component of coronary CT interpretation. On the other hand radiologists tend to neglect pericardial and cardiac pathologies in non-gated chest CT, which is primarily performed for the evaluation of the respiratory system or for tumor staging. Since the introduction of multi-detector spiral CT technology, the incidental detection of cardiac and pericardial findings has become possible using non-gated chest CT. This article reviews the imaging appearances and differential diagnostic considerations of incidental cardiac entities that may be encountered in non-gated chest CT. (orig.)

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease

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Malik, Archana [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); St. Christopher' s Hospital for Children, Department of Radiology, Philadelphia, PA (United States); Hellinger, Jeffrey C. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); New York Cardiovascular Institute at Lenox Hill Radiology, New York, NY (United States); Servaes, Sabah; Keller, Marc S. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Schwartz, Mathew C. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Levine Children' s Hospital, Sanger Heart and Vascular Institute, Charlotte, NC (United States); Epelman, Monica [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Nemours Children' s Health System/Nemours Children' s Hospital, Department of Medical Imaging/Radiology, Orlando, FL (United States)

2017-03-15

CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. Non-cardiovascular findings are common in children with

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease

International Nuclear Information System (INIS)

Malik, Archana; Hellinger, Jeffrey C.; Servaes, Sabah; Keller, Marc S.; Schwartz, Mathew C.; Epelman, Monica

2017-01-01

CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. Non-cardiovascular findings are common in children with

Diagnosis of preoperative staging of bladder cancer by CT and angiography

International Nuclear Information System (INIS)

Munechika, Hirotsugu; Saito, Kazuhiko; Tanaka, Osamu; Tomiie, Fumitaka; Aihara, Toshinori

1982-01-01

The accuracy of computed tomography (CT) and angiography in defining the extent of local invasion was studied retrospectively in 19 patients with surgically proven carcinoma of the bladder. The overall accuracy of CT and angiographic staging in these cases was 54 percent and 47 percent respectively. The diagnosis of carcinoma of the bladder by CT tended to do overstaging rather than understaging. A tangential view of the tumor-bearing area by the selective internal iliac arteriography allows an accurate estimation of the perivesical tumor extension. The topographic diagnosis should be made by CT prior to the angiographic study. (author)

The Interobserver Agreement between Residents and Experienced Radiologists for Detecting Pulmonary Embolism and DVT with Using CT Pulmonary Angiography and Indirect CT Venography

International Nuclear Information System (INIS)

Yavas, Ulas Savas; Calisir, Cuneyt; Ozkan; Ibrahim Ragip

2008-01-01

We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE

Cardiac hybrid imaging

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Gaemperli, Oliver [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

2014-05-15

Hybrid cardiac single photon emission computed tomography (SPECT)/CT imaging allows combined assessment of anatomical and functional aspects of cardiac disease. In coronary artery disease (CAD), hybrid SPECT/CT imaging allows detection of coronary artery stenosis and myocardial perfusion abnormalities. The clinical value of hybrid imaging has been documented in several subsets of patients. In selected groups of patients, hybrid imaging improves the diagnostic accuracy to detect CAD compared to the single imaging techniques. Additionally, this approach facilitates functional interrogation of coronary stenoses and guidance with regard to revascularization procedures. Moreover, the anatomical information obtained from CT coronary angiography or coronary artery calcium scores (CACS) adds prognostic information over perfusion data from SPECT. The use of cardiac hybrid imaging has been favoured by the dissemination of dedicated hybrid systems and the release of dedicated image fusion software, which allow simple patient throughput for hybrid SPECT/CT studies. Further technological improvements such as more efficient detector technology to allow for low-radiation protocols, ultra-fast image acquisition and improved low-noise image reconstruction algorithms will be instrumental to further promote hybrid SPECT/CT in research and clinical practice. (orig.)

[Image fusion of gated-SPECT and CT angiography in coronary artery disease. Importance of anatomic-functional correlation].

Science.gov (United States)

Nazarena Pizzi, M; Aguadé Bruix, S; Cuéllar Calabria, H; Aliaga, V; Candell Riera, J

2010-01-01

A 77-year old patient was admitted for acute coronary syndrome without ST elevation. His risk was stratified using the myocardial perfusion gated SPECT, mild inferior ischemia being observed. Thus, medical therapy was optimized and the patient was discharged. He continued with exertional dyspnea so a coronary CT angiography was performed. It revealed severe lesions in the proximal RCA. SPECT-CT fusion images correlated the myocardial perfusion defect with a posterior descending artery from the RCA, in a co-dominant coronary area. Subsequently, cardiac catheterism was indicated for his treatment. The current use of image fusion studies is limited to patients in whom it is difficult to attribute a perfusion defect to a specific coronary artery. In our patient, the fusion images helped to distinguish between the RCA and the circumflex artery as the culprit artery of ischemia. Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.

Cardiac complications of intravenous digital subtraction angiography

International Nuclear Information System (INIS)

Neergaard, K.; Dirksen, K.L.; Andersen, I.; Galloee, A.M.; Madsen, E.B.

1989-01-01

In a prospective study of 103 patients the incidence of cardiac events during intravenous digital subtraction angiography (i.v. DSA) was investigated. Of 103 patients 17 had known ischaemic heart disease. The examination was performed with an ionic contrast medium, Urografin 76% (sodium megluminediatrizoate), administered by bolus injection into the right atrium. Patients with severe cardiac disease were examined only if the procedure was considered of vital importance. Cardiac events were defined as ST-segment changes of more than 0.1 mV, changes in heart rate of more than 20%, arrhythmias and such symptoms as chest pain and dyspnoea. Ischaemic ST-segment changes during i.v. DSA were observed in approximately 20% of the patients and were not related to the presence of known ischaemic heart disease. Three patients developed angina during the procedure. Among 12 patients with known angina only one patient developed angina during the procedure. In this study chest pain was infrequent (3%), but there was a relative high frequency of ECG changes (20%) not related to patients with ischaemic heart disease only. It is concluded that there is a risk of cardiac events during i.v. DSA, but the risk is not increased in patients with known ischaemic heart disease (if they do not suffer from congestive heart failure) as compared with other patients without known ischaemic heart disease. (orig.)

New horizons in cardiac CT

International Nuclear Information System (INIS)

Harder, A.M. den; Willemink, M.J.; Jong, P.A. de; Schilham, A.M.R.; Rajiah, P.; Takx, R.A.P.; Leiner, T.

2016-01-01

Until recently, cardiovascular computed tomography angiography (CCTA) was associated with considerable radiation doses. The introduction of tube current modulation and automatic tube potential selection as well as high-pitch prospective ECG-triggering and iterative reconstruction offer the ability to decrease dose with approximately one order of magnitude, often to sub-millisievert dose levels. In parallel, advancements in computational technology have enabled the measurement of fractional flow reserve (FFR) from CCTA data (FFR_C_T). This technique shows potential to replace invasively measured FFR to select patients in need of coronary intervention. Furthermore, developments in scanner hardware have led to the introduction of dual-energy and photon-counting CT, which offer the possibility of material decomposition imaging. Dual-energy CT reduces beam hardening, which enables CCTA in patients with a high calcium burden and more robust myocardial CT perfusion imaging. Future-generation CT systems will be capable of counting individual X-ray photons. Photon-counting CT is promising and may result in a substantial further radiation dose reduction, vastly increased spatial resolution, and the introduction of a whole new class of contrast agents.

Multislice CT angiography

Energy Technology Data Exchange (ETDEWEB)

Prokop, Mathias E-mail: mathias.prokop@univie.ac.at

2000-11-01

Multislice CT has overcome past limitations of CT angiography (CTA): Scan length and spatial resolution can be simultaneously optimized with multislice CTA, contrast medium can be saved, and the evaluation of large anatomic areas and vessels smaller than 1 mm become possible. This article describes how to optimize scanning protocols and contrast injection, and discusses the main clinical applications of this new technique. Only three main scanning protocolssuffice for all indications. A high speed / high-volume protocol (using 4*2mm or 4*2.5mm collimation) can be employed to scan the chest or abdomen in 8-10s, or to cover the whole abdominal aorta and the peripheral runoff including the feet within 40-65s. A high resolution protocol (using 4*1mm or 4*1.25mm) can be employed for the aorta and most regional vascular beds. It allows for near isotrophic imaging and depicts fine vascular structures with excellent detail. Ultra-high resolution protocols (using 2*0.5mm or 4*0.5mm collimation) yield totally isotropic data sets, and are mainly reserved for cerebrovascular imaging. Image processing techniques, and, in particular, volume rendering have made image presentation faster and easier. Multislice CTA exceeds MRA in spatial resolution and is now able to display even small vascular side branches. Its main indications will be aortic diseases, suspected pulmonary embolism but also renal artery stenoses, preoperative workup of abdominal or cerebral vessels, and acute vascular diseases. Multisplice CTA will become a strong competitor of other minimally invasive vascular imaging techniques.

Preoperative CT angiography reduces surgery time in perforator flap reconstruction

NARCIS (Netherlands)

Smit, Jeroen M.; Dimopoulou, Angeliki; Liss, Anders G.; Zeebregts, Clark J.; Kildal, Morten; Whitaker, Iain S.; Magnusson, Anders; Acosta, Rafael

The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in

Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: evaluation of its application to a routine Coronial service.

Science.gov (United States)

Roberts, Ian S D; Traill, Zoe C

2014-01-01

Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd.

Diagnostic accuracy of dual-source CT coronary angiography in patients with atrial fibrillation: Meta analysis

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Sun, Gang, E-mail: cjr.sungang@vip.163.com [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Li, Min [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Jiang, Zhi-wei [Department of Health Statistics, School of Public Health, Fourth Military Medical University, No. 169, Changle West Road, Xi’an, Shaanxi 710032 (China); Xu, Lin [Department of Medical Cardiology, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Peng, Zhao-hui; Ding, Juan; Li, Li [Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031 (China); Jin, Zhi-tao [Department of Cardiology, General Hospital of the Second Artillery, Beijing 100088 (China)

2013-10-01

Rationale and objective: To synthesize the available data to underscore the diagnostic accuracy of dual-source CT (DSCT) coronary angiography in patients with atrial fibrillation (AF). Materials and methods: We searched in the electronic databases of PubMed for all published studies that examined patients with AF using DSCT. We used an exact binomial rendition of the bivariate mixed-effects regression model to synthesize the diagnostic data. Results: The positive and negative likelihood ratios (LRs) at the patient level were 6.0 (CI, 3.6–10.1) and 0.03(CI, 0.004–0.2), respectively. The negative predictive values higher than 90% were available for a CAD prevalence <78%. The pooled vessel- and segment-level estimates showed higher positive and negative LRs than the patient-level estimates (15.3 [CI, 9.8–23.9] and 0.1 [CI, 0.07–0.3]; 25.1 [CI, 10.8–58.5] and 0.2 [CI, 0.2–0.3], respectively). No statistically significant heterogeneity between studies and publication bias were found at the patient level estimate. A sensitivity analysis showed that no study influenced the pooled results larger than 0.02. Conclusions: Cardiac angiography with DSCT can be applied as an imaging test for ruling out CAD in patient with AF. However, DSCT angiography may be not an effective tool for risk stratification for the high negative LR at the artery and segment levels.

Novel Application of Postmortem CT Angiography for Evaluation of the Intracranial Vascular Anatomy in Cadaver Heads.

Science.gov (United States)

van Eijk, Ruben P A; van der Zwan, Albert; Bleys, Ronald L A W; Regli, Luca; Esposito, Giuseppe

2015-12-01

Postmortem CT angiography is a common procedure used to visualize the entire human vasculature. For visualization of a specific organ's vascular anatomy, casting is the preferred method. Because of the permanent and damaging nature of casting, the organ cannot be further used as an experimental model after angiography. Therefore, there is a need for a minimally traumatic method to visualize organ-specific vascular anatomy. The purpose of this study was to develop and evaluate a contrast enhancement technique that is capable of visualizing the intracranial vascular anatomy while preserving the anatomic integrity in cadaver heads. Seven human heads were used in this study. Heads were prepared by cannulating the vertebral and internal carotid arteries. Contrast agent was injected as a mixture of tap water, polyethylene glycol 600, and an iodinated contrast agent. Postmortem imaging was executed on a 64-MDCT scanner. Primary image review and 3D reconstruction were performed on a CT workstation. Clear visualization of the major cerebral arteries and smaller intracranial branches was achieved. Adequate visualization was obtained for both the anterior and posterior intracranial circulation. The minimally traumatic angiography method preserved the vascular integrity of the cadaver heads. A novel application of postmortem CT angiography is presented here. The technique can be used for radiologic evaluation of the intracranial circulation in cadaver heads. After CT angiography, the specimen can be used for further experimental or laboratory testing and teaching purposes.

Evaluation of the relationship between extremity soft tissue sarcomas and adjacent major vessels using contrast-enhanced multidetector CT and three-dimensional volume-rendered CT angiography - A preliminary study

International Nuclear Information System (INIS)

Li, YangKang; Lin, JianBang; Cai, AiQun; Zhou, XiuGuo; Zheng, Yu; Wei, XiaoLong; Cheng, Ying; Liu, GuoRui

2013-01-01

Background: Accurate description of the relationship between extremity soft tissue sarcoma and the adjacent major vessels is crucial for successful surgery. In addition to magnetic resonance imaging (MRI) or in patients who cannot undergo MRI, two-dimensional (2D) postcontrast computed tomography (CT) images and three-dimensional (3D) volume-rendered CT angiography may be valuable alternative imaging techniques for preoperative evaluation of extremity sarcomas. Purpose: To preoperatively assess extremity sarcomas using multidetector CT (MDCT), with emphasis on postcontrast MDCT images and 3D volume-rendered MDCT angiography in evaluating the relationship between tumors and adjacent major vessels. Material and Methods: MDCT examinations were performed on 13 patients with non-metastatic extremity sarcomas. Conventional CT images and 3D volume-rendered CT angiography were evaluated, with focus on the relationship between tumors and adjacent major vessels. Kappa consistency statistics were performed with surgery serving as the reference standard. Results: The relationship between sarcomas and adjacent vessels was described as one of three patterns: proximity, adhesion, and encasement. Proximity was seen in five cases on postcontrast CT images or in eight cases on volume-rendered images. Adhesion was seen in three cases on both postcontrast CT images and volume-rendered images. Encasement was seen in five cases on postcontrast CT images or in two cases on volume-rendered images. Compared to surgical results, postcontrast CT images had 100% sensitivity, 83.3% specificity, 87.5% positive predictive value, 100% negative predictive value, and 92.3% accuracy in the detection of vascular invasion (κ = 0.843, P = 0.002). 3D volume-rendered CT angiography had 71.4% sensitivity, 100% specificity, 100% positive predictive value, 75% negative predictive value, and 84.6% accuracy in the detection of vascular invasion (κ = 0.698, P = 0.008). On volume-rendered images, all cases

The role of CT and cerebral angiography in the neurosurgical treatment of cerebrovascular diseases and their sequels

International Nuclear Information System (INIS)

Bock, W.J.

1979-01-01

It is found that for cerebro-vascular diseases which can be surgically treated, neither angiography nor CT alone yields sufficient information. Only a combination of the two methods can help to reach a clear decision; CT is better suited for course control while angiography helps to make a diagnosis and to decide upon the best surgical treatment. (orig./AJ) [de

Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Dewey, Marc; Hamm, Bernd

2007-01-01

We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of EUR4,435 (10% likelihood) to EUR1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society. (orig.)

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

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Miller, Julie M.; Vavere, Andrea L.; Arbab-Zadeh, Armin; Bush, David E.; Lardo, Albert C.; Texter, John; Brinker, Jeffery; Lima, Joao A.C. [Johns Hopkins Hospital, Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Dewey, Marc [Charite - Universitaetsmedizin Berlin, Medical School, Humboldt-Universitaet und Freie Universitaet zu Berlin, Department of Radiology, Berlin, PO Box 10098 (Germany); Rochitte, Carlos E.; Lemos, Pedro A. [University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo (Brazil); Niinuma, Hiroyuki [Iwate Medical University, Department of Cardiology, Morioka (Japan); Paul, Narinder [Toronto General Hospital, Department of Medical Imaging, Toronto (Canada); Hoe, John [Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, Singapore (Singapore); Roos, Albert de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Yoshioka, Kunihiro [Iwate Medical University, Department of Radiology, Morioka (Japan); Cox, Christopher [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Clouse, Melvin E. [Harvard University, Department of Radiology, Beth Israel Deaconess, Boston, MA (United States)

2009-04-15

Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ''CORE-64'' trial (''Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors''). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows. (orig.)

CT coronary angiography in patients with atrial fibrillation; CT-Koronarangiographie bei Patienten mit Vorhofflimmern

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Kovacs, A.; Sommer, T.; Leiss, A.; Naehle, P.; Schild, H.; Flacke, S. [Universitaetsklinikum Bonn, Radiologische Klinik (Germany); Probst, C.; Welz, A. [Universitaetsklinikum Bonn, Klinik fuer Herzchirurgie (Germany)

2005-12-15

Purpose: Reliable visualization of the coronary arteries with multislice spiral CT angiography (MSCTA) in patients with atrial fibrillation (AF) remains a challenge despite retrospective ECG gating. A recently developed new algorithm automatically compensates dynamic changes in the heart rate during the scan, thus reducing misregistration and motion artifacts. The HeartBeat-RT algorithm combines a fixed percent delay determined from the first R wave and the fixed offset delay based on the second R wave in the ECG cycle. The purpose of this study was to find out the optimal reconstruction window in MSCTA in patients with AF for each of the three major coronary arteries during the cardiac cycle. Materials and methods: 20 patients with permanent AF were imaged on a 16-slice scanner (slice collimation: 16 x 0.75 mm; rotation time 0.42 s; 140 kV; 380 mAs; 120 ml Ultravist 370 {sup registered} i.v.). The patients had not received any previous drugs for heart frequency regulation. Acquisition was started after bolus tracking of a biphasic bolus of 120 ml Ultravist 370 injected intravenously. Each coronary segment was reconstructed at 0%-90% of the cardiac cycle in increments of 10%. For image analysis we used coronary segments as defined by the American Heart Association. Two blinded independent readers assessed the image quality in terms of visibility and artifacts (five-point rating scale 1=very poor, 2=poor, 3=fair, 4=good and 5=excellent) and the degree of stenosis (five-point rating scale 1=0%, 2=1%-49%, 3=50%-74%, 4=75%-99%, 5=100%) on axial slices, multiplanar reconstructions and three-dimensional volume-rendered images. (orig.)

Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

International Nuclear Information System (INIS)

Iyengar, S.S.; Morgan-Hughes, G.; Ukoumunne, O.; Clayton, B.; Davies, E.J.; Nikolaou, V.; Hyde, C.J.; Shore, A.C.; Roobottom, C.A.

2016-01-01

Aim: To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD). Materials and methods: Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥50%) stenosis and secondarily as the presence of severe (≥70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard. Results: No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis. Conclusion: The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role. - Highlights: • Diagnostic accuracy of High-Definition CT Angiography (HD-CTCA) has been assessed. • Invasive Coronary angiography (ICA) is the reference standard. • Diagnostic accuracy of HD-CTCA is comparable to ICA. • Diagnostic accuracy is not affected by coronary calcium or stents. • HD-CTCA provides a non-invasive alternative in high-risk patients.

Clinical Utility of Iopamidol (Pamiray 370) for Cardiac CT

International Nuclear Information System (INIS)

Kim, Mok Hee; Seon, Hyun Ju; Choi, Song; Kim, Yun Hyeon; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heong Keun

2011-01-01

We evaluated the utility of iopamidol-based nonionic contrast media (Pamiray 370) for cardiac CT, with assessment of its image quality and safety. The study included 100 patients who underwent cardiac CT with Pamiray 370 (experimental group), and 100 patients who underwent cardiac CT with Ultravist 370 (control group). A comparison of the image qualities and degree of vascular contrast enhancement was made between the two groups and evaluated statistically by an independent t-test. Changes in vital signs and adverse events during cardiac CT were evaluated in the experimental group. There were no statistically significant differences in the image quality (image quality score in experimental group vs. control group: 4.26 ± 0.63 vs. 4.24 ± 0.62), and mean attenuation values at the coronary arteries(p > 0.05) between two groups. For the experimental group, 12% experienced adverse events, including mild and transient reactions such as dizziness (7%), nausea (4%), and fatigue (1%). Further, 94% of patients complained of mild to moderate febrile sense just after contrast agent administration, which spontaneously disappeared within 3 minutes without any specific management. For cardiac CT, Pamiray 370 was comparable to the widely-used contrast agent (Ultravist 370) in terms of image quality and safety without any severe adverse reaction.

Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience

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Morsbach, Fabian; Gordic, Sonja; Husarik, Daniela; Frauenfelder, Thomas; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Desbiolles, Lotus; Leschka, Sebastian [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Kantonsspital St. Gallen, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Schmidt, Bernhard; Allmendinger, Thomas [Siemens AG, Healthcare Sector, Forchheim (Germany); Wildermuth, Simon [Kantonsspital St. Gallen, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland)

2014-08-15

To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). First, a cardiac motion phantom simulating heart rates (HRs) from 60-90 bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250 ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50 years) undergoing clinically indicated CCTA were included. In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1 mm or less. Distortion increased above 1 mm at HR of 80-90 bpm. Patients had a mean HR of 66 bpm (47-78 bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73 bpm. Average effective radiation dose in patients was 0.6 ± 0.3 mSv. Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75 bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6 mSv. (orig.)

Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience

International Nuclear Information System (INIS)

Morsbach, Fabian; Gordic, Sonja; Husarik, Daniela; Frauenfelder, Thomas; Alkadhi, Hatem; Desbiolles, Lotus; Leschka, Sebastian; Schmidt, Bernhard; Allmendinger, Thomas; Wildermuth, Simon

2014-01-01

To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). First, a cardiac motion phantom simulating heart rates (HRs) from 60-90 bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250 ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50 years) undergoing clinically indicated CCTA were included. In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1 mm or less. Distortion increased above 1 mm at HR of 80-90 bpm. Patients had a mean HR of 66 bpm (47-78 bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73 bpm. Average effective radiation dose in patients was 0.6 ± 0.3 mSv. Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75 bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6 mSv. (orig.)

Clinical utility of coronary CT angiography with low-dose chest CT in the evaluation of patients with atypical chest pain: a preliminary report

International Nuclear Information System (INIS)

Lim, Soo Jin; Choo, Ki Seok; Kim, Chang Won

2008-01-01

To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis

FDG PET-CT findings of extra-thoracic sarcoid are associated with cardiac sarcoid: A rationale for using FGD PET-CT for cardiac sarcoid evaluation.

Science.gov (United States)

Patel, Darshan C; Gunasekaran, Senthil S; Goettl, Christopher; Sweiss, Nadera J; Lu, Yang

2017-07-05

This retrospective study investigates the relationship between cardiac and extra-thoracic sarcoid findings on FDG PET-CT using a 72-hour pretest high-fat, high-protein, and very low-carbohydrate (HFHPVLC) diet. A total of 196 consecutive FDG PET-CT scans with 72-hour HFHPVLC diet preparation were performed between December 2014 and December 2015 in known sarcoid patients. Of these scans, 5 were excluded for non-adherence to diet preparation or underlying cancer. Cardiac and extra-thoracic sarcoid lesions were categorized and measured for radiotracer uptake. A total of 188 patients had 191 eligible FDG PET/CT scans (3 follow-up scans), of which there were 20 (10%) positive, 6 indeterminate (3%), and 165 (86%) negative for CS. Among the 20 scans positive for CS, 8 (40%) had findings of both cardiac and extra-thoracic sarcoid. Our study shows that 40% of CS patients also have FDG PET-CT findings of extra-thoracic sarcoid. This makes an intriguing case for FDG PET-CT use with pretest diet prep over cardiac MRI (CMR) for cardiac sarcoid evaluation, given that CMR is likely to overlook these extra-thoracic sites of disease.

An evaluation of automatic coronary artery calcium scoring methods with cardiac CT using the orCaScore framework.

Science.gov (United States)

Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; Coatrieux, Jean-Louis; Kelm, B Michael; Kondo, Satoshi; Salgado, Rodrigo A; Shahzad, Rahil; Shu, Huazhong; Snoeren, Miranda; Takx, Richard A P; van Vliet, Lucas J; van Walsum, Theo; Willems, Tineke P; Yang, Guanyu; Zheng, Yefeng; Viergever, Max A; Išgum, Ivana

2016-05-01

The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) events. In clinical practice, CAC is manually identified and automatically quantified in cardiac CT using commercially available software. This is a tedious and time-consuming process in large-scale studies. Therefore, a number of automatic methods that require no interaction and semiautomatic methods that require very limited interaction for the identification of CAC in cardiac CT have been proposed. Thus far, a comparison of their performance has been lacking. The objective of this study was to perform an independent evaluation of (semi)automatic methods for CAC scoring in cardiac CT using a publicly available standardized framework. Cardiac CT exams of 72 patients distributed over four CVD risk categories were provided for (semi)automatic CAC scoring. Each exam consisted of a noncontrast-enhanced calcium scoring CT (CSCT) and a corresponding coronary CT angiography (CCTA) scan. The exams were acquired in four different hospitals using state-of-the-art equipment from four major CT scanner vendors. The data were divided into 32 training exams and 40 test exams. A reference standard for CAC in CSCT was defined by consensus of two experts following a clinical protocol. The framework organizers evaluated the performance of (semi)automatic methods on test CSCT scans, per lesion, artery, and patient. Five (semi)automatic methods were evaluated. Four methods used both CSCT and CCTA to identify CAC, and one method used only CSCT. The evaluated methods correctly detected between 52% and 94% of CAC lesions with positive predictive values between 65% and 96%. Lesions in distal coronary arteries were most commonly missed and aortic calcifications close to the coronary ostia were the most common false positive errors. The majority (between 88% and 98%) of correctly identified CAC lesions were assigned to the correct artery. Linearly weighted Cohen's kappa

Motion estimation for cardiac functional analysis using two x-ray computed tomography scans.

Science.gov (United States)

Fung, George S K; Ciuffo, Luisa; Ashikaga, Hiroshi; Taguchi, Katsuyuki

2017-09-01

This work concerns computed tomography (CT)-based cardiac functional analysis (CFA) with a reduced radiation dose. As CT-CFA requires images over the entire heartbeat, the scans are often performed at 10-20% of the tube current settings that are typically used for coronary CT angiography. A large image noise then degrades the accuracy of motion estimation. Moreover, even if the scan was performed during the sinus rhythm, the cardiac motion observed in CT images may not be cyclic with patients with atrial fibrillation. In this study, we propose to use two CT scan data, one for CT angiography at a quiescent phase at a standard dose and the other for CFA over the entire heart beat at a lower dose. We have made the following four modifications to an image-based cardiac motion estimation method we have previously developed for a full-dose retrospectively gated coronary CT angiography: (a) a full-dose prospectively gated coronary CT angiography image acquired at the least motion phase was used as the reference image; (b) a three-dimensional median filter was applied to lower-dose retrospectively gated cardiac images acquired at 20 phases over one heartbeat in order to reduce image noise; (c) the strength of the temporal regularization term was made adaptive; and (d) a one-dimensional temporal filter was applied to the estimated motion vector field in order to decrease jaggy motion patterns. We describe the conventional method iME1 and the proposed method iME2 in this article. Five observers assessed the accuracy of the estimated motion vector field of iME2 and iME1 using a 4-point scale. The observers repeated the assessment with data presented in a new random order 1 week after the first assessment session. The study confirmed that the proposed iME2 was robust against the mismatch of noise levels, contrast enhancement levels, and shapes of the chambers. There was a statistically significant difference between iME2 and iME1 (accuracy score, 2.08 ± 0.81 versus 2.77�

Multiple detector-row CT angiography of the renal and mesenteric vessels

Energy Technology Data Exchange (ETDEWEB)

Fleischmann, Dominik. E-mail: dominik.fleischmann@univie.ac.at

2003-03-01

Computed tomography angiography (CTA) of the abdomen with multiple detector-row computed tomography (MD-CT) is an effective technique for minimally invasive imaging of the renal arteries and the visceral vasculature. This article reviews the clinical and technical aspects of MD-CT angiography in terms of image acquisition and reconstruction parameters, contrast medium application, and three-dimensional visualization with special attention to renal and mesenteric vascular imaging. Because of its high sensitivity to detect renal artery stenosis on the one hand, and because a normal renal CTA virtually excludes the presence of a significant renal artery stenosis on the other hand, renal CTA plays a useful role in the management of patients with suspected renovascular hypertension. Mesenteric CTA is a useful tool for visualizing normal vascular anatomy and its variants--particularly in the setting of organ transplantation. Vascular pathology, e.g. atherosclerotic disease (abdominal angina), or aneurysms of the visceral arteries are reliably assessed with CTA. Mesenteric CTA is an invaluable adjunct to abdominal CT in the setting of abdominal emergencies, because of its ability to detect the causes of acute intestinal ischemia (superior mesenteric artery embolism or thrombosis, superior mesenteric vein thrombosis). Accurate timing of the CTA acquisition and the subsequent parenchymal phase acquisition relative to the contrast medium transit time is critical to obtain excellent image quality in double-pass abdominal CT acquisitions.

The detectability of the origin of the inferior phrenic artery by paging method on multidetector-row CT angiography

International Nuclear Information System (INIS)

Terayama, Koshi

2005-01-01

We evaluated the ability to detect the origin of the inferior phrenic artery (IPA) by paging method on multidetector-row computed tomography (CT) angiography. In 104 patients who underwent multidetector-row CT, detectability of the origin of the IPA was assessed. In addition, in 30 patients in whom arteriographic study was performed, the IPA findings on multidetector-row CT were compared with those on arteriography. In 100 patients (96%) the origin of the right IPA was demonstrated with multidetector-row CT and in 93 patients (89%) the origin of the left IPA was demonstrated. CT angiographic findings concurred with arteriographic findings in all 30 patients (100%) who underwent arteriographic study. In conclusion, paging method on multidetector-row CT angiography provides valuable anatomical information regarding IPA. (author)

Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling - improved image quality by iterative metal artifact reduction

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Bier, Georg; Hempel, Johann-Martin; Oergel, Anja; Hauser, Till-Karsten; Ernemann, Ulrike; Hennersdorf, Florian [Eberhard Karls University Tuebingen, Department of Diagnostic and Interventional Neuroradiology, Tuebingen (Germany); Bongers, Malte Niklas [Eberhard Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

2017-07-15

This paper aims to evaluate a new iterative metal artifact reduction algorithm for post-interventional evaluation of brain tissue and intracranial arteries. The data of 20 patients that underwent follow-up cranial CT and cranial CT angiography after clipping or coiling of an intracranial aneurysm was retrospectively analyzed. After the images were processed using a novel iterative metal artifact reduction algorithm, images with and without metal artifact reduction were qualitatively evaluated by two readers, using a five-point Likert scale. Moreover, artifact strength was quantitatively assessed in terms of CT attenuation and standard deviation alterations. The qualitative analysis yielded a significant increase in image quality (p = 0.0057) in iteratively processed images with substantial inter-observer agreement (k = 0.72), while the CTA image quality did not differ (p = 0.864) and even showed vessel contrast reduction in six cases (30%). The mean relative attenuation difference was 27% without metal artifact reduction vs. 11% for iterative metal artifact reduction images (p = 0.0003). The new iterative metal artifact reduction algorithm enhances non-enhanced CT image quality after clipping or coiling, but in CT-angiography images, the contrast of adjacent vessels can be compromised. (orig.)

Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling - improved image quality by iterative metal artifact reduction

International Nuclear Information System (INIS)

Bier, Georg; Hempel, Johann-Martin; Oergel, Anja; Hauser, Till-Karsten; Ernemann, Ulrike; Hennersdorf, Florian; Bongers, Malte Niklas

2017-01-01

This paper aims to evaluate a new iterative metal artifact reduction algorithm for post-interventional evaluation of brain tissue and intracranial arteries. The data of 20 patients that underwent follow-up cranial CT and cranial CT angiography after clipping or coiling of an intracranial aneurysm was retrospectively analyzed. After the images were processed using a novel iterative metal artifact reduction algorithm, images with and without metal artifact reduction were qualitatively evaluated by two readers, using a five-point Likert scale. Moreover, artifact strength was quantitatively assessed in terms of CT attenuation and standard deviation alterations. The qualitative analysis yielded a significant increase in image quality (p = 0.0057) in iteratively processed images with substantial inter-observer agreement (k = 0.72), while the CTA image quality did not differ (p = 0.864) and even showed vessel contrast reduction in six cases (30%). The mean relative attenuation difference was 27% without metal artifact reduction vs. 11% for iterative metal artifact reduction images (p = 0.0003). The new iterative metal artifact reduction algorithm enhances non-enhanced CT image quality after clipping or coiling, but in CT-angiography images, the contrast of adjacent vessels can be compromised. (orig.)

Non invasive cardiac vein mapping: Role of multislice CT coronary angiography

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Malago, Roberto, E-mail: robertomalag@yahoo.it [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Pezzato, Andrea; Barbiani, Camilla; Sala, Giuseppe; Zamboni, Giulia A. [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Tavella, Domenico [Cardiology Service, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Mucelli, Roberto Pozzi [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy)

2012-11-15

Purpose: Coronary venous anatomy is of primary importance when implanting a cardiac resynchronization therapy device, besides, the coronary sinus can be differently enlarged depending on chronic heart failure. The aim of this study is to evaluate the usefulness of Coronary CTA in describing the coronary venous tree and in particular the coronary sinus and detecting main venous system variants. Materials and methods: 301 consecutive patients (196 Male-Sign , mean age 63.74 years) studied for coronary artery disease with 64 slice Coronary CTA were retrospectively examined. The acquisition protocol was the standard acquisition one used for coronary artery evaluation but the cardiac venous system were visualized. The cardiac venous system was depicted using 3D, MPR, cMPR and MIP post-processing reconstructions on an off-line workstation. For each patient image quality, presence and caliber of the coronary sinus (CS), great cardiac vein (GCV), middle vein (MV), anterior interventricular vein (AIV), lateral cardiac vein (LCV), posterior cardiac vein (PCV), small cardiac vein (SCV) and presence of variant of the normal anatomy were examined and recorded. Results: CS, GCV, MV and AIV were visualized in 100% of the cases. The LCV was visualized in 255/301 (84%) patients, the PCV in 248/301 (83%) patients and the SCV in 69/301 (23%) patients. Mean diameter of the CS was 8.7 mm in 276/301 (91.7%) patients without chronic heart failure and 9.93 mm in 25/301 (8.3%) patients with chronic heart failure. Conclusions: Coronary CTA allows non invasive mapping of the cardiac venous system and may represent a useful presurgical tool for biventricular pacemaker devices implantation.

Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation

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Carbone, Iacopo; Cannata, David; Algeri, Emanuela; Galea, Nicola; Napoli, Alessandro; Catalano, Carlo; Passariello, Roberto; Francone, Marco [Sapienza University of Rome, Department of Radiological, Onchological and Anatomopathological Sciences, Policlinico Umberto I, Rome (Italy); De Zorzi, Andrea [Bambino Gesu Hospital, Cardiology Division, Rome (Italy); Bosco, Giovanna; D' Agostino, Rita [Sapienza University of Rome, Unit of Paediatric Cardiology, Policlinico Umberto I, Rome (Italy); Menezes, Leon [University College of London, Institute of Nuclear Medicine, London (United Kingdom)

2011-09-15

Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. The study group comprised 12 patients (age 17.6 {+-} 2.9 years, mean{+-}SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6 {+-} 13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56 {+-} 0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n = 32), stenoses (n = 3) and occlusions (n = 9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures. (orig.)

Cardiac drugs used in cross-sectional cardiac imaging: what the radiologist needs to know

International Nuclear Information System (INIS)

McParland, P.; Nicol, E.D.; Harden, S.P.

2010-01-01

The demand for cross-sectional imaging of the heart is increasing dramatically and in many centres these imaging techniques are being performed by radiologists. Although radiologists are familiar with the computed tomography (CT) and magnetic resonance imaging (MRI) techniques to generate high-quality images and with using contrast agents, many are less familiar with administering the drugs necessary to perform CT coronary angiography and cardiac MR reliably. The aim of this article is to give an overview of the indications for and the contraindications to administering cardiac drugs in cross-sectional imaging departments. We also outline the complications that may be encountered and provide advice on how to treat these complications when they occur.

The present and future of cardiac CT in research and clinical practice. Moderated discussion and scientific debate with representatives from the four main vendors

International Nuclear Information System (INIS)

Dewey, M.; Vries, H. de; Vries, L. de; Haas, D.; Leidecker, C.

2010-01-01

Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future.

The present and future of cardiac CT in research and clinical practice. Moderated discussion and scientific debate with representatives from the four main vendors

Energy Technology Data Exchange (ETDEWEB)

Dewey, M. [Charite Berlin (Germany). Radiology; Vries, H. de [Toshiba Medical Systems Europe, Zoetermeer (Netherlands). CT; Vries, L. de [Philips Medical Systems Europe (Netherlands). CT; Haas, D. [GE Healthcare (Germany). CT; Leidecker, C. [Siemens Medical Solutions (Germany). CT

2010-04-15

Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future.

Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Ng, Ming Yen [University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada); The University of Hong Kong, Queen Mary Hospital, Department of Diagnostic Radiology, Hong Kong (China); Karimzad, Yasser; Menezes, Ravi J.; Wintersperger, Bernd J.; Li, Qin; Forero, Julian; Paul, Narinder S.; Nguyen, Elsie T. [University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada)

2016-10-15

To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. (orig.)

Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT

International Nuclear Information System (INIS)

Ng, Ming Yen; Karimzad, Yasser; Menezes, Ravi J.; Wintersperger, Bernd J.; Li, Qin; Forero, Julian; Paul, Narinder S.; Nguyen, Elsie T.

2016-01-01

To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. (orig.)

320-Multidetector row whole-head dynamic subtracted CT angiography and whole-brain CT perfusion before and after carotid artery stenting: Technical note

International Nuclear Information System (INIS)

San Millan Ruiz, Diego; Murphy, Kieran; Gailloud, Philippe

2010-01-01

Introduction: Multidetector CT (MDCT) is increasingly used for the investigation of neurovascular disorders, but restricted z-axis coverage (3.2 cm for 64-MDCT) currently limits perfusion to a small portion of the brain close to the circle of Willis, and precludes dynamic angiographic appreciation of the entire brain circulation. We illustrate the clinical potential of recently developed 320-MDCT extending the z-axis coverage to 16 cm in a patient with symptomatic carotid artery stenosis. Methods: In a 74-year-old patient presenting with critical symptomatic stenosis of the left CCA, pre- and post-carotid artery stenting whole-head subtracted dynamic MDCT angiography and perfusion were obtained in addition to CT angiography of the supra-aortic trunks. Both whole-head subtracted MDCT angiography and perfusion demonstrated delayed left ICA circulation, which normalized after carotid stenting. Discussion: 320-MDCT offers unprecedented z-axis coverage allowing for whole-brain perfusion and subtracted dynamic angiography of the entire intracranial circulation. These innovations can consolidate the role of MDCT as a first intention imaging technique for cerebrovascular disorders, in particular for the acute management of stroke.

Bolus timing in high-pitch CT angiography of the aorta

International Nuclear Information System (INIS)

Beeres, Martin; Loch, Matthias; Schulz, Boris; Kerl, Matthias; Al-Butmeh, Firas; Bodelle, Boris; Herrmann, Eva; Gruber-Rouh, Tatjana; Lee, Clara; Jacobi, Volkmar; Vogl, Thomas J.

2013-01-01

Objective: To investigate the bolus geometry in high-pitch CT angiography (CTA) of the aorta without ECG synchronisation in comparison to single-source CT. Methods: Overall 160 consecutive patients underwent CTA either in conventional single-source mode with a pitch of 1.2 (group 1), or in dual-source mode with a pitch of 3.0 (groups 2, 3 and 4) using different contrast media timings with bolus triggering at 140 HU (5 s, group 1; 10 s, group 2; 12 s, group 3; 14 s, group 4). Contrast material, saline flush, flow rate and kV/mAs settings were kept equal for optimum comparability. Aortic attenuation was measured along the z-axis of the patient at different anatomic landmarks and subjective image quality was compared. Results: The most homogeneous enhancement of the aorta was reached with a delay of 10 s after reaching the trigger threshold. The imaging length was not significantly different, but the examination time was significantly (p < 0.001) shorter in the high-pitch group (7.7 s vs. 1.7 s for group 1 vs. 2, 3 and 4). Conclusion: In high-pitch CT angiography using a start delay of 10 s after a trigger threshold of 140 HU in the descending aorta is reached, a homogenous contrast along the z-axis is accomplished

Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography

DEFF Research Database (Denmark)

Gutte, Henrik; Mortensen, Jann; Jensen, Claus Verner

2009-01-01

The diagnosis of pulmonary embolism (PE) is usually established by a combination of clinical assessment, D-dimer testing, and imaging with either pulmonary ventilation-perfusion (V/Q) scintigraphy or pulmonary multidetector CT (MDCT) angiography. Both V/Q SPECT and MDCT angiography seem to have...... high diagnostic accuracy. However, only limited data directly comparing these 2 modalities are available. Hybrid gamma-camera/MDCT systems have been introduced and allow simultaneous 3-dimensional lung V/Q SPECT and MDCT angiography, suitable for diagnosing PE. The aim of our study was to compare...

Digital subtraction angiography of the heart and lungs

International Nuclear Information System (INIS)

Moodie, D.S.; Yiannikas, J.

1986-01-01

This book contains 12 chapters. Some of the chapter titles are: Physical Principles of Cardiac Digital Subtraction Angiography, The Use of Intravenous Digital Subtraction Angiography in Evaluating Patients with Complex Congenital Heart Disease, Exercise Intravenous Digital Subtraction Angiograpny, Cardiomyopathic and Cardiac Neoplastic Disease, Digital Subtraction Angiography in the Catheterization Laboratory, and Cardiac Digital Subtraction Angiography - Future Directions

Catheter Angiography

Medline Plus

Full Text Available ... Z Catheter Angiography Catheter angiography uses a catheter, x-ray imaging guidance and an injection of contrast material ... vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging ( ...

A study of whole brain perfusion CT and CT angiography in hyperacute and acute cerebral infarction

International Nuclear Information System (INIS)

Zhang Yonghai; Bai Junhu; Zhang Ming; Yang Guocai; Tang Guibo; Fang Jun; Shi Wei; Li Xinghua; Liu Suping; Lu Qing; Tang Jun

2005-01-01

Objective: To evaluate the diagnostic value of whole-brain perfusion blood volume-weighted CT imaging (PWCT) and simultaneous CT angiography (CTA) on early stage of cerebral ischemic infarction. Methods: Non-contrast CT (NCCT), CT perfusion-weighted imaging (PWCT) and delayed CT (DCT) were conducted on 20 cases of early ischemic infarction of whose onset time ranged from 2 to 24 hours. All cases were reexamined with CT or MRI one week to one month later. CT values and perfusion blood volume (PBV) of central and peripheral low perfusion areas as well as those of collateral side were measured. CTA was reconstructed with PWCT as source images to evaluate occlusion or stenosis of blood vessel, and DCT was used to detect the collateral circulation. Results: Of the 20 cases, NCCT, PWCT and CTA were negative in 10 cases in which 6 were confirmed as Transient Ischemic Attack (TIA) on reexamined CT and clinical features, and the other 4 were confirmed as lacunar infarction. For the remaining 10 cases, a comparison was made with ANOVA between low perfusion area (central, peripheral inside and outside) and collateral side. The difference was significant (P<0.01). However, no significant difference was revealed in the central, peripheral inside and outside areas. PBV values were significant in low perfusion area and collateral side (P<0.05). The area of the final infarction was larger than that of the low perfusion area, and the percentage of enlargement exhibited medium negative correlation to the time of ischemia. CTA indicated that 2 cases suffered from left middle cerebral artery occlusion, meanwhile anterior and middle branches of MCA in the other 3 cases were not identified. The sensitivity of NCCT, PWCT and CTA were 28.5%, 71.4% and 35.7% respectively. DCT indicated that 5 cases had asymmetrical blood vessels. Conclusion: The whole-brain perfusion-weighted CT imaging and simultaneous CT angiography (CTA) is p roved to be a simple, timesaving and effective method for the

Cardiac MR imaging: Comparison with echocardiography and dynamic CT

International Nuclear Information System (INIS)

Colletti, P.M.; Norris, S.; Raval, J.; Boswell, W.; Lee, K.; Ralls, P.; Haywood, J.; Halls, J.

1986-01-01

The authors compared gated cardiac MR imaging with two-dimensional and Doppler echocardiography and dynamic CT. Gated cardiac MR imaging (VISTA unit, 0.5 T) was performed in 55 patients with a variety of conditions. Accuracy of diagnosis was compared. CT showed arterial, valvular, and pericardial calcifications not seen on MR imaging. Many lesions were seen as well on CT as on MR imaging. Two-dimensional echocardiography was superior in demonstrating wall motion and valvular disease. MR imaging was superior in demonstrating myocardial structures

Extent of hypoattenuation on CT angiography source images in basilar artery occlusion: prognostic value in the Basilar Artery International Cooperation Study.

Science.gov (United States)

Puetz, Volker; Khomenko, Andrei; Hill, Michael D; Dzialowski, Imanuel; Michel, Patrik; Weimar, Christian; Wijman, Christine A C; Mattle, Heinrich P; Engelter, Stefan T; Muir, Keith W; Pfefferkorn, Thomas; Tanne, David; Szabo, Kristina; Kappelle, L Jaap; Algra, Ale; von Kummer, Ruediger; Demchuk, Andrew M; Schonewille, Wouter J

2011-12-01

The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0-3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0-2). Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS≥8. Patients with a pc-ASPECTS≥8 more often had a favorable outcome than patients with a pc-ASPECTS<8 (crude RR, 1.7; 95% CI, 0.98-3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8-2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5-0.98) and functional independence (RR, 2.0; 95% CI, 1.1-3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2-7.5). pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.

Removal of arterial wall calcifications in CT angiography by local subtraction

International Nuclear Information System (INIS)

Straten, Marcel van; Venema, Henk W.; Streekstra, Geert J.; Reekers, Jim A.; Heeten, Gerard J. den; Grimbergen, Cornelis A.

2003-01-01

CT Angiography (CTA) is an established technique for the minimally invasive imaging of arteries. The technique of maximum intensity projection (MIP) is often used to get a comprehensive overview of the vascular anatomy. On a MIP, however, arterial wall calcifications may hinder the visualization of the arterial lumen. These calcifications are in direct contact with the contrast-enhanced blood, which makes removal difficult. We present a local subtraction method for the automatic removal of these calcifications. In our approach a second CT scan has to be made, prior to contrast injection. The calcifications in both scans are registered prior to subtraction to compensate for displacements in between the two scans. Local subtraction results are compared with results obtained by thresholding. The method was tested in a phantom and with data from four patients. The phantom represented an artery with different types of stenosis. Data were used from patients for which CTA of the renal arteries was performed. For two patients the electrocardiogram (ECG) was recorded during the CTA examination, making retrospective cardiac gated reconstructions possible. Both the phantom and the patient study showed that the local subtraction method is capable of removing calcifications and visualizing the residual lumen. In the patient study it appeared that some artifacts remained for higher pitch values. We conclude that the local subtraction method is less subjective and more accurate than thresholding. Best results are obtained by use of a small pitch, at the expense of the volume covered during a single breath hold

Comparing Methods for Cardiac Output

DEFF Research Database (Denmark)

Graeser, Karin; Zemtsovski, Mikhail; Kofoed, Klaus F

2018-01-01

of the left ventricular outflow tract. METHODS: The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed...... tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation......, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias...

Determining the proportion of coronary segments assessable on 16-slice CT coronary angiography: a brief report

International Nuclear Information System (INIS)

Soon, K. H.; Cox, N.; Eccleston, D.; Lim, Y.; Chaitowitz, I.; Bell, K. W.; Kelly, A-M.

2007-01-01

Computed tomography coronary angiography (CT-CA) is becoming a popular non-invasive coronary imaging method. We aimed to determine the proportion of coronary segments assessable on a 16-slice CT in comparison with conventional selective coronary angiography (SCA). We identified all patients who had both 16-slice CT-CA and recent SCA (less than 12 months) from March 2004 to July 2005. Two CT reporters blinded to SCA independently classified coronary segment assessability on CT-CA. A cardiologist blinded to CT findings classified assess-ability of coronary segments on SCA. Data were analysed using descriptive statistics and proportion of agreement. Ninety-five study pairs were included in the analysis. Of those, 1161 coronary segments were deemed assessable on SCA and 1103 segments (95%) were also assessable on CT-CA. Nonassessable segments on CT-CA were predominantly in the distal segments and branches of coronary arteries. Reasons for nonassessability were small calibre (48.3%), motion artefacts (20.7%) and poorly reconstructed segments (22.4%). The 16-slice CT was able to assess a high proportion of but not all coronary segments. Nonassessable segments were predominantly distal segments or branches of coronary arteries. Motion artefacts due to heart-rate changes, small calibre and poorly reconstructed images were main causes of nonassessability on 16-slice CT-CA

Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

NARCIS (Netherlands)

Westerlaan, H. E.; Gravendeel, J.; Fiore, D.; Metzemaekers, J. D. M.; Groen, R. J. M.; Mooij, J. J. A.; Oudkerk, M.

2007-01-01

Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in

Different contrast injection protocols for 64-slice spiral CT coronary angiography

International Nuclear Information System (INIS)

Lu Jinguo; Lv Bing; Bai Hua; Tang Xiang; Yang Xinling; Jiang Shiliang; Dai Ruiping; Qiu Jinhai; Chen Tao

2008-01-01

Objective: To determine the optimal contrast protocols for 64-slice spiral CT coronary angiography in order to reduce the volume of contrast injection. Methods: One hundred fifty patients scheduled to undergo 64-slice spiral CT coronary angiography were prospectively randomized into the following five groups with different injection protocols: group 1: uniphasic injection without a flush; group 2: biphasic injection with a flush; group 3, group 4 and group 5 : triphasic injection with a diluted contrast material with 3:7, 5:5, 7:3 contrast/saline ratio respectively. Attenuation was measured in the right atrium, right ventricle, left atrium, left ventricle, ascending aorta, right coronary artery and left coronary artery and analyzed with single factor variance test (ANOVA). The quality of the coronary artery images was evaluated and compared using person Chi-Square. Results: The total contrast material volume were (67.0±5.3) ml, (59.9±4.9) ml, (62.9±3.2) ml, (69.2±5.7) ml and (70.9±4.6) ml in five groups respectively (F=27.43, P 2 =18.81, P 2 =31.44, P<0.01). The artifacts in the superior vena cava in group 1 was the most, and in group 2 was the least. The mean enhancement values of right and left coronary arteries in group 2 were significantly greater than those in other groups (F=2.47 and 4.10, P<0.05). The visualization of both left ventricle and right ventricle cavities was the best in group 3. Conclusion: Biphasic injection and triphasic injection are better than uniphasic injection for 64-slice spiral CT coronary angiography and triphasic injection is better than biphasic injection for the visualization of both left ventricle and right ventricle cavities. (authors)

Preoperative cerebral aneurysm assessment by three-dimensional CT angiography. Feasibility of surgery without cerebral angiography

International Nuclear Information System (INIS)

Kashiwagi, Shiro; Yamashita, Katsuhiro; Kato, Shoichi; Ito, Haruhide; Kurokawa, Kensuke; Watanabe, Yutaka

1999-01-01

The purpose of this study is to assess the capability of three-dimensional CT angiography (3D-CTA) to replace conventional catheter angiography as a preoperative examination for unruptured intracranial aneurysms. A prospective study was designed to evaluate 18 patients with 20 unruptured intracranial aneurysms (13 middle cerebral artery aneurysms, 6 anterior communicating artery aneurysms, and 1 internal carotid posterior communicating artery aneurysm) who underwent surgery. There were 12 women and 6 men with the average age of 63 years old. All patients were initially diagnosed as having intracranial aneurysms by MR angiography, followed by 3D-CTA and conventional catheter angiography for confirmation. Three experienced neurosurgeons were in charge of the operations. One of the neurosurgeons (surgeon 1) was provided with only 3D-CTA as the preoperative radiological evaluation, while the others (surgeon 2 and 3) were given through assessments with MRA, 3D-CTA, and conventional angiography. Surgeon 1 carried out the operations under careful observation by the surgeons 2 and 3. Problems encountered by the surgeon 1 during surgery were recorded. Neck clipping in 19 aneurysms and dome wrapping in 1 were successfully accomplished. All patients were discharged without complication. Surgeries went smoothly in 16 aneurysms with 3D-CTA alone. Discrepancies between the 3D-CTA findings and microsurgical anatomy were noted in 4 aneurysms: the size of the neck was overestimated in 3 aneurysms, the relationships to parent arteries were obscure in 2 aneurysms, and a perforating artery problematic to neck clipping was missed in 1 aneurysms by 3D-CTA. The results of this study support the notion that 3D-CTA can replace conventional catheter angiography as preoperative examination in the majority of regular-sized anterior circulation aneurysms. Nevertheless, surgeons should recognize and be prepared for the fact that 3D-CTA can give false impression about the aneurysm neck and

Contrast agents for cardiac angiography: effects of a nonionic agent vs. a standard ionic agent

International Nuclear Information System (INIS)

Bettmann, M.A.; Bourdillon, P.D.; Barry, W.H.; Brush, K.A.; Levin, D.C.

1984-01-01

The effects on cardiac hemodynamics and of a standard contrast agent, sodium methylglucamine diatrizoate [Renografin 76] were compared with the effects of a new nonionic agent (iohexol) in a double-blind study in 51 patietns undergoing coronary angiography and left ventriculography. No significant alteration in measured blood parameters occurred with either contrast agent. Hemodynamic changes occurred with both, but were significantly greater with the standard renografin than with the low-osmolality, nonionic iohexol. After left ventriculography, heart rate increased and peripheral arterial pressure fell with both agents, but less with iohexol. It is concluded that iohexol causes less alteration in cardiac function than does the agent currently most widely used. Nonionic contrast material is likely to improve the safety of coronary angiography, particularly in those patients at greatest risk

CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Bechan, R.S.; Peluso, J.P.; Sluzewski, M.; Rooij, W.J. van [Sint Elisabeth Ziekenhuis Tilburg, Department of Radiology, Tilburg (Netherlands); Rooij, S.B. van [Medisch Centrum Alkmaar, Department of Radiology, Alkmaar (Netherlands); Sprengers, M.E.; Majoie, C.B. [Academisch Medisch Centrum, Department of Radiology, Amsterdam (Netherlands)

2015-12-15

CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

Hybrid ECG-gated versus non-gated 512-slice CT angiography of the aorta and coronary artery: image quality and effect of a motion correction algorithm.

Science.gov (United States)

Lee, Ji Won; Kim, Chang Won; Lee, Geewon; Lee, Han Cheol; Kim, Sang-Pil; Choi, Bum Sung; Jeong, Yeon Joo

2018-02-01

Background Using the hybrid electrocardiogram (ECG)-gated computed tomography (CT) technique, assessment of entire aorta, coronary arteries, and aortic valve can be possible using single-bolus contrast administration within a single acquisition. Purpose To compare the image quality of hybrid ECG-gated and non-gated CT angiography of the aorta and evaluate the effect of a motion correction algorithm (MCA) on coronary artery image quality in a hybrid ECG-gated aorta CT group. Material and Methods In total, 104 patients (76 men; mean age = 65.8 years) prospectively randomized into two groups (Group 1 = hybrid ECG-gated CT; Group 2 = non-gated CT) underwent wide-detector array aorta CT. Image quality, assessed using a four-point scale, was compared between the groups. Coronary artery image quality was compared between the conventional reconstruction and motion correction reconstruction subgroups in Group 1. Results Group 1 showed significant advantages over Group 2 in aortic wall, cardiac chamber, aortic valve, coronary ostia, and main coronary arteries image quality (all P ECG-gated CT significantly improved the heart and aortic wall image quality and the MCA can further improve the image quality and interpretability of coronary arteries.

Combined CT Angiography and CT Venography in Thromboembolic disease: clinical impact; Angio TC y flebo TC combinados en el diagnostico de la enfermedad tramboembolica: impacto clinico

Energy Technology Data Exchange (ETDEWEB)

Bouzas, R.; Migueles, Y.; Gomez, S.; Mallo, R.; Garcia-Tejedor, J. L.; Diaz Vega, M. J. [Complejo Hospitalario Xerar-Cies. Vigo. Pontevedra (Spain)

2002-07-01

Combined CT Venography and Pulmonary Angiography was described in 1998 as a tool for diagnostic Thromboembolic Disease. The purpose is to relate our own experience with this technique in a population with suspected pulmonary embolism. 46 consecutive patients with suspected pulmonary embolism underwent combined CT Venography after Pulmonary CT Angiography to depict Deep Venous Thrombosis (DVT). CT Venography where obtained with a 3 minutes delay from injection, without additional intravenous contrast, from upper abdomen to fibular head. A prospective study from emergency reports where used. The reports where aimed by nine different radiologist at diary emergency room (images where not retrospective review). We report if a pulmonary embolus or deep venous thrombus or another alternative diagnostic where done. An endo luminal thrombus in any pulmonary arteries was assessed as a positive study for PE. A Thrombus in the leg veins or in an abdominal vein without diminished size of vein was assessed as an acute DVT. In those patients with a CT negative to Thromboembolic Disease was the clinician who decide if more proves where needed. Those patients without evidence in CT of Thromboembolic Disease where asked for symptoms related to the episode in a 3 months period after initial CT. Patients free of symptoms for 3 months without anticoagulation therapy where considered true negative for CT. CT shows Thromboembolic Disease in 23 of 46 patients. 21PE, 14 DVT 2 of 14 patients with DVT don't show PE, CT excluded thromboembolic disease in 23 patients and in 15 of those patients an alternative diagnostic was shown. In 22 of those 23 patients CT excluded correctly Thromboembolic Disease. One patient result in a false negative CT, Pulmonary Angiography of that patient shows us a subsegmentary embolus. (Author) 9 refs.

CT of the heart

International Nuclear Information System (INIS)

Lipton, M.J.

1986-01-01

Advances based upon the detector elements instead of X-ray film have greatly increased the power of X-ray imaging. Computed tomography (CT) creates cross sectional rather than projected images. Recently, high speed CT devices have been developed for cardiovascular studies. The Cine-CT scanner employs a scanning electron beam deflected on an extended tungsten target ring. Fast scans of 50 millisecond exposures at multiple levels can provide information concerning blood flow in vessels and tissues, myocardial wall motion, valve integrity, coronary bypass graft patency and proximal coronary artery anatomy. Cine-CT dynamic scanning can also provide volume imaging with small quantities (0.05 - 1.5 ml/kg) of contrast medium administered via peripheral vein injections. Cine-CT provides simultaneous measurements of cardiac dimensions and function and is rapidly becoming a new tool for quantitating myocardial blood flow, cardiac chamber volumes and wall mechanics. The future outlook is very promising for this three-dimensional cine-CT technique with high spatial resolution. High speed CT should provide unique diagnostic information and as the technology continues to improve at a rapid speed, this new imaging modality could be a challenge for angiography. (Auth.)

Comparison of X-ray radiation exposure during digital subtraction angiography (DSA) and multislice CT angiography (CTA)

International Nuclear Information System (INIS)

Bai, Mei; Liu, Bin; Zheng, Junzheng

2008-01-01

Full text: Purpose: To compare radiation risk during digital subtraction angiography (DSA) and CT angiography (CTA). Materials and methods: Eighty patients randomly divided into two groups of 40 patients each, were evaluated for coronary atherosclerotic heart disease with 64-slice spiral CT angiography and DSA respectively. For CTA group we divided patients into two subgroups: regular mode and ECG modulation mode. Matix of thermoluminescent dosimeters (TLDs) were placed on patients' skin surface during each examination to access peak skin dose (PSD). A male ART phantom was equipped with TLDs in six different positions to assess achievable organ dose. Effective dose was calculated by commercially available computer programs. Results: For DSA, PSD was 64mGy. Phantom organ dose for lung, heart, stomach, liver, kidney and brain were 11.07mGy, 5.87mGy, 1.42mGy, 2.11mGy, 6.76mGy and 0.001mGy respectively, and effective dose was 4mSv. For regular mode CTA, PSD was 74.5mGy, and CTD vol was 37.9mGy. Phantom organ dose for lung, heart, stomach, liver, kidney and brain were 58mGy, 64.2mGy, 6.6mGy, 9.9mGy, 2.7mGy, 0.072mGy respectively, and effective dose was 16mSv. For ECG modulation mode, PSD was 50.9mGy, and CTD vol was 26.3mGy. Conclusion: According to measured PSD value, deterministic radiation risk for regular mode CTA was little higher than DSA. However for stochastic radiation risk which can be indicated by organ dose and effective dose, regular mode CTA was much higher than DSA. Comparing with regular mode, ECG modulation mode can effectively reduce both stochastic and deterministic radiation risk. (author)

320-detector row CT coronary angiography in patients with arrhythmia

International Nuclear Information System (INIS)

Lu Li; Zhang Zhaoqi; Xu Lei; Yang Lin

2011-01-01

Objective: To evaluate the feasibility of CT coronary angiography (CTCA) in patients with arrhythmia using 320-detector row CT. Methods: Thirty-one patients with persistent atrial fibrillation and 8 patients with premature ventricular contraction were enrolled in this study. All patients underwent 320- detector row CTCA. CT image quality was evaluated with 4-point grading scale by two radiologists. Inter- observer agreement was evaluated by Kappa statistics. The radiation dose was calculated. Results: In total 510 coronary segments, 496 (97.2%) segments met diagnostic standard. The mean effective dose was (12.7±4.8) mSv in this study. There was a good agreement in image quality scoring between the two reviewers (Kappa = 0.72). Conclusion: 320-detector row CTCA is feasible in patients with atrial fibrillation and premature ventricular contraction. Arrhythmia may not be considered as a contraindication to CTCA. (authors)

3D-CT angiography with ultrafast CT in the diagnosis of pulmonary thromboembolism

International Nuclear Information System (INIS)

Kuribayashi, Sachio; Hamada, Seiki; Takamiya, Makoto; Imakita, Satoshi; Yamada, Naoaki; Takase, Kei; Iino, Misako; Nakanishi, Norifumi

1995-01-01

The usefulness of 3D-CT angiography (3D-CTA) with ultrafast CT (UFCT) in the diagnosis of pulmonary thromboembolism (PTE) was evaluated. UFCT was carried out in 10 patients with PTE (acute: 5 cases, chronic: 5 cases) and one case with pulmonary artery thrombosis secondary to pulmonary hypertension with atrial septal defect. CT scanning was performed with Imatron C-100XL and C-150L. For the imaging, single-slice step volume scan mode was used with scan time of 100 msec and slice thickness of 6 mm. Contiguous axial images were obtained after contrast enhancement with slice interval of 6 mm. 3D-CTA was reconstructed from 2D-CT images with workstation, and was compared with pulmonary angiograms (PAG) or operative findings. The images of 3D-CTA had good quality and they were more useful than 2D-CT images in better understanding of the configuration and the extent of the thrombi. In comparison with PAG, 3D-CTA gave equivalent information in terms of central pulmonary emboli. Moreover, 3D-CTA had advantages over PAG in demonstrating both the blood lumen and the thrombus on the same image with capability of multi-directional displays. 3D-CTA with UFCT is the useful non-invasive imaging modality in the diagnosis of PTE. (author)

Preoperative evaluation of the artery of adamkiewicz by MR angiography and CT angiography in patients with a thoracic aortic aneurysm

International Nuclear Information System (INIS)

Niinuma, Hiroyuki; Ohira, Atsushi; Makita, Shinji; Moriai, Yoshiteru; Hiramori, Katsuhiko; Yoshioka, Kunihiro; Nakajima, Takayuki; Kawazoe, Kohei

2002-01-01

Paraplegia is known as an extremely serious and important complication of surgical repair in patients with a thoraco-abdominal aortic aneurysm. It is important to evaluate the artery of Adamkiewicz (AdA) before surgical repair to prevent paraplegia. But the AdA is difficult to visualize by the invasive and hazardous, conventional selective angiography. The aim of this study was to visualize AdA by MR angiography (MRA) and CT angiography (CTA). Twenty-one consecutive patients with a thoracic aortic aneurysm underwent both gadolinium-enhanced, three-dimensional MRA and CTA using multislice helical CT. The AdA was successfully visualized in 15 of the 21 patients (71.4%) by MRA, and in 17 of those 21 patients (80.9%) by CTA. Its continuity was depicted in 12 of 15 patients (80%) by MRA, and in 9 of 17 patients (47%) by CTA. AdA was visualized at 85.7% by MRA or CTA, respectively. This study shows that CTA is a much more sensitive method to detect AdA than MRA. On the other hand, MRA is better to evaluate the continuity of AdA from the descending aorta to the anterior spinal artery, than CTA. Therefore, MRA and CTA are both useful for a preoperative evaluation of AdA and its detailed vascular anatomy from the aorta to the anterior spinal artery. (author)

Evaluation of the low dose cardiac CT imaging using ASIR technique

Science.gov (United States)

Fan, Jiahua; Hsieh, Jiang; Deubig, Amy; Sainath, Paavana; Crandall, Peter

2010-04-01

Today Cardiac imaging is one of the key driving forces for the research and development activities of Computed Tomography (CT) imaging. It requires high spatial and temporal resolution and is often associated with high radiation dose. The newly introduced ASIR technique presents an efficient method that offers the dose reduction benefits while maintaining image quality and providing fast reconstruction speed. This paper discusses the study of image quality of the ASIR technique for Cardiac CT imaging. Phantoms as well as clinical data have been evaluated to demonstrate the effectiveness of ASIR technique for Cardiac CT applications.

Cardiac radiology: centenary review.

Science.gov (United States)

de Roos, Albert; Higgins, Charles B

2014-11-01

During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.

Science.gov (United States)

Ryu, Min-Jung; Park, Jeong Sook; Park, Heeok

2012-03-01

The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Diverse types of music have been claimed to improve sleeping elsewhere, but relatively little is known in South Korea. Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia, even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems. There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit. An experimental research design was used. Data collection was conducted in the cardiac care unit of K University Hospital in D city, from 3 September-4 October 2010. Fifty-eight subjects participated and were randomly assigned to the experimental group (earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm, while wearing an eyeshield, n = 29) and the control group (no music, but earplugs and eyeshield worn, n = 29). The quantity and quality of sleep were measured using questionnaires at 7 am the next morning for each group. Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group (t = 3·181, p = 0·002, t = 5·269, p music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit. Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients. Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography. © 2011 Blackwell Publishing Ltd.

Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion

International Nuclear Information System (INIS)

Hanson, Eric H.; Roach, Cayce J.; Ringdahl, Erik N.; Wynn, Brad L.; DeChancie, Sean M.; Mann, Nathan D.; Diamond, Alan S.; Orrison, William W.

2011-01-01

Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, -10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures. (orig.)

Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion

Energy Technology Data Exchange (ETDEWEB)

Hanson, Eric H. [Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); University of Nevada Las Vegas, Department of Health Physics and Diagnostic Sciences, 4505 Maryland Parkway, Box 453037, Las Vegas, NV (United States); Amigenics, Inc, Las Vegas, NV (United States); Roach, Cayce J. [Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); University of Nevada Las Vegas, School of Life Sciences, Las Vegas, NV (United States); Ringdahl, Erik N. [University of Nevada Las Vegas, Department of Psychology, Las Vegas, NV (United States); Wynn, Brad L. [Family Medicine Spokane, Spokane, WA (United States); DeChancie, Sean M.; Mann, Nathan D. [Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); Diamond, Alan S. [CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); Orrison, William W. [Touro University Nevada College of Osteopathic Medicine, Henderson, NV (United States); University of Nevada Las Vegas, Department of Health Physics and Diagnostic Sciences, 4505 Maryland Parkway, Box 453037, Las Vegas, NV (United States); CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); University of Nevada School of Medicine, Department of Medical Education, Reno, NV (United States)

2011-05-15

Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, -10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures. (orig.)

Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Gaemperli, Oliver; Valenta, Ines; Schepis, Tiziano [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); Husmann, Lars; Scheffel, Hans; Desbiolles, Lotus; Leschka, Sebastian; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

2008-06-15

The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 {+-} 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 {+-} 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions ({>=}50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis. (orig.)

Low-dose prospectively electrocardiogram-gated axial dual-source CT angiography in patients with pulsatile bilateral bidirectional Glenn Shunt: an alternative noninvasive method for postoperative morphological estimation.

Directory of Open Access Journals (Sweden)

Xiaopeng Ji

Full Text Available To explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG as an alternative noninvasive method for postoperative morphological estimation.Twenty patients with pulsatile bBDG (mean age 4.2±1.6 years underwent both low-dose PGA scanning and conventional cardiac angiography (CCA for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC and pulmonary artery (PA, the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland-Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated.The CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P0.The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively.CT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.

Carotid stenosis: a comparison between MR and spiral CT angiography

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Magarelli, N.; Carriero, A.; Bonomo, L. [Institute of Radiology, University ``G. D`Annunzio``, Chieti (Italy); Scarabino, T.; Simeone, A.L.; Florio, F. [IRCCS, Foggia (Italy); Salvolini, U. [Department of Neuroradiology, University of Ancona (Italy)

1998-06-01

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. (orig.) With 6 figs., 4 tabs., 17 refs.

Carotid stenosis: a comparison between MR and spiral CT angiography

International Nuclear Information System (INIS)

Magarelli, N.; Carriero, A.; Bonomo, L.; Scarabino, T.; Simeone, A.L.; Florio, F.; Salvolini, U.

1998-01-01

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. (orig.)

Comparative study of multi-slice spiral CT angiography and color doppler ultrasound in diagnosis of arteriosclerotic occlusive disease of lower extremity

International Nuclear Information System (INIS)

Li Wanjun; Lai Zhenhui; Cui Dong; Lin Xiupeng; Du Muxuan

2010-01-01

Objective: To compare the difference between multi-slice spiral CT angiography (MSCTA) and color doppler ultrasound in diagnosis of arteriosclerotic occlusive disease of lower extremity. Methods: Patients with arteriosclerosis occlusion were assessed by color doppler ultrasound, multi-slice spiral CT angiography and digital subtraction angiography (DSA). The image information of color doppler ultrasound and MSCTA were compared with that of DSA. Results: Color doppler ultrasound showed the anatomical shape and hemodynamics of the arteries of lower extremity. The sensitivity, specificity, and accuracy for diagnosis arteriosclerotic occlusive disease of lower extremity were 88.04%, 90.69% and 88.77% respectively. MSCTA showed the three dimensional structure of the arteries of lower extremity as well as the collateral arteries and the distal arterials. The sensitivity, specificity and accuracy of MSCTA were 97.69%, 96.90% and 97.66%, respectively. Conclusion: Multi-slice spiral CT angiography is an ideal imaging method for the diagnosis of arteriosclerotic occlusive disease of lower extremity. (authors)

Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality

International Nuclear Information System (INIS)

Oda, Seitaro; Weissman, Gaby; Weigold, W. Guy; Vembar, Mani

2015-01-01

The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality - graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality - was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. (orig.)

Three dimensional CT angiography (3D-CTA) in ruptured aneurysm surgery on acute stage

International Nuclear Information System (INIS)

Matsumoto, Masato; Endo, Yuji; Nakano, Masayuki

1998-01-01

We evaluated three-dimensional CT angiography (3D-CTA) for the treatment of acutely ruptured cerebral aneurysms. Sixty patients with subarachnoid hemorrhage from cerebral aneurysms were investigated both by 3D-CTA and conventional angiography and 26 patients were studied using 3D-CTA without conventional angiography. In the 60 cases, both 3D-CTA and the conventional angiography revealed 100% accuracy in diagnosing ruptured aneurysms, and 3D-CTA and the conventional angiography showed 96% and 92% accuracy for unruptured aneurysms respectively. 3D-CTA was equal or superior to the conventional angiography. Based on these data, since December, 1996, we have operated on 26 consecutive patients with ruptured aneurysms located in the anterior circulation of the circle of Willis, using 3D-CTA without conventional angiography. Thirty-one aneurysms, including 5 associated unruptured aneurysms, were visualized by 3D-CTA and verified at surgery. All aneurysms were clipped successfully. We think that it will be possible to operate on most ruptured aneurysms using only 3D-CTA without the conventional angiography except for the cases of the following situations: if a cerebral infarction is present, conventional angiography is required to evaluate for a stenotic or occlusive lesion of the intracranial arteries, cervical carotid, or vertebral arteries; in cases of giant or large aneurysms, the dynamic information provided by the conventional angiography is needed in case bypass surgery is necessary; and for aneurysms close to bony structures, such as an internal carotid-ophthalmic artery aneurysm, conventional angiography is necessary. (author)

Low-dose computed tomography scans with automatic exposure control for patients of different ages undergoing cardiac PET/CT and SPECT/CT.

Science.gov (United States)

Yang, Ching-Ching; Yang, Bang-Hung; Tu, Chun-Yuan; Wu, Tung-Hsin; Liu, Shu-Hsin

2017-06-01

This study aimed to evaluate the efficacy of automatic exposure control (AEC) in order to optimize low-dose computed tomography (CT) protocols for patients of different ages undergoing cardiac PET/CT and single-photon emission computed tomography/computed tomography (SPECT/CT). One PET/CT and one SPECT/CT were used to acquire CT images for four anthropomorphic phantoms representative of 1-year-old, 5-year-old and 10-year-old children and an adult. For the hybrid systems investigated in this study, the radiation dose and image quality of cardiac CT scans performed with AEC activated depend mainly on the selection of a predefined image quality index. Multiple linear regression methods were used to analyse image data from anthropomorphic phantom studies to investigate the effects of body size and predefined image quality index on CT radiation dose in cardiac PET/CT and SPECT/CT scans. The regression relationships have a coefficient of determination larger than 0.9, indicating a good fit to the data. According to the regression models, low-dose protocols using the AEC technique were optimized for patients of different ages. In comparison with the standard protocol with AEC activated for adult cardiac examinations used in our clinical routine practice, the optimized paediatric protocols in PET/CT allow 32.2, 63.7 and 79.2% CT dose reductions for anthropomorphic phantoms simulating 10-year-old, 5-year-old and 1-year-old children, respectively. The corresponding results for cardiac SPECT/CT are 8.4, 51.5 and 72.7%. AEC is a practical way to reduce CT radiation dose in cardiac PET/CT and SPECT/CT, but the AEC settings should be determined properly for optimal effect. Our results show that AEC does not eliminate the need for paediatric protocols and CT examinations using the AEC technique should be optimized for paediatric patients to reduce the radiation dose as low as reasonably achievable.

Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT.

Science.gov (United States)

Passen, Edward; Feng, Zekun

2015-01-01

Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Feasibility of coronary calcium and stent image subtraction using 320-detector row CT angiography

DEFF Research Database (Denmark)

Fuchs, Andreas; Kühl, J Tobias; Chen, Marcus Y

2015-01-01

BACKGROUND: The reader confidence and diagnostic accuracy of coronary CT angiography (CCTA) can be compromised by the presence of calcified plaques and stents causing blooming artifacts. Compared to conventional invasive coronary angiography (ICA), this may cause an overestimation of stenosis....... We defined target segments on CCTAconv as motion-free coronary segments with calcification or stent and low reader confidence. The effect of CCTAsub was assessed. No approval from the ethics committee was required according to Danish law. RESULTS: A total of 76 target segments were identified...

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

Energy Technology Data Exchange (ETDEWEB)

Rajaram, Smitha [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Sheffield (United Kingdom); Swift, Andrew J.; Wild, Jim M. [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Sheffield Cardiovascular Biomedical Research Unit, Sheffield (United Kingdom); Capener, David; Telfer, Adam [Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Davies, Christine; Hill, Catherine [Sheffield Teaching Hospitals Trust, Department of Radiology, Sheffield (United Kingdom); Condliffe, Robin; Elliot, Charles; Kiely, David G. [Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield (United Kingdom); Sheffield Cardiovascular Biomedical Research Unit, Sheffield (United Kingdom); Hurdman, Judith [Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield (United Kingdom)

2012-02-15

To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE). A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed. The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall. (orig.)

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

International Nuclear Information System (INIS)

Rajaram, Smitha; Swift, Andrew J.; Wild, Jim M.; Capener, David; Telfer, Adam; Davies, Christine; Hill, Catherine; Condliffe, Robin; Elliot, Charles; Kiely, David G.; Hurdman, Judith

2012-01-01

To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE). A 2 year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed. The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall. (orig.)

Spiral CT angiography of middle cerebral artery stenoses

International Nuclear Information System (INIS)

Lehmann, K.J.; Neff, K.W.; Ries, S.; Sommer, A.; Steinke, W.; Georgi, M.

1996-01-01

Transcranial Doppler ultrasonography (TCD) and magnetic resonance angiography (MRA) are well-established techniques for ascertaining intracranial obstructive artery disease. The short examination time required for additional helical CT angiography (CTA) allows quick management of emergency patients already undergoing native CT. However, today the ability of CTA to detect stenoses of the middle cerebral artery (MCA) has not been proven. To analyse the value of CTA in the classification of atherosclerotic disease 23 MCA stenoses confirmed by TCD and MRA were investigated. CTA was performed on a Hispeed advantage scanner (GE) using a bolus injection of 70 ml KM and 40 ml NaCl with a flow rate of 2.5 ml/s, a thickness of 1 mm, a pitch of 1.5 and a 1 mm increment. CTA was presented as maximum intensity projection (MIP) and as multi-projection volume reconstruction (MPVR). A three-step classification of stenosis was compared with the results of TCD and MRA. Good opacification of the MCA was achieved in M1 and M2 segments in all patients. Classification of stenosis by CTA agreed with MRA and TCD in 14 cases; 7 stenoses were assigned to a lower classification by CTA. Two lowgrade stenoses could not be proven by CTA. Although MIP and MPVR yield the same result in stenosis classification MPVR showed a sharper image quality. In contrast to MRA, veins were highly opacified in CTA. Artery and vein were sometimes superimposed, which had to be avoided by changing the projection angle. Medium- and high-grade MCA stenoses can be demonstrated by CTA quickly and reliably. Compared to MRA and TCD, CTA provides lower grading of stenosis. (orig.) [de

Evaluation of the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography

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Zahra Pourmovahed

2016-02-01

Full Text Available Background: Patients experience high levels of anxiety before angiography, which is mostly associated with irreparable effects on health status of such individuals. Use of alternative medicine to reduce stress and anxiety is of paramount importance. Therefore, this study aimed to evaluate the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography. Methods: This clinical trial was conducted on 70 patients admitted to cardiac wards before angiography in three selected hospitals of Shiraz, Iran in 2015. Samples were selected through randomized and available sampling and divided into two groups of control (n=35 and intervention (n=35. In this study, the intervention group received one hour of music before angiography for 20 minutes, whereas the usual care of ward was provided for the control group. Data was collected using the state-trait anxiety inventory (STAI by Spielberger one hour before angiography (immediately before the intervention and 20 minutes after angiography (immediately after the intervention through interviews with all the participants. Data analysis was performed in SPSS version 22 using descriptive statistics, Chi-square, as well as paired and independent-tests. Results: In this study, mean anxiety scores of patients in the intervention and control groups before the intervention were 48.45±6.63 and 48.25±6.63, respectively. After the intervention, these scores were changed to 44.28±5.21 and 49.02±7.74 in the intervention (P=0.004 and control (P=0.90 groups, respectively. Therefore, a significant difference was observed between the groups after the intervention (P=0.008. Conclusion: According to the results of this study, music before angiography could lead to a significant decrease in anxiety level of patients. Therefore, this approach could be used as an effective method to alleviate anxiety in patients.

Evaluation of the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography

Directory of Open Access Journals (Sweden)

Pourmovahed Zahra

2016-08-01

Full Text Available Background and Objective: Patients experience high levels of anxiety before angiography, which is mostly associated with irreparable effects on health status of such individuals. Use of alternative medicine to reduce stress and anxiety is of paramount importance. Therefore, this study aimed to evaluate the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography. Materials and Method: This clinical trial was conducted on 70 patients admitted to cardiac wards before angiography in three selected hospitals of Shiraz, Iran in 2015. Samples were randomized convenience sampling and divided into two groups of control (n=35 and intervention (n=35. In this study, the intervention group received one hour of music before angiography for 20 minutes, whereas the usual care of ward was provided for the control group. Data was collected using the state-trait anxiety inventory (STAI by Spielberger one hour before angiography (immediately before the intervention and 20 minutes after angiography (immediately after the intervention through interviews with all the participants. Data analysis was performed in SPSS version 22 using descriptive statistics, Chi-square, as well as paired and independent-tests. Results: In this study, mean anxiety scores of patients in the intervention and control groups before the intervention were 48.45±6.63 and 48.25±6.63, respectively. After the intervention, these scores were changed to 44.28±5.21 and 49.02±7.74 in the intervention (P=0.004 and control (P=0.90 groups, respectively. Therefore, a significant difference was observed between the groups after the intervention (P=0.008. Conclusion: According to the results of this study, music before angiography could lead to a significant decrease in anxiety level of patients. Therefore, this approach could be used as an effective method to alleviate anxiety in patients.

The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: a Pictorial Essay

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Kumar, Sheo; Neyaz, Zafar; Gupta, Archna [Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India)

2010-06-15

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.

The utility of 64 channel multidetector CT angiography for evaluating the renal vascular anatomy and possible variations: a pictorial essay.

Science.gov (United States)

Kumar, Sheo; Neyaz, Zafar; Gupta, Archna

2010-01-01

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.

The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: a Pictorial Essay

International Nuclear Information System (INIS)

Kumar, Sheo; Neyaz, Zafar; Gupta, Archna

2010-01-01

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment

High-pitch dual-source CT angiography of the whole aorta without ECG synchronisation: Initial experience

International Nuclear Information System (INIS)

Beeres, Martin; Schell, Boris; Mastragelopoulos, Aristidis; Kerl, Josef Matthias; Gruber-Rouh, Tatjana; Lee, Clara; Siebenhandl, Petra; Bodelle, Boris; Zangos, Stephan; Vogl, Thomas J.; Jacobi, Volkmar; Bauer, Ralf W.; Herrmann, Eva

2012-01-01

To investigate the feasibility, image quality and radiation dose for high-pitch dual-source CT angiography (CTA) of the whole aorta without ECG synchronisation. Each group of 40 patients underwent CTA either on a 16-slice (group 1) or dual-source CT device with conventional single-source (group 2) or high-pitch mode with a pitch of 3.0 (group 3). The presence of motion or stair-step artefacts of the thoracic aorta was independently assessed by two readers. Subjective and objective scoring of motion and artefacts were significantly reduced in the high-pitch examination protocol (p < 0.05). The imaging length was not significantly different, but the imaging time was significantly (p < 0.001) shorter in the high-pitch group (12.2 vs. 7.4 vs. 1.7 s for groups 1, 2 and 3). The ascending aorta and the coronary ostia were reliably evaluable in all patients of group 3 without motion artefacts as well. High-pitch dual-source CT angiography of the whole aorta is feasible in unselected patients. As a significant advantage over regular pitch protocols, motion-free imaging of the aorta is possible without ECG synchronisation. Thus, this CT mode bears potential to become a standard CT protocol before trans-catheter aortic valve implantation (TAVI). (orig.)

CT coronary angiography versus conventional invasive coronary angiography. The view of the referring physician

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Maurer, Martin H. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Universitaetsspital Bern (Switzerland). Dept. fuer Diagnostische, Interventionelle und Paediatrische Radiologie; Zimmermann, E.; Hamm, B. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Dewey, M.

2014-12-15

Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. 53 questionnaires (30%) were assessable, corresponding to more than 72% of the patients referred. Of the referring physicians who responded, 94% saw a concrete advantage of CCTA in the treatment of patients, whereby 87% were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1-5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42% of the referring physicians. 90% of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87% of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

Whole-body CT. Spiral and multislice CT. 2. tot. rev. and enl. ed.; Ganzkoerper-Computertomographie. Spiral- und Multislice-CT

Energy Technology Data Exchange (ETDEWEB)

Prokop, M.; Galanski, M.; Schaefer-Prokop, C.; Molen, A.J. van der

2007-07-01

Spiral and multidetector techniques have improved the diagnostic possibilities of CT, so that image analysis and interpretation have become increasingly complex. This book represents the current state of the art in CT imaging, including the most recent technical scanner developments. The second edition comprises the current state of knowledge in cT imaging. There are new chapters on image processing, application of contrasting agents and radiation dose. All organ-specific pathological findings are discussed in full. There are hints for optimum use and interpretation of CT, including CT angiography, CT colonography, CT-IVPL, and 3D imaging. There is an introduction to cardio-CT, from calcium scoring and CTA of the coronary arteries to judgement of cardiac morphology. There are detailed scan protocols with descriptions of how to go about parameter selection. Practical hints are given for better image quality and lower radiation exposure of patients, guidelines for patient preparation and complication management, and more than 1900 images in optimum RRR quality. (orig.)

Clinical application of transvenous temporary cardiac pacemaker in performing extra-cranial carotid angiography and stent implantation

International Nuclear Information System (INIS)

Liu Juan; Yao Guoen; Zhou Huadong; Jiang Xiaojiang; Chen Qiao

2012-01-01

Objective: To assess the safety and effectiveness of transvenous temporary cardiac pacemaker in preventing hemodynamic instability occurred during the perioperative period of extra-cranial carotid angiography and stent implantation. Methods: Preoperative install of temporary cardiac pacemaker via left femoral vein was carried out in 41 patients who were at high risk for developing hemodynamic instability, which was followed by extra-cranial carotid angiography and stent implantation. The pacing rhythm of the pacemaker was fixed at 60 beats/min. During and after the procedure the patients were under close observation for the signs of discomfort symptoms as well as the changes in blood pressure and heart rate. The working condition of the pacemaker was also monitored. Results: All the installed pacemakers were technically and hemodynamically effective in producing electrical ventricular responses in all 25 patients who had received balloon dilatation of carotid in advance. Transient pacemaker activation appeared in 25 patients. The longest activation time was one day. During pacemaker activation, one patient developed symptomatic hypotension. The longest duration of hypotension lasted for 4 days. No pacemaker-related or procedure-related complications occurred. Conclusion: Hemodynamic instability is a common complication occurred during perioperative period of extra-cranial carotid angiography and stent implantation. As a prophylactic measure, preoperative placement of temporary cardiac pacemaker can promptly and effectively correct the hemodynamic disorders and prevent perioperative complications such as stroke, etc. Therefore, this technique is worth employing in clinical practice, and it is especially useful for patients with high risks. (authors)

Preliminary study of the scan-delay-time during the combined examation of CT perfusion and CT angiography after contrast media administration in cerebral and cervical CT angiography

International Nuclear Information System (INIS)

Cai Wu; Gong Jianping; Zhu Jiangtao; Qiao Fang; Chen Guangqiang; Zhang Bo; Yi Bixing; Qian Minghui

2010-01-01

Objective: To discuss the feasibility of the time to peak of cerebral CT perfusion (CTP) in predicting the scan-delay-time after contrast media administration in cerebral and cervical CT angiography (CTA). Methods: Retrospective Analysis was performed in eighty patients who had been examined with cerebral and cervical CTA, they were divided randomly into two groups. Group A:40 patients were performed by the method of experience of 20 seconds as scan-delay-time. Group B:the other 40 patients were examined with the combination scanning technology of CTP-CTA. They were all measured with enhancement value of CT in the M1 segment of left middle cerebral artery, superior sagittal sinus , left common carotid artery adjacent to the fourth cervical vertebrace and internal jugular vein, and then calculate the difference between the arterys and the veins in the same layer. Statistical significance was determined with t test. Results: (1)The enhancement value of CT in the cerebral and cervical artery vessels and the resolving power between the arterys and the veins in the same layer of group B were higher than that in group A. (2) Group B whose cerebral and cervical artery vessels rescontructed from the raw CT data set showed clearly; There were an advance in 3 cases (7.5%), a delay in 5 cases (12.5%) in group A whose cerebral and cervical artery vessels rescontructed from the raw CT data set didn't show clearly.Conclusion It's a satisfactory method based on successful cerebral and cervical CTA study to take the time to peak in CT perfusion as the scan-delay-time during the combined examination of CTP and CTA with 64-detector spiral CT. (authors)

Generalised brain edema and brain infarct in ergotamine abuse: Visualization by CT, MR and angiography

International Nuclear Information System (INIS)

Toedt, C.; Hoetzinger, H.; Salbeck, R.; Beyer, H.K.

1989-01-01

Abuse of ergotamine can release a generalised brain edema and brain infarctions. This can be visualized by CT, MR and angiography. The reason, however, can only be found in the patients history. (orig.) [de

Normal values of left ventricularmass and cardiac chamber volumes assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study

DEFF Research Database (Denmark)

Fuchs, Andreas; Mejdahl, Mads Rams; Kühl, J Tobias

2016-01-01

Aims Normal values of left ventricular mass (LVM) and cardiac chamber sizes are prerequisites for the diagnosis of individuals with heart disease. LVM and cardiac chamber sizes may be recorded during cardiac computed tomography angiography (CCTA), and thus modality specific normal values are need...

3D Deep Learning Angiography (3D-DLA) from C-arm Conebeam CT.

Science.gov (United States)

Montoya, J C; Li, Y; Strother, C; Chen, G-H

2018-05-01

Deep learning is a branch of artificial intelligence that has demonstrated unprecedented performance in many medical imaging applications. Our purpose was to develop a deep learning angiography method to generate 3D cerebral angiograms from a single contrast-enhanced C-arm conebeam CT acquisition in order to reduce image artifacts and radiation dose. A set of 105 3D rotational angiography examinations were randomly selected from an internal data base. All were acquired using a clinical system in conjunction with a standard injection protocol. More than 150 million labeled voxels from 35 subjects were used for training. A deep convolutional neural network was trained to classify each image voxel into 3 tissue types (vasculature, bone, and soft tissue). The trained deep learning angiography model was then applied for tissue classification into a validation cohort of 8 subjects and a final testing cohort of the remaining 62 subjects. The final vasculature tissue class was used to generate the 3D deep learning angiography images. To quantify the generalization error of the trained model, we calculated the accuracy, sensitivity, precision, and Dice similarity coefficients for vasculature classification in relevant anatomy. The 3D deep learning angiography and clinical 3D rotational angiography images were subjected to a qualitative assessment for the presence of intersweep motion artifacts. Vasculature classification accuracy and 95% CI in the testing dataset were 98.7% (98.3%-99.1%). No residual signal from osseous structures was observed for any 3D deep learning angiography testing cases except for small regions in the otic capsule and nasal cavity compared with 37% (23/62) of the 3D rotational angiographies. Deep learning angiography accurately recreated the vascular anatomy of the 3D rotational angiography reconstructions without a mask. Deep learning angiography reduced misregistration artifacts induced by intersweep motion, and it reduced radiation exposure

Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management

International Nuclear Information System (INIS)

Gruettner, Joachim; Fink, Christian; Walter, Thomas; Meyer, Mathias; Apfaltrer, Paul; Schoepf, U. Joseph; Saur, Joachim; Sueselbeck, Tim; Traunwieser, Dominik; Takx, Richard

2013-01-01

Objective: To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. Materials and methods: 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Results: Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated D-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Conclusion: Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis

Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management

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Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Fink, Christian, E-mail: Christian.Fink@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Walter, Thomas, E-mail: thomas.walter@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); Saur, Joachim, E-mail: joachim.saur@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Sueselbeck, Tim, E-mail: tim.sueselbeck@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Traunwieser, Dominik, E-mail: dominik.traunwieser@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Takx, Richard, E-mail: richard.takx@gmail.com [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); and others

2013-01-15

Objective: To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. Materials and methods: 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Results: Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated D-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Conclusion: Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis.

Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

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Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

2010-11-15

Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

Noninvasive physiologic assessment of coronary stenoses using cardiac CT.

Science.gov (United States)

Xu, Lei; Sun, Zhonghua; Fan, Zhanming

2015-01-01

Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation.

Science.gov (United States)

Andreini, Daniele; Pontone, Gianluca; Mushtaq, Saima; Mancini, Maria Elisabetta; Conte, Edoardo; Guglielmo, Marco; Volpato, Valentina; Annoni, Andrea; Baggiano, Andrea; Formenti, Alberto; Ditali, Valentina; Perchinunno, Marco; Fiorentini, Cesare; Bartorelli, Antonio L; Pepi, Mauro

2018-04-01

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). 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 (ethics committee approved the study protocol. 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. • 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.

The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

Directory of Open Access Journals (Sweden)

Beganu Elena

2017-09-01

Full Text Available Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.

Microdose computed tomographic cardiac angiography in normal cats.

Science.gov (United States)

Rodriguez, Kiira T; O'Brien, Mauria A; Hartman, Susan K; Mulherin, Allison C; McReynolds, Casie J; McMichael, Maureen; Rapoport, Gregg; O'Brien, Robert T

2014-03-01

To determine if microdose contrast-enhanced multi-detector computed tomographic angiography (MDCTA) allows characterization of cardiac chambers in lightly sedated normal cats. Seven healthy domestic cats. Lightly sedated normal cats were imaged pre-contrast and with microdose (0.22 ml/kg of non-ionic iodinated contrast medium, 300 mg I/ml) triple-phase MDCTA in a motion restriction device. On pre-contrast images, the aorta (median: 52.43 Hounsfield units [HU], range 27.35-76.74 HU) was outlined by significantly (p = 0.015) lower attenuating periaortic fat (-66.16 HU, -42.62 to -92.77 HU). On post-contrast images, median peak contrast enhancement in the right ventricle (111.77 HU, 36.09-141.60 HU) was achieved in 3.1 s (range 2.9-7.3 s), in the aorta (149.30 HU, 99.43-319.60 HU) and left atrium (180.83 HU, 88.53-266.84 HU) in 6.4 s (range 5.6-7.7 s) and in the left ventricle (147.89 HU, 57.23-245.77 HU) in 7.10 s (range 6.2-11.2 s). Significantly higher attenuation was measured between all chambers and walls, the right ventricular lumen and interventricular septum (median ratio 53.78 HU, range 0.21-83.20 HU), left ventricular lumen and left ventricular free wall (89.32 HU, 38.81-185.95 HU) and aorta and periaortic fat (190.43 HU, 143.22-425.44 HU) on post-contrast images. Sufficient biological contrast is available on survey CT to discriminate between the aorta and the left atrium, and microdose MDCTA provides sufficient contrast enhancement for adequate visualization of the heart chambers in normal cats. Copyright © 2014 Elsevier B.V. All rights reserved.

Assessment of Myocardial Bridge and Mural Coronary Artery Using ECG-Gated 256-Slice CT Angiography: A Retrospective Study

Directory of Open Access Journals (Sweden)

En-sen Ma

2013-01-01

Full Text Available Recent clinical reports have indicated that myocardial bridge and mural coronary artery complex (MB-MCA might cause major adverse cardiac events. 256-slice CT angiography (256-slice CTA is a newly developed CT system with faster scanning and lower radiation dose compared with other CT systems. The objective of this study is to evaluate the morphological features of MB-MCA and determine its changes from diastole to systole phase using 256-slice CTA. The imaging data of 2462 patients were collected retrospectively. Two independent radiologists reviewed the collected images and the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter, and thickness of MB-MCA in diastole and systole phases were recorded, and changes of MB-MCA were calculated. Our results showed that among the 2462 patients examined, 336 have one or multiple MB-MCA (13.6%. Out of 389 MB-MCA segments, 235 sites were located in LAD2 (60.41%. The average diameter change of MCA in LAD2 from systole phase to diastole phase was  mm, and 34.9% of MCA have more than 50% diameter stenosis in systole phase. This study suggested that 256-slice CTA multiple-phase reconstruction technique is a reliable method to determine the changes of MB-MCA from diastole to systole phase.

Echocardiography as an indication of continuous-time cardiac quiescence

Science.gov (United States)

Wick, C. A.; Auffermann, W. F.; Shah, A. J.; Inan, O. T.; Bhatti, P. T.; Tridandapani, S.

2016-07-01

Cardiac computed tomography (CT) angiography using prospective gating requires that data be acquired during intervals of minimal cardiac motion to obtain diagnostic images of the coronary vessels free of motion artifacts. This work is intended to assess B-mode echocardiography as a continuous-time indication of these quiescent periods to determine if echocardiography can be used as a cost-efficient, non-ionizing modality to develop new prospective gating techniques for cardiac CT. These new prospective gating approaches will not be based on echocardiography itself but on CT-compatible modalities derived from the mechanics of the heart (e.g. seismocardiography and impedance cardiography), unlike the current standard electrocardiogram. To this end, echocardiography and retrospectively-gated CT data were obtained from ten patients with varied cardiac conditions. CT reconstructions were made throughout the cardiac cycle. Motion of the interventricular septum (IVS) was calculated from both echocardiography and CT reconstructions using correlation-based, deviation techniques. The IVS was chosen because it (1) is visible in echocardiography images, whereas the coronary vessels generally are not, and (2) has been shown to be a suitable indicator of cardiac quiescence. Quiescent phases were calculated as the minima of IVS motion and CT volumes were reconstructed for these phases. The diagnostic quality of the CT reconstructions from phases calculated from echocardiography and CT data was graded on a four-point Likert scale by a board-certified radiologist fellowship-trained in cardiothoracic radiology. Using a Wilcoxon signed-rank test, no significant difference in the diagnostic quality of the coronary vessels was found between CT volumes reconstructed from echocardiography- and CT-selected phases. Additionally, there was a correlation of 0.956 between the echocardiography- and CT-selected phases. This initial work suggests that B-mode echocardiography can be used as a

Dynamic CT myocardial perfusion imaging

International Nuclear Information System (INIS)

Caruso, Damiano; Eid, Marwen; Schoepf, U. Joseph; Jin, Kwang Nam; Varga-Szemes, Akos; Tesche, Christian; Mangold, Stefanie

2016-01-01

Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

Dynamic CT myocardial perfusion imaging

Energy Technology Data Exchange (ETDEWEB)

Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome “Sapienza”, Latina (Italy); Eid, Marwen [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Mangold, Stefanie [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen (Germany); and others

2016-10-15

Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

Closing in on the K Edge : Coronary CT Angiography at 100, 80, and 70 kV-Initial Comparison of a Second-versus a Third-Generation Dual-Source CT System

NARCIS (Netherlands)

Meyer, Mathias; Haubenreisser, Holger; Schoepf, U. Joseph; Vliegenthart, Rozemarijn; Leidecker, Christianne; Allmendinger, Thomas; Lehmann, Ralf; Sudarski, Sonja; Borggrefe, Martin; Schoenberg, Stefan O.; Henzler, Thomas

2014-01-01

Purpose: To prospectively evaluate radiation and contrast medium requirements for performing high-pitch coronary computed tomographic (CT) angiography at 70 kV using a third-generation dual-source CT system in comparison to a second-generation dual-source CT system. Materials and Methods: All

Multislice CT coronary angiography: evaluation of an automatic vessel detection tool

International Nuclear Information System (INIS)

Dewey, M.; Schnapauff, D.; Lembcke, A.; Hamm, B.; Rogalla, P.; Laule, M.; Borges, A.C.; Rutsch, W.

2004-01-01

Purpose: To investigate the potential of a new detection tool for multisliceCT (MSCT) coronary angiography with automatic display of curved multiplanar reformations and orthogonal cross-sections. Materials and Methods: Thirty-five patients were consecutively enrolled in a prospective intention-to-diagnose study and examined using a MSCT scanner with 16 x 0.5 mm detector collimation and 400 ms gantry rotation time (Aquilion, Toshiba). A multisegment algorithm using up to four segments was applied for ECG-gated reconstruction. Automatic and manual detection of coronary arteries was conducted using the coronary artery CT protocol of a workstation (Vitrea 2, Version 3.3, Vital Images) to detect significant stenoses (≥50%) in all segments of ≥1.5 mm in diameter. Each detection tool was used by one reader who was blinded to the results of the other detection method and the results of conventional coronary angiography. Results: The overall sensitivity, specificity, nondiagnostic rate, and accuracy of the automatic and manual approach were 90 vs. 94%, 89 vs. 84%, 6 vs. 6%, and 89 vs. 88%, respectively (p=n.s.). The vessel length detected with the automatic and manual approach were highly correlated for the left main/left anterior descending (143±30 vs. 146±24 mm, r=0.923, p [de

Nuclear magnetic resonance imaging with cardiac synchronization in chronic thrombosis of main pulmonary arteries. A case review with CT scan imaging correlation

International Nuclear Information System (INIS)

Coulomb, M.; Wolf, J.E.; Rose-Pittet, L.; Le Bas, J.F.; Dalsoglio, S.; Paramelle, B.

1986-01-01

Results of nuclear magnetic resonance exploration in a patient with chronic thrombosis of main pulmonary arteries are used to outline an elementary semiology in agreement with current documented data. Signs observed relate to the thrombosis and showing of flow due to associated pulmonary artery hypertension. Cardiac synchronization is essential: obtaining 2 echos by the spin-echo technique allows differentiation of circulatory slowing phenomena, which provoke increased strength of 2nd echo, from the thrombus itself. Correlations established with V/Q scintigraphy, angiography and CT scan findings in this case provided preliminary evaluation of use of this imaging technique in this affection [fr

TRIAGE OF PATIENTS TO ANGIOGRAPHY FOR DETECTION OF AORTIC RUPTURE AFTER BLUNT CHEST TRAUMA - COST-EFFECTIVENESS ANALYSIS OF USING CT

NARCIS (Netherlands)

HUNINK, MGM; BOS, JJ

OBJECTIVE. The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest

Evaluation of left ventricular function by cardiac CT

International Nuclear Information System (INIS)

Naito, Hiroaki; Kozuka, Takahiro

1982-01-01

Left ventricular function was evaluated by CT, which was compared with the data of left ventriculography for various cardiac diseases. The end diastolic volume of the left ventricle can be readily computed from CT, with a satisfactory correlation with that of left ventriculography (r = 0.95). The left ventricular ejection fraction, calculated from the areal ratio of the left ventricular lumen in end-diastolic imaging to that in end-sytolic imaging, also roughly reflects left ventricular contractile function, but shows correlation with left ventriculography by only r = 0.79. Although the cardiac output is not sensitive for functional evaluation, it can be directly calculated by means of dynamic scanning and shows a satisfactory correlation with the ear piece pigment dilution (r = 0.85). Evaluation of left ventricular function by CT shows a high precision in comparison with left ventriculography, but still lacks temporal resolving power. (Chiba, N.)

Evaluation of Right Ventricular Function with Radionuclide Cardiac Angiography - Right Ventricular Ejection Fraction in Chronic Obstructive Lung Disease

International Nuclear Information System (INIS)

Sohn, In; Shin, Sung Hae; Chung, June Key; Lee, Myung Chul; Cho, Bo Youn; Lee, Young Woo; Han, Yong Cheol; Koh, Chang Soon

1982-01-01

To evaluate the usefulness of radionuclide cardiac angiography in the assessment of the right ventricular function, we measured right ventricular ejection fraction (RVEF) using single pass method. In 12 normal persons, RVEF averaged 52.7±5.9% (mean±S.D.). In 25 patients with chronic obstructive lung disease, RVEF was 37.2±10.6% and significantly lower than that of normal person (p<0.01). All 10 patients with right ventricular failure had abnormal RVEF, which was significantly lower than that of 14 persons without right ventricular failure (27.6±5.7%, 43.9±8.5%, respectively, p<0.01). It concluded that RVEF measured by single pass radionuclide cardiac angiography was a useful, noninvasive method to assess right ventricular function.

Low dose coronary CT angiography with 256-slice helical CT

International Nuclear Information System (INIS)

Zhang Xiaodong; Tang Binghang; Li Fangyun

2011-01-01

Objective: To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral ( RGS) technique on a 256-slice CT scanner. Methods: A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: (1) 50 patients with an average heart rate (HR) ≤ 70 bpm were scanned with a data acquisition time window centered at the 75% of the R-R cycle (group A) and (2) 50 patients with HR > 70 bpm were scanned with the data acquisition time window centered at the 45% of the R-R cycle, including a phase tolerance of ± 5% (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤ 70 bpm were scanned with cardiac dose right set to phase of 75% ( group C) and (4) 50 patients with HR > 70 bpm were scanned with cardiac ose Rdight set to phases of 45% and 75% (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 (1: excellent; 4: non-assessable). Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test. The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A Spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode. Results: Of 2338 coronary artery segments, excellent or good image quality (score of 1 or 2) was achieved in 96.5% (585 of 606) in group A, 77.7% (445

Dose modulated retrospective ECG-gated versus non-gated 64-row CT angiography of the aorta at the same radiation dose: Comparison of motion artifacts, diagnostic confidence and signal-to-noise-ratios

International Nuclear Information System (INIS)

Schernthaner, Ruediger E.; Stadler, Alfred; Beitzke, Dietrich; Homolka, Peter; Weber, Michael; Lammer, Johannes; Czerny, Martin; Loewe, Christian

2012-01-01

Purpose: To compare ECG-gated and non-gated CT angiography of the aorta at the same radiation dose, with regard to motion artifacts (MA), diagnostic confidence (DC) and signal-to-noise-ratios (SNRs). Materials and methods: Sixty consecutive patients prospectively randomized into two groups underwent 64-row CT angiography, with or without dose-modulated ECG-gating, of the entire aorta, due to several pathologies of the ascending aorta. MA and DC were both assessed using a four-point scale. SNRs were calculated by dividing the mean enhancement by the standard deviation. The dose-length-product (DLP) of each examination was recorded and the effective dose was estimated. Results: Dose-modulated ECG-gating showed statistically significant advantages over non-gated CT angiography, with regard to MA (p < 0.001) and DC (p < 0.001), at the aortic valve, at the origin of the coronary arteries, and at the dissection membrane, with a significant correlation (p < 0.001) between MA and DC. At the aortic wall, however, ECG-gated CT angiography showed statistically significant fewer MA (p < 0.001), but not a statistically significant higher DC (p = 0.137) compared to non-gated CT angiography. At the supra-aortic vessels and the descending aorta, the ECG-triggering showed no statistically significant differences with regard to MA (p = 0.861 and 0.526, respectively) and DC (p = 1.88 and 0.728, respectively). The effective dose of ECG-gated CT angiography (23.24 mSv; range, 18.43–25.94 mSv) did not differ significantly (p = 0.051) from that of non-gated CT angiography (24.28 mSv; range, 19.37–29.27 mSv). Conclusion: ECG-gated CT angiography of the entire aorta reduces MA and results in a higher DC with the same SNR, compared to non-gated CT angiography at the same radiation dose.

18F-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material.

Science.gov (United States)

Pizzi, María N; Dos-Subirà, L; Roque, Albert; Fernández-Hidalgo, Nuria; Cuéllar-Calabria, Hug; Pijuan Domènech, Antonia; Gonzàlez-Alujas, María T; Subirana-Domènech, M T; Miranda-Barrio, B; Ferreira-González, Ignacio; González-López, Juan J; Igual, Albert; Maisterra-Santos, Olga; García-Dorado, David; Castell-Conesa, Joan; Almirante, Benito; Escobar Amores, Manuel; Tornos, Pilar; Aguadé-Bruix, Santiago

2017-12-01

Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18 F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥18years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC+PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. Between November-2012 and April-2017, 25 patients (15 men; median age 40years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC+PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

The role of CT angiography in the evaluation of pediatric renovascular hypertension

Energy Technology Data Exchange (ETDEWEB)

Kurian, Jessica [The Perelman School of Medicine, University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); The Children' s Hospital at Montefiore, Bronx, NY (United States); Epelman, Monica [The Perelman School of Medicine, University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Darge, Kassa; Nijs, Els [The Perelman School of Medicine, University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Meyers, Kevin [The Perelman School of Medicine, University of Pennsylvania, Division of Nephrology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Hellinger, Jeffrey C. [The Perelman School of Medicine, University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); New York Cardiovascular Institute and Lenox Hill Radiology, New York, NY (United States)

2013-04-15

Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility. Additionally, in our experience high-quality renal CTA can be performed using low-dose radiation exposures and can be acquired without sedation in most instances. This article illustrates by examples the usefulness of renal CTA for diagnosis of childhood renovascular hypertension and provides an overview of renal CTA findings in the most common childhood renovascular diseases. (orig.)

Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

Energy Technology Data Exchange (ETDEWEB)

Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

2015-12-15

Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

Assessment of vertebral artery stents using 16-slice multi-detector row CT angiography in vivo evaluation: Comparison of a medium-smooth kernel and a sharp kernel

International Nuclear Information System (INIS)

Yoo, Won Jong; Lim, Yeon Soo; Ahn, Kook Jin; Choi, Byung Gil; Kim, Ji Young; Kim, Sung Hoon

2009-01-01

Objectives: To assess the lumen visibility of extracranial vertebral artery stents examined with 16-slice multi-detector row computed tomography (MDCT) angiography in vivo using a medium-smooth kernel (B30s) and a sharp kernel (B60s), and to compare these with digital subtraction angiography (DSA) after stent placement. Methods: Twenty stents from 20 patients (14 men, 6 women; mean age, 62.7 ± 10.1 years) who underwent CT angiography (CTA) with 16-slice MDCT were retrospectively analyzed. In CT angiograms using a B30s and a B60s, the lumen diameters and CT attenuations of the stented vessels were measured three times by three observers, and artificial luminal narrowing (ALN) was calculated. To assess measurement reliability on CT angiograms, the intraclass correlation coefficient (ICC) was used. DSA served as the reference standard for the in-stent luminal measurements on CT angiography. The median interval between CT angiography and DSA was 1 day (range 1-10). Results: For interobserver reliability, intraclass correlation coefficients for the lumen diameters on CT angiograms with a B30s and a B60s were 0.90 and 0.96, respectively. The lumen diameters on CT angiograms using a B30s were consistently smaller than that on CT angiograms using a B60s (p < 0.01). The mean ALN was 37 ± 7% on CT angiograms using a B30s and 25 ± 9% on CT angiograms using a B60s. The mean CT attenuation in in-stent lumen was 347 ± 55 HU on CT angiograms using a B30s and 295 ± 46 HU on CT angiograms using a B60s. The ALN and CT attenuation within the stented vessels between CT angiograms using a B30s and a B60s was significant (p < 0.01). Conclusions: 16-slice MDCT using a sharp kernel allows good visualization of the stented vessels and is useful in the assessment of vertebral artery stent patency after stent placement.

Whole-body CT. Spiral and multislice CT. 2. tot. rev. and enl. ed.

International Nuclear Information System (INIS)

Prokop, M.; Galanski, M.; Schaefer-Prokop, C.; Molen, A.J. van der

2007-01-01

Spiral and multidetector techniques have improved the diagnostic possibilities of CT, so that image analysis and interpretation have become increasingly complex. This book represents the current state of the art in CT imaging, including the most recent technical scanner developments. The second edition comprises the current state of knowledge in cT imaging. There are new chapters on image processing, application of contrasting agents and radiation dose. All organ-specific pathological findings are discussed in full. There are hints for optimum use and interpretation of CT, including CT angiography, CT colonography, CT-IVPL, and 3D imaging. There is an introduction to cardio-CT, from calcium scoring and CTA of the coronary arteries to judgement of cardiac morphology. There are detailed scan protocols with descriptions of how to go about parameter selection. Practical hints are given for better image quality and lower radiation exposure of patients, guidelines for patient preparation and complication management, and more than 1900 images in optimum RRR quality. (orig.)

Catheter Angiography

Medline Plus

Full Text Available ... further information please consult the ACR Manual on Contrast Media and its references. The risk of serious allergic ... View full size with caption Related Articles and Media Angioplasty and Vascular Stenting MR Angiography (MRA) Contrast Materials CT Angiography (CTA) X-ray, Interventional Radiology ...

Renal computed angiography. Part I: Renal CT phlebography. Renal veins variants

International Nuclear Information System (INIS)

Al-Amin, M.; Krupev, M.; Hadjidekov, V.; Plachkov, I.

2012-01-01

The changing trend in renal surgery, transplantation and minimal invasive urology implies preprocedure evaluation of renal veins. Development of imaging methods offers new possibilities for venographic visualization. The goal of this study is to present authors experience in visualization of renal veins using 64 MDCT and to evaluate the utility in assessments of their variants. 128 patients (68 females and 60 males, mean age 53,3) with urological complaints underwent 64MDCT examination including CT angiography. Contrast enhancement includes 3-4ml/sec injection flow of 90 ml contrast medium followed by 20 ml saline at the same rate. In 23 out of 128 examined patients some of the common variants of the renal vein is found. 64 MDCT angiography visualize very well renal veins and becomes method of choice in preoperative assessment of renal vein anatomy. (authors)

Noninvasive Physiologic Assessment of Coronary Stenoses Using Cardiac CT

Directory of Open Access Journals (Sweden)

Lei Xu

2015-01-01

Full Text Available Coronary CT angiography (CCTA has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD. CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive “one-stop-shop” diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT, and transluminal attenuation gradient (TAG, CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

Computer graphic display of cardiac CT scans

International Nuclear Information System (INIS)

Palmer, R.; Carlsson, E.

1982-01-01

In order to improve spatial conception and quantitative assessment of the cardiac structures based on cardiac computed tomography, methods for computer graphic display were developed. Excised hearts and living dogs with myocardial infarctions were subjected to CT scanning. The data on the scanner tapes were processed to provide isodensity plots, linear section plots, time-weighted integrated isodensity plots as well as topographical density displays and three-dimensional spatial reconstructions of single and multi-layer scans. (orig.)

Statistical coronary motion models for 2D + t/3D registration of X-ray coronary angiography and CTA

DEFF Research Database (Denmark)

Baka, N.; Metz, C. T.; Schultz, C.

2013-01-01

Accurate alignment of intra-operative X-ray coronary angiography (XA) and pre-operative cardiac CT angiography (CTA) may improve procedural success rates of minimally invasive coronary interventions for patients with chronic total occlusions. It was previously shown that incorporating patient...... specific coronary motion extracted from 4D CTA increases the robustness of the alignment. However, pre-operative CTA is often acquired with gating at end-diastole, in which case patient specific motion is not available. For such cases, we investigate the possibility of using population based coronary...

The role of angiography in the congruence of cardiovascular measurements between autopsy and postmortem imaging.

Science.gov (United States)

Troxler, Renaud; Minoiu, Costin; Vaucher, Paul; Michaud, Katarzyna; Doenz, Francesco; Ducrot, Kewin; Grabherr, Silke

2018-01-01

Postmortem CT angiography is the method of choice for the postmortem imaging investigations of the cardiovascular (CV) system. However, autopsy still remains the gold standard for CV measurement. Nevertheless, there are not any studies on CV measurements on the multi-phase postmortem angiography (MPMCTA) which includes comparisons with autopsy. Therefore, the aim of this study is to compare CV measurements between the native CT scan and the three phases of the MPMCTA to find out which of these modalities correlate the best with autopsy measurements. For this study, we selected retrospectively 50 postmortem cases that underwent both MPMCTA and autopsy. A comparison was carried out between the CV measurements obtained with imaging (aorta; heart cavities and cardiac wall thicknesses; maximum cardiac diameter and cardiothoracic ratio) and at the autopsy (aorta; cardiac valves, ventricular thicknesses, and weight). Our results show that the dynamic phase displays an advantage for the measurement of the aortas. However, the MPMCTA is not accurate to measure the cardiac wall thicknesses. The measurements of the heart cavities show no correlation with the heart valves. The cardiothoracic ratio measured by the MPMCTA shows no correlation with the heart weight. Nevertheless, the maximum cardiac diameter exhibits a correlation with the latter on the venous and dynamic phase. These results show that only few CV parameters measured with imaging correlate with measurement obtained at the autopsy. These results indicate that in order to better estimate values obtained at the autopsy, we need to define new reference values for the CV measurement on MPMCTA.

Maximum-intensity-projection CT angiography for evaluating head and neck tumors. Usefulness of helical CT and auto bone masking method

International Nuclear Information System (INIS)

Sakai, Osamu; Nakashima, Noriko; Ogawa, Chiaki; Shen, Yun; Takata, Yasunori; Azemoto, Shougo.

1994-01-01

Angiographic images of 10 adult patients with head and neck tumors were obtained by helical computed tomography (CT) using maximum intensity projection (MIP). In all cases, the vasculature of the head and neck region was directly demonstrated. In the head and neck, bone masking is a more important problem than in other regions. We developed an effective automatic bone masking method (ABM) using 2D/3D connectivity. Helical CT angiography with MIP and ABM provided accurate anatomic depiction, and was considered to be helpful in preoperative evaluation of head and neck tumors. (author)

Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography A systematic review and meta-analysis

DEFF Research Database (Denmark)

Abdulla, Jawdat; Asferg, Camilla Lundegaard; Kofoed, Klaus Fuglsang

2011-01-01

To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings. A systematic literature search and meta...

Multidetector CT angiography in Takayasu arteritis

Energy Technology Data Exchange (ETDEWEB)

Khandelwal, Niranjan; Kalra, Naveen [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Garg, Mandeep Kumar, E-mail: gargmandeep@hotmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Kang, Mandeep; Lal, Anupam [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Jain, Sanjay [Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India); Suri, Sudha [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012 (India)

2011-02-15

Objective: To analyse the spectrum of Takayasu's arteritis (TA) on multidetector CT angiography (MDCTA). Materials and methods: A retrospective analysis of the MDCTA findings was performed on 15 patients clinically diagnosed as Takayasu's arteritis. The spectrum and incidence of imaging findings on CTA were compared to studies in literature on catheter angiography in Takayasu's arteritis. Laboratory parameters were available in nine patients. The disease was considered active if erythrocyte sedimentation rate (ESR) levels were elevated and 'C' reactive protein (CRP) was positive. An attempt was made to correlate disease activity with the imaging findings. Results: Ascending aorta, arch of aorta and descending thoracic aorta were involved in 14 out of 15 (93%) patients. The wall thickness varied between 1 and 10 mm with maximal involvement in arch and descending thoracic aorta. Major neck vessels were involved in 11 (73%) patients with most pronounced changes seen in the brachiocephalic trunk, left common carotid artery (CCA) and left subclavian artery (SCA). Abdominal aorta and its branches were involved in all the 11 (100%) patients in whom abdominal CTA was performed. Celiac axis and SMA were involved in 10 (91%) and seven (64%) patients, respectively while renal artery stenosis was present in five (45%) patients. In six patients, ESR was elevated and CRP was positive indicating active disease. All patients in whom the laboratory parameters were available showed mural thickening in the aorta and at least one of the neck vessels except for one patient with inactive disease who had aortic mural thickening only. Conclusion: MDCTA provides information about both the vessel wall and lumen in patients with Takayasu's disease.

Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

Science.gov (United States)

Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

2002-01-01

Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

A Novel Approach of Cardiac Segmentation In CT Image Based On Spline Interpolation

International Nuclear Information System (INIS)

Gao Yuan; Ma Pengcheng

2011-01-01

Organ segmentation in CT images is the basis of organ model reconstruction, thus precisely detecting and extracting the organ boundary are keys for reconstruction. In CT image the cardiac are often adjacent to the surrounding tissues and gray gradient between them is too slight, which cause the difficulty of applying classical segmentation method. We proposed a novel algorithm for cardiac segmentation in CT images in this paper, which combines the gray gradient methods and the B-spline interpolation. This algorithm can perfectly detect the boundaries of cardiac, at the same time it could well keep the timeliness because of the automatic processing.

Preoperative evaluation of renal anatomy and renal masses with helical CT, 3D-CT and 3D-CT angiography.

Science.gov (United States)

Toprak, Uğur; Erdoğan, Aysun; Gülbay, Mutlu; Karademir, Mehmet Alp; Paşaoğlu, Eşref; Akar, Okkeş Emrah

2005-03-01

The aim of this prospective study was to determine the efficacy of three-dimensional computed tomography (3D-CT) and three-dimensional computed tomographic angiography (3D-CTA) that were reconstructed by using the axial images of the multiphasic helical CT in the preoperative evaluation of renal masses and demonstration of renal anatomy. Twenty patients that were suspected of having renal masses upon initial physical examination and ultrasonographic evaluation were examined through multiphasic helical CT. Two authors executed CT evaluations. Axial images were first examined and then used to reconstruct 3D-CT and 3D- CTA images. Number, location and size of the renal masses and other findings were noted. Renal vascularization and relationships of the renal masses with the neighboring renal structures were further investigated with 3D-CT and 3D-CTA images. Out of 20 patients, 13 had histopathologically proven renal cell carcinoma. The diagnoses of the remaining seven patients were xanthogranulomatous pyelonephritis, abscess, simple cyst, infected cyst, angiomyolipoma, oncocytoma and arteriovenous fistula. In the renal cell carcinoma group, 3 patients had stage I, 7 patients had stage II, and 3 patients had stage III disease. Sizes of renal cell carcinoma masses were between 23 mm to 60 mm (mean, 36 mm). Vascular invasion was shown in 2 renal cell carcinoma patients. Collecting system invasion was identified in 11 of 13 renal cell patients. These radiologic findings were confirmed with surgical specimens. Three-dimensional CT and 3D-CTA are non-invasive, effective imaging techniques for the preoperative evaluation of renal masses.

Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience

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Ierardi, Anna Maria; Duka, Ejona [University of Insubria, Interventional Radiology, Department of Radiology (Italy); Radaelli, Alessandro [Philips Healthcare (Netherlands); Rivolta, Nicola; Piffaretti, Gabriele [University of Insubria, Vascular Surgery Department (Italy); Carrafiello, Gianpaolo, E-mail: gcarraf@gmail.com [University of Insubria, Interventional Radiology, Department of Radiology (Italy)

2016-01-15

AimTo evaluate the feasibility of image fusion (IF) of pre-procedural arterial-phase CT angiography or MR angiography with intra-procedural fluoroscopy for road-mapping in endovascular treatment of aorto-iliac steno-occlusive disease.Materials and MethodsBetween September and November, 2014, we prospectively evaluated 5 patients with chronic aorto-iliac steno-occlusive disease, who underwent endovascular treatment in the angiography suite. Fusion image road-mapping was performed using angiographic phase CT images or MR images acquired before and intra-procedural unenhanced cone-beam CT. Radiation dose of the procedure, volume of intra-procedural iodinated contrast medium, fluoroscopy time, and overall procedural time were recorded. Reasons for potential fusion imaging inaccuracies were also evaluated.ResultsImage co-registration and fusion guidance were feasible in all procedures. Mean radiation dose of the procedure was 60.21 Gycm2 (range 55.02–63.75 Gycm2). The mean total procedure time was 32.2 min (range 27–38 min). The mean fluoroscopy time was 12 min and 3 s. The mean procedural iodinated contrast material dose was 24 mL (range 20–40 mL).ConclusionsIF gives Interventional Radiologists the opportunity to use new technologies in order to improve outcomes with a significant reduction of contrast media administration.

Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience

International Nuclear Information System (INIS)

Ierardi, Anna Maria; Duka, Ejona; Radaelli, Alessandro; Rivolta, Nicola; Piffaretti, Gabriele; Carrafiello, Gianpaolo

2016-01-01

AimTo evaluate the feasibility of image fusion (IF) of pre-procedural arterial-phase CT angiography or MR angiography with intra-procedural fluoroscopy for road-mapping in endovascular treatment of aorto-iliac steno-occlusive disease.Materials and MethodsBetween September and November, 2014, we prospectively evaluated 5 patients with chronic aorto-iliac steno-occlusive disease, who underwent endovascular treatment in the angiography suite. Fusion image road-mapping was performed using angiographic phase CT images or MR images acquired before and intra-procedural unenhanced cone-beam CT. Radiation dose of the procedure, volume of intra-procedural iodinated contrast medium, fluoroscopy time, and overall procedural time were recorded. Reasons for potential fusion imaging inaccuracies were also evaluated.ResultsImage co-registration and fusion guidance were feasible in all procedures. Mean radiation dose of the procedure was 60.21 Gycm2 (range 55.02–63.75 Gycm2). The mean total procedure time was 32.2 min (range 27–38 min). The mean fluoroscopy time was 12 min and 3 s. The mean procedural iodinated contrast material dose was 24 mL (range 20–40 mL).ConclusionsIF gives Interventional Radiologists the opportunity to use new technologies in order to improve outcomes with a significant reduction of contrast media administration

Myocardial perfusion imaging with dual energy CT

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Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); De Cecco, Carlo N. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome (Italy); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Spandorfer, Adam; Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States)

2016-10-15

Highlights: • Stress dual-energy sCTMPI offers the possibility to directly detect the presence of myocardial perfusion defects. • Stress dual-energy sCTMPI allows differentiating between reversible and fixed myocardial perfusion defects. • The combination of coronary CT angiography and dual-energy sCTMPI can improve the ability of CT to detect hemodynamically relevant coronary artery disease. - Abstract: Dual-energy CT (DECT) enables simultaneous use of two different tube voltages, thus different x-ray absorption characteristics are acquired in the same anatomic location with two different X-ray spectra. The various DECT techniques allow material decomposition and mapping of the iodine distribution within the myocardium. Static dual-energy myocardial perfusion imaging (sCTMPI) using pharmacological stress agents demonstrate myocardial ischemia by single snapshot images of myocardial iodine distribution. sCTMPI gives incremental values to coronary artery stenosis detected on coronary CT angiography (CCTA) by showing consequent reversible or fixed myocardial perfusion defects. The comprehensive acquisition of CCTA and sCTMPI offers extensive morphological and functional evaluation of coronary artery disease. Recent studies have revealed that dual-energy sCTMPI shows promising diagnostic accuracy for the detection of hemodynamically significant coronary artery disease compared to single-photon emission computed tomography, invasive coronary angiography, and cardiac MRI. The aim of this review is to present currently available DECT techniques for static myocardial perfusion imaging and recent clinical applications and ongoing investigations.

Evaluation of peripheral artery stent with 64-slice multi-detector row CT angiography: Prospective comparison with digital subtraction angiography

International Nuclear Information System (INIS)

Li Xiaoming; Li Yuhua; Tian Jianming; Xiao Yi; Lu Jianping; Jing Zaiping; Sheng Jing; Edwin, Angela; Wu Fanghong

2010-01-01

Purpose: To assess the accuracy of 64-slice multi-detector row computed tomography (MDCT) angiography in the evaluation of peripheral artery in-stent or peristent restenosis, with conventional digital subtraction angiography (DSA) as the reference standard. Materials and methods: Forty-one patients (30 men, 11 women; mean age, 69.8 ± 9.2 years) with symptomatic peripheral arterial occlusive disease after peripheral artery stenting (81 stented lesions) underwent both conventional DSA and 64-slice MDCT angiography. Each stent was classified as evaluable or unevaluable, and every stent was divided into three segments (proximal stent, stent body, and distal stent), resulting in 243 segments. For evaluation, stenosis was graded as follows: 1, none or slight stenosis (<25%); 2, mild stenosis (25-49%); 3, moderate stenosis (50-74%); 4, severe stenosis or total occlusion (≥75%). Two readers evaluated all CT angiograms with regard to narrowing of in-stent or peristent restenosis by consensus. Results were compared with findings of the DSA. Results: Of 81 stents, 62 (76.5%) were determined to be assessable. The metal artifact of the gold marker and motion artifact increased uninterpretability of the images of stents. Overall, 24 of 28 in-stent restenosis and 38 of 53 persistent restenosis were correctly detected by MDCT (85.7% and 71.7% sensitivity). In evaluable stents, 21 of 22 in-stent restenoses and 27 of 28 persistent restenosis were correctly detected (95.4% and 96.4% sensitivity). Additionally, as the grade of stenosis increases, the mean level of CT values in the stent lumina decreases linearly accordingly. Conclusion: 64-Slice MDCT has a high accuracy for the detection of significant in-stent or peristent restenosis of assessable stents in patients with peripheral artery stent implantation and therefore can be considered as a valuable noninvasive technique for stent surveillance.

Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy

International Nuclear Information System (INIS)

Sun Zhonghua; Ng, Kwan-Hoong

2012-01-01

Purpose: To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and methods: A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies. Results: 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p < 0.001). The mean dose length product was 225 mGy cm (95% CI: 188, 262 mGy cm) and 822 mGy cm (95% CI: 630, 1013 mGy cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p < 0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p = 0.047). Conclusion: Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value.

Comparison of CT angiography and digital subtraction angiography in the evaluation of intracranial aneurysmal neck

International Nuclear Information System (INIS)

Kim, Yoo Kyung; Baik, Seung Kug; Shin, Mi Jeong; Choi, Han Yong

2001-01-01

To compare the usefulness of three-dimensional multislice CT angiography(CTA) and digital subtraction angiography (DSA) in the evaluation of intracranial aneurysmal neck. Nineteen patients with intracranial aneurysm (23 cases) underwent DSA and subsequent CTA. Using a multislice CT scanner and the SSD(shaded surface display) technique, clipping, cutting and the MPR technique, three-dimensional images were obtained. These were (a) external, (b) internal, from the direction of the parent artery, (c) internal, from the direction of the aneurysmal dome, and (d) an aneurysmal cutting image. The CTA findings were retrospectively compared with the DSA images. Twenty aneurysms were small and three were large. In eleven cases aneurysm neck was small, in nine it was wide, and in three it was relatively wide. For aneurysmal neck evaluation, CTA was superior to DSA in six of nine wide-neck aneurysms and all three large-sized wide-neck aneurysms. In small neck aneurysms 8 of 11 cases and in relatively wide neck all 3 cases showed similarly good images by both modalities. Of the 23 cases demonstrated by four different images, 14 cases showed the best image in internal image from parent artery direction and 6 cases showed similarly good image in both aneurysmal cutting image and internal image from parent artery direction. In the evaluation of wide neck aneurysms, 7 of 9 cases showed the best image at internal image from parent artery direction, compared with other three different images. In two cases of aneurysms, calcification was visible in the aneurysmal wall, so it was difficult to evaluate the aneurysmal neck. CTA was superior to DSA in the evaluating the intracranial aneurysmal neck. CTA maybe an additional available modality to evaluate the aneurysmal neck which is difficult to detect by the DSA. And the information of intracranial aneurysmal neck through CTA will be of value in surgical and endovascular treatment

The comparative study between multi-slice spiral CT angiography and color flow ultrasonography in hepatic and splenic trauma

International Nuclear Information System (INIS)

Yan Youxia; Zhang Jin'e; Chen Xiaocong; Cai Shufang

2007-01-01

Objective: To investigate the clinical value of multi-slice spiral CT angiography and color flow ultra- sonography in hepatic and splenic trauma. Methods Thirty-six cases of hepatic and splenic trauma were collected, the MSCT were analyzed and compared with that of color flow ultrasonography. Results: Seventeen cases were Hepatic trauma including nine cases of hepatic contusion, six cases of sub-envelope hematoma, two cases of both sub-envelope hematoma and hepatic contusion. Nineteen cases were splenic trauma including nine cases of splenic contusion, ten cases of sub-envelope hematoma. Conclusion: Multi-slice spiral CT angiography show hepatic and splenic trauma clearer than that of color flow ultrasonography, and can provide reliable basis for clinic diagnosis and therapy. (authors)

Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

Science.gov (United States)

Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

2014-03-01

Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial

Efficacy of 'fine' focal spot imaging in CT abdominal angiography

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Oh, Lawrence Chia Wei; Devapalasundaram, Ashwini; Ardley, Nicholas [Monash Health, Department of Diagnostic Imaging, Clayton, Victoria (Australia); Lau, Kenneth K. [Monash Health, Department of Diagnostic Imaging, Clayton, Victoria (Australia); Monash University, Department of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Victoria (Australia); Buchan, Kevin [Phillips Healthcare, Clinical Science, PO Box 312, Mont Albert, Victoria (Australia); Huynh, Minh [RMIT University, School of Mathematical and Geospatial Sciences, Victoria (Australia)

2014-12-15

To assess the efficacy of fine focal spot imaging in calcification beam-hardening artefact reduction and vessel clarity on CT abdominal angiography (CTAA). Adult patients of any age and gender who presented for CTAA were included. Thirty-nine patients were examined with a standard focal spot size (SFSS) of 1 x 1 mm in the first 3 months while 31 consecutive patients were examined with a fine focal spot size (FFSS) of 1 x 0.5 mm in the following 3 months. Vessel clarity and calcification beam-hardening artefacts of the abdominal aorta, celiac axis, superior mesenteric artery, inferior mesenteric artery, renal arteries, and iliac arteries were assessed using a 5-point grading scale by two blinded radiologists randomly. Cohen's Kappa test indicated that on average, there was substantial agreement among reviewers for vessel wall clarity and calcification artefact grading. Mann-Whitney test showed that there was a significant difference between the two groups, with FFSS performing significantly better for vessel clarity (U, 6481.50; p < 0.001; r, 0.73) and calcification artefact reduction (U, 1916; p < 0.001; r, 0.77). Fine focus CT angiography produces images with better vessel wall clarity and less vessel calcification beam-hardening artefact. (orig.)

Clinical application of three-dimensional spiral CT cerebral angiography with volume rendering

International Nuclear Information System (INIS)

Duan Shaoyin; Huang Xi'en; Kang Jianghe; Zhang Dantong; Lin Qingchi; Cai Guoxiang; Xu Meixin; Pang Ruilin

2002-01-01

Objective: To study the methodology and assess the clinical value of three-dimensional CT angiography (3D-CTA) with volume rendering (VR) in cerebral vessels. Methods: Sixty-two patients were examined by means of 3D-CTA with volume rendering. VR was used in the reconstruction of 3D images, and the demonstration of normal vessels and vascular lesions were particularly analyzed. At the same time, comparisons were made between the images of VR and SSD, MIP, and also between the diagnosis of VR-CTA and DSA or postoperative results. Results: In VR images, cerebral vessel routes and vessel cavities were showed clearly, while the relationship among vascular lesions, surrounding vessels, and neighboring structure was distinguished. 50 cases (80.6%) were found positive, 48 of which were correct and 2 were false-positive compared with DSA or postoperative results. The accurate rate of diagnosis was 96.0%. There was no obvious difference in showing the cerebral vessel among the images of VR, SSD and MIP (P > 0.25). Conclusion: Three-dimensional CT cerebral angiography with VR is a new noninvasive effective method. It can even partly replace the DSA. The 3D-images have the characteristics of showing the cerebral vascular cavity and overlapped vessels without cutting the skull

Laparoscopic resection aided by preoperative 3-D CT angiography for rectosigmoid colon cancer associated with a horseshoe kidney: A case report.

Science.gov (United States)

Maeda, Yoshiaki; Shinohara, Toshiki; Nagatsu, Akihisa; Futakawa, Noriaki; Hamada, Tomonori

2014-11-01

We herein report a case of laparoscopic high anterior resection with D3 lymph node dissection for rectosigmoid colon cancer with a horseshoe kidney. A 65-year-old Japanese man referred to our hospital for rectosigmoid colon cancer was found to have a horseshoe kidney on a CT scan. On 3-D CT angiography, an aberrant renal artery was visualized feeding the renal isthmus that arises from the aorta just below the root of the inferior mesenteric artery (IMA). Laparoscopic anterior rectal resection with D3 lymph node dissection was performed. During the operation, the IMA, left ureter, left gonadal vessels and hypogastric nerve plexus could be seen passing over the horseshoe kidney isthmus. With the aid of preoperative 3-D CT angiography, the root of the IMA was identified on the temporal side of the isthmus and divided safely just above the hypogastric nerve. As a horseshoe kidney is often accompanied by aberrant renal arteries and/or abnormal running of the ureter, 3-D CT angiography is useful for determining the location of these structures and avoiding intraoperative injury. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Detection of thin wall regions of unruptured cerebral aneurysms by ECG synchronous reconstruction 3D-CT angiography (4D-CTA) using 16 slices per rotation CT

International Nuclear Information System (INIS)

Fujita, Shigekiyo

2004-01-01

The objective of this study was to evaluate the capability of electrocardiogram (ECG) synchronous reconstruction 3D-CT angiography (4D-CTA) using 16 sequence MD-CT to detect weak portions of unruptured cerebral aneurysm. 4D-CT angiography of unruptured cerebral aneurysms was performed on 26 patients, 28 cerebral aneurysms, using 16 sequence MD-CT (GE, HiLight Matrix II). Contrast material of iodine (300 mg/ml) was injected over 30 sec period into the ante-cubital vein with a rate of 0.06 ml/Kg/sec. ECG synchronous reconstruction images (10 images at intervals of 10% between R-R of ECG) were generated (GE, Workstation Advantage 4.1). After careful inspection of the wall motion of an aneurysm from many aspects, cine images were made from several directions. Acquisition of data required 9 seconds, total volume data were generated within 15 minutes, and ECG synchronous reconstruction image processing was performed in about 5 minutes. Animation creation for one direction was completed within one minute. Even in 3-mm aneurysms, changes of its form and size within a heartbeat were fully observed. Timing of maximum and minimum sizes were also recognized. The pulsatile changes and nipple extent, bleb, daughter, and dome of aneurysms were well visualized. The projecting motion of the pulsatory enlargement of nipple was detected in nine cases, and definite increases in bleb sizes were detected in five cases. Since the easily reptured thin walled portion of a cerebral aneurysm can be recognized by this method, 4D-CT angiography is likely to become indispensable in judging how to cope with unruptured cerebral aneurysms, in deciding whether to operate or observe. (author)

Noninvasive evaluation of cerebral arteriovenous malformations by 4D-CT angiography using 320-detector row CT

International Nuclear Information System (INIS)

Tajiri, H.; Jin, L.; Tsukiyama, M.; Suzuki, Y.; Sekine, S.; Shimizu, T.; Ohiwa, T.

2012-01-01

Full text: Objective: Four-dimensional computed tomography angiography (4D-CTA) is a new and promising technique in the diagnosis of patients with cerebral arteriovenous malformations (AVMs). The purpose of this retrospective study was to investigate the utility of 4D-CTA using whole-brain 320-detector row CT for assessing cerebral AVMs compared with conventional angiography (CA). Materials and methods: Participants included patients admitted to our institution from November 2010 to March 2012 due to cerebral AVMs who underwent both 4D-CTA and CA within 14 days. The diagnosis of AVM was finally confirmed by CA. Two readers reviewed 4D-CTA and CA under consensus regarding AVM detection rate and each component of the AVM (feeders, nidi, drainers) using a four-point grading scale (excellent=3, good=2, fair=1, poor=0), and the Spetzler-Martin (S-M) grade. Results: During the study period, 11 patients met the inclusion criteria. The average score for feeders, nidi, and drainers was 2.0, 2.3, and 2.5 in 4D-CTA and 2.4, 2.6, and 2.7 in CA, respectively. The average S-M grade score was 2.0 in all patients. There were no statistically significant differences between the two modalities (P<.005). Conclusion: 4D-CTA using 320-detector row CT is a very reliable method and offers diagnostic performance equivalent to CA for detecting and predicting S-M classification of cerebral AVMs.

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT.

Science.gov (United States)

Tang, Lijun; Zhu, Xiaomei; Xu, Yi; Yu, Tongfu; Xu, Hai; Tang, Jinhua; Dogra, Vikram; Wang, Dehang

2011-02-01

CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and

SU-E-P-10: Imaging in the Cardiac Catheterization Lab - Technologies and Clinical Applications

International Nuclear Information System (INIS)

Fetterly, K

2014-01-01

Purpose: Diagnosis and treatment of cardiovascular disease in the cardiac catheterization laboratory is often aided by a multitude of imaging technologies. The purpose of this work is to highlight the contributions to patient care offered by the various imaging systems used during cardiovascular interventional procedures. Methods: Imaging technologies used in the cardiac catheterization lab were characterized by their fundamental technology and by the clinical applications for which they are used. Whether the modality is external to the patient, intravascular, or intracavity was specified. Specific clinical procedures for which multiple modalities are routinely used will be highlighted. Results: X-ray imaging modalities include fluoroscopy/angiography and angiography CT. Ultrasound imaging is performed with external, trans-esophageal echocardiography (TEE), and intravascular (IVUS) transducers. Intravascular infrared optical coherence tomography (IVOCT) is used to assess vessel endothelium. Relatively large (>0.5 mm) anatomical structures are imaged with x-ray and ultrasound. IVUS and IVOCT provide high resolution images of vessel walls. Cardiac CT and MRI images are used to plan complex cardiovascular interventions. Advanced applications are used to spatially and temporally merge images from different technologies. Diagnosis and treatment of coronary artery disease frequently utilizes angiography and intra-vascular imaging, and treatment of complex structural heart conditions routinely includes use of multiple imaging modalities. Conclusion: There are several imaging modalities which are routinely used in the cardiac catheterization laboratory to diagnose and treat both coronary artery and structural heart disease. Multiple modalities are frequently used to enhance the quality and safety of procedures. The cardiac catheterization laboratory includes many opportunities for medical physicists to contribute substantially toward advancing patient care

Subtraction imaging of the ECG gated cardiac CT

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Tanegashima, K.; Fukui, M.; Hyodo, H.

1987-05-01

The subtracting manipulation of contrast-enhanced gated cardiac CT (GCCT) images was experimentally studied with TCT 60A - 30 type (Toshiba) for clinical use, thereby reducing the amount of contrast medium (CM). Initially the optimum relationship between the concentration of CM and its injected velocity was determined using the model of resected canine hearts and in actual dogs. The emphasized good-subtracted images were obtained when the difference of CT values was approximately 40 H.U. between cardiac cavity and myocardium. Such condition was feasible in the use of 25 % Diatrizoic acid and its injected velocity of 0.02 ml/kg/sec. Finally the reduction of the amount of CM by 1/3 became possible in clinical settings. The method is applicable to multi-slice GCCT in various heart diseases.

Four-dimensional CT angiography (4D-CTA) in the evaluation of juvenile nasopharyngeal angiofibromas: comparison with digital subtraction angiography (DSA) and surgical findings.

Science.gov (United States)

Xiao, Zebin; Zheng, Yingyan; Li, Jian; Chen, Dehua; Liu, Fang; Cao, Dairong

2017-12-01

To explore the value of four-dimensional CT angiography (4D-CTA) in the preoperative evaluation of juvenile nasopharyngeal angiofibromas (JNAs) using 320-row volume CT. 4D-CTA and DSA data of 18 patients with histopathologically proven JNAs were retrospectively reviewed. The location, extent, feeding vessels and stage of JNAs were assessed by two radiologists independently and blindly. The agreements between both reviewers and between 4D-CTA and surgical findings for assessing the above indicators were analysed, respectively. The radiation dose and the number of feeding arteries between 4D-CTA and digital subtraction angiography (DSA) were also compared. 4D-CTA showed high diagnostic consistency with surgical pathology for JNAs with consistent rates of 96.2 and 100% in both reviewers, respectively. The effective dose of 4D-CTA was significantly less than that of DSA (p 0.05). 4D-CTA can provide a reliable preoperative diagnosis and assessment of JNAs, which is useful for determining the surgical strategy and management of this condition.

CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.

Science.gov (United States)

Pallesen, Lars P; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik Jrj; Algra, Ale; Kapelle, L Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M; Schonewille, Wouter; Puetz, Volker

2017-02-01

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

Subprosthetic Pannus after Aortic Valve Replacement Surgery: Cardiac CT Findings and Clinical Features.

Science.gov (United States)

Han, Kichang; Yang, Dong Hyun; Shin, So Youn; Kim, Namkug; Kang, Joon-Won; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Lim, Tae-Hwan

2015-09-01

To investigate the cardiac computed tomographic (CT) findings and clinical implications of subprosthetic pannus in patients who have undergone aortic valve replacement. The institutional review board approved this retrospective study, and the need to obtain written informed consent was waived. From April 2011 to March 2012, 88 patients (mean age, 63 years; 45 men) with a prosthetic aortic valve who underwent cardiac CT were retrospectively selected. Dynamic cardiac CT images were analyzed by using a multiplanar reformatted technique. The presence or absence of subprosthetic pannus and its extent were evaluated at cardiac CT. The geometric orifice area and the effective orifice area of each prosthetic valve were measured to enable analysis of the pannus encroachment ratio in the systolic phase. Hemodynamic parameters at echocardiography, including mean transprosthetic pressure gradient (MTPG), were compared between patients with and those without pannus. The encroachment ratio and the MTPG were correlated by using the Spearman test to evaluate the relationship between the two variables. Seventeen patients (19%) had subprosthetic pannus at cardiac CT. In patients with subprosthetic pannus, MTPG, peak pressure gradient, transvalvular peak velocity, and left ventricular ejection fraction (LVEF) were significantly higher than in patients without pannus (MTPG: 28.1 mm Hg ± 19.8 [standard deviation] vs 14.0 mm Hg ± 6.5, P = .004; peak pressure gradient: 53.1 mm Hg ± 38.4 vs 26.1 mm Hg ± 11.4, P = .004; transvalvular peak velocity: 3.3 m/sec ± 1.3 vs 2.5 m/sec ± 0.5; and LVEF: 64.7% ± 7.4 vs 56.8% ± 10.5, P = .004). A high MTPG (≥40 mm Hg) was observed in four patients at echocardiography, and subprosthetic panni were identified at CT in all four patients. In patients with increased MTPGs, the encroachment ratio by subprosthetic pannus at CT was significantly higher than that in patients with MTPGs of less than 40 mm Hg (42.7 ± 13.3 vs 7.6 ± 3, P = .012

Coronary CT angiography using prospective ECG triggering. High diagnostic accuracy with low radiation dose

International Nuclear Information System (INIS)

Arnoldi, E.; Ramos-Duran, L.; Abro, J.A.; Costello, P.; Zwerner, P.L.; Schoepf, U.J.; Nikolaou, K.; Reiser, M.F.

2010-01-01

The purpose of this study was to evaluate the diagnostic performance of coronary CT angiography (coronary CTA) using prospective ECG triggering (PT) for the detection of significant coronary artery stenosis compared to invasive coronary angiography (ICA). A total of 20 patients underwent coronary CTA with PT using a 128-slice CT scanner (Definition trademark AS+, Siemens) and ICA. All coronary CTA studies were evaluated for significant coronary artery stenoses (≥50% luminal narrowing) by 2 observers in consensus using the AHA-15-segment model. Findings in CTA were compared to those in ICA. Coronary CTA using PT had 88% sensitivity in comparison to 100% with ICA, 95% to 88% specificity, 80% to 92% positive predictive value and 97% to 100% negative predictive value for diagnosing significant coronary artery stenosis on per segment per patient analysis, respectively. Mean effective radiation dose-equivalent of CTA was 2.6±1 mSv. Coronary CTA using PT enables non-invasive diagnosis of significant coronary artery stenosis with high diagnostic accuracy in comparison to ICA and is associated with comparably low radiation exposure. (orig.) [de

Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT.

Science.gov (United States)

Yunaga, Hiroto; Ohta, Yasutoshi; Kaetsu, Yasuhiro; Kitao, Shinichiro; Watanabe, Tomomi; Furuse, Yoshiyuki; Yamamoto, Kazuhiro; Ogawa, Toshihide

2017-07-01

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). 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. 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). Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions. • 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.

Optimisation of post mortem cardiac computed tomography compared to optical coherence tomography and histopathology - Technical note

DEFF Research Database (Denmark)

Falk, Erling

2014-01-01

. Here, a new method for optimising cardiac coronary CT with optical coherence tomography (OCT) and histopathology is presented. Materials and methods: Twenty human hearts obtained from autopsies were used. A contrast agent that solidifies after cooling was injected into the coronary arteries. CT...... of the images was also developed. Results: We have succeeded in developing a new method for post-mortem coronary CT angiography in which an autopsy heart is placed in a chest phantom to simulate clinical CT. Conclusion: The new method permits comparison of CT with OCT and histopathology. This method can also...

Noncardiac findings on cardiac CT. Part II: spectrum of imaging findings.

LENUS (Irish Health Repository)

Killeen, Ronan P

2012-02-01

Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive cardiac imaging methods include its ability to directly evaluate the coronary arteries and to provide a unique opportunity to evaluate for alternative diagnoses by assessing the extracardiac structures, such as the lungs and mediastinum, particularly in patients presenting with the chief symptom of acute chest pain. Some centers reconstruct a small field of view (FOV) cropped around the heart but a full FOV (from skin to skin in the area irradiated) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient\\'s presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this 2-part review we outline the issues surrounding the concept of the noncardiac read, looking for noncardiac findings on cardiac CT. Part I focused on the pros and cons for and against the practice of identifying noncardiac findings on cardiac CT. Part II illustrates the imaging spectrum of cardiac CT appearances of benign and malignant noncardiac pathology.

Pilot study of dynamic cine CT angiography for the evaluation of abdominal aortic aneurysms : Implications for endograft treatment

NARCIS (Netherlands)

Teutelink, A; Rutten, A; Muhs, BE; Olree, M; van Herwaarden, JA; de Vos, AM; Prokop, M; Moll, FL; Verhagen, HJM

Purpose: To utilize 40-slice electrocardiographically (ECG)-gated cine computed tomographic angiography (CTA) to characterize normal aortic motion during the cardiac cycle at relevant anatomical landmarks in preoperative abdominal aortic aneurysm (AAA) patients. Methods: In 10 consecutive

ECG-gating in non-cardiac digital subtraction angiography

International Nuclear Information System (INIS)

Gattoni, F.; Baldini, V.; Cairo, F.

1987-01-01

This paper reports the results of the ECG-gating in non-cardiac digital subtraction angiography (DSA). One hundred and fifteen patients underwent DSA (126 examinations); ECG-gating was applied in 66/126 examinations: images recorded at 70% of R wave were subtracted. Artifacts produced by vascular movements were evaluated in all patients: only 40 examinations, carried out whithout ECG-gating, showed vascular artifacts. The major advantage of the ECG-gated DSA is the more efficent subtraction because of the better images superimposition: therefore, ECG-gating can be clinically helpful. On the contrary, it could be a problem in arrhytmic or bradycardic patients. ECG-gating is helpful in DSA imaging of the thoracic and abdominal aorta and of the cervical and renal arteries. In the examinations of peripheral vessels of the limbs it is not so efficent as in the trunk or in the neck

Role of coronary CT angiography in asymptomatic patients with type 2 diabetes mellitus

International Nuclear Information System (INIS)

Kamimura, Munehiro; Moroi, Masao; Hiroe, Michiaki; Isobe, Mitsuaki

2012-01-01

Diabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis >70%. High-risk plaque was defined as plaque having both a CT density <30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P=0.022). We found significant stenosis even in patients whose CAC score =0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P=0.033) and current smoking (P=0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (author)

Practical applications and methods in performing cardiac digital subtraction angiography

International Nuclear Information System (INIS)

Markovic, D.M.; Withrow, S.; Moodie, D.S.

1986-01-01

One of the purposes of this book is to outline the utility of digital subtraction angiography (DSA) in common clinical practice. No text has dealt with the actual physical setup of the room or the patient prior and during a digital subtraction angiographic study at rest and with exercise. This chapter outlines the steps commonly used when cardiac DSA is performed on patients in the authors' laboratory. The authors have learned over the last few years the best way to prepare the patient and the equipment and it is hoped that utilizing this experience, other centers may avoid the mistakes the authors have made in the past and develop new techniques for the future

Cardiac computed tomography in patients with acute coronary syndrome; Kardiale CT beim akuten Koronarsyndrom

Energy Technology Data Exchange (ETDEWEB)

Schlett, C.L. [Universitaetsklinikum, Heidelberg (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Alkadhi, H. [Universitaetsspital, Zuerich (Switzerland); Bamberg, F. [Universitaetsklinikum, Tuebingen (Germany). Diagnostische und Interventionelle Radiologie

2014-09-15

Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

The clinical significance of perivalvular pannus in prosthetic mitral valves: Can cardiac CT be helpful?

Science.gov (United States)

Chang, Suyon; Suh, Young Joo; Han, Kyunghwa; Kim, Jin Young; Kim, Young Jin; Chang, Byung-Chul; Choi, Byoung Wook

2017-12-15

The clinical significance of pannus in the prosthetic mitral valve (MV) is not well documented. To investigate the clinical significance of pannus on cardiac computed tomography (CT) in patients with a prosthetic MV. A total of 130 patients with previous MV replacement who underwent cardiac CT were retrospectively included in this study. The presence of pannus, paravalvular leak (PVL) around the prosthetic MV and limitation of motion (LOM) of the MV were analyzed using CT. Between patients with MV pannus and those without pannus, CT, echocardiographic, and redo-surgery findings were compared. The diagnostic performance of CT and transesophageal echocardiography (TEE) for the detection of MV pannus was also compared, using surgical findings as a standard reference. MV pannus was observed on cardiac CT in 32.3% of the study population. Patients with MV pannus detected on CT more commonly had LOM (28.2% vs. 15.2%) and less frequently had PVL of the prosthetic MV (16.7% vs. 25%) than patients without MV pannus (P>0.05). Prosthetic valve obstruction (PVO) due prosthetic MV pannus requiring redo-surgery was present in only five patients (11.9%). Cardiac CT detected MV pannus with sensitivity of 65.2% and specificity of 80.9% and showed better diagnostic performance than TEE (Ppannus can frequently be seen on cardiac CT. However, its clinical significance should be assessed with careful consideration, because PVO due to MV pannus is relatively uncommon, and pannus can be seen in patients without any clinical problems. Copyright © 2017 Elsevier B.V. All rights reserved.

Relationship between noise, dose, and pitch in cardiac multi-detector row CT.

Science.gov (United States)

Primak, Andrew N; McCollough, Cynthia H; Bruesewitz, Michael R; Zhang, Jie; Fletcher, Joel G

2006-01-01

In spiral computed tomography (CT), dose is always inversely proportional to pitch. However, the relationship between noise and pitch (and hence noise and dose) depends on the scanner type (single vs multi-detector row) and reconstruction mode (cardiac vs noncardiac). In single detector row spiral CT, noise is independent of pitch. Conversely, in noncardiac multi-detector row CT, noise depends on pitch because the spiral interpolation algorithm makes use of redundant data from different detector rows to decrease noise for pitch values less than 1 (and increase noise for pitch values > 1). However, in cardiac spiral CT, redundant data cannot be used because such data averaging would degrade the temporal resolution. Therefore, the behavior of noise versus pitch returns to the single detector row paradigm, with noise being independent of pitch. Consequently, since faster rotation times require lower pitch values in cardiac multi-detector row CT, dose is increased without a commensurate decrease in noise. Thus, the use of faster rotation times will improve temporal resolution, not alter noise, and increase dose. For a particular application, the higher dose resulting from faster rotation speeds should be justified by the clinical benefits of the improved temporal resolution. RSNA, 2006

Diagnostic performance of coronary CT angiography, stress dual-energy CT perfusion, and stress perfusion single-photon emission computed tomography for coronary artery disease: Comparison with combined invasive coronary angiography and stress perfusion cardiac MRI

Energy Technology Data Exchange (ETDEWEB)

Chung, Hyun Woo; Ko, Sung Min; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun [Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul (Korea, Republic of); Lee, Eun Jeong [Dept. of Nuclear Medicine, Seoul Medical Center, Seoul (Korea, Republic of)

2017-06-15

To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.

Dynamics of the aortic annulus in 4D CT angiography for transcatheter aortic valve implantation patients

NARCIS (Netherlands)

Elattar, Mustafa A.; Vink, Leon W.; van Mourik, Martijn S.; Baan, Jan; Vanbavel, Ed T.; Planken, R. Nils; Marquering, Henk A.

2017-01-01

Transcatheter aortic valve implantation (TAVI) is a well-established treatment for patients with severe aortic valve stenosis. This procedure requires pre-operative planning by assessment of aortic dimensions on CT Angiography (CTA). It is well-known that the aortic root dimensions vary over the

Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols

International Nuclear Information System (INIS)

Neefjes, Lisan A.; Kate, Gert-Jan R. ten; Rossi, Alexia; Nieman, Koen; Papadopoulou, Stella L.; Dharampal, Anoeshka S.; Dedic, Admir; Feyter, Pim J. de; Mollet, Nico R.; Genders, Tessa S.S.; Hunink, M.G.M.; Schultz, Carl J.; Weustink, Annick C.; Dijkshoorn, Marcel L.; Straten, Marcel van; Cademartiri, Filippo; Krestin, Gabriel P.

2013-01-01

To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction. We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients. In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P = 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P > 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv, P 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv, P < 0.001). Diagnostic performance was comparable in both groups. Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose. circle 128-slice dual-source CT coronary angiography offers several different acquisition protocols. (orig.)

Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography

International Nuclear Information System (INIS)

Gonzalez-Darder, J.M.; Pesudo-Martinez, J.V.; Feliu-Tatay, R.A.

2001-01-01

Objective. To study the possibilities of the microsurgical management of ruptured intracranial aneurysms with the sole preoperative information provided by computed tomography angiography with three-dimensional reconstruction (3D-CTA). Methods. Patients were studied with 3D-CTA after diagnosis of subarachnoid hemorrhage. If the study had an adequate quality and revealed an aneurysm congruent with the clinical findings or neurological examination and/or with the location of the bleeding on computed tomography (CT) scan an early microsurgical clipping of the lesion was done. When the quality of the 3D-CTA study was not adequate or the quality being adequate displayed no lesions or the findings were not accurate enough to warrant direct microsurgical treatment, the patient was studied with cerebral digital substraction (DS) angiography. A total of 44 consecutive patients harboring a total of 47 intracranial aneurysms diagnosed by 3D-CTA and without preoperative DS angiography were submitted to microsurgical clipping and included in the study. Results. The overall mortality was 15.9 % and the favorable results evaluated 6 months after discharge by means of the Glasgow outcome scale reached 70.4 %. All lesions were successfully clipped. Surgery was done a mean of 4.1 days after the admission bleeding. A total of four microlesions undiagnosed by 3D-CTA were found at surgery and clipped. Postoperative DS angiography and necropsy findings were also used as control of the 3D-CTA findings but no additional information was provided excepting the finding in DS angiography of an asymptomatic intracavemous aneurysm. Therefore the sensitivity of the 3D-CTA for diagnosis of symtomatic aneurysms was 100 % and the overall sensitivity 90.4 %. Conclusions. We have reached similar results in patients operated on with or without preoperative angiography. 3D-CTA provides very valuable anatomical information, which has an additional value in the microsurgical treatment of aneurysms of the

Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Bastarrika, Gorka [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Cardiac Imaging Unit, Clinica Univ. de Navarra, Pamplona (Spain)], e-mail: bastarrika@unav.es

2012-06-15

Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 {+-} 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 {+-} 58.3 mL) with respect to ECG-gated CT (142.7 {+-} 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 {+-} 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.

Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

International Nuclear Information System (INIS)

Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria; Bastarrika, Gorka

2012-01-01

Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 ± 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 ± 58.3 mL) with respect to ECG-gated CT (142.7 ± 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 ± 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols

Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus; Diagnostische Genauigkeit der Dual-energy-CT-Angiographie bei Patienten mit Diabetes mellitus

Energy Technology Data Exchange (ETDEWEB)

Schabel, C.; Bongers, M.N.; Syha, R. [Klinikum der Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Klinikum der Eberhard-Karls-Universitaet, Sektion fuer Experimentelle Radiologie der Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Ketelsen, D.; Homann, G.; Notohamiprodjo, M.; Nikolaou, K.; Bamberg, F. [Klinikum der Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany); Thomas, C. [Universitaetsklinikum Duesseldorf, Abteilung fuer Diagnostische und Interventionelle Radiologie, Duesseldorf (Germany)

2015-04-01

Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. Among the 30 subjects included in the analysis (83 % male, mean age 70.0 ± 10.5 years, 83 % diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30 %). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100 % and 93.1 %, respectively) and MIP images (99 % and 91.8 %, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1 % vs. 99.2 vs. 90.9 %; respectively, p < 0.001). The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs. (orig.) [German] Die periphere arterielle Verschlusskrankheit (PAVK) ist eine wesentliche Komplikation des Diabetes mellitus und stellt aufgrund ausgepraegter Gefaessverkalkungen eine diagnostische

Computed tomography versus invasive coronary angiography

DEFF Research Database (Denmark)

Napp, Adriane E.; Haase, Robert; Laule, Michael

2017-01-01

Objectives: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate...... angiography (ICA) is the reference standard for detection of CAD.• Noninvasive computed tomography angiography excludes CAD with high sensitivity.• CT may effectively reduce the approximately 2 million negative ICAs in Europe.• DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest...

Exposed dose comparison between coronary computed tomographic angiography and coronary angiography. Basic examination by phantom

International Nuclear Information System (INIS)

Kato, Kyoichi; Takahashi, Yoshimasa; Takahashi, Toshiyuki; Sai, Syogo; Fujimura, Kazumasa; Watanabe, Hiroyuki; Sato, Hisaya; Imai, Yasuhiro; Nakazawa, Yasuo

2007-01-01

The new type of coronary angiography (CAG) that uses 40 mm volumetric computed tomography (VCT) has great potential for cardiac disease. However, it is still necessary to be cognizant of exposure dose. We measured doses of CAG by both VCT and cardiovascular X-ray using a body phantom within 170 glass dosimeters. VCT protocols were 120 kV, 570 mA, and 0.35 sec/rot with and without the dose-reduction features (small cardiac X-ray beam filter and electrocardiogram (ECG) mA modulation). The cardiovascular X-ray protocol was Auto (65-77 kV) kV, Auto (41-46 mA) mA, 5 sec x 11 shots + 11 min fluoroscopy (minimum protocol for screening). VCT with and without the dose-reduction features has the same dose distribution, however, the dose-reduction features reduced the amount of dose by about 40-50%. For VCT with those features, measured dose was about 70 mGy in the cardiac area and 60 mGy at the skin of the back, whereas those of cardiovascular X-ray were 10 mGy and 30 mGy. We measured detailed dose distributions and variations in the phantom, and we also demonstrated the possibility of VCT's dose-reduction features. The CT dose was still higher than that of cardiovascular X-ray, however, there were advantages of CT scanning, for instance, information about calcification, soft plaque, and three-dimensional (3D) visualization. We think it is important to use both systems with an understanding of their advantages and limitations. (author)

Impaired left ventricular function has a detrimental effect on image quality in multi-detector row CT coronary angiography

International Nuclear Information System (INIS)

Manghat, N.E.; Morgan-Hughes, G.J.; Shaw, S.R.; Marshall, A.J.; Roobottom, C.A.

2008-01-01

Aim: To determine whether there is a relationship between left ventricular (LV) haemodynamic parameters, circulation times, and arterial contrast opacification that might affect the image quality of computed tomography (CT) coronary angiography. Methods: Thirty-six patients were included in the study: 18 with cardiomyopathy (CM) and LV dilatation of suspected ischaemic aetiology [age 57.9 ± 13.7 years, range 30-77 years; 14 male, four female; body mass index (BMI) = 27.7 ± 4.5, range 25.5-31.8] and 18 controls (age 62.3 ± 9.4 years, range 47-89 years; 10 male, eight female; BMI 27.8 ± 6.6; range 19.2-33.6). Coronary artery image quality was assessed using a three-point visual scale; contrast medium circulation times, aortic root contrast attenuation, and LV functional parameters were studied. Results: Visually reduced contrast opacification impaired image quality more often in the CM group than the control group (27.4 versus 5.1%). A total of 55.6% CM patients had a contrast transit time ranging from 30-75 s; the number of 'unassessable' segments increased with increasing transit time conforming to a fitted quadratic model (R 2 = 0.74). The relationship between LV ejection fraction and contrast attenuation may also conform to a quadratic model (R 2 = 0.71). Conclusion: LV haemodynamics influence coronary artery opacification using cardiac CT, and users imaging this subgroup must do so with the knowledge of this potential pitfall. The results indicate the need for further studies examining CT protocols in this clinical subgroup

Three-dimensional CT angiography in the diagnosis of cerebrovascular disease

International Nuclear Information System (INIS)

Eguchi, Takahiko; Nikaido, Yuji; Nakamura, Takeshi; Yoneda, Shigeru

1995-01-01

We reported the usefulness of three dimensional CT angiography (3 DCTA) in cerebrovascular disease. Twenty two of twenty three intracerebral aneurysms were visualized in 3 DCTA. 3 DTPA was especially useful for the evaluation of posterior-projection anterior communicating arteries and the distinction between a carotid-posterior communicating aneurysm and an infundibular dilatation. An anterior-projection carotid bifurcation aneurysm, which we missed in DSA, was visualized clearly in 3 DCTA. Stenotic cervical carotid artery lesions were well evaluated in 3 DCTA, including ulceration. 3 DCTA was not so useful for evaluation of intracranial artery stenosis. 3 DCTA was useful as a non-invasive method to evaluate cerebrovascular diseases. (author)

Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

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Dournes, Gael; Verdier, Damien; Montaudon, Michel; Laurent, Francois; Lederlin, Mathieu [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France); University Bordeaux Segalen, Bordeaux Cedex (France); Bullier, Eric; Riviere, Annalisa [Hopital Haut-Leveque, CHU Bordeaux, Department of Nuclear Medicine, Pessac (France); Dromer, Claire [Hopital Haut-Leveque, CHU Bordeaux, Department of Respiratory Diseases, Pessac (France); Picard, Francois [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiology, Pessac (France); Billes, Marc-Alain [Hopital Haut-Leveque, CHU Bordeaux, Department of Cardiac Surgery, Pessac (France); Corneloup, Olivier [Hopital Haut-Leveque, CHU Bordeaux, Department of Medical Imaging, Pessac (France)

2014-01-15

To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

International Nuclear Information System (INIS)

Dournes, Gael; Verdier, Damien; Montaudon, Michel; Laurent, Francois; Lederlin, Mathieu; Bullier, Eric; Riviere, Annalisa; Dromer, Claire; Picard, Francois; Billes, Marc-Alain; Corneloup, Olivier

2014-01-01

To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy. Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated. Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively. Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities. (orig.)

Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

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Busch, S.; Johnson, T.R.C.; Wintersperger, B.J.; Minaifar, N.; Bhargava, A.; Rist, C.; Reiser, M.F.; Becker, C.; Nikolaou, K. [University of Munich, Department of Clinical Radiology, Munich (Germany)

2008-03-15

-observer variability were amounted to 0.85 for EDV, ESV and EF. DSCT offers the possibility to quantify left ventricular function from coronary CT angiography datasets with sufficient diagnostic accuracy, adding to the value of the modality in a comprehensive cardiac assessment. The observed differences in the measured values may be due to different post-processing methods and physiological reactions to contrast material injection without beta-blocker medication. (orig.)

Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

International Nuclear Information System (INIS)

Busch, S.; Johnson, T.R.C.; Wintersperger, B.J.; Minaifar, N.; Bhargava, A.; Rist, C.; Reiser, M.F.; Becker, C.; Nikolaou, K.

2008-01-01

amounted to 0.85 for EDV, ESV and EF. DSCT offers the possibility to quantify left ventricular function from coronary CT angiography datasets with sufficient diagnostic accuracy, adding to the value of the modality in a comprehensive cardiac assessment. The observed differences in the measured values may be due to different post-processing methods and physiological reactions to contrast material injection without beta-blocker medication. (orig.)

Anomalous vessel in the middle ear: the role of CT and MR angiography

International Nuclear Information System (INIS)

Caldas, J.G.M.P.; Iffenecker, C.; Lasjaunias, P.; Doyon, D.; Attal, P.

1998-01-01

An 8-year-old child was examined because of conductive hearing loss with a retrotympanic mass on otoscopy. CT and MR angiography showed a large inferior tympanic artery traversing the hypotympanum and joining a thin, irregular internal carotid artery with a normal middle meningeal artery. These investigations, coupled with knowledge of the embryological development allowed a diagnosis of a complex vascular anomaly in the middle ear and avoided potential surgical complications. (orig.)

Assessment of the usefulness of three-dimensional CT angiography after peripheral arterial bypass surgery

International Nuclear Information System (INIS)

Hayashi, Saihou; Sasaki, Masaru; Kawamoto, Jun

1997-01-01

Conventional CT and three-dimensional CT angiography (3D-CTA) were conducted after peripheral arterial bypass surgery on 17 patients (26 grafts) from October, 1994 to April, 1996. Seventeen grafts were patent. The following objectives were satisfied in these cases: 1. Prosthetic graft or saphenous vein was depicted by 3D-CTA, 2. The distal portion of the native artery was depicted by 3D-CTA, and 3. Opacification of the graft interior was recognized by transverse section of CT. Nine grafts were occluded but prosthetic grafts were depicted in 5 cases, and prosthetic grafts and the distal portions of native arteries in 3 cases. Opacification of the graft interior was not seen in any case. Achievement of the above three objectives was considered necessary to determine graft patency. (author)

Effect of the degree of sternal depression on the cardiac rotation in pectus excavatum: evaluation with spiral CT

International Nuclear Information System (INIS)

Yu Jianqun; Yang Zhigang; Li Zhenlin; Guo Yingkun; Lu Chunyan; Zhang Mei

2004-01-01

Objective: To evaluate the effects of the degree of sternal depression on the cardiac rotation in pectus excavatum by using spiral CT. Methods: Spiral CT features of 32 patients with surgically corrected pectus excavatum were retrospectively reviewed. They included 27 males and 5 females ranging in age from 6 months to 17 years (mean, 6.3 years). Analysis was based on relationship among the degree of sternal depression, CT depression index, cardiac rotation angle, and PV angle. Results: 32 cases of pectus excavatum presented the sternal depression (21 ± 7) mm, CT depression index 2.9 ± 1.8, cardiac rotation angle (55.9 ± 9.8) degree, and PV angle (49.8 ± 14.0) degree, respectively. The sternal depression (17 mm) in cases with CT depression index less than 2.4 was smaller than those with CT depression index 2.4-2.9 (21 mm) and CT depression index larger than 2.9 (27 mm) (F 5.39, P<0.01). Cardiac rotation angle (49.7 degree) in cases with CT depression index less than 2.4 was smaller than those with CT depression index 2.4-2.9 (55.5 degree) and CT depression index larger than 2.9 (66.9 degree) (F=7.44, P<0.01). PV angle (58.7 degree) in cases with CT depression index less than 2.4 was larger than those with CT depression index 2.4-2.9 (46.5 degree) and CT depression index more than 2.9 (42.4 degree) ( F=3.33, P<0.05). Cardiac rotation angle of pectus excavatum had positive correlation with the CT depression index (γ=0.73, P<0.01). Conclusion: Spiral CT is a better tool for revealing chest deformity and corresponding cardiac rotation. The degree of sternal depression in pectus excavatum directly influences the cardiac rotation, and they had positive correlation. (authors)

Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

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Bilhim, Tiago [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Pisco, Joao M. [Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Universidade Nova de Lisboa, Departamento Universitario de Radiologia, Faculdade de Ciencias Medicas, Lisbon (Portugal); Furtado, Andrea; Casal, Diogo; Pais, Diogo; O' Neill, Joao E.G. [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Campos Pinheiro, Luis [Universidade Nova de Lisboa, Departamento Universitario de Urologia, Faculdade de Ciencias Medicas, Lisbon (Portugal)

2011-05-15

To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

International Nuclear Information System (INIS)

Bilhim, Tiago; Pisco, Joao M.; Furtado, Andrea; Casal, Diogo; Pais, Diogo; O'Neill, Joao E.G.; Campos Pinheiro, Luis

2011-01-01

To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

Multi-slice spiral CT coronary angiography: influence of heart rate and reconstruction window on image quality

International Nuclear Information System (INIS)

Mao Dingbiao; Hua Yanqing; Wang Mingpeng; Zhang Guozhen; Wu Weilan; Hu Fei; Ge Xiaojun; Ding Qiyong

2004-01-01

Objective: To evaluate the influence of heart rate and reconstruction window on image quality of multi-slice spiral CT coronary angiography. Methods: Retrospectively ECG-gated MSCT coronary angiography were performed in 80 healthy cases. Results: Four coronary (RCA, LM, LAD, LCX) segments were analyzed in each patient with regard to image quality. 82.1% (46/56) of the coronary segments were sufficient for analysis in patients with heart rate ≤60 bpm, 63.4% (104/164) with 61-70 bpm, 41.2%(28/68) with 71-80 bpm, and 31.2%(10/32) with>80 bpm, respectively. The left anterior descending artery, left circumflex artery, and the right coronary artery were best visualized when the reconstruction window was 60%-70%, 50%-60%, and 50%-70%, respectively. Conclusion: Image quality of MSCT coronary angiography is highly dependent on heart rate and reconstruction window

Detection of coronary artery calcification by ultrafast CT and correlation with angiography

International Nuclear Information System (INIS)

Zhang Shaoxiong; Dai Ruping; Lu Bin

1997-01-01

To investigate the relationship between coronary calcification and significant coronary stenosis ninety patients including 81 men and 9 women were studied asithage ranging from 27∼72 years (mean, 58 years). All patients had both ultrafast CT (UFCT) examination and coronary angiography within one month. Single slice mode with ECG gating and thickness of 3 mm were used in UFCT scan. Selected coronary angiography was performed by the Judkins technique. Among 160 vessels in which coronary calcifications were identified, 74% had significant coronary stenosis (>50% stenosis), and 77% of 154 vessels with significant coronary stenosis had calcification demonstrable by UFCT. In the younger age group the sensitivity of calcification for evaluating stenosis of coronary artery was lower and the specificity was generally higher than those in the elderly group. UFCT is a promising procedure for detecting coronary arterial disease, since this examination has high sensitivity and specificity, easy to conduct, noninvasive, and widely applicable for screening a large population

Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation

International Nuclear Information System (INIS)

Andreini, Daniele; Fiorentini, Cesare; Pontone, Gianluca; Mushtaq, Saima; Mancini, Maria Elisabetta; Conte, Edoardo; Guglielmo, Marco; Volpato, Valentina; Annoni, Andrea; Baggiano, Andrea; Formenti, Alberto; Ditali, Valentina; Pepi, Mauro; Perchinunno, Marco; Bartorelli, Antonio L.

2018-01-01

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). 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. 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) 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. (orig.)

Evaluation of cardiac morphology and function in mitral stenosis using CT

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Ohnishi, Masaki [Chiba Univ. (Japan). School of Medicine

1992-11-01

The purpose of this study was to evaluate cardiac morphology and function in patients with mitral stenosis (MS). The subjects consisted of 96 patients (23 males and 73 females) with MS who underwent plain and contrast-enhanced CT. Follow-up examinations were performed at least twice in 42 patients, including 18 who were examined before and after surgery. The volume of each cardiac chamber was calculated by Simpson's rule and was divided by body surface area (BSA). The average left atrial (LA) volume was 171[+-]80 cm[sup 3]/m[sup 2] BSA in the 96 MS patients, and 46[+-]10 cm[sup 3]/m[sup 2] BSA in normal control subjects. Atrial fibrillation (Af) was present in 61 patients (64%), and left atrial thrombi were detected in 15 (25%) of them. LA volume increased by 16% in 24 patients without surgery during a mean follow-up period of 4.1 years. The LA tended to enlarge more in the patients with a smaller mitral valve area, a larger LA volume at the first examination, or Af. In 18 patients, after open surgery or percutaneous transvenous mitral commissurotomy, pulmonary CT values decreased significantly as a result of the improvement of pulmonary congestion. LA and RA volume decreased significantly and LV volume increased after surgery. It was concluded that CT was useful for evaluating cardiac function and morphological changes, not only by detecting mitral valve calcification and LA thrombi but also by measuring cardiac volume and pulmonary CT values. (author).

Tube potential can be lowered to 80 kVp in test bolus phase of CT coronary angiography (CTCA) and CT pulmonary angiography (CTPA) to save dose without compromising diagnostic quality

International Nuclear Information System (INIS)

Rodrigues, J.C.L.; Manghat, N.E.; Hamilton, M.C.K.; Joshi, D.; Lyen, S.M.; Negus, I.S.

2014-01-01

The purpose of this study was to determine whether performing the test bolus (TB) of computed tomography coronary angiography (CTCA) and computed tomography pulmonary angiography (CTPA) at 80 kVp reduces dose without compromising diagnostic quality. An 80 kVp TB protocol for CTCA and CTPA was retrospectively compared to standard TB protocol (non-obese: 100 kVp, obese: 120 kVp). CT angiogram parameters were unchanged between cohorts. Thirty-seven consecutive 80 kVp TB CTCA images were compared to 53 standard CTCA images. Fifty consecutive CTPAs from each protocol were analysed. Diagnostic quality of the CT angiogram was assessed by: mean attenuation, signal-to-noise ratio (SNR) in the ascending aorta (AA) in CTCA and in the main pulmonary artery (MPA) in CTPA, diagnostic rate, and number of repeated monitoring scans. Mean effective dose was estimated using the dose-length product. Mean TB effective doses were significantly lower (P < 0.0001) for 80 kVp scans compared to the standard in non-obese CTCA (0.15 ± 0.04 mSv Vs 0.33 ± 0.09 mSv), obese CTCA (0.17 ± 0.06 mSv Vs 0.57 ± 0.12 mSv), and CTPA patients (0.07 ± 0.03 mSv Vs 0.15 ± 0.06 mSv). No difference was demonstrated in mean attenuation, SNR (AA), SNR (MPA), diagnostic rates, or number of repeated monitoring scans between protocols. Routinely performing TB at 80 kVp, regardless of body habitus, in CTCA and CTPA results in a small but significant dose reduction, without compromising CT angiogram diagnostic quality. (orig.)

Tube potential can be lowered to 80 kVp in test bolus phase of CT coronary angiography (CTCA) and CT pulmonary angiography (CTPA) to save dose without compromising diagnostic quality

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Rodrigues, J.C.L.; Manghat, N.E.; Hamilton, M.C.K. [University Hospitals Bristol NHS Foundation Trust, Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom); University Hospitals Bristol NHS Foundation Trust, National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol Royal Infirmary, Bristol (United Kingdom); Joshi, D.; Lyen, S.M. [University Hospitals Bristol NHS Foundation Trust, Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom); Negus, I.S. [University Hospitals Bristol NHS Foundation Trust, Department of Medical Physics and Bioengineering, Bristol Royal Infirmary, Bristol (United Kingdom)

2014-10-15

The purpose of this study was to determine whether performing the test bolus (TB) of computed tomography coronary angiography (CTCA) and computed tomography pulmonary angiography (CTPA) at 80 kVp reduces dose without compromising diagnostic quality. An 80 kVp TB protocol for CTCA and CTPA was retrospectively compared to standard TB protocol (non-obese: 100 kVp, obese: 120 kVp). CT angiogram parameters were unchanged between cohorts. Thirty-seven consecutive 80 kVp TB CTCA images were compared to 53 standard CTCA images. Fifty consecutive CTPAs from each protocol were analysed. Diagnostic quality of the CT angiogram was assessed by: mean attenuation, signal-to-noise ratio (SNR) in the ascending aorta (AA) in CTCA and in the main pulmonary artery (MPA) in CTPA, diagnostic rate, and number of repeated monitoring scans. Mean effective dose was estimated using the dose-length product. Mean TB effective doses were significantly lower (P < 0.0001) for 80 kVp scans compared to the standard in non-obese CTCA (0.15 ± 0.04 mSv Vs 0.33 ± 0.09 mSv), obese CTCA (0.17 ± 0.06 mSv Vs 0.57 ± 0.12 mSv), and CTPA patients (0.07 ± 0.03 mSv Vs 0.15 ± 0.06 mSv). No difference was demonstrated in mean attenuation, SNR (AA), SNR (MPA), diagnostic rates, or number of repeated monitoring scans between protocols. Routinely performing TB at 80 kVp, regardless of body habitus, in CTCA and CTPA results in a small but significant dose reduction, without compromising CT angiogram diagnostic quality. (orig.)

Studies on intracranial collateral circulation with multi-slice CT angiography in patients with symptomatic cerebral artery stenosis

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Shu-qing ZHOU

2011-06-01

Full Text Available Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection(MIP and volume rendering(VR images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack(TIA and 1 of moyamoya disease(MMD.Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels(including massive cerebral infarction in 4 cases and watershed infarction in 2 cases,and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.

Multi-slice and dual-source CT in cardiac imaging. Principles - protocols - indications - outlook. 2. ed.

International Nuclear Information System (INIS)

Ohnesorge, B.M.; Flohr, T.G.; Becker, C.R.; Reiser, M.F.; Knez, A

2007-01-01

Cardiac diseases, and in particular coronary artery disease, are the leading cause of death and morbidity in industrialized countries. The development of non-invasive imaging techniques for the heart and the coronary arteries has been considered a key element in improving patient care. A breakthrough in cardiac imaging using CT occurred in 1998, with the introduction of multi-slice computed tomography (CT). Since then, amazing advances in performance have taken place with scanners that acquire up to 64 slices per rotation. This book discusses the state-of-the-art developments in multi-slice CT for cardiac imaging as well as those that can be anticipated in the future. It serves as a comprehensive work that covers all aspects of this technology, from the technical fundamentals and image evaluation all the way to clinical indications and protocol recommendations. This fully reworked second edition draws on the most recent clinical experience obtained with 16- and 64-slice CT scanners by world-leading experts from Europe and the United States. It also includes ''hands-on'' experience in the form of 10 representative clinical case studies, which are included on the accompanying CD. As a further highlight, the latest results of the very recently introduced dual-source CT, which may soon represent the CT technology of choice for cardiac applications, are presented. This book will not only convince the reader that multi-slice cardiac CT has arrived in clinical practice, it will also make a significant contribution to the education of radiologists, cardiologists, technologists, and physicists-whether newcomers, experienced users, or researchers. (orig.)

Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

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Xu, Lei; Yang, Lin; Fan, Zhanming; Yu, Wei; Lv, Biao; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China)

2011-05-15

To evaluate the feasibility, diagnostic accuracy, and radiation dose of CT coronary angiography (CTCA) in patients with atrial fibrillation (AF) using 320-detector CT. Thirty-seven patients with persistent AF and suspected coronary artery disease (CAD) were enrolled. All patients underwent both 320-detector CTCA and conventional coronary angiography (CCA). CT image quality and the presence of significant ({>=}50%) stenosis were evaluated by two radiologists blinded to the results of CCA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using CCA as the reference standard. Differences in detection of coronary artery stenosis between 320-detector CTCA and CCA were evaluated with McNemar's test. Patient radiation dose was calculated by multiplying dose length product by conversion coefficient of 0.017. In total 474 evaluated coronary segments, 459 (96.8%) segments were diagnostically evaluable. On per-segment analysis, sensitivity, specificity, PPV and NPV were 90.0% (18 of 20), 99.3% (436 of 439), 85.7% (18 of 21) and 99.5% (436 of 438). No significant difference was found between 320-detector CTCA and CCA on the detection of significant stenosis (P = 1.000). Effective doses of 320-detector CTCA was 13.0 {+-} 4.7 mSv. 320-detector CTCA is feasible and accurate in excluding CAD in patients with AF. (orig.)

Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

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Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

2014-08-15

Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

International Nuclear Information System (INIS)

Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol

2014-01-01

Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

Assessment of coronary artery aneurysms in paediatric patients with Kawasaki disease by multidetector row CT angiography: feasibility and comparison with 2D echocardiography

International Nuclear Information System (INIS)

Chu, W.C.W.; Lam, W.W.M.; Mok, G.C.F.; Yam, M.; Sung, R.Y.T.

2006-01-01

Transthoracic ECHO is the locally accepted method for coronary surveillance of patients with Kawasaki disease but it may have limited visualization in the older child. To assess the feasibility of multidetector CT (MDCT) angiography in the follow-up of coronary artery aneurysms in children with previous Kawasaki disease. Six children (5 boys, 1 girl; mean age 11.5 years) with known Kawasaki disease and coronary artery involvement underwent CT coronary angiography using 16-detector MDCT. The visualized lengths and diameter of all coronary segments were measured. The number, size and location of coronary artery aneurysms were recorded and compared with recent ECHO. Twelve coronary artery aneurysms (seven saccular, five fusiform) were identified by MDCT angiography. One saccular aneurysm at the junction of the distal right coronary artery and posterior descending artery was not detected by ECHO while the remaining six in proximal segments were detected by both modalities. Two of five fusiform aneurysms were not detected by ECHO due to their small sizes. Excellent agreement was found between CT and ECHO for maximal diameter and length of the visualized aneurysms. MDCT angiography accurately defines coronary artery aneurysms. It is more sensitive for detecting aneurysms at distal coronary segments and fusiform aneurysms of small size

The value of whole-brain CT perfusion imaging and CT angiography using a 320-slice CT scanner in the diagnosis of MCI and AD patients

Energy Technology Data Exchange (ETDEWEB)

Zhang, Bo; Gu, Guo-jun; Jiang, Hong; Guo, Yi [Medical School of Tongji University, Department of Medical Imaging, Tongji Hospital, Shanghai (China); Shen, Xing [Traditional Chinese Hospital, Department of Radiology, Kun Shan, Jiangsu Province (China); Li, Bo; Zhang, Wei [Medical School of Jiaotong University, Department of Medical Imaging, Renji Hospital, Shanghai (China)

2017-11-15

To validate the value of whole-brain computed tomography perfusion (CTP) and CT angiography (CTA) in the diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Whole-brain CTP and four-dimensional CT angiography (4D-CTA) images were acquired in 30 MCI, 35 mild AD patients, 35 moderate AD patients, 30 severe AD patients and 50 normal controls (NC). Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and correlation between CTP and 4D-CTA were analysed. Elevated CBF in the left frontal and temporal cortex was found in MCI compared with the NC group. However, TTP was increased in the left hippocampus in mild AD patients compared with NC. In moderate and severe AD patients, hypoperfusion was found in multiple brain areas compared with NC. Finally, we found that the extent of arterial stenosis was negatively correlated with CBF in partial cerebral cortex and hippocampus, and positively correlated with TTP in these areas of AD and MCI patients. Our findings suggest that whole-brain CTP and 4D-CTA could serve as a diagnostic modality in distinguishing MCI and AD, and predicting conversion from MCI based on TTP of left hippocampus. (orig.)

The value of whole-brain CT perfusion imaging and CT angiography using a 320-slice CT scanner in the diagnosis of MCI and AD patients

International Nuclear Information System (INIS)

Zhang, Bo; Gu, Guo-jun; Jiang, Hong; Guo, Yi; Shen, Xing; Li, Bo; Zhang, Wei

2017-01-01

To validate the value of whole-brain computed tomography perfusion (CTP) and CT angiography (CTA) in the diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Whole-brain CTP and four-dimensional CT angiography (4D-CTA) images were acquired in 30 MCI, 35 mild AD patients, 35 moderate AD patients, 30 severe AD patients and 50 normal controls (NC). Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and correlation between CTP and 4D-CTA were analysed. Elevated CBF in the left frontal and temporal cortex was found in MCI compared with the NC group. However, TTP was increased in the left hippocampus in mild AD patients compared with NC. In moderate and severe AD patients, hypoperfusion was found in multiple brain areas compared with NC. Finally, we found that the extent of arterial stenosis was negatively correlated with CBF in partial cerebral cortex and hippocampus, and positively correlated with TTP in these areas of AD and MCI patients. Our findings suggest that whole-brain CTP and 4D-CTA could serve as a diagnostic modality in distinguishing MCI and AD, and predicting conversion from MCI based on TTP of left hippocampus. (orig.)

Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture.

Science.gov (United States)

Koektuerk, Buelent; Yorgun, Hikmet; Koektuerk, Oezlem; Turan, Cem H; Gorr, Eduard; Horlitz, Marc; Turan, Ramazan G

2016-02-01

Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure. © 2015 John Wiley & Sons Ltd.

Three-dimensional anatomical evaluation of bronchial artery with CT angiography

International Nuclear Information System (INIS)

Yu Hong; Li Huimin; Xiao Xiangsheng; Liu Shiyuan; Li Chengzhou; Tao Xiaofeng

2006-01-01

Objective: To evaluate the ability of CT angiography in identifying and demonstrating the origins and courses of bronchial arteries by using the three-dimensional reformation technique. Methods Four hundred and forty-three eases were examined with thin-section enhanced MSCT. Three-dimensional images of bronchial arteries were processed at the workstation. Spatial anatomical characters of the bronchial arteries using volume rendering(VR), muhiplanar reconstruction (MPR), and maxium intensity projection (MIP) were observed. Results: At least one bronchial artery was clearly displayed in VR in 359 eases. The right bronchial arteries mainly appeared to originate from the right intercostal artery (213/436, 48.85% ) and descending aorta (207/436, 47.48%), while the left bronchial arteries mainly from the descending aorta (363/371, 97.84%). The right bronchial arteries of the descending aorta were mainly arised from fight wall (95/207, 45.89%), and then the anterior wall (88/207, 42.51%), while the left bronchial arteries of the descending aorta mainly arised from anterior wall of the aorta (272/363, 74.93%). The common trunk originated from the descending aorta mainly positioned in the anterior wall (57/77, 74.03%). 49.31% (215/436) of the fight bronchial arteries were coursing across the posterior edge of the right main bronchi, 35.55% (155/436) coursing the inferior edge, while 60.11% (223/371) of left bronchial arteries coursing forward across the superior edger of the left main bronchi, the others coursing the inferior or the posterior edge. There were eleven bronchial artery distribution patterns, with the right and left ones predominating (192/359, 53.48%), and then two right and one left (63/359, 17.55%). Conclusion: The bronchial artery anatomy was complicated, and CT angiography could clearly visualize the features. (authors)

CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Energy Technology Data Exchange (ETDEWEB)

Seeters, Tom van; Schaaf, Irene C. van der; Dankbaar, Jan Willem; Horsch, Alexander D.; Niesten, Joris M.; Luitse, Merel J.A.; Mali, Willem P.T.M.; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Vos, Jan Albert [St. Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Schonewille, Wouter J. [St. Antonius Hospital, Department of Neurology, Nieuwegein (Netherlands); Walderveen, Marianne A.A. van [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Wermer, Marieke J.H. [Leiden University Medical Center, Department of Neurology, Leiden (Netherlands); Duijm, Lucien E.M. [Catharina Hospital, Department of Radiology, Eindhoven (Netherlands); Keizer, Koos [Catharina Hospital, Department of Neurology, Eindhoven (Netherlands); Bot, Joseph C.J. [VU University Medical Center, Department of Radiology, Amsterdam (Netherlands); Visser, Marieke C. [VU University Medical Center, Department of Neurology, Amsterdam (Netherlands); Lugt, Aad van der [Erasmus MC University Medical Center, Department of Radiology, Rotterdam (Netherlands); Dippel, Diederik W.J. [Erasmus MC University Medical Center, Department of Neurology, Rotterdam (Netherlands); Kesselring, F.O.H.W. [Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Hofmeijer, Jeannette [Rijnstate Hospital, Department of Neurology, Arnhem (Netherlands); Lycklama a Nijeholt, Geert J. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Boiten, Jelis [Medical Center Haaglanden, Department of Neurology, The Hague (Netherlands); Rooij, Willem Jan van [St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Kort, Paul L.M. de [St. Elisabeth Hospital, Department of Neurology, Tilburg (Netherlands); Roos, Yvo B.W.E.M. [Academic Medical Center, Department of Neurology, Amsterdam (Netherlands); Meijer, Frederick J.A. [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands); Pleiter, C.C. [St. Franciscus Hospital, Department of Radiology, Rotterdam (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: Dutch acute stroke study (DUST) investigators

2016-04-15

We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R{sup 2} was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R{sup 2} = 0.58) was superior to patient characteristics and non-contrast CT alone (R{sup 2} = 0.44) and to addition of CTA alone (R{sup 2} = 0.55) or CTP alone (R{sup 2} = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

Noncardiac findings on cardiac CT part I: Pros and cons.

LENUS (Irish Health Repository)

Killeen, Ronan P

2012-02-01

Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive imaging modalities include its ability to evaluate directly the coronary arteries and to provide an opportunity to evaluate extracardiac structures, such as the lungs and mediastinum. Some centers reconstruct a small field of view (FOV) cropped around the heart, but a full FOV (from skin to skin in the irradiated area) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV evaluation. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient\\'s presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this two-part review we outline the issues surrounding the concept of the noncardiac read looking for noncardiac findings on cardiac CT. Part I focuses on the pros and cons of the practice of identifying noncardiac findings on cardiac CT.

[Giant aneurysm of posterior comunicating artery (PCoA) in cerebral panarteriography and CT angiography (CTA)].

Science.gov (United States)

Jaźwiec, Przemysław; Chwiszczuk, Luiza; Sasiadek, Marek; Całka, Karol; Kuniej, Tomasz; Plucińska, Irena

2008-01-01

We present a case of 32-year-old woman, who was admitted to the Department of Neurology in the emergency mode, due to: instantaneous pupillary dilation (mydriasis), ptosis of the left eyeball and double vision. We performed plain CT, panarteriography of cerebral vessels, CT angiography with RT3D (volume-rendered three-dimensional) reconstruction images. On the base of imaging studies the diagnosis of giant saccular aneurysm of the left posterior communicating artery was established. The patient was operated on and the giant aneurysm of left posterior communicating artery was clipped, confirming radiological diagnosis. During operation and postoperative period no complications were noted.

Low-dose CT pulmonary angiography on a 15-year-old CT scanner: a feasibility study

Directory of Open Access Journals (Sweden)

Moritz Kaup

2016-12-01

Full Text Available Background Computed tomography (CT low-dose (LD imaging is used to lower radiation exposure, especially in vascular imaging; in current literature, this is mostly on latest generation high-end CT systems. Purpose To evaluate the effects of reduced tube current on objective and subjective image quality of a 15-year-old 16-slice CT system for pulmonary angiography (CTPA. Material and Methods CTPA scans from 60 prospectively randomized patients (28 men, 32 women were examined in this study on a 15-year-old 16-slice CT scanner system. Standard CT (SD settings were 100 kV and 150 mAs, LD settings were 100 kV and 50 mAs. Attenuation of the pulmonary trunk, various anatomic landmarks, and image noise were quantitatively measured; contrast-to-noise ratios (CNR and signal-to-noise ratios (SNR were calculated. Three independent blinded radiologists subjectively rated each image series using a 5-point grading scale. Results CT dose index (CTDI in the LD series was 66.46% lower compared to the SD settings (2.49 ± 0.55 mGy versus 7.42 ± 1.17 mGy. Attenuation of the pulmonary trunk showed similar results for both series (SD 409.55 ± 91.04 HU; LD 380.43 HU ± 93.11 HU; P = 0.768. Subjective image analysis showed no significant differences between SD and LD settings regarding the suitability for detection of central and peripheral PE (central SD/LD, 4.88; intra-class correlation coefficients [ICC], 0.894/4.83; ICC, 0.745; peripheral SD/LD, 4.70; ICC, 0.943/4.57; ICC, 0.919; all P > 0.4. Conclusion The LD protocol, on a 15-year-old CT scanner system without current high-end hardware or post-processing tools, led to a dose reduction of approximately 67% with similar subjective image quality and delineation of central and peripheral pulmonary arteries.

Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC)

DEFF Research Database (Denmark)

Flotats, Albert; Gutberlet, Matthias; Knuuti, Juhani

2011-01-01

. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients...

ASCI 2010 contrast media guideline for cardiac imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

Science.gov (United States)

Kitagawa, Kakuya; Tsai, I-Chen; Chan, Carmen; Yu, Wei; Yong, Hwan Seok; Choi, Byoung Wook

2010-01-01

The use of contrast media for cardiac imaging becomes increasing as the widespread of cardiac CT and cardiac MR. A radiologist needs to carefully consider the indication and the injection protocol of contrast media to be used as well as the possibility of adverse effect. There are several guidelines for contrast media in western countries. However, these are focusing the adverse effect of contrast media. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and created a guideline, which summarizes the integrated knowledge of contrast media for cardiac imaging. In cardiac imaging, coronary artery evaluation is feasible by non-contrast MR angiography, which can be an alternative examination in high risk patients for the use of iodine contrast media. Furthermore, the body habitus of Asian patients is usually smaller than that of their western counterparts. This necessitates modifications in the injection protocol and in the formula for calculation of estimated glomerular filtration rate. This guideline provided fundamental information for the use of contrast media for Asian patients in cardiac imaging. PMID:20931289

Comparative evaluation of 64-slice CT angiography and digital subtraction angiography in assessing the cervicocranial vasculature

Directory of Open Access Journals (Sweden)

Randolf Klingebiel

2008-08-01

Full Text Available Randolf Klingebiel1, Max Kentenich3, Hans-Christian Bauknecht3, Florian Masuhr2, Eberhard Siebert1, Markus Busch2, Georg Bohner11Department of Neuroradiology, 2Department of Neurology, 3Department of Radiology, Charité Universitary Medicine Berlin, GermanyBackground: Noninvasive 64-slice computed tomography angiography (64-MSCTA closely approximates conventional catheter angiography (DSA in terms of detail resolution. Objective: Retrospective evaluation of cervicocranial (cc 64-MSCTA in comparison with DSA in patients with presumptive cc vascular disorders.Material and methods: Twenty-four 64-MSCTA studies (32 mm detector width, slice thickness 0.5 mm, 120 kv, 150 mAs, pitch 0.75 of patients with presumptive cc vascular pathology (13 men, 11 women, mean age 38.3 ± 11.3 yrs, range 19–54 yrs were assessed in comparison with DSA studies without abnormal findings in age-matched patients (11 men, 13 women, mean age 39.7 ± 11.9 yrs, range 18–54 yrs. Study readings were performed in a blinded manner by two neuroradiologists with respect to image quality and assessibility of various cc vascular segments by using a five-point scale. Radiation exposure was calculated for 64-MSCTA.Results: Each reader assessed 384/528 different vessel segments (64-MSCTA/DSA. Superior image quality was attributed to DSA with respect to the C1 ICA–C6 ICA, A3 ACA, and P3 PCA segments as well the AICA and SCA. 64-MSCTA was scored superior for C7 ICA and V4 VA segments. A significantly increased number of nonassessable V2- and V3 VA segments in DSA studies was noted. The effective dose for 64-MSCTA amounted to 2.2 mSv.Conclusions: 64-MSCTA provides near-equivalent diagnostic information of the cc vasculature as compared with DSA. According to our results, DSA should be considered primarily when peripheral vessels (A3/P3 or ICA segments close to the skull base (C2-5 are of interest, such as in primary angiitis or stenoocclusive ICA disease, respectively.Keywords: CT-angiography

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

International Nuclear Information System (INIS)

Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

2011-01-01

Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

Intracranial aneurysms: reproduction of the surgical view using 3D-CT angiography

Energy Technology Data Exchange (ETDEWEB)

Siablis, Dimitrios [Department of Radiology, School of Medicine, University of Patras, Rion GR 26500 (Greece)]. E-mail: siablis@med.upatras.gr; Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion GR 26500 (Greece); Karamessini, Maria T. [Department of Radiology, School of Medicine, University of Patras, Rion GR 26500 (Greece); Konstantinou, Dimitrios [Department of Neurosurgery, School of Medicine, University of Patras, Rion GR 26500 (Greece); Karnabatidis, Dimitrios [Department of Radiology, School of Medicine, University of Patras, Rion GR 26500 (Greece); Petsas, Theodore [Department of Radiology, School of Medicine, University of Patras, Rion GR 26500 (Greece); Nikiforidis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion GR 26500 (Greece)

2005-07-01

Our purpose was to describe a technique for simulating the surgical view of ruptured intracranial aneurysms, using volume-rendering techniques in spiral computed tomography (CT) angiography data. The 3D (three-dimensional) rendered images were assessed by a team consisted of four radiologists, one neurosurgeon and one medical physicist. The resultant 'surgical view' image was standardized in space using a three-dimensional coordinate system, which allowed for its reproduction in the operating theatre. The surgical views are a potentially useful tool for the surgical planning of intracranial aneurysms.

Intracranial aneurysms: reproduction of the surgical view using 3D-CT angiography

International Nuclear Information System (INIS)

Siablis, Dimitrios; Kagadis, George C.; Karamessini, Maria T.; Konstantinou, Dimitrios; Karnabatidis, Dimitrios; Petsas, Theodore; Nikiforidis, George C.

2005-01-01

Our purpose was to describe a technique for simulating the surgical view of ruptured intracranial aneurysms, using volume-rendering techniques in spiral computed tomography (CT) angiography data. The 3D (three-dimensional) rendered images were assessed by a team consisted of four radiologists, one neurosurgeon and one medical physicist. The resultant 'surgical view' image was standardized in space using a three-dimensional coordinate system, which allowed for its reproduction in the operating theatre. The surgical views are a potentially useful tool for the surgical planning of intracranial aneurysms

Image quality on dual-source computed-tomographic coronary angiography

International Nuclear Information System (INIS)

Rixe, Johannes; Rolf, Andreas; Conradi, Guido; Elsaesser, Albrecht; Moellmann, Helge; Nef, Holger M.; Hamm, Christian W.; Dill, Thorsten; Bachmann, Georg

2008-01-01

Multi-detector CT reliably permits visualization of coronary arteries, but due to the occurrence of motion artefacts at heart rates >65 bpm caused by a temporal resolution of 165 ms, its utilisation has so far been limited to patients with a preferably low heart rate. We investigated the assessment of image quality on computed tomography of coronary arteries in a large series of patients without additional heart rate control using dual-source computed tomography (DSCT). DSCT (Siemens Somatom Definition, 83-ms temporal resolution) was performed in 165 consecutive patients (mean age 64±11.4 years) after injection of 60-80 ml of contrast. Data sets were reconstructed in 5% intervals of the cardiac cycle and evaluated by two readers in consensus concerning evaluability of the coronary arteries and presence of motion and beam-hardening artefacts using the AHA 16-segment coronary model. Mean heart rate during CT was 65±10.5 bpm; visualisation without artefacts was possible in 98.7% of 2,541 coronary segments. Only two segments were considered unevaluable due to cardiac motion; 30 segments were unassessable due to poor signal-to-noise ratio or coronary calcifications (both n=15). Data reconstruction at 65-70% of the cardiac cycle provided for the best image quality. For heart rates >85 bpm, a systolic reconstruction at 45% revealed satisfactory results. Compared with earlier CT generations, DSCT provides for non-invasive coronary angiography with diagnostic image quality even at heart rates >65 bpm and thus may broaden the spectrum of patients that can be investigated non-invasively. (orig.)

Interobserver variability in the evaluation of internal carotid artery stenosis by CT angiography

International Nuclear Information System (INIS)

Carrascosa, Patricia; Meli, Francisco; Sampere, Tulio; Capunay, Carlos; Sanchez, Flavio; Carrascosa, Jorge

2001-01-01

Ischemic cerebral vascular events are primarily due to atherosclerotic narrowing of carotid bifurcation. Catheter Angiography (CA) is the best test for determining carotid artery stenosis, but it is invasive and has some risks. The purpose of this study was to evaluate CT Angiography (CTA) as a non-invasive method compared with CA. Different estimate procedures (NASCET, ESCT and area quantification) were done to compare the Sensitivity (S) and Specificity (E) of each one with CA. Afterwards, interobserver variability of the three procedures was evaluated. Thirty-eight internal carotid arteries were studied in 19 patients with transient ischemic attacks. CTA studies were done in a helical CT scanner. The images were evaluated in a workstation by two radiologists, who were blinded to the percentage of stenosis determined by CA. For statistical analysis, the measurement of stenosis percentage was divided in two groups: a) Negative (0-69%) and b) Positive:(70-100%). Kappa analysis (K) was used to determine the agreement of stenosis. Results: Observer 1: Sensitivity (S) NASCET: 94%, ESCT: 77% and area 94% and Specificity (E): 91%, 87,5% and 87,5%. Observer 2: 77%, 77% and 74%. The interobserver K was 0.83, 0792 and 0.78 for NASCET, ESCT and area quantification methods respectively. In conclusion, CTA has high S and E especially in NASCET and area quantification. (author)

Prospective comparison of helical CT with angiography in pulmonary embolism: global and selective vascular territory analysis. Interobserver agreement

International Nuclear Information System (INIS)

Ruiz, Yolanda; Caballero, Paloma; Caniego, Jose Luis; Friera, Alfonsa; Olivera, Maria Jose; Tagarro, David; Alvarez-Sala, Rodolfo

2003-01-01

The objective of this prospective study was to evaluate the sensitivity, specificity, positive and negative predictive values, and interobserver agreement in the diagnosis of pulmonary embolism with helical CT, compared with pulmonary angiography, for both global results and for selective vascular territories. Helical CT and pulmonary angiography were performed on 66 consecutive patients with clinical suspicion of pulmonary embolism. The exams were blindly interpreted by a vascular radiologist and by two independent thoracic radiologists. Results were analyzed for the final diagnosis as well as separately for 20 different arterial territories in each patient. Pulmonary angiography revealed embolism in 25 patients (38%); 48% were main, 28% lobar, 16% segmental, and 8% subsegmental. The sensitivity, specificity, and positive and negative predictive values of helical CT for observer 1 were, respectively, 91, 81.5, 75, and 94%; in 7.5% of the patients the exam was considered indeterminate. For observer 2 the values were, respectively, 88, 86, 81.5, and 91%; in 9% of the patients the exam was considered indeterminate. Main arteries were considered as non-valuable in 0-0.8%, the lobar in 1.5%, the segmental in 7.5-8.5%, and the subsegmental in 55-60%. Interobserver agreement for the final diagnosis was 80% (kappa 0.65). For each vascular territory, this was 98% (kappa 0.91) for main arteries, 92% (kappa 0.78) for lobar arteries, 79% (kappa 0.56) for segmental arteries, and 59% (kappa 0.21) for subsegmental arteries. Helical CT is a reliable method for pulmonary embolism diagnosis, with good interobserver agreement for main, lobar, and segmental territories. Worse results are found for subsegmental arteries, with high incidence of non-valuable branches and poor interobserver agreement. (orig.)