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Sample records for ct angiography cta

  1. CT Angiography (CTA)

    Science.gov (United States)

    ... during the procedure. Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images and ... of the procedure, you may be asked to complete a questionnaire to ensure your safety during this ...

  2. Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-based wavelet-transformed angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kunz, Wolfgang G.; Sommer, Wieland H.; Meinel, Felix G.; Ertl-Wagner, Birgit; Thierfelder, Kolja M. [Ludwig-Maximilian-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Havla, Lukas; Dietrich, Olaf [Ludwig-Maximilian-University Hospital Munich, Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Munich (Germany); Dorn, Franziska [Ludwig-Maximilian-University Hospital Munich, Department of Neuroradiology, Munich (Germany); Buchholz, Grete [Ludwig-Maximilian-University Hospital Munich, Department of Neurology, Munich (Germany)

    2017-06-15

    To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion. Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions. Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041). waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy. (orig.)

  3. CT angiography - abdomen and pelvis

    Science.gov (United States)

    Computed tomography angiography - abdomen and pelvis; CTA - abdomen and pelvis; Renal artery - CTA; Aortic - CTA; Mesenteric CTA ... belly or pelvis Masses and tumors in the abdomen or pelvis, including cancer, when needed to help ...

  4. Coronary CT angiography and MR angiography of Kawasaki disease

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    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Paediatric Cardiology, Asan Medical Center, Seoul (Korea)

    2006-07-15

    Although the incidence of coronary artery aneurysms has diminished in patients with Kawasaki disease, coronary artery involvement is still regarded as a major complication of the disease, significantly affecting morbidity and mortality. Recent technical advances in coronary CT angiography (CTA) and MR angiography (MRA) have led to the possibility of using these two imaging methods as minimally invasive alternatives to the more invasive diagnostic catheter angiography in evaluating coronary artery abnormalities, such as aneurysm, stenosis, and occlusion. In this article, we describe imaging techniques and findings of coronary CTA and MRA in Kawasaki disease. (orig.)

  5. Evaluation of exposure dose reduction in multislice CT coronary angiography (MS-CTA) with prospective ECG-gated helical scan

    Science.gov (United States)

    Ota, Takamasa; Tsuyuki, Masaharu; Okumura, Miwa; Sano, Tomonari; Kondo, Takeshi; Takase, Shinichi

    2008-03-01

    A novel low-dose ECG-gated helical scan method to investigate coronary artery diseases was developed. This method uses a high pitch for scanning (based on the patient's heart rate) and X-rays are generated only during the optimal cardiac phases. The dose reduction was obtained using a two-level approach: 1) To use a 64-slice CT scanner (Aquilion, Toshiba, Otawara, Tochigi, Japan) with a scan speed of 0.35 s/rot. to helically scan the heart at a high pitch based on the patient's heart rate. By changing the pitch from the conventional 0.175 to 0.271 for a heart rate of 60 bpm, the exposure dose was reduced to 65%. 2) To employ tube current gating that predicts the timing of optimal cardiac phases from the previous cardiac cycle and generates X-rays only during the required cardiac phases. The combination of high speed scanning with a high pitch and appropriate X-ray generation only in the cardiac phases from 60% to 90% allows the exposure dose to be reduced to 5.6 mSv for patients with a heart rate lower than 65 bpm. This is a dose reduction of approximately 70% compared to the conventional scanning method recommended by the manufacturer when segmental reconstruction is considered. This low-dose protocol seamlessly allows for wide scan ranges (e.g., aortic dissection) with the benefits of ECG-gated helical scanning: smooth continuity for longitudinal direction and utilization of data from all cardiac cycles.

  6. Subtraction CT angiography for evaluation of intracranial aneurysms: comparison with conventional CT angiography

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    Li, Qi; Li, Kewei; Xie, Peng [The First Affiliated Hospital, Chongqing Medical University, Department of Neurology, Chongqing (China); Lv, Fajin; Li, Yongmei; Luo, Tianyou [The First Affiliated Hospital, Chongqing Medical University, Department of Radiology, Chongqing (China)

    2009-09-15

    The purpose of our study was to compare the diagnostic performance of subtraction computed tomography angiography (CTA) with conventional nonsubtracted CTA and digital subtraction angiography (DSA) for the detection of intracranial aneurysms. A total of 76 patients underwent both subtraction CTA and conventional CTA for the detection and therapy planning of suspected intracranial aneurysms. Subtraction and conventional CTA images were independently assessed by two readers in a blinded manner. The possibility of endovascular treatment or surgical clipping was also assessed based on information provided by CT angiograms alone. In 64 patients, 75 aneurysms were present on DSA. On a per-aneurysm basis, the sensitivity of subtraction CTA was 98.6% for reader 1, and 100% for reader 2. However, sensitivity of conventional CTA was 94.6% for reader 1, and 93.3% for reader 2. Therapeutic decisions could be made regarding 63 patients based on information provided by subtraction CTA images. However, conventional CTA provided sufficient information to make this decision for 55 patients. Conventional CTA has limited sensitivity in detecting very small aneurysms as well as aneurysms adjacent to bone. Subtraction CTA performed on a 64-row multidetector CT is an accurate and promising diagnostic tool that seems to be equivalent to 2D DSA for the detection and pretreatment planning of intracranial aneurysms. (orig.)

  7. Spiral CT angiography of renal arteries: comparison with angiography

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    Wittenberg, G.; Kenn, W.; Tschammler, A.; Sandstede, J.; Hahn, D. [Inst. fuer Roentgendiagnostik der Universitaet Wuerzburg (Germany)

    1999-04-01

    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.) With 2 figs., 1 tab., 25 refs.

  8. Usefulness of three-dimensional CT angiography (3D-CTA) with a single bolus injection of contrast material for the examination of intracranial and cervical arteries in cerebrovascular disease screening

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    Takamura, Yukio [Sapporo National Hospital (Japan); Tanooka, Atsushi; Morimoto, Shigefumi

    2001-05-01

    Three-dimensional CT angiography (3D-CTA) has been gaining wide acceptance as a clinically useful tool in the field of neurosurgery. The great diagnostic value of 3D-CTA for cerebral aneurysm or other cerebrovascular diseases has been well established. However, images of the intracranial and cervical arteries have not been obtained simultaneously because of the limitation of the scanning area and the need for contrast material. In order to use 3D-CTA to screen for cerebrovascular disease, we used a helical CT scan with an intravenous single bolus injection of contrast material to perform 3D-CTA of the intracranial and cervical arteries simultaneously. A spiral computed tomographic scan was performed with a Hispeed Advantage RP (General Electric). After injection of 150 ml of nonionized contrast material at a rate of 3 mm/sec in an antecubital vein, an axial computed tomographic scan (120 kV, 200 mA) of the cranial region was performed with a delay of 20-25 seconds after starting the injection. Section thickness was 1 mm with table increments of 1 mm per rotation. The scan volume included 20-30 mm above and below the sella turcica. An axial computed tomographic scan (120 kV, 190 mA) of the cervical region was performed with a delay of 30 seconds after completion of cranial CTA. Section thickness was 3 mm with table increments of 3 mm per rotation. Image reconstruction was carried out through surface rendering and maximum intensity projection processing. From November 1995 to August 1998, we used this technique to screen 218 consecutive outpatients for cerebrovascular disease. Unruptured cerebral aneurysms were found in 20 cases (9.2%). Atherosclerotic diseases of the cervical carotid artery were found in 58 cases (26.6%), as follows: carotid artery occlusion in 2 cases, carotid bifurcation stenosis in 22 cases, and intramural calcification of the internal carotid artery in 50 cases. Atherosclerotic diseases of the intracranial artery were found in 99 cases (45

  9. Order of CT stroke protocol (CTA before or after CTP): impact on image quality

    Energy Technology Data Exchange (ETDEWEB)

    Dorn, Franziska [Technical University, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); University Hospital of Cologne, Department of Radiology and Neuroradiology, Cologne (Germany); Institut fuer Radiologie, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Munich (Germany); Liebig, Thomas [University Hospital of Cologne, Department of Radiology and Neuroradiology, Cologne (Germany); Muenzel, Daniela; Meier, Reinhard; Rummeny, Ernst J.; Huber, Armin [Technical University, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Poppert, Holger [Technical University, Department of Neurology, Klinikum rechts der Isar, Munich (Germany)

    2012-02-15

    The purpose of this study was to determine the appropriate order of CT angiography and CT perfusion in a multimodal stroke CT protocol. Forty patients with clinical suspicion of an acute cerebral infarct underwent non-enhanced CT (NECT), CT angiography (CTA), and CT perfusion (CTP). Twenty examinations were performed with CTP before CTA (group 1) and 20 in reversed order (group 2). Mean densities were determined at baseline and peak enhancement of CTP, as well as on source images of CTA in defined brain regions. Contrast of extra-/intracranial arteries and veins was rated according to a 5-point scale (1 = excellent, 5 = poor). CT-perfusion maps were assessed by determining the mean transit time (MTT), cerebral blood flow (CBF), and blood volume (CBV) in identical regions. Mean densities between both groups were not significantly different for CTA and CTP at peak enhancement. At CTP baseline, mean densities between groups 1 and 2 were different for all points except for GM and WM. There was no significant difference between both groups for the mean delta (the difference between baseline and peak enhancement), as well as for mean MTT, CBV, and CBF. Subjective evaluation of the CTA quality revealed no difference between both protocols, except for the extracranial venous contrast, which was less severe in group 2. Reversal of CT stroke protocol had no significant influence on quantitative parameters of CTP. Subjective quality of extracranial venous contrast was rated to be superior when CTA was performed before CTP. (orig.)

  10. Usefulness of 3D-CT angiography using multislice CT for diagnosing cardiovascular anomalies in infants

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    Kani, Hiroyuki; Matsuki, Mitsuru; Masuda, Kiyohiro; Narabayashi, Isamu; Katayama, Hiroshi; Mori, Yasuhiko; Tamai, Hiroshi [Osaka Medical Coll., Takatsuki (Japan)

    2003-05-01

    We compared three-dimensional computed tomographic angiography using multislice CT (3D-CTA) with echocardiography and angiography in terms of usefulness in the diagnosis of 13 infants with cardiovascular anomalies. 3D-CTA clearly depicted stenoses of the pulmonary artery and vein, and coarctation of the aorta in some cases, which could not be revealed by echocardiography and angiography. Moreover, it provided objectively more information on vascular morphologic characteristics and 3D anatomic relations than echocardiography and angiography. 3D-CTA is a noninvasive and convenient diagnostic technique for cardiovascular anomalies in infants. (author)

  11. Coronary CT angiography-derived quantitative markers for predicting in-stent restenosis

    NARCIS (Netherlands)

    Tesche, Christian; De Cecco, Carlo N.; Vliegenthart, Rozemarijn; Duguay, Taylor M.; Stubenrauch, Andrew C.; Rosenberg, Russell D.; Varga-Szemes, Akos; Bayer, Richard R.; Yang, Junjie; Ebersberger, Ullrich; Baguet, Moritz; Jochheim, David; Hoffmann, Ellen; Steinberg, Daniel H.; Chiaramida, Salvatore A.; Schoepf, U. Joseph

    2016-01-01

    Objective: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) performed prior to percutaneous coronary intervention (PCI) with stent placement for predicting in-stent restenosis (ISR) as defined by quantitative coronary angiography (QCA). Materials and methods: We

  12. Coronary CT angiography in symptomatic patients

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    Becker, C.R. [Inst. of Radiologic Diagnostic, Univ. of Munich, Klinikum Grosshadern, Munich (Germany)

    2005-02-01

    The currently best available spatial and temporal resolution for retrospectively ECG gated coronary multi-detector-row CT angiography is 0.4 mm and 165 ms, respectively. These acquisition parameters are already rather close to cardiac catheter. Studies so far compared non-invasive coronary CT and convention angiography for the detection of coronary artery stenoses. The most promising result reported by all authors was the high negative predictive value of the CTA. It now needs to be determined if CTA is a reliable tool to rule out coronary artery stenoses in a patient cohort with low likelihood of CAD, such as those with atypical chest pain or ambiguous stress test. CTA may furthermore establish as a rapid and widely available tool to detect vulnerable plaques or intracoronary thrombus in patients with acute coronary syndrome and unstable angina. In patients with chronic stable angina, tools that determine myocardial ischemia under stress such as SPECT and MRI are probably better suited to determine the relevance of coronary artery stenoses. In this particular cohort, by displaying the extent and morphology of coronary atherosclerosis, CTA may help to direct the therapy to either intervention or surgery. (orig.)

  13. 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)

  14. Feasibility of low contrast media volume in CT angiography of the aorta

    NARCIS (Netherlands)

    Seehofnerová, Anna; Kok, Madeleine; Mihl, Casper; Douwes, Dave; Sailer, Anni; Nijssen, Estelle; de Haan, Michiel J W; Wildberger, Joachim E; Das, Marco

    2015-01-01

    OBJECTIVES: Using smaller volumes of contrast media (CM) in CT angiography (CTA) is desirable in terms of cost reduction and prevention of contrast-induced nephropathy (CIN). The purpose was to evaluate the feasibility of low CM volume in CTA of the aorta. METHODS: 77 patients referred for CTA of th

  15. CTA-enhanced perfusion CT: an original method to perform ultra-low-dose CTA-enhanced perfusion CT

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    Tong, Elizabeth; Wintermark, Max [University of Virginia, Department of Radiology, Neuroradiology Division, Charlottesville, VA (United States)

    2014-11-15

    Utilizing CT angiography enhances image quality in PCT, thereby permitting acquisition at ultra-low dose. Dynamic CT acquisitions were obtained at 80 kVp with decreasing tube current-time product [milliamperes x seconds (mAs)] in patients suspected of ischemic stroke, with concurrent CTA of the cervical and intracranial arteries. By utilizing fast Fourier transformation, high spatial frequencies of CTA were combined with low spatial frequencies of PCT to create a virtual PCT dataset. The real and virtual PCT datasets with decreasing mAs were compared by assessing contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and noise and PCT values and by visual inspection of PCT parametric maps. Virtual PCT attained CNR and SNR three- to sevenfold superior to real PCT and noise reduction by a factor of 4-6 (p < 0.05). At 20 mAs, virtual PCT achieved diagnostic parametric maps, while the quality of real PCT maps was inadequate. At 10 mAs, both real and virtual PCT maps were nondiagnostic. Virtual PCT (but not real PCT) maps regained diagnostic quality at 10 mAs by applying 40 % adaptive statistical iterative reconstruction (ASIR) and improved further with 80 % ASIR. Our new method of creating virtual PCT by combining ultra-low-dose PCT with CTA information yields diagnostic perfusion parametric maps from PCT acquired at 20 or 10 mAs with 80 % ASIR. Effective dose is approximately 0.20 mSv, equivalent to two chest radiographs. (orig.)

  16. CT angiography in patients with spontaneous intracerebral hematoma

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    Yoon, Dae Young; Shim, Joo Eun; Yi, Jeong Geun; Kim, Ho Chul; Choi, Chul Soon; Bae, Sang Hoon [Hallym University College of Medicine, Choonchun (Korea, Republic of)

    1998-01-01

    The purpose of this study was to assess the usefulness of CT angiography (CTA) in patients with intracerebral hematoma. Eighteen patients with spontaneous intracerebral hematoma underwent CTA; 20-30 seconds after the onset of an injection of contrast media (100mL), with the use of a power injector, at a rate of 3mL/sec, scanning (30-second continuous exposure and 60-90mm length) was performed with a table speed of 2-3 mm/sec and section thickness of 2mm. The starting point selected was the floor of the sella turcica. The resulting data were reformatted by maximum intensity projection (MIP) after reconstruction at 1-mm intervals, and CTA findings were compared with those of conventional angiography (n=17), surgery (n=6), and postcontrast CT(n=10). The diagnostic findings of CTA included five arteriovenous malformations, two aneurysms, one venous angioma, and one venous sinus occlusion, while the remaining nine patients had no vascular lesion. In all cases, CTA findings correlated well with those of postcontrast CT. In one cases of arteriovenous malformation, however, the feeding artery and draining vein were not definite on CTA, and in one case of sinus occlusion, the full length of the superior sagittal sinus could not be delineated. In patients with spontaneous intracerebral hematoma, CTA is a valuable screening method. (author). 15 refs., 4 figs.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  18. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Niinuma, Hiroyuki; Ohira, Atsushi; Makita, Shinji; Moriai, Yoshiteru; Hiramori, Katsuhiko [Iwate Medical Univ., Morioka (Japan). School of Medicine; Yoshioka, Kunihiro; Nakajima, Takayuki; Kawazoe, Kohei [Iwate Medical Univ., Morioka (Japan). Memorial Heart Center

    2002-08-01

    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)

  20. Hybrid CT angiography and quantitative (15)O-water PET for assessment of coronary artery disease

    DEFF Research Database (Denmark)

    Thomassen, Anders; Petersen, Henrik; Diederichsen, Axel C P;

    2013-01-01

    CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combinati...... of the two might improve diagnostic accuracy. We conducted a head-to-head comparison of CTA, measurement of MBF by (15)O-water PET, and hybrid PET/CTA for the detection of significant coronary artery stenoses....

  1. CT angiography and CT perfusion in acute ischemic stroke

    NARCIS (Netherlands)

    Seeters, T. van

    2016-01-01

    CT angiography and CT perfusion are used in patients with acute ischemic stroke for diagnostic purposes and to select patients for treatment. In this thesis, the reproducibility of CT angiography and CT perfusion is examined, the additional value of CT angiography and CT perfusion for stroke outcome

  2. Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Yoshiyuki [National Cardiovascular Center, Department of Radiology, Osaka (Japan); St. Luke' s International Hospital, Department of Radiology, Tokyo (Japan); Uotani, Kensuke; Nakazawa, Tetsuro; Higashi, Masahiro; Yamada, Naoaki; Hori, Yoshiro; Kanzaki, Suzu; Fukuda, Tetsuya; Naito, Hiroaki [National Cardiovascular Center, Department of Radiology, Osaka (Japan); Itoh, Toshihide [Siemens Asahi Medical Technologies, Tokyo (Japan)

    2009-04-15

    Dual-energy CT can be applied for bone elimination in cerebral CT angiography (CTA). The aim of this study was to compare the results of dual-energy direct bone removal CTA (DE-BR-CTA) with those of digital subtraction angiography (DSA). Twelve patients with intracranial aneurysms and/or ICA stenosis underwent a dual-source CT in dual-energy mode. Post-processing software selectively removed bone structures using the two energy data sets. Three-dimensional images with and without bone removal were reviewed and compared to DSA. Dual-energy bone removal was successful in all patients. For 10 patients, bone removal was good and CTA maximum-intensity projection (MIP) images could be used for vessel evaluation. For two patients, bone removal was moderate with some bone remnants, but this did not inhibit the three-dimensional visualization. Three aneurysms adjacent to the skull base were only partially visible in conventional CTA but were fully visible in DE-BR-CTA. In five patients with ICA stenosis, DE-BR-CTA revealed the stenotic lesions on the MIP images. The correlation between DSA and DE-BR-CTA was good (R {sup 2}=0.822), but DE-BR-CTA led to an overestimation of stenosis. DE-BR-CTA was able to eliminate bone structure using only a single CT data acquisition and is useful to evaluate intracranial aneurysms and stenosis. (orig.)

  3. 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 diagnos

  4. Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?

    Science.gov (United States)

    Foley, P T; Ganeshan, A; Anthony, S; Uberoi, R

    2010-02-01

    This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.

  5. 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.

  6. Cerebral artery evaluation of dual energy CT angiography with dual source CT

    Institute of Scientific and Technical Information of China (English)

    MA Rui; LIU Cheng; DENG Kai; SONG Shao-juan; WANG Dao-ping; HUANG Ling

    2010-01-01

    Background Conventional computed tomography angiography (CTA) is time consuming, user-dependent and has poor image quality in skull base region. This study assessed the feasibility of a new method, dual energy CTA for depicting the cerebral artery.Methods Phantom scan was done with head CTA sequences on dual source CT and 64 spiral CT for radiation dose calculation. Dual energy CTA was done with dual source CT on 36 patients who were suspected of having cerebral vascular disease. Three series axial images in 0.75 mm thick, 0.4 mm increment were acquired, which were named with 80 kV, 140 kV and merged images; 80 kV and 140 kV images were transferred into dual energy software, and maximum intensity projection (MIP) image was generated quickly by dual energy bone remove (DEBR group); merged images were transferred into In Space software to acquire MIP image through manual conventional bone remove (CoBR group). Post processing time and reading time were compared. Image qualities of the two groups were compared, mainly focusing on skull base segments of internal carotid artery and bone subtraction. ANOVA and SNK tests were applied for radiation dose comparison. Student's t test and Wilcoxon rank sum test were applied for assessing differences between data for significance. Cohen's kappa was used for interobserver agreement. Results Radiation dose of phantom scan showed dual energy CTA was between digital bone subtraction and conventional CTA. The post processing time and reading time were much shorter in DEBR than CoBR, and image quality in skull base was much higher in DEBR than CoBR (P0.5). Interobserver agreement for all vessel segments was excellent (kappa=0.97). Conclusions Dual energy CTA is a reliable, new modality for depicting cerebral artery, overcoming the limitation of conventional CTA in the skull base region. It can save much time in post processing and reading than conventional CTA.

  7. CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Shankar, Jai Jai Shiva [Dalhousie University, Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Center, Halifax (Canada); Tan, Irene Y.L.; Krings, Timo; Terbrugge, Karel; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2012-03-15

    Cerebral vasospasm (CV) is one of the most dreaded complications in patients who survive acute subarachnoid haemorrhage (SAH), and conventional cerebral angiography (DSA) is the gold standard for its diagnosis. We evaluated CT angiography (CTA) as a non-invasive alternative for diagnosis of CV and assessed if CTA could have a role in choosing appropriate treatment. Consecutive patients with SAH and suspected vasospasm were included when DSA was performed within 24 h from CTA. Two neuro-radiologists retrospectively analysed CTA and DSA studies independently. Assessment included presence of central and peripheral vasospasm and grading of severity of central CV. A treatment recommendation based on CTA was compared to actual treatment received. Final analysis included 34 patients. CTA was more accurate for diagnosis of central then for peripheral CV with high sensitivity (reader 1, 91%; reader 2, 92%), specificity (reader 1, 73%; reader 2, 90%), accuracy, positive predictive value and negative predictive value for central vasospasm. For grading the severity of CV CTA's sensitivity, specificity and accuracy were high for most central arteries. The reader's recommendation of angioplasty according to CTA was significantly predictive of actual receipt of angioplasty but overestimated actual receipt of triple H treatment. CTA is adequate for detecting central vasospasm in symptomatic SAH patients. A negative result should not prevent further investigation especially when evaluating arterial segments adjacent to metal artefacts from coils or clips. CTA is helpful in treatment decision making specifically regarding the need for balloon angioplasty. (orig.)

  8. 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.)

  9. Correlation between abdominal perforator vessels identified with preoperative CT angiography and intraoperative fluorescent angiography in the microsurgical breast reconstruction patient.

    Science.gov (United States)

    Pestana, Ivo A; Zenn, Michael R

    2014-01-01

    CT angiography (CTA) has become a reliable method of perforator vessel identification. Indocyanine green fluorescent angiography (ICGLA) produces a real-time image of large- and small-caliber blood vessels. The aim of this prospective study was to compare ICGLA with CTA to evaluate its reliability of vessel identification and correlation to perforator vessel size and number determined preoperatively by CTA. The effect of both imaging techniques on flap design or intraoperative plan was also evaluated. Over a 1-year period, patients presenting for free-tissue transfer breast reconstruction underwent preoperative CTA mapping of abdominal perforators followed by intraoperative ICGLA. Using visualization software, scaling factors were calculated so CTA and ICGLA data could be compared. Eighteen patients (24 breast reconstructions) were included. Larger CTA perforator size was associated with larger actual size (P = 0.04). The largest CTA perforator or largest actual perforator was used 78% of the time. Increasing body mass index was not associated with larger CTA perforator size (P = 0.67) or more intense ICGLA blushes (P = 0.13). No significant correlation was found between CTA perforator location and ICGLA skin blush location, size, or intensity. CTA or SPY guided intraoperative procedure adjustments in 72% of patients. ICGLA identified poor soft-tissue perfusion and guided flap resection in 46% of patients. ICGLA skin blush location, size, and intensity do not correlate with CTA-identified perforating vessel location or actual perforating vessel size. Despite this, the ICGLA information was useful for evaluation of soft-tissue perfusion and flap design.

  10. Improved diagnosis of actively bleeding aneurysm on CT angiography using delayed CT images

    Energy Technology Data Exchange (ETDEWEB)

    Kathuria, Sudhir, E-mail: skathur2@jhmi.edu [Division of Interventional Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Division of Interventional Neuroradiology, Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Deveikis, John P.; Westesson, Per-Lennart [Division of Diagnostic and Interventional Neuroradiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642 (United States); Gandhi, Dheeraj [Division of Interventional Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Division of Interventional Neuroradiology, Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (United States)

    2011-08-15

    Computed tomographic angiography (CTA) is being increasingly utilized in the non-invasive diagnosis of aneurysmal subarachnoid hemorrhage (SAH). There are emerging reports of diagnosis of active aneurysmal bleeding on CTA, furthering our understanding of imaging features of active extravasation on cross-sectional studies. We demonstrate imaging characteristics of two such cases of active contrast extravasation from intracranial aneurysms. Additionally, we demonstrate that delayed CT images greatly improve the confidence of this diagnosis by demonstrating pooling of contrast in the subarachnoid space. Prompt recognition and management can improve prognosis of this potentially lethal condition.

  11. Stent-assisted intracranial angioplasty: potentials and limitations of pre- and postinterventional CT angiography; Stentgestuetzte intrakranielle Angioplastie: Moeglichkeiten und Grenzen der prae- und postinterventionellen CT-Angiografie

    Energy Technology Data Exchange (ETDEWEB)

    Schloetzer, W.; Schmitz, B.L. [Universitaetsklinikum Ulm (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Huber, R. [Universitaetsklinikum Ulm (Germany). Klinik fuer Neurologie

    2009-02-15

    CT angiography (CTA) is a noninvasive technique for evaluating intracranial arterial stenoses and for following up on intracranial stents. We analyzed a series of patients to assess the capabilities of CTA with respect to preinterventional und postinterventional diagnostic imaging for stent-assisted intracranial angioplasty. We examined 8 patients with 9 symptomatic intracranial arterial stenoses before and after stent placement with CTA. CT angiographies were compared to the periprocedural conventional angiography with regard to the quality of the visualization as well as the dimensions of the identified stenoses and the implanted stents. The extent of the preinterventional intracranial stenoses identified with CTA differed between -15 % to + 12 % from conventional angiography. In any case we were able to assess stent position, expansion, and perfusion with postinterventional CTA. The mean residual stenosis after stent placement was 33 % (13 - 48 %) measured with conventional angiography and it was accurately estimated with a difference of {+-} 15 % in 5 of 9 stents by CTA. 4 residual stenoses were underestimated or overestimated between -20 % and + 26 %. Further CTA controls of several patients showed good visualization of in-stent neointimal hyperplasia. CTA is useful for stent planning and follow-up of symptomatic intracranial stenoses. Intracranial stents and their lumina are adequately visualized by CTA, especially in vertebrobasilar vessels. However, residual stenosis and restenosis especially in the intracranial internal carotid artery and in the presence of calcified plaques may be incorrectly estimated by CTA. In case of doubt patients must undergo invasive angiography. In summary the use of CTA is a possibility for the primary follow-up of intracranial stents. It cannot generally prevent further diagnostics, but it is a potential method for reducing invasive angiography. (orig.)

  12. Intravenous flat detector CT angiography for non-invasive visualisation of intracranial flow diverter: technical feasibility.

    Science.gov (United States)

    Struffert, Tobias; Saake, Marc; Ott, Sabine; Engelhorn, Tobias; Gölitz, Philipp; Kloska, Stephan; Doelken, Marc; Doerfler, Arnd

    2011-08-01

    To demonstrate the feasibility of intravenous Flat Detector CT Angiography (FD-CTA) for visualisation of intracranial Flow Diverting Devices. Flow Diverting Devices are used increasingly for treatment of intracranial aneurysms. A close follow up is necessary because it becomes obvious that a significant proportion of aneurysms treated with these devices remain patent. A minimally invasive method is highly desirable. In two patients treated with flow diverters a Flat Detector CT (FD-CT) with intravenous contrast medium application was performed. Post-processing was performed using commercially available software. In both patients the lumen of the device and the lumen of the aneurysm could be clearly evaluated. Some beam hardening artefacts due to the marker wires of the device were obvious. Flat Detector CT with intravenous contrast material application to evaluate flow-diverting devices seems to be feasible. Further studies are necessary to perform comparative evaluation of FD-CTA with angiography and other techniques like MRA or conventional CT angiography.

  13. 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.)

  14. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy.

    Science.gov (United States)

    Ridge, Carole A; McDermott, Shaunagh; Freyne, Bridget J; Brennan, Donal J; Collins, Conor D; Skehan, Stephen J

    2009-11-01

    The purpose of this study was to retrospectively compare the diagnostic adequacy of lung scintigraphy with that of pulmonary CT angiography (CTA) in the care of pregnant patients with suspected pulmonary embolism. Patient characteristics, radiology report content, additional imaging performed, final diagnosis, and diagnostic adequacy were recorded for pregnant patients consecutively referred for lung scintigraphy or pulmonary CTA according to physician preference. Measurements of pulmonary arterial enhancement were performed on all pulmonary CTA images of pregnant patients. Lung scintigraphy and pulmonary CTA studies deemed inadequate for diagnosis at the time of image acquisition were further assessed, and the cause of diagnostic inadequacy was determined. The relative contribution of the inferior vena cava to the right side of the heart was measured on nondiagnostic CTA images and compared with that on CTA images of age-matched nonpregnant women, who were the controls. Twenty-eight pulmonary CTA examinations were performed on 25 pregnant patients, and 25 lung scintigraphic studies were performed on 25 pregnant patients. Lung scintigraphy was more frequently adequate for diagnosis than was pulmonary CTA (4% vs 35.7%) (p = 0.0058). Pulmonary CTA had a higher diagnostic inadequacy rate among pregnant than nonpregnant women (35.7% vs 2.1%) (p lung scintigraphy was more reliable than pulmonary CTA in pregnant patients. Transient interruption of contrast material by unopacified blood from the inferior vena cava is a common finding at pulmonary CTA of pregnant patients.

  15. Model generation of coronary artery bifurcations from CTA and single plane angiography

    Energy Technology Data Exchange (ETDEWEB)

    Cardenes, Ruben; Diez, Jose L.; Duchateau, Nicolas; Pashaei, Ali; Frangi, Alejandro F. [Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018 (Spain); Cardiology Department, University Hospital Dr. Peset, Valencia 46017 (Spain); Hospital Clinic Provincial de Barcelona, Institut d' investigacions Biomediques August Pi i Sunyer-Universitat de Barcelona, Barcelona 08036 (Spain); Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018 (Spain); Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018, Spain and Department of Mechanical Engineering, University of Sheffield, Sheffield S1 3JD (United Kingdom)

    2013-01-15

    Purpose: To generate accurate and realistic models of coronary artery bifurcations before and after percutaneous coronary intervention (PCI), using information from two image modalities. Because bifurcations are regions where atherosclerotic plaque appears frequently and intervention is more challenging, generation of such realistic models could be of high value to predict the risk of restenosis or thrombosis after stent implantation, and to study geometrical and hemodynamical changes. Methods: Two image modalities have been employed to generate the bifurcation models: computer tomography angiography (CTA) to obtain the 3D trajectory of vessels, and 2D conventional coronary angiography (CCA) to obtain radius information of the vessel lumen, due to its better contrast and image resolution. In addition, CCA can be acquired right before and after the intervention in the operation room; therefore, the combination of CTA and CCA allows the generation of realistic preprocedure and postprocedure models of coronary bifurcations. The method proposed is semiautomatic, based on landmarks manually placed on both image modalities. Results: A comparative study of the models obtained with the proposed method with models manually obtained using only CTA, shows more reliable results when both modalities are used together. The authors show that using preprocedure CTA and postprocedure CCA, realistic postprocedure models can be obtained. Analysis carried out of the Murray's law in all patient bifurcations shows the geometric improvement of PCI in our models, better than using manual models from CTA alone. An experiment using a cardiac phantom also shows the feasibility of the proposed method. Conclusions: The authors have shown that fusion of CTA and CCA is feasible for realistic generation of coronary bifurcation models before and after PCI. The method proposed is efficient, and relies on minimal user interaction, and therefore is of high value to study geometric and

  16. Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    FANG Bing; LI Tie-lin; ZHANG Jian-min; DUAN Chuan-zhi; WANG Qiu-jing; ZAO Qing-ping

    2004-01-01

    Objective:To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year,there were 10 patients diagnosed as having multiple intracranial aneurysms by 3D-CTA and altogether 24 aneurysms were visualized,including 10 small aneurysms(≤5mm.Three dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site,shape,size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick,reliable,and relatively noninvasive method for diagnosing multiple intracranial aneurysms.It delineates detailed aneurysmal morphology,and provides useful information for planning microsurgical approaches.

  17. 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

  18. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail: rohan50000@yahoo.com; Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Coleman, Patrick [Department of Renal Medicine, Westmead Hospital, Sydney, NSW (Australia)

    2007-03-15

    Objective: The aim of this study was to evaluate the role and detection rate of multidetector spiral CT renal angiography (CTA) as compared with conventional angiography (CA), the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia (FMD). In addition, the role of CTA reconstructions (multiplanar reformatted images (MPR), maximum intensity projections (MIP) and shaded-surface display (SSD)) in the detection of FMD was also evaluated. Materials and methods: CTA results were retrospectively reviewed in 21 hypertensive patients with CA-proven FMD. Clinical indications for referral included resistant hypertension (requiring greater than three antihypertensive medications), labile hypertension, hypertension in combination with renal impairment and the presence of abdominal bruits in the context of systemic hypertension. In some cases, these clinical indications were supplemented by positive results in other tests, including plasma renin assay, captopril scintigraphy and/or Doppler ultrasound. The findings of CA in these 21 patients were compared to CTA. Results: Mean patient age was 62.33 + 14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. Conclusion: Our experience suggests that CTA is a non-invasive, reliable and accurate method for the diagnosis of renal artery fibromuscular dysplasia. Moreover, in our experience CTA has many advantages as a diagnostic screening tool over CA, including accessibility, speed, lower complication profile, versatility and cost-effectiveness. CTA shows great potential as a guiding tool for directing subsequent

  19. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  20. Catheter Angiography

    Medline Plus

    Full Text Available ... you! Do you have a personal story about radiology? Share your patient story here Images × Image Gallery ... Contrast Materials CT Angiography (CTA) X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to ...

  1. Run-Off Computed Tomography Angiography (CTA for Discriminating the Underlying Causes of Intermittent Claudication.

    Directory of Open Access Journals (Sweden)

    Alexandra Preuß

    Full Text Available To evaluate run-off computed tomography angiography (CTA of abdominal aorta and lower extremities for detecting musculoskeletal pathologies and clinically relevant extravascular incidental findings in patients with intermittent claudication (IC and suspected peripheral arterial disease (PAD. Does run-off CTA allow image-based therapeutic decision making by discriminating the causes of intermittent claudication in patients with suspected peripheral arterial disease PAD?Retrospective re-evaluation of CTAs performed in patients with acute or chronic intermittent claudication (i.e., Fontaine stages I to IIB between January 2005 and October 2013. Allocation to one of three categories of underlying causes of IC symptoms: vascular, musculoskeletal (MSK or both. Clinically relevant extravascular incidental findings were evaluated. Medical records were reviewed to verify specific therapies as well as main and incidental findings.While focused on vascular imaging, CTA image quality was sufficient for evaluation of the MSK system in all cases. The underlying cause of IC was diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%, n = 10 (4%, and n = 66 (31% cases, respectively. Specific vascular or MSK therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was possible. Clinically relevant extravascular incidental findings were detected in n = 65 patients (30% with neoplasia, ascites and pleural effusion being the most common findings.Run-off CTA allows identification of vascular, MSK, and combined causes of IC in patients with suspected PAD and can guide specific therapy. CTA also allowed confident detection of crEVIF although detection did not necessarily trigger workup or treatment.

  2. Flat-detector computed tomography in the assessment of intracranial stents: comparison with multi detector CT and conventional angiography in a new animal model.

    Science.gov (United States)

    Struffert, Tobias; Ott, Sabine; Adamek, Edyta; Schwarz, Marc; Engelhorn, Tobias; Kloska, Stephan; Deuerling-Zheng, Yu; Doerfler, Arnd

    2011-08-01

    Careful follow up is necessary after intracranial stenting because in-stent restenosis (ISR) or residual stenosis (RS) is not rare. A minimally invasive follow-up imaging technique is desirable. The objective was to compare the visualisation of stents in Flat Detector-CT Angiography (FD-CTA) after intravenous contrast medium injection (i.v.) with Multi Detector Computed Tomography Angiography (MD-CTA) and Digital Subtracted Angiography (DSA) in an animal model. Stents were implanted in the carotid artery of 12 rabbits. In 6 a residual stenosis (RS) was surgically created. Imaging was performed using FD-CTA, MD-CTA and DSA. Measurements of the inner and outer diameter and cross-section area of the stents were performed. Stenosis grade was calculated. In subjective evaluation FD-CTA was superior to MD-CTA. FD-CTA was more accurate compared with DSA than MD-CTA. Cross-sectional area of the stent lumen was significantly larger (p < 0.05) in FD-CTA in comparison to MD-CTA. Accurate evaluation of stenosis was impossible in MD-CTA. There was no statistically significant difference in the stenosis grade of DSA and FD-CTA. Our results show that visualisation of stent and stenosis using intravenous FD-CTA compares favourably with DSA and may replace DSA in the follow-up of patients treated with intracranial stents.

  3. Value of Dual-source CT Angiography in the Diagnosis of Vertebral Artery Sulcus Ring%双源 CTA 在椎动脉沟环中的诊断价值

    Institute of Scientific and Technical Information of China (English)

    闫如意; 张朝利; 刘军华; 费军

    2014-01-01

    [Objective] To explore the value of dual-source CT angiography (DSCTA ) in the diagnosis of vertebral artery sulcus ring .[Methods]Clinical data of 62 patients with vertebral artery sulcus ring diagnosed by DSCTA were col-lected .The types of whole-ring-type vertebral artery sulcus ring were analyzed .The diameter of vertebral artery was measured .[Results] The types of 62 patients with vertebral artery included Ⅳ type in 38 patients(61 .3% ) in which 25 patients were bilateral whole-ring type and 13 patients were unilateral whole-ring type(8 patients with right side and 4 pa-tients with left side) ,Ⅲ type in 6 patients (9 .7% ) which were bone breaking in curve bone bridge arch with both beak-like sides ,typeⅠandⅡ in 18 patients(29 .0% ) in which 3 patients were type I anterior semi-ring and 15 patients were typeⅡ posterior semi-ring .The upper and lower diameters of whole-ring type vertebral artery sulcus ring were 3 .1~8 .2 (4 .8 ± 0 .3)mm and anteroposterior diameters were 4 .2~9 .1(7 .10 .3)mm .The diameter of vertebral artery in atlas ver-tebral artery sulcus ring was 1 .8~5 .9(3 .7 ± 0 .8)mm .Local stenosis of vertebral artery was found in 15 patients ,and the stenosis rate was 10% ~30% .[Conclusion]DSCTA can accurately display the shape of atlas vertebral artery sulcus ring and stenosis caused by vertebral artery entrapment .%【目的】探讨双源CT血管成像(CTA)在椎动脉沟环中的诊断价值。【方法】收集头颈部双源CTA检查中发现椎动脉沟环的患者62例的临床资料,分析椎动脉沟环分型并测量椎动脉直径。【结果】62例椎动脉沟环的分型:Ⅳ型38例,占61.3%,其中25例为双侧全环型,13例为单侧全环型(右侧8例、左侧4例);Ⅲ型6例,占9.7%,为弧形骨桥弓顶部骨质中断,两端呈鸟嘴状;Ⅰ型及Ⅱ型18例,占29.0%,其中Ⅰ型(前半环)3例、Ⅱ型(后半环)15例。测量全环型椎动脉沟环上下径3.1

  4. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2012-02-01

    OBJECTIVE: The purpose of this study was to retrospectively compare the diagnostic adequacy of lung scintigraphy with that of pulmonary CT angiography (CTA) in the care of pregnant patients with suspected pulmonary embolism. MATERIALS AND METHODS: Patient characteristics, radiology report content, additional imaging performed, final diagnosis, and diagnostic adequacy were recorded for pregnant patients consecutively referred for lung scintigraphy or pulmonary CTA according to physician preference. Measurements of pulmonary arterial enhancement were performed on all pulmonary CTA images of pregnant patients. Lung scintigraphy and pulmonary CTA studies deemed inadequate for diagnosis at the time of image acquisition were further assessed, and the cause of diagnostic inadequacy was determined. The relative contribution of the inferior vena cava to the right side of the heart was measured on nondiagnostic CTA images and compared with that on CTA images of age-matched nonpregnant women, who were the controls. RESULTS: Twenty-eight pulmonary CTA examinations were performed on 25 pregnant patients, and 25 lung scintigraphic studies were performed on 25 pregnant patients. Lung scintigraphy was more frequently adequate for diagnosis than was pulmonary CTA (4% vs 35.7%) (p = 0.0058). Pulmonary CTA had a higher diagnostic inadequacy rate among pregnant than nonpregnant women (35.7% vs 2.1%) (p < 0.001). Transient interruption of contrast material by unopacified blood from the inferior vena cava was identified in eight of 10 nondiagnostic pulmonary CTA studies. CONCLUSION: We found that lung scintigraphy was more reliable than pulmonary CTA in pregnant patients. Transient interruption of contrast material by unopacified blood from the inferior vena cava is a common finding at pulmonary CTA of pregnant patients.

  5. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost

    Directory of Open Access Journals (Sweden)

    Waqas Shuaib

    2014-12-01

    Full Text Available Purpose: Vertebral artery injuries (VAIs can be seen in cervical injuries. This investigation was conducted to assess the impact of head and neck computed tomography (CT angiography (CTA on planning treatment of vertebral artery injuries, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast material. Methods: This retrospective review included all patients who underwent CT of the cervical spine and CTA of the head and neck from March 2011 to October 2012 at a single institution. Patients were divided into two groups, those with and those without cervical spine fracture appreciated on CT of the cervical spine. The frequency of vascular injury on CTA in those with a cervical fracture was assessed. The frequency of vascular injury treatment and modifications owed to a positive CTA of head and neck were also assessed. A study was considered appropriate if it was ordered in accordance with the modified Denver Screening criteria. Effective radiation dose (mSv was calculated by multiplying dose length product (DLP from the scanner with the standard conversion coefficient (k (k = 0.0021 mSv/mGy x cm.Results: In the 387 CTAs of head and neck, a cervical injury was recorded in 128 patients. Twenty CTA scans were correctly ordered for non-spinal indications, and 19 were ordered off protocol. CTA was found positive in 1 patient for whom the imaging was off protocol and 1 for whom the clinical indication was non-cervical. There were 19 positive CTA cases of head and neck, none of which underwent surgical intervention. CTA was positive in 13 of 48 patients who had suffered a C2 fracture; this accounted for 13 of the 19 positive CTA studies (p < 0.01. Estimated fee for CTA was $3783, and radiation exposure was 4 mSv with a standard deviation (±1.3. Conclusion: CTA of head and neck ordered off an institutional imaging protocol has a low probability of being positive. Adherence to protocols for CTA of

  6. Fully automatic multi-atlas segmentation of CTA for partial volume correction in cardiac SPECT/CT

    Science.gov (United States)

    Liu, Qingyi; Mohy-ud-Din, Hassan; Boutagy, Nabil E.; Jiang, Mingyan; Ren, Silin; Stendahl, John C.; Sinusas, Albert J.; Liu, Chi

    2017-05-01

    Anatomical-based partial volume correction (PVC) has been shown to improve image quality and quantitative accuracy in cardiac SPECT/CT. However, this method requires manual segmentation of various organs from contrast-enhanced computed tomography angiography (CTA) data. In order to achieve fully automatic CTA segmentation for clinical translation, we investigated the most common multi-atlas segmentation methods. We also modified the multi-atlas segmentation method by introducing a novel label fusion algorithm for multiple organ segmentation to eliminate overlap and gap voxels. To evaluate our proposed automatic segmentation, eight canine 99mTc-labeled red blood cell SPECT/CT datasets that incorporated PVC were analyzed, using the leave-one-out approach. The Dice similarity coefficient of each organ was computed. Compared to the conventional label fusion method, our proposed label fusion method effectively eliminated gaps and overlaps and improved the CTA segmentation accuracy. The anatomical-based PVC of cardiac SPECT images with automatic multi-atlas segmentation provided consistent image quality and quantitative estimation of intramyocardial blood volume, as compared to those derived using manual segmentation. In conclusion, our proposed automatic multi-atlas segmentation method of CTAs is feasible, practical, and facilitates anatomical-based PVC of cardiac SPECT/CT images.

  7. 100 kVp条件下碘克沙醇(270 mg I/mL)应用于主动脉CTA 检查的可行性研究%Feasibility of aorta CT angiography using 100kVp technique and iodixanol(270mg I/mL)as contrast medium

    Institute of Scientific and Technical Information of China (English)

    姜原; 赵永为; 王霄英; 张保翠; 王蕊; 罗健; 高福生; 何静

    2014-01-01

    目的:探讨100 kVp条件下碘克沙醇(270 mg I/mL)应用于主动脉CTA 检查的可行性。方法:临床疑诊主动脉病变而行主动脉CTA检查的连续21例患者,分为两组,分别采用不同的CT 扫描方案:A 组10例,采用管电压120 kVp,对比剂为碘帕醇(370 mg I/mL);B组共11例,采用管电压100 kVp,对比剂为碘克沙醇(270 mg I/mL)。采用两独立样本t检验(非正态分布采用 Mann-Whitney U检验)来比较两组的临床资料、CT辐射剂量、图像质量主、客观评价指标。结果:两组患者的性别、年龄和身体质量指数(BMI)的差异均无统计学意义(P=0.132、0.151和0.814)。两组的CT 辐射剂量差异亦无统计学意义(P>0.05)。B组患者接受碘的剂量明显低于A 组,且差异有高度统计学意义(P<0.001)。两组图像主观评分的差异无统计学意义(P=0.898)。图像的客观评分:两组的主动脉主干及其主要分支的 CT 值均>300 HU,差异无统计学意义(P>0.05);A 组 CNR 优于 B 组,2组差异有高度统计学意义(P=0.002)。结论:使用100 kVp、碘克沙醇(270 mg I/mL)进行主动脉CTA检查可以满足临床诊断需要。%Objective:To evaluate the feasibility of using 100kVp as tube voltage and iodixanol (270mg I/mL)as contrast medium in aorta CT angiography (CTA).Methods:2 1 continuous patients with clinically suspected aortic lesion un-derwent aorta CT angiography.They were divided into two groups(Group A and B)based on different scan protocol.Group A included 10 patients using following parameters:120kVp and iopamidol (370mg I/mL).Group B included 11 patients using following parameters:100kVp and iodixanol (270mg I/mL).The clinical information,CT radiation dose,objective and subjective assessment of image quality of these two groups were retrospectively analyzed by independentttest or Mann-Whitney U test.Results:The differences of

  8. CT angiography - head and neck

    Science.gov (United States)

    ... often on the face or scalp Swallowing problems Stroke Transient ischemic attack (TIA) Weakness in one part of your body CTA of the neck may also be done: After trauma to the neck to look for damage to blood vessels For planning before carotid artery ...

  9. Helical CT angiography of renal arteries: two-years of experience; Angioscanographie helicoidale des arteres renales

    Energy Technology Data Exchange (ETDEWEB)

    Beregi, J.P.; Louvegny, S.; Ceugnart, L.; Willoteaux, S.; Elkohen, M.; Desmoucelle, F.; Deklunder, G.; Wattinne, L. [Centre Hospitalier Universitaire, 59 - Lille (France)

    1997-08-01

    To evaluate the role of helical CT angiography (CTA) in the detection of renal artery stenosis in hypertensive patients. We studied 300 hypertensive patients (50 prospectively and 250 consecutively) with CTA and arteriography (n = 118). Helical acquisition (collimation 3 mm; pitch = 1, 20 seconds acquisition time) was performed 20-45 seconds after contrast injection (300 mgl/ml; 120 ml, 4 ml/sec). Transverse axial views and 3D reconstructions were analysed (360 deg interpolation algorithm, 1 mm overlapped). In the prospective series, CTA sensibility was 100 % for main renal artery stenoses and specificity was 98.2 %; however 7/32 renal accessory arteries were not visualized. In the 300 patients studies, seventy-four stenoses were detected. There were 5 false-positive and 5 false-negative studies. Secondary hypertension was detected in 26 % of patients (including 14 cases of adrenal hyperplasia). CTA is a promising technique for the detection of renal artery stenosis in hypertensive patients. (authors).

  10. Automated attenuation-based tube voltage selection for body CTA: Performance evaluation of 192-slice dual-source CT

    Energy Technology Data Exchange (ETDEWEB)

    Winklehner, Anna; Gordic, Sonja; Lauk, Eliane; Frauenfelder, Thomas; Alkadhi, Hatem; Husarik, Daniela B. [University Hospital Zurich, Institute for Diagnostic and Interventional Radiology, Zurich (Switzerland); Leschka, Sebastian [University Hospital Zurich, Institute for Diagnostic and Interventional Radiology, Zurich (Switzerland); Division of Radiology and Nuclear Medicine, St. Gallen (Switzerland)

    2015-08-15

    To assess radiation dose and image quality in body CT-angiography (CTA) with automated attenuation-based tube voltage selection (ATVS) on a 192-slice dual-source CT (DSCT). Forty patients (69.5 ± 9.6 years) who had undergone body CTA with ATVS (ref.kVp 100, ref.mAs 90) using a 2x192-slice CT in single-source mode were retrospectively included. All patients had undergone prior CTA with a 2x128-slice CT and ATVS with identical imaging and contrast media protocols, serving for comparison. Images were reconstructed with iterative reconstruction at similar strength levels. Radiation dose was determined. Image quality was assessed semi-quantitatively (1:excellent, 5:non-diagnostic), aortic attenuation, noise and CNR were determined. As compared to 128-slice DSCT, 192-slice DSCT selected tube voltages were lower in 30 patients (75 %), higher in 3 (7.5 %), and similar in 7 patients (17.5 %). CTDI{sub vol} was lower with 192-slice DSCT (4.7 ± 1.9 mGy vs. 5.8 ± 2.1 mGy; p < 0.001). Subjective image quality, mean aortic attenuation (342 ± 67HU vs. 268 ± 67HU) and CNR (9.8 ± 2.5 vs. 8.2 ± 2.9) were higher with 192-slice DSCT (all p < 0.01), all datasets being diagnostic. Our study suggests that ATVS of 192-slice DSCT for body CTA is associated with an improved image quality and further radiation dose reduction of 19 % compared to 128-slice DSCT. (orig.)

  11. Detection of hemorrhage source: the diagnostic value of post-mortem CT-angiography.

    Science.gov (United States)

    Palmiere, C; Binaghi, S; Doenz, F; Bize, P; Chevallier, C; Mangin, P; Grabherr, S

    2012-10-10

    The aim of this study was to compare the diagnostic value of post-mortem computed tomography angiography (PMCTA) to conventional, ante-mortem computed tomography (CT)-scan, CT-angiography (CTA) and digital subtraction angiography (DSA) in the detection and localization of the source of bleeding in cases of acute hemorrhage with fatal outcomes. The medical records and imaging scans of nine individuals who underwent a conventional, ante-mortem CT-scan, CTA or DSA and later died in the hospital as a result of an acute hemorrhage were reviewed. Post-mortem computed tomography angiography, using multi-phase post-mortem CTA, as well as medico-legal autopsies were performed. Localization accuracy of the bleeding was assessed by comparing the diagnostic findings of the different techniques. The results revealed that data from ante-mortem and post-mortem radiological examinations were similar, though the PMCTA showed a higher sensitivity for detecting the hemorrhage source than did ante-mortem radiological investigations. By comparing the results of PMCTA and conventional autopsy, much higher sensitivity was noted in PMCTA in identifying the source of the bleeding. In fact, the vessels involved were identified in eight out of nine cases using PMCTA and only in three cases through conventional autopsy. Our study showed that PMCTA, similar to clinical radiological investigations, is able to precisely identify lesions of arterial and/or venous vessels and thus determine the source of bleeding in cases of acute hemorrhages with fatal outcomes.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  13. Coronary CT angiography using prospective ECG triggering. High diagnostic accuracy with low radiation dose; CT-Angiographie der Koronarien mit prospektivem EKG-Triggering. Hohe diagnostische Genauigkeit bei niedriger Strahlendosis

    Energy Technology Data Exchange (ETDEWEB)

    Arnoldi, E. [Medical University of South Carolina, Charleston, Department of Radiology and Radiological Science, Charleston (United States); Klinikum der Ludwigs-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Ramos-Duran, L.; Abro, J.A.; Costello, P. [Medical University of South Carolina, Charleston, Department of Radiology and Radiological Science, Charleston (United States); Zwerner, P.L.; Schoepf, U.J. [Medical University of South Carolina, Charleston, Department of Radiology and Radiological Science, Charleston (United States); Medical University of South Carolina, Charleston, Department of Medicine, Division of Cardiology, Charleston (United States); Nikolaou, K.; Reiser, M.F. [Klinikum der Ludwigs-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2010-06-15

    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.) [German] Ziel unserer Untersuchungen war es, die CT-Angiographie der Koronarien (Koronar-CTA) unter Verwendung des prospektiven EKG-Triggerings (PT) hinsichtlich ihrer diagnostischen Genauigkeit zur Detektion signifikanter Koronarstenosen mit der Herzkatheteruntersuchung (HK) zu vergleichen. Bei 20 Patienten wurden eine Koronar-CTA mit PT an einem 128-Zeilen-CT-Scanner (Definition trademark, AS+, Siemens) und eine HK durchgefuehrt. Alle CTA-Studien wurden von 2 Radiologen bzgl. signifikanter Koronarstenosen ({>=}50% Lumeneinengung) anhand des 15-Segment-Modells der American Heart Association (AHA) im Konsensus ausgewertet. Die Ergebnisse der CTA wurden mit den Befunden der HK verglichen. Die Koronar-CTA mit PT zeigte fuer die Diagnose signifikanter Stenosen im Vergleich zur HK eine Sensitivitaet von 88 bzw. 100%, eine Spezifitaet

  14. Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients

    Energy Technology Data Exchange (ETDEWEB)

    Morhard, Dominik; Fink, Christian; Becker, Christoph; Reiser, Maximilian F.; Nikolaou, Konstantin [Ludwig-Maximilians-University of Munich, Institute of Clinical Radiology, Munich (Germany)

    2008-05-15

    Non-contrast-enhanced cranial computed tomography (NECT) and CT angiography (CTA) are the most frequently used modalities in the triage of patients with acute ischemic and hemorrhagic stroke. CTA bone removal can improve the delineation of vasculature closely adjacent to bony structures, which is sometimes limited in standard CTA. The aim of this study was the evaluation of the clinical benefit of bone subtraction (BS) regarding delineation of cerebral vasculature, reading time and depiction of vascular pathologies compared to standard CTA without BS. A total of 100 patients who underwent NECT and supraaortic CTA on a 64-slice CT system were retrospectively included in the study. Bone removal was performed by subtraction of the NECT data from the CTA data using a dedicated workstation. Standard and BS CTA of each patient was reviewed for delineation of cerebral vasculature (grading scale from 1 = 'excellent delineation' to 10 = 'hardly any delineation'), reading time and depiction of vascular pathologies (standardized catalog) by two blinded readers. For BS data sets, the quality of BS was rated by a combination of the criteria complete bone removal, depiction of vascular structures and sufficient quality for diagnostic evaluation. The use of BS significantly reduced reading time from 4.60 min to 3.49 min (p < 0.001). Performing BS, the quality of vascular delineation of the cerebral arteries, cerebral veins and cavernous segment of the ICA increased significantly as compared to standard CTA (1.70 vs. 2.70; 2.60 vs. 4.12; 2.35 vs. 4.40, all p < 0.001). Consensus reading showed 41 pathologies in 35 patients. Diagnosis was missed or wrong overall in 15 cases, with 3 missed aneurysms (CTA: 2 vs. BS: 1), 8 wrong stenotic findings (CTA: 3 vs. BS: 5) and 4 missed partial thromboses (CTA: 2 vs. BS: 2). Performing BS in supraaortic CTA for the evaluation of cerebral vasculature reduces reading time and improves delineation of vessels. Diagnostic

  15. From 3D to 4D: Integration of temporal information into CT angiography studies.

    Science.gov (United States)

    Haubenreisser, Holger; Bigdeli, Amir; Meyer, Mathias; Kremer, Thomas; Riester, Thomas; Kneser, Ulrich; Schoenberg, Stefan O; Henzler, Thomas

    2015-12-01

    CT angiography is the current clinical standard for the imaging many vascular illnesses. This is traditionally done with a single arterial contrast phase. However, advances in CT technology allow for a dynamic acquisition of the contrast bolus, thus adding temporal information to the examination. The aim of this article is to highlight the clinical possibilities of dynamic CTA using 2 examples. The accuracy of the detection and quantification of stenosis in patients with peripheral arterial occlusive disease, especially in stadium III and IV, is significantly improved when performing dynamic CTA examinations. The post-interventional follow-up of examinations of EVAR benefit from dynamic information, allowing for a higher sensitivity and specificity, as well as allowing more accurate classification of potential endoleaks. The described radiation dose for these dynamic examinations is low, but this can be further optimized by using lower tube voltages. There are a multitude of applications for dynamic CTA that need to be further explored in future studies.

  16. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... a stroke, especially with a new technique called Perfusion CT. brain tumors. enlarged brain cavities (ventricles) in ... X-Ray and CT Exams Blood Clots CT Perfusion of the Head CT Angiography (CTA) Stroke Brain ...

  17. Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Floegel, Thomas [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Kitzler, Hagen H. [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Alexandrov, Andrei V. [The University of Tennessee Health Science Center, Department of Neurology, Memphis, TN (United States)

    2016-09-15

    The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r{sub s} = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

  18. 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.)

  19. Improved dynamic CT angiography visualization by flow territory masking

    Directory of Open Access Journals (Sweden)

    Søren Christensen

    2015-01-01

    Full Text Available Backgound and Purpose: Computerized tomography (CT perfusion (or CTP source images from CT scanners with small detector widths can be used to create a dynamic CT angiogram (CTA similar to digital subtraction angiography (DSA. Because CTP studies use a single intravenous injection, all arterial territories enhance simultaneously, and individual arterial territories [i.e., anterior cerebral artery (ACA, middle cerebral artery (MCA, and posterior cerebral artery (PCA] cannot be delineated. This limits the ability to assess collateral flow patterns on dynamic CTAs. The aim of this study was to devise and test a postprocessing method to selectively color-label the major arterial territories on dynamic CTA. Materials and Methods: We identified 22 acute-stroke patients who underwent CTP on a 320-slice CT scanner within 6 h from symptom onset. For each case, two investigators independently generated an arterial territory map from CTP bolus arrival maps using a semiautomated method. The volumes of the arterial territories were calculated for each map and the average relative difference between these volumes was calculated for each case as a measure of interrater agreement. Arterial territory maps were superimposed on the dynamic CTA to create a vessel-selective dynamic CTA with color-coding of the main arterial territories. Two experts rated the arterial territory maps and the color-coded CTAs for consistency with expected arterial territories on a 3-point scale (excellent, moderate, poor. Results: Arterial territory maps were generated for all 22 patients. The median difference in arterial territory volumes between investigators was 2.2% [interquartile range (IQR 0.6-8.5%]. Based on expert review, the arterial territory maps and the vessel-selective dynamic CTAs showed excellent consistency with the expected arterial territories in 18 of 22 patients, moderate consistency in 2 patients, and poor consistency in another 2 patients. Conclusion: Using a

  20. Cardiovascular CT angiography in neonates and children : Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

    NARCIS (Netherlands)

    Tricarico, Francesco; Hlavacek, Anthony M.; Schoepf, U. Joseph; Ebersberger, Ullrich; Nance, John W.; Vliegenthart, Rozemarijn; Cho, Young Jun; Spears, J. Reid; Secchi, Francesco; Savino, Giancarlo; Marano, Riccardo; Schoenberg, Stefan O.; Bonomo, Lorenzo; Apfaltrer, Paul

    To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose

  1. Cardiovascular CT angiography in neonates and children : Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

    NARCIS (Netherlands)

    Tricarico, Francesco; Hlavacek, Anthony M.; Schoepf, U. Joseph; Ebersberger, Ullrich; Nance, John W.; Vliegenthart, Rozemarijn; Cho, Young Jun; Spears, J. Reid; Secchi, Francesco; Savino, Giancarlo; Marano, Riccardo; Schoenberg, Stefan O.; Bonomo, Lorenzo; Apfaltrer, Paul

    2013-01-01

    To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reduct

  2. Clinical evaluation of automatic tube voltage selection in chest CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Niemann, Tilo; Henry, Simon; Faivre, Jean-Baptiste; Yasunaga, Kanna; Bendaoud, Sofiane; Simeone, Ariana; Remy, Jacques [University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette (EA 2694), Lille (France); Duhamel, Alain [University Lille Nord de France, Department of Medical Statistics (EA 2694), Lille (France); Flohr, Thomas [Siemens Medical Systems, Department of Research and Development, Forchheim (Germany); Remy-Jardin, Martine [Hospital Calmette, Department of Thoracic Imaging, Lille cedex (France)

    2013-10-15

    To evaluate the clinical impact of automatic tube voltage selection on chest CT angiography (CTA). Ninety-three patients were prospectively evaluated with a CT protocol aimed at comparing two successive CTAs acquired under similar technical conditions except for the kV selection: (1) the initial CTA was systematically obtained at 120 kVp and 90 ref mAs; (2) the follow-up CTA was obtained with an automatic selection of the kilovoltage (Care KV; Siemens Healthcare) for optimised CTA. At follow-up, 90 patients (97 %) underwent CTA with reduced tube voltage, 100 kV (n = 26; 28 %) and 80 kV (n = 64; 69 %), resulting in a significant dose-length-product reduction (follow-up: 87.27; initial: 141.88 mGy.cm; P < 0.0001; mean dose reduction: 38.5 %) and a significant increase in the CNR at follow-up (follow-up: 11.5 {+-} 3.5 HU; initial: 10.9 {+-} 3.7 HU; P = 0.03). The increase in objective image noise at follow-up (follow-up: 23.2 {+-} 6.7 HU vs. 17.8 {+-} 5.1 HU; P < 0.0001) did not alter the diagnostic value of images. Automatic tube voltage selection reduced the radiation dose delivered during chest CT angiograms by 38.5 % while improving the contrast-to-noise ratio of the examinations. (orig.)

  3. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to ''triage'' patients' treatment

    Energy Technology Data Exchange (ETDEWEB)

    Agid, R.; Lee, S.K.; Willinsky, R.A.; Farb, R.I.; TerBrugge, K.G. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2006-11-15

    To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm. (orig.)

  4. 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...

  5. Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R. [Istituto di Radiologia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Gaetani, P.; Rodriguez y Baena, R. [Neurosurgery, Istituto Clinico ``Humanitas``, I-20089 Rozzano (Midway Islands) (Italy); Cecchini, A. [Servizio di Radiodiagnostica, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Infuso, L. [Neurochirurgia, Dipartimento di Chirurgia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy)

    1998-06-02

    We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 {+-} 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 {+-} 0.12 cm vs 1.09 {+-} 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients

  6. Effects of automatic tube potential selection on radiation dose index, image quality, and lesion detectability in pediatric abdominopelvic CT and CTA: a phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Brinkley, Michael F.; Choudhury, Kingshuk Roy; Frush, Donald P. [Duke University School of Medicine, Department of Radiology, DUMC Box 3808, Durham, NC (United States); Ramirez-Giraldo, Juan C. [Siemens Healthcare, Malvern (United States); Samei, Ehsan; Wilson, Joshua M.; Christianson, Olav I. [Duke University School of Medicine, Clinical Imaging Physics Group, Department of Radiology, Durham, NC (United States); Frush, Daniel J. [Duke University School of Medicine, Medical Physics, Durham, NC (United States)

    2016-01-15

    To assess the effect of automatic tube potential selection (ATPS) on radiation dose, image quality, and lesion detectability in paediatric abdominopelvic CT and CT angiography (CTA). A paediatric modular phantom with contrast inserts was examined with routine pitch (1.4) and high pitch (3.0) using a standard abdominopelvic protocol with fixed 120 kVp, and ATPS with variable kVp in non-contrast, contrast-enhanced, and CTA mode. The volume CT dose index (CTDI{sub vol}), contrast-to-noise ratio (CNR) and lesion detectability index (d') were compared between the standard protocol and ATPS examinations. CTDI{sub vol} was reduced in all routine pitch ATPS examinations, with dose reductions of 27-52 % in CTA mode (P < 0.0001), 15-33 % in contrast-enhanced mode (P = 0.0003) and 8-14 % in non-contrast mode (P = 0.03). Iodine and soft tissue insert CNR and d' were improved or maintained in all ATPS examinations. kVp and dose were reduced in 25 % of high pitch ATPS examinations and in none of the full phantom examinations obtained after a single full phantom localizer. ATPS reduces radiation dose while maintaining image quality and lesion detectability in routine pitch paediatric abdominopelvic CT and CTA, but technical factors such as pitch and imaging range must be considered to optimize ATPS benefits. (orig.)

  7. 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

  8. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  9. Intravenous flat detector CT angiography for non-invasive visualisation of intracranial flow diverter: technical feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, Tobias; Saake, Marc; Ott, Sabine; Engelhorn, Tobias; Goelitz, Philipp; Kloska, Stephan; Doelken, Marc; Doerfler, Arnd [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany)

    2011-08-15

    To demonstrate the feasibility of intravenous Flat Detector CT Angiography (FD-CTA) for visualisation of intracranial Flow Diverting Devices. Flow Diverting Devices are used increasingly for treatment of intracranial aneurysms. A close follow up is necessary because it becomes obvious that a significant proportion of aneurysms treated with these devices remain patent. A minimally invasive method is highly desirable. In two patients treated with flow diverters a Flat Detector CT (FD-CT) with intravenous contrast medium application was performed. Post-processing was performed using commercially available software. In both patients the lumen of the device and the lumen of the aneurysm could be clearly evaluated. Some beam hardening artefacts due to the marker wires of the device were obvious. Flat Detector CT with intravenous contrast material application to evaluate flow-diverting devices seems to be feasible. Further studies are necessary to perform comparative evaluation of FD-CTA with angiography and other techniques like MRA or conventional CT angiography. (orig.)

  10. Placing two parallel catheters by Seldinger`s approach through the femoral artery for CT angiography and CT during arterioportography. Evaluation of efficacy and safety

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Kazuhiro; Goto, Yasuyuki; Saito, Toshitaka [Musashino Red Cross Hospital, Tokyo (Japan); Wakabayashi, Yukari; Abe, Kimihiko

    1998-02-01

    The purpose of this study was to evaluate the efficacy and safety of placing two parallel catheters by Seldinger`s approach through the femoral artery for CT angiography (CTA) and CT during arterioportography (CTAP). We performed an analysis of 30 patients. Two introducers were successfully placed in all cases. Only one minor complication was observed, a localized inguinal hematoma. The CTA/CTAP procedures were successful in all patients except six who had anatomical variations of the hepatic arterial supply. Our methods proved to be useful and safe for patients with standard hepatic arterial supply. (author)

  11. Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: The role of cervical CT and CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Payabvash, Seyedmehdi, E-mail: spayab@gmail.com [Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN (United States); McKinney, Alexander M., E-mail: mckinrad@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); McKinney, Zeke J., E-mail: zeke.mckinney@hcmed.org [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); Palmer, Christopher S., E-mail: palme018@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); Truwit, Charles L., E-mail: truwit@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States)

    2014-03-15

    Objective: To evaluate the clinical utility of nonenhanced CT (NECT)-based screening criteria and CTA in detection of blunt vertebral artery injury (BVAI) in trauma patients with C1 and/or C2 fractures. Methods: We retrospectively reviewed the clinical records of all blunt trauma patients with C1 and/or C2 fractures between 8/2006 and 9/2011. Cervical CTA was prompted by cervical fractures involving/adjacent to a transverse foramen, and/or subluxation on NECT. Two neuroradiologists independently reviewed the CTA studies, and graded the BVAI. Results: 210 patients were included; of these, 124 underwent CTA (21/124 with digital subtraction angiography, DSA), and 2 underwent DSA only. Overall, 30/126 suffered BVAI. Among 21 patients who underwent both CTA and DSA, there was 1 false negative and 1 false positive (both grade 1). There was strong interobserver agreement regarding CTA-based BVAI detection (kappa = 0.93, p < 0.001) and grading (kappa = 0.90, p < 0001). Only 3/30 BVAI patients suffered a posterior circulation stroke; none of the patients who had a negative CTA or were not selected for CTA, based on NECT screening criteria, suffered symptomatic stroke. While C1/C2 comminuted fracture was more common in patients with high grade BVAI (p = 0.039), simultaneous C3–C7 comminuted fracture increased the overall BVAI risk (p = 0.011). Conclusion: CTA reliably detects symptomatic BVAI in patients with upper cervical fractures. Utilization of NECT-based screening criteria such as transverse foraminal involvement or subluxation may be adequate in deciding whether to perform CTA, as no patients who were not selected for CTA suffered a symptomatic stroke. However, CTA may miss lower grade, asymptomatic BVAI.

  12. Accuracy of CT angiography in the assessment of the circle of Willis: comparison of volume-rendered images and digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Han, Ari; Yoon, Dae Young; Chang, Suk Ki (Dept. of Radiology, Kangdong Seong-Sim Hospital, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)), email: evee0914@chollian.net; Lim, Kyoung Ja (Dept. of Radiology, Kangdong Seong-Sim Hospital, Hallym Univ. College of Medicine, Seoul (Korea, Republic of); Dept. of Radiology, Kangwon National Univ. College of Medicine, Chuncheon, Kangwon-do (Korea, Republic of)); Cho, Byung-Moon (Dept. of Neurosurgery, Kangdong Seong-Sim Hospital, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)); Shin, Yoon Cheol (Dept. of Thoracic Surgery, Kangdong Seong-Sim Hospital, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)); Kim, Sam Soo (Dept. of Radiology, Kangwon National Univ. College of Medicine, Chuncheon, Kangwon-do (Korea, Republic of)); Kim, Keon Ha (Dept. of Radiology, Samsung Medical Center, Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background Computed tomography angiography (CTA) is increasingly used for non-invasive imaging of the cerebrovascular diseases. Purpose To evaluate the accuracy of CTA in the assessment of the variation of the segment calibers of the circle of Willis. Material and Methods One hundred and 17 patients with acute SAH (51 men and 66 women, mean age 50.9 years) who underwent CTA using a 16 detector-row CT scanner and DSA were evaluated retrospectively. The CTA and DSA studies were performed within 24 h after the onset of symptoms and within 24 h of each other. A total of 819 arterial segments (A-comA, right and left A1 segment, right and left P-com A, and right and left P1 segment) of the circle of Willis were determined to be aplastic (grade 1), hypoplastic (grade 2), or normal-sized (grade 3) by blinded observers evaluating CTA volume-rendered images. The CTA results were then compared with findings on the corresponding DSA images (reference standard). Results The overall agreement between CTA and DSA was 92.4%. We had 62 (7.6%) cases of disagreement (58 cases of under-estimation and four cases of over-estimation by CTA) between tow modalities. The sensitivity and specificity of CTA in the detection of aplastic and normal-sized segments were more than 90%. In contrast, subgroup analysis of the hypoplastic segments showed a sensitivity of 52.6% and a specificity of 98.2%. Conclusion CTA is highly accurate in the assessment of anatomical variations of the circle of Willis; however, its sensitivity is limited in depicting hypoplastic segments

  13. Cardiac CT Angiography in Congestive Heart Failure.

    Science.gov (United States)

    Levine, Avi; Hecht, Harvey S

    2015-06-01

    Cardiac CT angiography has become an important tool for the diagnosis and treatment of congestive heart failure. Differentiation of ischemic from nonischemic cardiomyopathy; evaluation of myocardial perfusion; characterization of hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia; and delineation of congenital heart defects and valvular abnormalities are the primary diagnostic applications. Therapeutic use includes visualization of the coronary venous anatomy for optimal implementation of cardiac resynchronization therapy and evaluation of left ventricular assist devices and transplant vasculopathy.

  14. CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography.

    Science.gov (United States)

    Silvennoinen, H M; Ikonen, S; Soinne, L; Railo, M; Valanne, L

    2007-01-01

    To compare multisection CT angiography (CTA) analyzed with source/maximum intensity projection (MIP) images as well as semiautomated vessel analysis software with intra-arterial digital subtraction angiography (DSA) in detection and grading of carotid artery bifurcation stenosis. Consecutive patients with sonography evidence of a marked internal carotid artery stenosis underwent both carotid CTA and DSA (37 patients, 73 vessels). In CTA, the grade of stenosis was determined using axial source and MIP images as well as vessel analysis. The scans were blind-analyzed by 2 neuroradiologists using the NASCET criteria. Correlation of CTA source/MIP images versus DSA estimates of stenosis (R = 0.95) was higher than for the vessel analysis method versus DSA (R = 0.89). Compared with DSA, CTA source/MIP images underestimated high (78.2% versus 86.4%, P grades of stenosis (57.3% versus 63.1%, P grade stenosis, sensitivity and specificity of source/MIP image CTA were 75% and 96%, respectively, whereas for the vessel analysis method, they were 47% and 96%, respectively. For moderate stenosis, the source/MIP image CTA sensitivity and specificity were 88% and 82%, respectively, and for vessel analysis method, 62% and 82%, respectively. CTA detected all 4 occlusions. In evaluation of carotid stenosis, CTA provides an adequate, less invasive alternative with a high correlation to conventional DSA, though it tends to underestimate clinically relevant grades of stenosis. Its accuracy is not improved by semiautomated analysis. The data support the use of CTA in confirming carotid occlusion.

  15. Flat-detector computed tomography with intravenous contrast material application in experimental aneurysms: comparison with multislice CT and conventional angiography.

    Science.gov (United States)

    Struffert, Tobias; Doelken, Marc; Adamek, Edyta; Schwarz, Marc; Engelhorn, Tobias; Kloska, Stephan; Ott, Sabine; Doerfler, Arnd

    2010-05-01

    Despite limited soft tissue resolution flat-detector computed tomography (FD-CT) provides substantial superior spatial resolution in comparison with multislice computed tomography (MS-CT). This may add value in the visualization of small vascular structures if intravenous contrast application leads to substantial opacification and visibility of intracranial vessels or aneurysms. To evaluate the feasibility of visualization of vascular structures by FD-CT angiography (FD-CTA) after intravenous contrast injection compared with MS-CTA and intra-arterial digital subtracted angiography (IADSA) in an animal model. Aneurysms were created in the right common carotid artery in six New Zealand White Rabbits using the elastase technique. Imaging was performed using FD-CTA, MS-CTA (injection of 1 ml/kg body weight) and IADSA. Anonymized volume rendering reconstruction (VRT), maximum intensity projection (MIP), and multiplanar reconstruction (MPR) images were reconstructed and evaluated by two experienced reviewers for aneurysm geometry and vascular structure anatomy using standard tools of a dedicated workstation. Aneurysms could be successfully created in all animals. Measurements of aneurysm geometry (aneurysm height, width, neck width) and vascular structures (brachiocephalic trunk, carotid artery diameter and plane) were nearly identical in all three modalities. Intra- and inter-observer correlations of the different parameters showed high r values between 0.83 and 0.99. Our results show the feasibility of FD-CTA in comparison with MS-CTA and IADSA in an animal model. Despite limited soft tissue resolution, opacification of vascular structures with sufficient contrast to the surrounding structures was possible in all animals. Vascular structures appeared better delineated in FD-CTA than in MS-CTA, probably due to the superior spatial resolution.

  16. 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

  17. CT血管造影图像后处理技术%Image Processing Technology of CT Angiography

    Institute of Scientific and Technical Information of China (English)

    安静

    2014-01-01

    This paper introduces the concepts and characteristics of various image processing technologies of CT angiography (CTA) including multiplanar reconstruction (MPR), minimum intensity projection (MinIP), volume rendering (VR), maximum intensity projection (MIP), virtual endoscopy (VE), Surface Shaded Displace (SSD). Then discusses the advantages of CTA by comparing CTA with digital subtraction angiography (DSA).%本文阐述了多层面重建法(MPR)、最小密度投影法(MinIP)、容积再现(VR)、最大密度投影(MIP)、仿真内窥镜法(VE)、表面遮盖法(SSD)等CT血管造影(CTA)方法的概念及技术特点,并通过与脑血管造影(DSA)检查进行比较,探讨了CTA的优势。

  18. Imaging of Blood Flow in Cerebral Arteries with Dynamic Helical Computed Tomography Angiography (DHCTA) Using a 64-Row CT Scanner

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    Pekkola, J.; Kangasniemi, M. (Helsinki Medical Imaging Center, Helsinki Univ. Central Hospital, Helsinki (Finland))

    2009-08-15

    Background: Cerebral computed tomography angiography (CTA) depicts a structural image of intracranial arteries without providing much time-resolved information on blood flow dynamics. Current CT technology allows obtaining of rapidly repeated helical scans during the arterial contrast filling phase after an intravenous contrast injection. Purpose: To report our experience on dynamic CT imaging in determining the direction of contrast filling within proximal intracranial arteries of operated cerebral artery aneurysm patients. Such dynamic information can help detect vascular occlusion or severe spasm. The method is here referred to as dynamic helical CT angiography (DHCTA). Material and Methods: We retrospectively collected image and related technical data for 23 patients who underwent DHCTA and CTA during their first postoperative day after cerebral artery aneurysm surgery. For DHCTA, we had helically scanned a 4-cm tissue volume three times in succession with a 64-row CT scanner at intervals of 2.6 s during arterial contrast filling after an intravenous contrast injection. We assessed how well DHCTA succeeded in demonstrating the direction of contrast filling in the proximal intracranial arteries, evaluated clinically relevant structural information provided by DHCTA and CTA, and compared radiation doses for the two methods. Results: For 21 patients, DHCTA outlined the direction of contrast filling in proximal intracranial arteries. As to arterial spasm and residual filling of the operated aneurysm, CTA and DHCTA gave similar information. Radiation doses were higher (P<0.000001) for DHCTA than for CTA at 120 kV tube voltage. At 100 kV, the difference was smaller, but doses for DHCTA still exceeded (P<0.05) those for CTA. Conclusion: DHCTA gave dynamic information unobtainable with CTA and could prove useful in selected clinical settings

  19. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

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    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  20. Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism: Correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome

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    Apfaltrer, Paul, E-mail: paul.apfaltrer@medma.uni-heidelberg.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Bachmann, Valentin, E-mail: valentin.bachmann@googl.com [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, Thomas, E-mail: Thomas.Henzler@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Barraza, John M., E-mail: barraza@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, PO Box 250322, 169 Ashley Avenue, Charleston, SC 29425 (United States); Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Walter, Thomas, E-mail: Thomas.Walter2@umm.de [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, PO Box 250322, 169 Ashley Avenue, Charleston, SC 29425 (United States); and others

    2012-11-15

    Purpose: To investigate the prognostic value of perfusion defect volume (PDvol) at dual-energy-CT-angiography (DE-CTA) in patients with acute pulmonary embolism (PE) by correlating PDvol with CTA-obstruction-scores (OS), CT parameters of right-ventricular-dysfunction (RVD), and adverse-clinical-outcome. Materials and methods: DE-CTA of 60 patients (mean age: 65 {+-} 14.4 years) with PE were analyzed. Iodine maps were generated, and normalized PDvol - defined as volume of perfusion defects/total lung volume - was quantified. Furthermore, established prognostic parameters (Qanadli and Mastora-OS, and CT parameters of RVD) were obtained. CT parameters of RVD - namely the right ventricle/left ventricle (RV/LV) diameter ratio measured on transverse sections (RV/LVtrans), four-chamber views (RV/LV4ch), and RV/LV volume ratios (RV/LVvol) - were assessed. PDvol was correlated with OS, CT parameters of RVD and adverse clinical outcome (defined as the need for intensive care treatment or death). Results: 10 of 60 patients with PE experienced adverse clinical outcome. Patients with adverse clinical outcome showed significantly higher PDvol (35 {+-} 11% vs. 23 {+-} 10%, p = 0.002), RV/LV ratios (RV/LV4ch 1.46 {+-} 0.32 vs. 1.18 {+-} 0.26, p = 0.005; RV/LVvol 2.25 {+-} 1.33 vs. 1.19 {+-} 0.56, p = 0.002) and higher Mastora global scores (52 vs. 13, p = 0.02) compared to those without adverse clinical outcome. A weak correlation was observed between PDvol and the Mastora global score (r = 0.5; p = 0.0003), as well as between PDvol and RV/LV4Ch (r = 0.432, p = 0.0006). No correlation was found between PDvol and the Qanadli score or the remainder of the RVD-CT parameters. Conclusion: The extent of perfusion defects as assessed by DE-CTA correlates with adverse clinical outcome in patients with PE. Therefore, volumetric quantification of perfusion defects at DE-CTA allows the identification of low-risk patients who do not require intensified monitoring and treatment.

  1. Evaluation of middle cerebral artery stents using multidetector row CT angiography in vivo study: comparison of the three different kernels

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    Jang, Jin Hee; Lim, Yeon Soo; Lee, Youn Joo; Yoo, Won Jong; Sung, Mi Sook (Dept. of Radiology, Bucheon St Mary' s Hospital, Coll. of Medicine, The Catholic Univ. of Korea, Bucheon (Korea, Republic of)), email: wjyu@catholic.ac.kr; Kim, Bum Soo (Dept. of Radiology, Seoul St Mary' s Hospital, Coll. of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of))

    2012-05-15

    Background: There are very few reports assessing middle cerebral artery (MCA) stents using multidetector computed tomography (MDCT). Purpose: To assess MCA stents using multidetector CT angiography (CTA) in vivo evaluation: the differences in the CTA results according to the three different kernels. Material and Methods: We retrospectively evaluated 27 MCA stents from 26 patients who underwent CTA with 16- and 64-slice MDCT after percutaneous transluminal angioplasty and stenting (PTAS). By CTA, using medium-smooth kernel (B30), medium-sharp kernel (B50), and sharp kernel (B60), the lumen diameter, artificial luminal narrowing (ALN), and subjective visibility score of the stented vessels were evaluated. The subjective visibility score ranged from 1 (poor quality) to 5 (excellent) using a five-point scale. Results: There were excellent inter-observer agreements for the lumen diameter measurements (P < 0.001). The mean diameter of the stented vessels was 2.10 +- 0.31 mm on digital subtraction angiography (DSA), 0.93 +- 0.20 mm on CTA using B30, 1.18 +- 0.27 mm on CTA using B50, and 1.29 +- 0.29 mm on CTA using B60. The mean ALN was 55.7 +- 6.0% on CTA using B30, 43.8 +- 7.5% on CTA using B50, and 38.7 +- 8.3% on CTA using B60. CTA with higher kernels had a smaller ALN than images with smaller kernels. The median subjective visibility score on the CTA using B50 was 3, which was higher than for the other kernels. The differences in the lumen diameter, ALN, and the subjective visibility score of the stented vessels on CTA using the three different kernels was statistically significant (P < 0.001). Conclusion: The sharp kernel was better to assess the lumen diameter and ALN, but was inferior to the medium-sharp kernel for in-stent evaluation due to high image-to-noise. CTA with medium-sharp kernel showed good lumen visibility and acceptable ALN for MCA stents. This could therefore be a non-invasive, readily applicable clinical method for assessing MCA stent patency after

  2. Diagnostic value of 64-slice spiral CT angiography in the diagnosis of multiple intracranial aneurysms: a report of 25 cases

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    Hong-sheng WANG

    2013-02-01

    Full Text Available Objective  To evaluate the diagnostic value of 64-slice spiral CT angiography (CTA in multiple intracranial aneurysms (MIA. Methods  Twenty-five patients (9 males and 16 females, aged from 17 to 68 years with suspected MIA underwent 64-slice spiral CTA with slice thickness of 0.625mm. The data of all patients were reconstructed with multiplanar reconstruction (MPR, 3-dimensional shade surface display (3-SSD, volume rendering (VR and maximum intensity projection (MIP. The clinical diagnostic value was evaluated with the results of surgery or interventional embolization therapy. Results  A total of 61 aneurysms were detected by 64-slice spiral CTA in 25 patients, among them 17 patients were with 2 aneurysms, 6 patients with 3 aneurysms, 1 patient with 4 aneurysms and 1 patient with 5 aneurysms. The 64-slice spiral CTA could not only clearly demonstrate MIA, but also the size, neck, axis point and parent artery of each aneurysm, and the spatial relationship between aneurysm and the adjacent vessels and bone structures. Twenty-one patients underwent microsurgery and four underwent embolization, the location, size and shape of aneurysm and its spatial relationship with adjacent structures were in accordance with the findings of 64-slice spiral CTA. Conclusion  The 64-slice spiral CTA could be used as the first choice in the diagnosis of MIA for its high accuracy, and may be an important adjunct to digital subtraction angiography (DSA in MIA treatment.

  3. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Seligman, Renato; Knorst, Marli Maria, E-mail: mknorst@gmail.com [Hospital de Clinicas de Porto Alegre, Porto Alegre, RS (Brazil); Guerra, Vinicius Andre [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS (Brazil). Faculdade de Medicina. Programa de Pos-Graduacao em Ciencias Pneumologicas; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre (Brazil). Faculdade de Medicina

    2016-01-15

    Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients. (author)

  4. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Science.gov (United States)

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa; Guerra, Vinicius André; Seligman, Renato; Knorst, Marli Maria

    2016-01-01

    Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients. PMID:26982039

  5. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Eleci Vaz Ferreira

    2016-02-01

    Full Text Available Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA in patients with suspected pulmonary thromboembolism (PTE who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%. Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%. Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%. Among those 75 cases, there were only 39 (20.4% in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases. Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001. Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

  6. Characteristics of coronary artery disease in symptomatic type 2 diabetic patients: evaluation with CT angiography

    Directory of Open Access Journals (Sweden)

    Zhu Zhi-yu

    2010-11-01

    Full Text Available Abstract Background Coronary artery disease (CAD is a common and severe complication of type 2 diabetes mellitus (DM. The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA. Methods From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes. Results In total, 287 coronary vessels (2.5 ± 1.1 per patient and 470 segments (4.2 ± 2.8 per patient were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p p p p p = 0.855. Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients. Conclusions Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.

  7. Interleaving cerebral CT perfusion with neck CT angiography. Pt. II. Clinical implementation and image quality

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    Oei, Marcel T.H.; Meijer, Frederick J.A.; Woude, Willem-Jan van der; Smit, Ewoud J.; Ginneken, Bram van; Manniesing, Rashindra; Prokop, Mathias [Radboud University Medical Centre, Department of Radiology and Nuclear Medicine, P.O. Box 9101, Nijmegen (Netherlands)

    2017-06-15

    Feasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA. Twenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol. Arterial enhancement and contrast-to-noise ratio (CNR) in the carotid arteries was assessed. Three observers scored artefacts and image quality of the cervical arteries. The total z-coverage was evaluated. Mean enhancement in the carotid bifurcation was rated higher in the vCTA (595 ± 164 HU) than CTA (441 ± 117 HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artefacts, although not rated as diagnostically relevant. In ten patients, the origin of the left common carotid artery was missed by 1.6 ± 0.8 cm. Mean patient height was 1.8 ± 0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients. The One-Step Stroke Protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients. (orig.)

  8. Assessment of anemia during CT pulmonary angiography

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    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.

  9. Registration of 3D+t coronary CTA and monoplane 2D+t X-ray angiography.

    Science.gov (United States)

    Metz, Coert T; Schaap, Michiel; Klein, Stefan; Baka, Nora; Neefjes, Lisan A; Schultz, Carl J; Niessen, Wiro J; van Walsum, Theo

    2013-05-01

    A method for registering preoperative 3D+t coronary CTA with intraoperative monoplane 2D+t X-ray angiography images is proposed to improve image guidance during minimally invasive coronary interventions. The method uses a patient-specific dynamic coronary model, which is derived from the CTA scan by centerline extraction and motion estimation. The dynamic coronary model is registered with the 2D+t X-ray sequence, considering multiple X-ray time points concurrently, while taking breathing induced motion into account. Evaluation was performed on 26 datasets of 17 patients by comparing projected model centerlines with manually annotated centerlines in the X-ray images. The proposed 3D+t/2D+t registration method performed better than a 3D/2D registration method with respect to the accuracy and especially the robustness of the registration. Registration with a median error of 1.47 mm was achieved.

  10. Spiral-CT angiography after intraarterial iliac stent placement; Spiral-CT-Angiographie nach arterieller iliakaler Stentapplikation

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    Freund, M. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Palmie, S. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Wesner, F. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik; Heller, M. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik

    1995-10-01

    In a prospective study 32 patients underwent CT-A after stent placement in the iliac arteries. The vascular morphology was analyzed regarding neointimal hyperplasia and calcification pattern. The results were compared with those of clinical findings (walking distance), Doppler ultrasound (ankle-brachial index) and DSA. All 47 stents were visible and patent (100%). One misplacement was identified. A good correlation was found between an improved ankle-brachial index and CT-A (88.5%) and extension of the walking distance and CT-A (92.3%). Concerning location, number and grade of stenoses the results between CT-A and DSA matched in 42.1%. An exact mapping of calcified plaques was possible in all cases. (orig./MG) [Deutsch] Nach perkutaner transluminaler Angioplastie (PTA) und Stenteinlage wurden 32 Patienten prospektiv mittels CT-A untersucht. Es erfolgte eine Analyse der Gefaessmorphologie hinsichtlich neointimaler Hyperplasien und Verkalkungsmuster. Weiterhin wurden die Ergebnisse mit denen der intraarteriellen digitalen Subtraktionsangiographie (i.a. DSA), dem klinischen Befund (Gehstrecke) und der Doppler-Ultraschalluntersuchung (Arm-Knoechel-Index/AKI) verglichen. Alle 47 Stents konnten in der CT-A exakt lokalisiert und als offen identifiziert werden (100%). Eine Stentfehllage wurde diagnostiziert. Der Nachweis neointimaler Hyperplasie gelang aufgrund von Metallartefakten im Stentniveau nicht. Verkalkungen waren in allen Faellen nachweisbar. Eine Uebereinstimmung zwischen DSA und CT-A hinsichtlich des Schweregrades, der Anzahl und Lokalisation von Stenosen fand sich nur in 42,1%. In 88,5% der Faelle bestand eine Uebereinstimmung zwischen CT-morphologischem Befund und verbessertem AKI, in 92,3% mit verlaengerter Gehstrecke. (orig./MG)

  11. Multislice CT angiography of interrupted aortic arch

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    Yang, Dong Hyun; Goo, Hyun Woo [Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiac Surgery, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiology, Seoul (Korea)

    2008-01-15

    Interrupted aortic arch (IAA) is defined as complete luminal and anatomic discontinuity between the ascending and descending aorta. Because almost all patients with IAA become critically ill during the neonatal period, they should undergo urgent corrective surgery. This clinical urgency necessitates a fast and accurate noninvasive diagnostic method. Although echocardiography remains the primary imaging tool for this purpose, it is not always sufficient for planning surgical correction of IAA, principally due to a limited acoustic window and the inexperience of imagers. In this context, multislice CT angiography is regarded as an appropriate imaging technique complementary to echocardiography because it is fast, accurate, and objective for the diagnosis of IAA. In this article we describe what cardiac radiologists should know about IAA in their clinical practice, including clinicopathological features, CT features with contemporary surgical methods and postoperative complications, and differentiation from coarctation of the aorta and aortic arch atresia. (orig.)

  12. Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography.

    Science.gov (United States)

    Kidoh, Masafumi; Nakaura, Takeshi; Nakamura, Shinichi; Namimoto, Tomohiro; Nozaki, Toshimitsu; Sakaino, Naritsugu; Harada, Kazunori; Yamashita, Yasuyuki

    2014-12-01

    Dedicated coronary computed tomography (CT) scan has been proven to be an accurate diagnostic modality in evaluating coronary artery disease. A second phase scan starting immediately after the coronary CT scan might enable visualization of the different vascular territories of the entire chest. To investigate the feasibility of a contrast material and radiation dose reduction triple-rule-out (TRO) CT angiography (CTA) protocol with serial non-ECG-gated low kVp scan of the whole chest, which utilizes a recirculated contrast agent. Thirty patients were scanned with the new TRO-CTA protocol; after the coronary scan with retrospective ECG-gating, non-ECG-gated whole-chest CTA was performed at 80 kVp to evaluate aortic arch (AAr) and pulmonary trunk (PT). Another 30 patients were scanned by our conventional TRO-CTA protocol at 120 kVp with retrospective ECG-gating. We compared the estimated effective dose (ED), contrast material (CM) dose, contrast-to-noise ratio (CNR) of the ascending aorta (AAo), and the rate of patients who could achieve adequate attenuation of the AAr and PT between the two protocols. The total ED of the new TRO-CTA protocol was 29.6% lower than that of the conventional protocol (P TRO-CTA protocol was significantly lower than in the conventional protocol (60.1 ± 9.6 mL vs. 91.8 ± 22.6 mL, P TRO-CTA protocol than with the conventional protocol (P 0.05). The new TRO-CTA protocol can reduce the total dose of radiation and the contrast dose and yield adequate vascular enhancement compared with the conventional protocol. © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Learning-based automatic detection of severe coronary stenoses in CT angiographies

    Science.gov (United States)

    Melki, Imen; Cardon, Cyril; Gogin, Nicolas; Talbot, Hugues; Najman, Laurent

    2014-03-01

    3D cardiac computed tomography angiography (CCTA) is becoming a standard routine for non-invasive heart diseases diagnosis. Thanks to its high negative predictive value, CCTA is increasingly used to decide whether or not the patient should be considered for invasive angiography. However, an accurate assessment of cardiac lesions using this modality is still a time consuming task and needs a high degree of clinical expertise. Thus, providing automatic tool to assist clinicians during the diagnosis task is highly desirable. In this work, we propose a fully automatic approach for accurate severe cardiac stenoses detection. Our algorithm uses the Random Forest classi cation to detect stenotic areas. First, the classi er is trained on 18 CT cardiac exams with CTA reference standard. Then, then classi cation result is used to detect severe stenoses (with a narrowing degree higher than 50%) in a 30 cardiac CT exam database. Features that best captures the di erent stenoses con guration are extracted along the vessel centerlines at di erent scales. To ensure the accuracy against the vessel direction and scale changes, we extract features inside cylindrical patterns with variable directions and radii. Thus, we make sure that the ROIs contains only the vessel walls. The algorithm is evaluated using the Rotterdam Coronary Artery Stenoses Detection and Quantication Evaluation Framework. The evaluation is performed using reference standard quanti cations obtained from quantitative coronary angiography (QCA) and consensus reading of CTA. The obtained results show that we can reliably detect severe stenosis with a sensitivity of 64%.

  14. Discordance between CT and angiography in the PIOPED II study.

    Science.gov (United States)

    Wittram, Conrad; Waltman, Arthur C; Shepard, Jo-Anne O; Halpern, Elkan; Goodman, Lawrence R

    2007-09-01

    To retrospectively evaluate the causes of discordant computed tomographic (CT)-angiographic readings from the Prospective Investigation of Pulmonary Embolism Diagnosis, or PIOPED, II study. Institutional review board approval was obtained for this HIPAA-compliant study. Of 1036 patients suspected of having pulmonary embolism who were examined with CT, 226 underwent angiography; 206 patients had concordant results and 20 had discordant results according to two independent readers. Of these 20 patients, 10 were men and 10 were women (mean age, 49 years). Among the 20 studies with discordant results, central readers identified seven cases as negative and 13 as positive for pulmonary embolism at CT; these findings were reversed at angiography. Side-by-side comparisons of discordant studies were performed in consensus. The time between CT and angiography and all locations of pulmonary embolism vascular territory were recorded. The McNemar binomial test was used. One patient had false-positive findings at angiography, 13 patients had false-negative findings at angiography, and two patients had false-negative findings at CT. Four patients had true-negative findings at CT; however, findings were positive for thrombus at angiography. The sensitivity for the detection of pulmonary embolism was 87% for CT and 32% for angiography (P=.007). The largest missed thrombus at angiography was subsegmental in eight patients, segmental in two patients, and lobar in three patients; at CT it was subsegmental in two patients. The mean time between CT and angiography was 40 hours+/-21 (standard deviation) (range, 10-97 hours). In the interval between CT and angiography, thrombi can remain the same, resolve, develop, or result from angiography. Copyright (c) RSNA, 2007.

  15. High-pitch coronary CT angiography with third generation dual-source CT: limits of heart rate.

    Science.gov (United States)

    Gordic, Sonja; Husarik, Daniela B; Desbiolles, Lotus; Leschka, Sebastian; Frauenfelder, Thomas; Alkadhi, Hatem

    2014-08-01

    To determine the average heart rate (HR) and heart rate variability (HRV) required for diagnostic imaging of the coronary arteries in patients undergoing high-pitch CT-angiography (CTA) with third-generation dual-source CT. Fifty consecutive patients underwent CTA of the thoracic (n = 8) and thoracoabdominal (n = 42) aorta with third-generation dual-source 192-slice CT with prospective electrocardiography (ECG)-gating at a pitch of 3.2. No β-blockers were administered. Motion artifacts of coronary arteries were graded on a 4-point scale. Average HR and HRV were noted. The average HR was 66 ± 11 beats per minute (bpm) (range 45-96 bpm); the HRV was 7.3 ± 4.4 bpm (range 3-20 bpm). Interobserver agreement on grade of image quality for the 642 coronary segments evaluated by both observers was good (κ = 0.71). Diagnostic image quality was found for 608 of the 642 segments (95%) in 43 of 50 patients (86%). In 14% of the patients, image quality was nondiagnostic for at least one segment. HR (p = 0.001) was significantly higher in patients with at least one non-diagnostic segment compared to those without. There was no significant difference (p > 0.05) in HRV between patients with nondiagnostic segments and those with diagnostic images of all segments. All patients with a HR CT allows for coronary angiography in the prospectively ECG-gated high-pitch mode with diagnostic image quality at HR up to 70 bpm. HRV is not significantly related to image quality of coronary CTA.

  16. Infundibular dilation and aneurysm at the origin of the posterior communicating artery: differential diagnosis by CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Min, Kyung-Jun; Yoon, Dae-Young [Hallym University College of Medicine, Department of Radiology, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of); Kim, Heung-Chul [Hallym University College of Medicine, Department of Radiology, Chuncheon Sacred Heart Hospital, Chuncheon (Korea, Republic of); Lee, Jong-Young; Cho, Byung-Moon [Hallym University College of Medicine, Department of Neurosurgery, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of)

    2014-11-15

    Infundibular dilation (ID) and aneurysm at the internal carotid artery (ICA)-posterior communicating artery (PComA) junction can be difficult to distinguish but may differ in clinical significance. The aim of this study was to evaluate the utility of CT angiography (CTA) in differentially diagnosing IDs and small unruptured aneurysms at the ICA-PComA junction. This retrospective study comprised 88 patients diagnosed with 107 protrusions (70 IDs and 37 aneurysms <5 mm; 19 bilateral lesions) at the ICA-PComA junction who underwent both CTA and digital subtraction angiography (DSA). Two neuroradiologists independently reviewed CTA and DSA images according to these criteria: (a) size (maximum dimension <3 or ≥3 mm), (b) shape (triangular or round/oval/irregular), (c) aneurysmal neck (absent or present), (d) horizontal direction (posteriomedial or posteriolateral), and (e) PComA origin (apex, no PComA, or base). The intermodality (between CTA and DSA) and interobserver (between the two readers) agreement were determined for each finding. We also evaluated the sensitivity and specificity of CTA for distinguishing ID and aneurysm, using DSA as the reference standard. The mean κ values of intermodality agreement for the size, shape, aneurysmal neck, horizontal direction, and PComA origin were 0.88, 0.87, 0.84, 0.71, and 0.56, respectively. All interobserver agreements of CTA and DSA were excellent. The sensitivity, specificity, and accuracy of CTA for differentiating aneurysms from IDs were 94.6, 100, and 98.0 %, respectively. CTA may be a useful noninvasive modality for differential diagnosis of ID and aneurysm at the ICA-PComA junction. (orig.)

  17. Moyamoya disease: diagnosis with three-dimensional CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, K. (Dept. of Radiology, National Defense Medical Coll., Saitama (Japan) Dept. of Radiology, Kyorin Univ. School of Medicine, Tokyo (Japan)); Makita, K. (Dept. of Radiology, National Defense Medical Coll., Saitama (Japan) Dept. of Radiology, Social Health Insurance Medical Center, Tokyo (Japan)); Furui, S. (Dept. of Radiology, National Defense Medical Coll., Saitama (Japan) Dept. of Diagnostic Radiology, Toranomon Kyosai Hospital, Tokyo (Japan))

    1994-08-01

    Our purpose was to assess the value of three-dimensional (3D) CT angiography in the diagnosis of moyamoya disease. We studied seven patients with moyamoya disease proved by conventional angiography. Three-dimensional (3D) CT angiography was performed using rapid sequence or helical (spiral) scanning in conjunction with a bolus injection of intravenous contrast medium. All seven patients could be diagnosed as having moyamoya disease on the basis of the following 3D CT angiographic findings: poor visualisation of the main trunks and/or major branches of anterior and middle cerebral arteries (7 patients); dilated leptomeningeal anastomotic channels from the posterior cerebral arteries (4); and demonstration of ''moyamoya vessels'' in the basal ganglia (2). Although conventional angiography remains the principal imaging technique for demonstrating anatomical changes in detail, less invasive 3D CT angiography provides a solid means of diagnosing moyamoya disease when it is suspected on CT, MRI, or clinical grounds. (orig.)

  18. CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Karamessini, Maria T.; Kagadis, George C.; Petsas, Theodore; Karnabatidis, Dimitrios; Konstantinou, Dimitrios; Sakellaropoulos, George C.; Nikiforidis, George C.; Siablis, Dimitrios E-mail: siablis@med.upatras.gr

    2004-03-01

    Introduction: Cerebral CT angiography (CTA) is an established method applied to both the detection and treatment planning of intracranial aneurysms. The aim of our study was to compare CTA and digital subtraction angiography (DSA) findings with the surgical results mainly in patients with acute SAH and to evaluate the clinical usefulness of CTA. Materials and methods: During the last 2 years, 82 consecutive patients were admitted under clinical symptoms and signs suggestive of harboring an intracranial aneurysm. CT angiography performed immediately afterwards the plain CT, while DSA was performed within the first 48 h of admission. All aneurysms detected were confirmed during surgery or endovascular embolization. Repeat DSA was performed in all patients having both the initial CTA and the DSA 15 days after the onset of symptoms negative. CT angiograms and conventional angiographies were studied by a consensus of two radiologists for each technique, who performed aneurysm detection, morphological features characterization and evaluation of the technique. Results: Surgical or/and endovascular treatment was performed in 45 patients and 53 aneurysms were confirmed. Using 3D-CT angiography, we detected 47 aneurysms in 42 patients. Conventional angiography depicted 43 aneurysms in 39 patients. The sensitivity of CTA for the detection of all aneurysms versus surgery was 88.7%, the specificity 100%, the positive predictive value (PPV) 100%, the negative predictive value (NPV) 80.7% and the accuracy 92.3%. Accordingly, the sensitivity of DSA was 87.8%, the specificity 98%, the PPV 97.7%, the NPV 89.1% and the accuracy 92.9%. Considering aneurysms {>=}3 mm, CTA showed a sensitivity ranging from 93.3 to 100%, equal to that of DSA. Conclusion: Cerebral CT angiography has an equal sensitivity to DSA in the detection of intracranial aneurysms >3 mm. It has also 100% detection rate in AcoA and MCA bifurcation aneurysms, while some locations, like posterior communicating artery

  19. Evaluation of Anterior Ethmoidal Artery by 320-Slice CT Angiography with Comparison to Three-Dimensional Spin Digital Subtraction Angiography: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Juan; Sun, Gang; Yu, Bling Bing; Li, Min; Li, Guo Ying; Peng, Zhao Hui; Zhang, Xu Ping [Dept. of Medical Imaging, Jinan Military General Hospital, Jinan (China); Lu, Yang [Dept. of Radiology, University of Illinois College of Medicine, Illinois (United States)

    2012-11-15

    To explore the usefulness of 320-slice CT angiography (CTA) for evaluating the course of the anterior ethmoidal artery (AEA) and its relationship with adjacent structures by using three-dimensional (3D) spin digital subtraction angiography (DSA) as standard reference. From December 2008 to December 2010, 32 patients with cerebrovascular disease, who underwent both cranial 3D spin DSA and 320-slice CTA within a 30 day period from each other, were retrospectively reviewed. AEA course in ethmoid was analyzed in DSA and CTA. In addition, adjacent bony landmarks (bony notch in medial orbital wall, anterior ethmoidal canal, and anterior ethmoidal sulcus) were evaluated with CTA using the MPR technique oriented along the axial, coronal and oblique coronal planes in all patients. The dose length product (DLP) for CTA and the dose-area product (DAP) for 3D spin DSA were recorded. Effective dose (ED) was calculated. The entire course of the AEA was seen in all 32 cases (100%) with 3D spine DSA and in 29 of 32 cases (90.1%) with 320-slice CTA, with no significant difference (p = 0.24). In three cases where AEA was not visualized on 320-slice CTA, two were due to the dominant posterior ethmoidal artery, while the remaining case was due to diminutive AEA. On MPR images of 320-slice CT, a bony notch in the orbital medial walls was detected in all cases (100%, 64 of 64); anterior ethmoidal canal was seen in 28 of 64 cases (43.8%), and the anterior ethmoidal sulcus was seen in 63 of 64 cases (98.4%). The mean effective dose in CTA was 0.6 {+-} 0.25 mSv, which was significantly lower than for 3D spin DSA (1.3 {+-} 0.01 mSv) (p < 0.001). 320-slice CTA has a similar detection rate for AEA to that of 3D spin DSA; however, it is noninvasive, and may be preferentially used for the evaluation of AEA and its adjacent bony variations and pathologic changes in preoperative patients with paranasal sinus diseases.

  20. Low tube voltage and low contrast material volume cerebral CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Song [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Xuzhou Medical College, School of Medical Imaging, Xuzhou, Jiangsu (China); Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Meinel, Felix G.; McQuiston, Andrew D. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Zhou, Chang Sheng; Qi, Li [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2014-07-15

    To evaluate the image quality, radiation dose and diagnostic accuracy of low kVp and low contrast material volume cerebral CT angiography (CTA) in intracranial aneurysm detection. One hundred twenty patients were randomly divided into three groups (n = 40 for each): Group A, 70 ml iodinated contrast agent/120 kVp; group B, 30 ml/100 kVp; group C, 30 ml/80 kVp. The CT numbers, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured in the internal carotid artery (ICA) and middle cerebral artery (MCA). Subjective image quality was evaluated. For patients undergoing DSA, diagnostic accuracy of CTA was calculated with DSA as reference standard and compared. CT numbers of ICA and MCA were higher in groups B and C than in group A (P < 0.01). SNR and CNR in groups A and B were higher than in group C (both P < 0.05). There was no difference in subjective image quality among the three groups (P = 0.939). Diagnostic accuracy for aneurysm detection among these groups had no statistical difference (P = 1.00). Compared with group A, the radiation dose of groups B and C was decreased by 45 % and 74 %. Cerebral CTA at 100 or 80 kVp using 30 ml contrast agent can obtain diagnostic image quality with a low radiation dose while maintaining the same diagnostic accuracy for aneurysm detection. (orig.)

  1. Differentiation of total occlusion and high-grade stenosis in coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Erffa, J. von; Ropers, D.; Pflederer, T.; Schmid, M.; Marwan, M.; Daniel, W.G.; Achenbach, S. [University of Erlangen, Department of Internal Medicine 2, Erlangen (Germany)

    2008-12-15

    In coronary CT angiography (CTA), both high-grade stenoses and total occlusions of a coronary artery may appear as a complete interruption of the contrast-enhanced lumen. Parameters to differentiate between occlusions and stenoses have not been systematically assessed. We evaluated 40 consecutive patients with a lesion demonstrating complete interruption of the contrast-enhanced lumen in coronary CTA and in whom invasive coronary angiography was available. Length of the vessel segment without luminal contrast enhancement; luminal enhancement proximal, in and distal to the lesion; degree of coronary remodelling; and the degree of lesion calcification were assessed by a blinded observer unaware of the invasive angiogram. Mean length of complete occlusions (n = 20; range 4-54 mm; mean 16.6 {+-} 3.5 mm) was significantly longer than for high-grade stenoses (n = 20; 2-8 mm; mean 4.6 {+-} 1.7 mm, p < 0.001). A lesion length {>=} 9 mm was 100% specific and 70% sensitive for an occlusion. No significant differences were found for vessel enhancement in or distal to the lesion, remodelling index or degree of calcification. Lesion length is the only parameter that may differentiate complete occlusions and high-grade stenoses in coronary CTA. For lesions {>=} 9 mm, an occlusion is very likely. (orig.)

  2. Bolus timing in high-pitch CT angiography of the aorta

    Energy Technology Data Exchange (ETDEWEB)

    Beeres, Martin, E-mail: beeres@gmx.net [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Loch, Matthias, E-mail: MatthiasLoch@gmx.net [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schulz, Boris, E-mail: boris.schell@googlemail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Kerl, Matthias, E-mail: matthias.kerl@gmail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Al-Butmeh, Firas, E-mail: Firas.Albutmeh@gmail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Bodelle, Boris, E-mail: bbodelle@googlemail.com [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Herrmann, Eva, E-mail: Herrmann@Med.Uni-Frankfurt.de [Clinic of the Goethe University, Department of Biostatistics, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Lee, Clara, E-mail: Clara.Lee@kgu.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Jacobi, Volkmar, E-mail: Volkmar.Jacobi@kgu.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J., E-mail: T.Vogl@em.uni-frankfurt.de [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); and others

    2013-06-15

    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.

  3. Evaluation of radiation dose of triple rule-out coronary angiography protocols with different scan length using 256-slice CT

    Science.gov (United States)

    Tsai, Chia-Jung; Lee, Jason J. S.; Chen, Liang-Kuang; Mok, Greta S. P.; Hsu, Shih-Ming; Wu, Tung-Hsin

    2011-10-01

    Triple rule-out coronary CT angiography (TRO-CTA) is a new approach for providing noninvasive visualization of coronary arteries with simultaneous evaluation of pulmonary arteries, thoracic aorta and other intrathoracic structures. The increasing use of TRO-CTA examination with longer scan length is associated with the concerns about radiation dose and their corresponding cancer risk. The purpose of this study is to evaluate organ dose and effective dose for the TRO-CTA examination with 2 scan lengths: TRO std and TRO ext, using 256-slice CT. TRO-CTA examinations were performed on a 256-slice CT scanner without ECG-based tube current modulation. Absorbed organ doses were measured using an anthropomorphic phantom and thermal-luminance dosimeters (TLDs). Effective dose was determined by taking a sum of the measured absorbed organ doses multiplied with the tissue weighting factor based on ICRP-103, and compared to that calculated using the dose-length product (DLP) method. We obtained high organ doses in the thyroid, esophagus, breast, heart and lung in both TRO-CTA protocols. Effective doses of the TRO std and TRO ext protocols with the phantom method were 26.37 and 42.49 mSv, while those with the DLP method were 19.68 and 38.96 mSv, respectively. Our quantitative dose information establishes a relationship between radiation dose and scanning length, and can provide a practical guidance to best clinical practice.

  4. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Power, Sarah, E-mail: drsarahpower@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); McEvoy, Sinead H., E-mail: sineadmcevoy@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Cunningham, Jane, E-mail: janecunningham0708@gmail.com [Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Ti, Joanna P., E-mail: joannapearlyti@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Looby, Seamus, E-mail: seamuslooby@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); O' Hare, Alan, E-mail: alanohare@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Williams, David, E-mail: davidwilliams@rcsi.ie [Department of Geriatrics and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI) and Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Brennan, Paul, E-mail: paulbrennan@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Thornton, John, E-mail: johnthornton@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland)

    2015-07-15

    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome.

  5. Best-Quality Vessel Identification Using Vessel Quality Measure in Multiple-Phase Coronary CT Angiography

    Science.gov (United States)

    Liu, Jordan; Chan, Heang-Ping; Zhou, Chuan; Wei, Jun; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella

    2016-01-01

    The detection of stenotic plaques strongly depends on the quality of the coronary arterial tree imaged with coronary CT angiography (cCTA). However, it is time consuming for the radiologist to select the best-quality vessels from the multiple-phase cCTA for interpretation in clinical practice. We are developing an automated method for selection of the best-quality vessels from coronary arterial trees in multiple-phase cCTA to facilitate radiologist's reading or computerized analysis. Our automated method consists of vessel segmentation, vessel registration, corresponding vessel branch matching, vessel quality measure (VQM) estimation, and automatic selection of best branches based on VQM. For every branch, the VQM was calculated as the average radial gradient. An observer preference study was conducted to visually compare the quality of the selected vessels. 167 corresponding branch pairs were evaluated by two radiologists. The agreement between the first radiologist and the automated selection was 76% with kappa of 0.49. The agreement between the second radiologist and the automated selection was also 76% with kappa of 0.45. The agreement between the two radiologists was 81% with kappa of 0.57. The observer preference study demonstrated the feasibility of the proposed automated method for the selection of the best-quality vessels from multiple cCTA phases.

  6. Computed tomographic coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE HF Project 1-C).

    Science.gov (United States)

    Chow, Benjamin J W; Green, Rachel E; Coyle, Doug; Laine, Mika; Hanninen, Helena; Leskinen, Hanna; Rajda, Miroslav; Larose, Eric; Hartikainen, Juha; Hedman, Marja; Mielniczuk, Lisa; O'Meara, Eileen; deKemp, Robert A; Klein, Ran; Paterson, Ian; White, James A; Yla-Herttuala, Seppo; Leber, Alex; Tandon, Vikas; Lee, Ting; Al-Hesayen, Abdul; Hessian, Renee; Dowsley, Taylor; Kass, Malek; Kelly, Cathy; Garrard, Linda; Tardif, Jean-Claude; Knuuti, Juhani; Beanlands, Rob S; Wells, George A

    2013-12-26

    The prevalence of heart failure (HF) is rising in industrialized and developing countries. Though invasive coronary angiography (ICA) remains the gold standard for anatomical assessment of coronary artery disease in HF patients, alternatives are being sought. Computed tomographic coronary angiography (CTA) has emerged as an accurate non-invasive diagnostic tool for coronary artery disease (CAD) and has been demonstrated to have prognostic value. Whether or not CTA can be used in HF patients is unknown. Acknowledging the aging population, the growing prevalence of HF and the increasing financial burden of healthcare, we need to identify non-invasive diagnostic tests that are available, safe, accurate and cost-effective. The proposed study aims to provide insight into the efficacy of CTA in HF patients. A multicenter randomized controlled trial will enroll 250 HF patients requiring coronary anatomical definition. Enrolled patients will be randomized to either CTA or ICA (n = 125 per group) as the first test to define coronary anatomy. The primary outcomes will be collected to determine downstream resource utilization. Secondary outcomes will include the composite clinical events and major adverse cardiac events. In addition, the accuracy of CTA for detecting coronary anatomy and obstruction will be assessed in patients who subsequently undergo both CTA and ICA. It is expected that CTA will be a more cost-effective strategy for diagnosis: yielding similar outcomes with fewer procedural risks and improved resource utilization. ClinicalTrials.gov, NCT01283659. Team grant #CIF 99470.

  7. In vitro comparison of different carotid artery stents: a pixel-by-pixel analysis using CT angiography and contrast-enhanced MR angiography at 1.5 and 3 T

    Energy Technology Data Exchange (ETDEWEB)

    Lettau, Michael; Sauer, Annett; Heiland, Sabine; Rohde, Stefan; Reinhardt, Julia; Bendszus, Martin; Haehnel, Stefan [University of Heidelberg, Medical Center, Division of Neuroradiology, Department of Neurology, Heidelberg (Germany)

    2010-09-15

    CT angiography (CTA) and MR angiography (MRA) are increasingly used methods for evaluation of stented vessel segments. The purpose of this study was to compare CTA, contrast-enhanced MRA (CEMRA) at 1.5 T, and CEMRA at 3 T for the visualization of carotid artery stents and to define the best noninvasive imaging technique for each stent. CTA and CEMRA appearances of 18 carotid artery stents of different designs and sizes (4.0 to 10.0 mm) were investigated in vitro. The profile of the contrast-to-noise ratio (CNR) of the lumen of each stent was calculated semiautomatically by a pixel-by-pixel analysis using the medical imaging software OSIRIS {sup registered}. For each stent, artificial lumen narrowing (ALN) was calculated. In all but one stents, ALN was lower on CEMRA at 3 T than at 1.5 T. With CEMRA at 3 T and at 1.5 T, ALN in most nitinol stents was lower than in the groups of stainless steel and cobalt alloy stents. In most nitinol stents, ALN on CEMRA at 3 T was lower than on CTA. In all stainless steel stents and cobalt alloy stents, ALN was lower on CTA than on CEMRA. With CTA and CEMRA, in most stents ALN decreased with increasing stent diameter. CTA and CEMRA evaluation of vessel patency after stent placement is possible, but considerably impaired by ALN. Investigators should be informed about the method of choice for every stent. (orig.)

  8. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism. Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Michaely, H.J. [Inst. fuer Klinische Radiologie und Nuklearmedizin, Universitaetsklinikum Mannheim, Univ. Heidelberg (Germany); Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany); Johnson, T.R.; Morhard, D.; Becker, C.; Reiser, M.; Nikolaou, K. [Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany)

    2008-10-15

    To evaluate the feasibility of dual-energy CT angiography (CTA) of the lung in patients with suspected pulmonary embolism (PE). 24 patients with suspected PE were examined with a single-acquisition, dual-energy CTA protocol (A-system: 140 kV/65 mAsref, B-system: 80 kV/190 mAsref) on a dual-source CT system. Lung perfusion was visualized by color-coding voxels containing iodine and air using dedicated dual-energy post-processing software. Perfusion defects were classified by two blinded radiologists as being consistent or non-consistent with PE. Subjective image quality of perfusion maps and CTA was rated using a 5-point scale (1: excellent, 5: poor). The reading of a third independent radiologist served as the standard of reference for the diagnosis of PE. In all patients with PE (n = 4), perfusion defects classified as being consistent with PE were identified in lung areas affected by PE. Both readers did not record perfusion defects classified as being consistent with PE in any of the patients without PE. Thus, on a per patient basis the sensitivity and specificity for the assessment of PE was 100% for both readers. On a per segment basis the sensitivity and specificity ranged between 60 - 66.7% and 99.5 - 99.8%. The interobserver agreement was good (k = 0.81). Perfusion defects rated as non-consistent with PE were most frequently caused by streak artifacts from dense contrast material in the great thoracic vessels. The median score of the image quality of both the perfusion maps and CTA was 2. In conclusion, dual-energy CTA of pulmonary embolism is feasible and allows the assessment of perfusion defects caused by pulmonary embolism. Further optimization of the injection protocol is required to reduce artifacts from dense contrast material. (orig.)

  9. Electrocardiogram-gated coronary CT angiography dose estimates using ImPACT.

    Science.gov (United States)

    Kobayashi, Masanao; Asada, Yasuki; Matsubara, Kosuke; Suzuki, Shouichi; Koshida, Kichiro; Matsunaga, Yuta; Haba, Tomonobu; Kawaguchi, Ai; Toyama, Hiroshi; Kato, Ryouichi

    2016-07-08

    The primary study objective was to assess radiation doses using a modified form of the Imaging Performance Assessment of Computed Tomography (CT) scanner (ImPACT) patient dosimetry for cardiac applications on an Aquilion ONE ViSION Edition scanner, including the Ca score, target computed tomography angiography (CTA), prospective CTA, continuous CTA/cardiac function analysis (CFA), and CTA/CFA modulation. Accordingly, we clarified the CT dose index (CTDI) to determine the relationship between heart rate (HR) and X-ray exposure. As a secondary objective, we compared radiation doses using modified ImPACT, a whole-body dosimetry phantom study, and the k-factor method to verify the validity of the dose results obtained with modified ImPACT. The effective dose determined for the reference person (4.66 mSv at 60 beats per minute (bpm) and 33.43 mSv at 90bpm) were approximately 10% less than those determined for the phantom study (5.28 mSv and 36.68 mSv). The effective doses according to the k-factor (0.014 mSv•mGy-1•cm-1; 2.57 mSv and 17.10 mSv) were significantly lower than those obtained with the other two methods. In the present study, we have shown that ImPACT, when modified for cardiac applications, can assess both absorbed and effective doses. The results of our dose comparison indicate that modified ImPACT dose assessment is a promising and practical method for evaluating coronary CTA.

  10. Assessment Of Coronary Arterial Stents By Multislice-CT Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Maintz, D.; Fallenberg, E. M.; Heindel, W.; Fischbach, R. [Univ. of Muenster (Germany). Dept. of Clinical Radiology; Grude, M. [Univ. of Muenster (Germany). Dept. of Cardiology and Angiology

    2003-11-01

    Purpose: To assess patency and lumen visibility of coronary artery stents by multislice-CT angiography (MSCTA) in comparison with conventional coronary angiography as the standard of reference. Material and Methods: 47 stents of 13 different types were evaluated in 29 patients. MSCTA was performed on a 4-slice scanner with a standard coronary protocol (detector collimation 4 x 1 mm; table feed 1.5 mm/rotation, 400 mAs, 120 kV). Image evaluation was performed by two readers who were blinded to the reports from the catheter angiography. MIP reconstructions were evaluated for image quality on a 4-point scale (1 = poor, 4 = excellent) and stent patency (contrast distal to the stent as an indirect patency sign). Axial images and multiplanar reformations through the stents were used for assessment of stent lumen visibility (measurement of the visible stent lumen diameter) and detection of relevant in-stent stenosis (50%). Results: Image quality was fair to good on average (score 2.64 {+-} 1.0) and depended on the heart rate (heart rate 45-60: average score 3.2, heart rate 61-70: average score 2.8, heart rate >71: average score 1.4). Thirty-seven stents were correctly classified as patent, 1 was correctly classified as occluded and 9 stents were not assessable due to insufficient image quality because of triggering artifacts. Parts of the stent lumen could be visualized in 30 cases. On average, 20-40% of the stent lumen diameter was visible. Twenty-five stents were correctly classified as having no stenosis, 1 was falsely classified as stenosed, 1 was correctly classified as occluded. In 20 stents lumen visibility was not sufficient for stenosis evaluation. Conclusion: Although the stent lumen may be partly visualized in most stents, a reliable evaluation of in-stent stenoses does not seem practical by 4-slice MSCT. Nevertheless, for stent patency evaluation, MS-CTA might provide valuable clinical information. With submillimeter MSCT (e.g. 16-slice scanners) and more

  11. Evaluation of intra-aortic CT angiography performances for the visualisation of spinal vascular malformations' angioarchitecture

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic; Gabrieli, Joseph; Chiras, Jacques [Pitie-Salpetriere Hospital, Department of Interventional Neuroradiology, Paris (France); Paris VI University, Pierre et Marie Curie University, Paris (France); Di Maria, Federico; Sourour, Nader-Antoine; Shotar, Eimad; Cormier, Evelyne; Fahed, Robert [Pitie-Salpetriere Hospital, Department of Interventional Neuroradiology, Paris (France); Nouet, Aurelien [Pitie-Salpetriere Hospital, Department of Neurosurgery, Paris (France); Cornu, Philippe [Paris VI University, Pierre et Marie Curie University, Paris (France); Pitie-Salpetriere Hospital, Department of Neurosurgery, Paris (France)

    2016-10-15

    To evaluate the performances of the CT-angiography by direct intra-aortic contrast media injection (IA-CTA) for spinal vascular malformations (SVMs)' imaging. Thirteen patients (8 males, 5 females, mean age: 56 y) with suspected SVM underwent IA-CTAs by direct intra-aortic iodinated contrast media injection (5 cc/s; 100 cc) via an arterial femoral or humeral access. Two independent observers evaluated the angioarchitecture of the SVMs and the visualisation of both the Adamkiewicz artery and the anterior spinal artery. Then a consensus was obtained between the 2 reviewers; the results of the IA-CTA were finally compared with those of the full spinal DSA evaluated in consensus. The IA-CTA was feasible in all cases and depicted the SVM in all except one case (92 %). Interrater agreement was good for the location of the SVMs' level. Intermodality (IA-CTA/DSA) agreement was excellent for the level and side of the shunt point, as well as for the SVM subtype evaluation. In 77 % of the cases, the Adamkiewicz artery was satisfactorily seen at the same time on IA-CTA. IA-CTA is a new technique that seems helpful to reach a better understanding of SMVs and may help to tailor more precisely their treatment. (orig.)

  12. Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Chengcheng; Leach, Joseph R.; Hope, Michael D. [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Tian, Bing; Liu, Qi; Lu, Jianping; Chen, Luguang [Changhai Hospital, Department of Radiology, Shanghai (China); Saloner, David [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Radiology Service, VA Medical Center, San Francisco, CA (United States)

    2017-05-15

    Management of abdominal aortic aneurysms (AAAs) is based on diameter. CT angiography (CTA) is commonly used, but requires radiation and iodinated contrast. Non-contrast MRI is an appealing alternative that may allow better characterization of intraluminal thrombus (ILT). This study aims to 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI. 28 patients with AAAs (diameter 50.7 ± 12.3 mm) underwent CTA and non-contrast MRI. MRI was acquired at 3 T using 1) a conventional 3D gradient echo (GRE) sequence and 2) a 3D T{sub 1}-weighted black blood fast-spin-echo sequence. Two radiologists independently measured the AAA diameter. The ratio of signal of ILT and adjacent psoas muscle (ILT{sub r} = signal{sub ILT}/signal{sub Muscle}) was quantified. Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs ≥5.5 cm and <5.5 cm had a variety of distributions of old/fresh ILT types. Non-contrast 3D black blood MRI provides accurate and reproducible AAA diameter measurements as validated by CTA. It also provides unique information about ILT composition, which may be linked with elevated risk for disease progression. (orig.)

  13. Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis.

    Science.gov (United States)

    He, Bosheng; Yang, Jushun; Xiao, Jing; Gu, Jinhua; Chen, Feixiang; Wang, Lin; Zhao, Chengjin; Qian, Junbo; Gong, Shenchu

    2017-08-01

    To estimate the diagnostic value of multi-slice spiral CT angiography (CTA) in lower gastrointestinal bleeding by a meta-analysis. The relevant clinical studies on the diagnostic value of CTA were searched on PubMed, Embase and other electronic documents databases with the deadline of 2016 September. Language was limited to English. A diagnostic meta-analysis was performed by using Meta-DiSc software. The effect sizes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) and 95% confidence interval (CI). The Cochran-Q test and I(2) statistic based on χ(2) test were used for estimation of the heterogeneity. Meta-regression was performed to explore the source of heterogeneity. SROC curve was established. A total of 14 articles including 549 patients with lower gastrointestinal bleeding were enrolled in the meta-analysis. The combined PLR, NLR and DOR were respectively 8.149, 0.158 and 56.213. There were significant heterogeneities in all estimations but we could not find the sources by meta-regression based on study design, study location, CT slices and sample size. The AUC and Q index under the fixed effect model was respectively 0.9463 and 0.8856. The multi-slice CTA has high diagnostic value for lower gastrointestinal bleeding. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Prospective ECG-gated 320-row CT angiography of the whole aorta and coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Li, Yu.; Fan, Zhanming; Xu, Lei; Yang, Lin; Xin, Haiyan; Zhang, Nan [Capital Medical University, Department of Radiology, Beijing An Zhen Hospital, Beijing (China); Capital Medical University, Ministry of Education, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing (China); Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing An Zhen Hospital, Beijing (China)

    2012-11-15

    To investigate the feasibility of using a prospective ECG-gated wide-volume protocol in CT angiography (CTA) of the whole aorta and coronary arteries (CA). A total of 61 consecutive patients with suspected acute aortic diseases underwent CTA of the whole aorta using a prospective ECG-gated wide-volume CT protocol without heart rate (HR) control. The exposure window was set at 40-50 % of R-R interval (HR {>=}70 bpm) or 70-80 % of R-R interval (HR <70 bpm) in a single heartbeat. The image quality of the ascending aorta, aortic valve and CA was evaluated for motion artefacts. The mean attenuation was measured at different levels of the aorta. The radiation dose and contrast medium volume were recorded. All of the examinations were performed successfully. The image quality was acceptable in the ascending aorta, aortic valve (100 %) and CA (94.4 %). The mean radiation dose was 18.42 {+-} 5.02 mSv. Of 61 patients, 14 were diagnosed with aortic aneurysm and 35 were diagnosed with aortic dissection or intramural haematoma. Coronary artery stenosis was detected in 12 patients. For patients with aortic diseases, CTA of the whole aorta using a prospective ECG-gated wide-volume protocol has the potential to provide additional information about the CA and aortic valve with lower radiation exposure. (orig.)

  15. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Linde, Jesper J; Hove, Jens D; Sørgaard, Mathias

    2015-01-01

    was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain. RESULTS: We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients......OBJECTIVES: The aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care....... BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS: Patients with acute chest pain but normal electrocardiograms and troponin values were randomized...

  16. [The Difference of CT Value Related to Monitor Position in the Head CT-angiography Bolus Tracking Method for Patients with Subarachnoid Hemorrhage].

    Science.gov (United States)

    Mizui, Masato; Mizoguchi, Yuji; Tashiro, Takao

    2016-01-01

    The head computed tomography-angiography (head CT-A) examination is excellent for the detection and diagnosis of cerebral artery aneurysm. If we use bolus tracking method when implementing this examination, we must choose a monitoring point. We investigated the influence which the monitoring point (MCA or carotid-A) exerts on the CT value. As for the result, MCA monitoring point method was more excellent than the carotid artery monitoring point method. The CT value was higher about 50 HU in the MCA monitoring point than in the carotid artery monitoring point (average;carotid artery: 349.6±57.8 HU, MCA: 413.2±67.9 HU). So, we conclude that in the bolus tracking method of monitoring point of head CTA, MCA monitoring point should be used.

  17. The effect of equipment set up on patient radiation dose in conventional and CT angiography of the renal arteries.

    Science.gov (United States)

    Kemerink, G J; De Haan, M W; Vasbinder, G B C; Frantzen, M J; Schultz, F W; Zoetelief, J; Jansen, J Th M; Van Engelshoven, J M A

    2003-09-01

    Patient radiation dose in angiography of the renal arteries was assessed and optimized after installing new radiological equipment. In three separate studies (n=50, 25 and 20) patient exposure was monitored in detail. For the first study default factory settings were used, for the second the number of digital subtraction angiography (DSA) images was halved and the X-ray beam filtering during fluoroscopy was increased, and for the third study filtering during DSA was increased as well. Standard projections were derived and used in Monte Carlo simulations to derive dose conversion coefficients to calculate effective dose from the dose-area product (DAP). Dose conversion coefficients were also calculated for CT angiography (CTA). Using default factory settings on the new angiography system, DAP, number of images and effective dose were much higher than on the replaced unit. For the studies given above, DAP was reduced from 144 Gy cm(2) to 65 Gy cm(2) to 32 Gy cm(2), and effective dose from 22 mSv to 11 mSv to 9.1 mSv, respectively. Effective dose due to CTA was 5.2 mSv. It is concluded that modern angiography systems, resulting in high customer satisfaction, may readily cause much higher patient exposure than older systems. These doses may also be much higher than necessary. Optimization before putting such systems into use is absolutely essential. Internationally accepted recommendations for image quality and technique factors in angiography would be of great help.

  18. Optimal sequence timing of CT angiography and perfusion CT in patients with stroke

    Energy Technology Data Exchange (ETDEWEB)

    Morhard, D., E-mail: morhard@nrad.de [Institute of Clinical Radiology, University of Munich, Munich (Germany); Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum Muenchen-Harlaching, Munich (Germany); Wirth, C.D. [Institute of Clinical Radiology, University of Munich, Munich (Germany); Department of General Internal Medicine, University Hospital Inselspital, University of Bern, Bern (Switzerland); Reiser, M.F. [Institute of Clinical Radiology, University of Munich, Munich (Germany); Schulte-Altedorneburg, G. [Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum Muenchen-Harlaching, Munich (Germany); Ertl-Wagner, B. [Institute of Clinical Radiology, University of Munich, Munich (Germany)

    2013-06-15

    Objective: Standard stroke CT protocols start with non-enhanced CT followed by perfusion-CT (PCT) and end with CTA. We aimed to evaluate the influence of the sequence of PCT and CTA on quantitative perfusion parameters, venous contrast enhancement and examination time to save critical time in the therapeutic window in stroke patients. Methods and materials: Stroke CT data sets of 85 patients, 47 patients with CTA before PCT (group A) and 38 with CTA after PCT (group B) were retrospectively analyzed by two experienced neuroradiologists. Parameter maps of cerebral blood flow, cerebral blood volume, time to peak and mean transit time and contrast enhancements (arterial and venous) were compared. Results: Both readers rated contrast of brain-supplying arteries to be equal in both groups (p = 0.55 (intracranial) and p = 0.73 (extracranial)) although the extent of venous superimposition of the ICA was rated higher in group B (p = 0.04). Quantitative perfusion parameters did not significantly differ between the groups (all p > 0.18), while the extent of venous superimposition of the ICA was rated higher in group B (p = 0.04). The time to complete the diagnostic CT examination was significantly shorter for group A (p < 0.01). Conclusion: Performing CTA directly after NECT has no significant effect on PCT parameters and avoids venous preloading in CTA, while examination times were significantly shorter.

  19. Pulmonary CT angiography protocol adapted to the hemodynamic effects of pregnancy.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2012-02-01

    OBJECTIVE: The purpose of this study was to compare the image quality of a standard pulmonary CT angiography (CTA) protocol with a pulmonary CTA protocol optimized for use in pregnant patients with suspected pulmonary embolism (PE). MATERIALS AND METHODS: Forty-five consecutive pregnant patients with suspected PE were retrospectively included in the study: 25 patients (group A) underwent standard-protocol pulmonary CTA and 20 patients (group B) were imaged using a protocol modified for pregnancy. The modified protocol used a shallow inspiration breath-hold and a high concentration, high rate of injection, and high volume of contrast material. Objective image quality and subjective image quality were evaluated by measuring pulmonary arterial enhancement, determining whether there was transient interruption of the contrast bolus by unopacified blood from the inferior vena cava (IVC), and assessing diagnostic adequacy. RESULTS: Objective and subjective image quality were significantly better for group B-that is, for the group who underwent the CTA protocol optimized for pregnancy. Mean pulmonary arterial enhancement and the percentage of studies characterized as adequate for diagnosis were higher in group B than in group A: 321 +\\/- 148 HU (SD) versus 178 +\\/- 67 HU (p = 0.0001) and 90% versus 64% (p = 0.05), respectively. Transient interruption of contrast material by unopacified blood from the IVC was observed more frequently in group A (39%) than in group B (10%) (p = 0.05). CONCLUSION: A pulmonary CTA protocol optimized for pregnancy significantly improved image quality by increasing pulmonary arterial opacification, improving diagnostic adequacy, and decreasing transient interruption of the contrast bolus by unopacified blood from the IVC.

  20. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Schepis, Tiziano; Koepfli, Pascal; Valenta, Ines; Soyka, Jan [University Hospital Zurich NUK C 40, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Leschka, Sebastian; Desbiolles, Lotus; Husmann, Lars; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 40, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (CIHP), Zurich (Switzerland)

    2007-08-15

    CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using {sup 99m}Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD). MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses {>=}50% and {>=}75% were compared with the MPI findings. In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses {>=}50% in 57 of 376 coronary arteries (15.2%) and stenoses {>=}75% in 32 (8.5%) coronary arteries. Using a cut-off at {>=}75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively. Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia. (orig.)

  1. Real-time fusion of coronary CT angiography with X-ray fluoroscopy during chronic total occlusion PCI

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Takx, Richard A.P. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Boston, MA (United States); Stone, Luke L.; Yeh, Robert W.; Jaffer, Farouc A. [Harvard Medical School, Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA (United States); Girard, Erin E. [Siemens Healthcare, Princeton, NJ (United States); Brilakis, Emmanouil S. [Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX (United States); Lombardi, William L. [University of Washington, Cardiology Division, Seattle, WA (United States)

    2017-06-15

    The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with X-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. (orig.)

  2. 3D-CT angiography in high-grade aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, Kenji; Suda, Yoshitaka; Shioya, Hitoshi; Shindo, Kenjiro [Yuri Kumiai General Hospital, Honjo, Akita (Japan)

    1998-03-01

    We analyzed the role of 3D-CT angiography (3D-CTA) in the management of high-grade patients with severe subarachnoid hemorrhage (SAH) who were classified as Grade 5 by the Hunt-Kosnik grading system. From February 1995 to January 1997, 86 out of 92 patients with SAH were studied using 3D-CTA. There were 30 Grade 5 SAH patients (32.6%) including 5 patients who arrived in cardiopulmonary arrest (CPA). There were 13 men and 17 women, ranging in age from 46 to 89 years. Two-thirds were older than age 65 years. All patients underwent CT scan and were diagnosed with SAH. Excluding 5 CPA patients and one other patient, the remaining 24 patients successfully underwent 3D-CTA. As a result, ruptured aneurysms responsible for the SAH were clearly delineated in 19 patients (79.2%), and their anatomical relationships to the surrounding vessels were easily assessed. There were 8 patients with ICA aneurysms, 5 with MCA aneurysms, 2 with ACoA aneurysms, 2 with VA aneurysms, 1 with distal ACA aneurysm and 1 with distal PICA aneurysm. Intracranial vessels were not seen in 4 patients, 3 of whom had huge intracerebral hematomas associated with severe SAH. Proximal clipping was performed in a 46-years-old man with dissecting VA aneurysm. He later gained consciousness and became a surgical candidate. A 62-years-old woman underwent coil embolization for the large ICPC aneurysm after the level of her consciousness improved slightly following ventricular drainage. In conclusion, 3D-CTA can be performed safely and has a high detection rate of ruptured aneurysm even in patients with severe SAH. The results from these studies may gain further insight into epidemiology of SAH and ruptured aneurysms. (author)

  3. Diagnostic value of time-resolved CT angiography for the lower leg.

    Science.gov (United States)

    Sommer, Wieland H; Helck, Andreas; Bamberg, Fabian; Albrecht, Edda; Becker, Christoph R; Weidenhagen, Rolf; Kramer, Harald; Reiser, Maximilian F; Nikolaou, Konstantin

    2010-12-01

    The aim of this study was to test the feasibility of time-resolved computed tomography angiography (TR-CTA) for use in the lower leg. Fifty-nine patients with suspected peripheral arterial occlusive disease were examined with a standard CTA (S-CTA) of the lower run-off and with an additional TR-CTA of the calves (12 phases; 2.5 s/phase, 80 kV, 120 mAs, volume of contrast medium 50 mL, flow rate 5.0 mL/s). For seven lower-leg artery segments, arterial contrast and the presence of venous overlay were tested for S-CTA and TR-CTA. Stenoses were classified on a three-point scale separately for S-CTA and TR-CTA, and diagnostic confidence for stenosis assessment was evaluated for both datasets. Contrast arrival times and HU values were evaluated in patients with asymmetric proximal stenoses. TR-CTA resulted in significantly higher contrast enhancement (P < 0.0001) and less venous overlay as compared to S-CTA (P < 0.05). Diagnostic confidence for stenosis rating was significantly higher in TR-CTA (P < 0.0001). Asymmetric proximal stenoses lead to significantly delayed and diminished contrast enhancement on the stenotic side. TR-CTA of the calves is feasible and provides higher enhancement and higher diagnostic confidence as compared to monophasic CTA of the lower legs.

  4. Diagnostic value of time-resolved CT angiography for the lower leg

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, Wieland H. [Ludwig-Maximilians University Munich, Department of Clinical Radiology, University Hospital-Grosshadern, Munich (Germany); University of Munich, Grosshadern Campus, Department of Clinical Radiology, Munich (Germany); Helck, Andreas; Bamberg, Fabian; Albrecht, Edda; Becker, Christoph R.; Kramer, Harald; Reiser, Maximilian F.; Nikolaou, Konstantin [Ludwig-Maximilians University Munich, Department of Clinical Radiology, University Hospital-Grosshadern, Munich (Germany); Weidenhagen, Rolf [Ludwig-Maximilians University Munich, Department of Surgery, University Hospital-Grosshadern, Munich (Germany)

    2010-12-15

    The aim of this study was to test the feasibility of time-resolved computed tomography angiography (TR-CTA) for use in the lower leg. Fifty-nine patients with suspected peripheral arterial occlusive disease were examined with a standard CTA (S-CTA) of the lower run-off and with an additional TR-CTA of the calves (12 phases; 2.5 s/phase, 80 kV, 120 mAs, volume of contrast medium 50 mL, flow rate 5.0 mL/s). For seven lower-leg artery segments, arterial contrast and the presence of venous overlay were tested for S-CTA and TR-CTA. Stenoses were classified on a three-point scale separately for S-CTA and TR-CTA, and diagnostic confidence for stenosis assessment was evaluated for both datasets. Contrast arrival times and HU values were evaluated in patients with asymmetric proximal stenoses. TR-CTA resulted in significantly higher contrast enhancement (P < 0.0001) and less venous overlay as compared to S-CTA (P < 0.05). Diagnostic confidence for stenosis rating was significantly higher in TR-CTA (P < 0.0001). Asymmetric proximal stenoses lead to significantly delayed and diminished contrast enhancement on the stenotic side. TR-CTA of the calves is feasible and provides higher enhancement and higher diagnostic confidence as compared to monophasic CTA of the lower legs. (orig.)

  5. Head-to-head comparison between {sup 18}F-FDOPA PET/CT and MR/CT angiography in clinically recurrent head and neck paragangliomas

    Energy Technology Data Exchange (ETDEWEB)

    Heimburger, Celine; Hubele, Fabrice; Namer, Izzie Jacques [University Hospitals of Strasbourg, Department of Biophysics and Nuclear Medicine, Strasbourg (France); CNRS/University of Strasbourg, ICube, UMR 7357, Strasbourg (France); University of Strasbourg, FMTS, Faculty of Medicine, Strasbourg (France); Veillon, Francis; Riehm, Sophie; Cavalcanti, Marcela [University Hospitals of Strasbourg, Department of Radiology, Strasbourg (France); Taieb, David [Aix-Marseille University, Department of Nuclear Medicine, La Timone University Hospital, Marseille (France); Aix-Marseille University, European Center for Research in Medical Imaging, Marseille (France); Institut Paoli-Calmettes, Inserm UMR1068 Marseille Cancerology Research Center, Marseille (France); Goichot, Bernard; Chabrier, Gerard [University Hospitals of Strasbourg, Department of Internal Medicine, Strasbourg (France); Petit-Thomas, Julie; Charpiot, Anne [University Hospitals of Strasbourg, Department of Otolaryngology and Maxillofacial Surgery, Strasbourg (France); Averous, Gerlinde [University Hospitals of Strasbourg, Department of Pathology, Strasbourg (France); Imperiale, Alessio [University Hospitals of Strasbourg, Department of Biophysics and Nuclear Medicine, Strasbourg (France); CNRS/University of Strasbourg, ICube, UMR 7357, Strasbourg (France); University of Strasbourg, FMTS, Faculty of Medicine, Strasbourg (France); Hautepierre University Hospital, Biophysics and Nuclear Medicine, Strasbourg Cedex (France)

    2017-06-15

    Head and neck paragangliomas (HNPGLs) can relapse after primary treatment. Optimal imaging protocols have not yet been established for posttreatment evaluation. The aim of the present study was to assess the diagnostic value of {sup 18}F-FDOPA PET/CT and MR/CT angiography (MRA/CTA) in HNPGL patients with clinical relapse during their follow-up. Sixteen consecutive patients presenting with local pain, tinnitus, dysphagia, hoarse voice, cranial nerve involvement, deafness, or retrotympanic mass appearing during follow-up after the initial treatment of HNPGLs were retrospectively evaluated. Patients underwent both {sup 18}F-FDOPA PET/CT and MRA (15 patents) or CTA (1 patent). Both methods were first assessed under blinded conditions and afterwards correlated. Head and neck imaging abnormalities without histological confirmation were considered true-positive results based on a consensus between radiologists and nuclear physicians and on further {sup 18}F-FDOPA PET/CT and/or MRA. {sup 18}F-FDOPA PET/CT and MRA/CTA were concordant in 14 patients and in disagreement in 2 patients. {sup 18}F-FDOPA PET/CT and MRA/CTA identified, respectively, 12 and 10 presumed recurrent HNPGLs in 12 patients. The two lesions diagnosed by PET/CT only were confirmed during follow-up by otoscopic examination and MRA performed 29 and 17 months later. {sup 18}F-FDOPA PET/CT images were only slightly influenced by the posttreatment sequelae, showing a better interobserver reproducibility than MRA/CTA. Finally, in 2 of the 16 studied patients, {sup 18}F-FDOPA PET/CT detected two additional synchronous primary HNPGLs. {sup 18}F-FDOPA PET/CT is highly sensitive in posttreatment evaluation of patients with HNPGLs, and also offers better interobserver reproducibility than MRA/CTA and whole-body examination. We therefore suggest that {sup 18}F-FDOPA PET/CT is performed as the first diagnostic imaging modality in symptomatic patients with suspicion of HNPGL relapse after primary treatment when {sup 68

  6. Multidetector-CT angiography in pulmonary embolism - can image parameters predict clinical outcome?

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, Christoph M.; Lemburg, Stefan P.; Nicolas, Volkmar; Roggenland, Daniela [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Bochum (Germany); Knoop, Heiko [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Medical Clinic III - Pneumology, Allergology, and Sleep Medicine, Bochum (Germany); Holland-Letz, Tim [Ruhr-University of Bochum, Department of Medical Informatics, Biometry and Epidemiology, Bochum (Germany)

    2011-09-15

    To assess if pulmonary CT angiography (CTA) can predict outcome in patients with pulmonary embolism (PE). Retrospective analysis of CTA studies of patients with PE and documentation of pulmonary artery (PA)/aorta ratio, right ventricular (RV)/left ventricular (LV) ratio, superior vena cava (SVC) diameter, pulmonary obstruction index (POI), ventricular septal bowing (VSB), venous contrast reflux (VCR), pulmonary infarction and pleural effusion. Furthermore, duration of total hospital stay, necessity for/duration of ICU therapy, necessity for mechanical ventilation and mortality were recorded. Comparison was performed by logistic/linear regression analysis with significance at 5%. 152 patients were investigated. Mean duration of hospital stay was 21 {+-} 24 days. 66 patients were admitted to the ICU; 20 received mechanical ventilation. Mean duration of ICU therapy was 3 {+-} 8 days. Mortality rate was 8%. Significant positive associations of POI, VCR and pulmonary infarction with necessity for ICU therapy were shown. VCR was significantly associated with necessity for mechanical ventilation and duration of ICU treatment. Pleural effusions were significantly associated with duration of total hospital stay whereas the RV/LV ratio correlated with mortality. Selected CTA findings showed significant associations with the clinical course of PE and may thus be used as predictive parameters. (orig.)

  7. Quantification of Intracranial Aneurysm Morphodynamics from ECG-gated CT Angiography

    NARCIS (Netherlands)

    Firouzian, A.; Manniesing, R.; Metz, C.T.; Risselada, R.; Klein, S.; Kooten, F. van; Sturkenboom, M.C.; Lugt, A. van der; Niessen, W.J.

    2013-01-01

    Rationale and Objectives: Aneurysm morphodynamics is potentially relevant for assessing aneurysm rupture risk. A method is proposed for automated quantification and visualization of intracranial aneurysm morphodynamics from ECG-gated computed tomography angiography (CTA) data. Materials and Methods:

  8. Technical note: Electrocardiogram electrode repositioning for 320-row coronary CT angiography in patients with regular and recurrent premature ventricular contractions.

    Science.gov (United States)

    Kondo, Takeshi; Matsutani, Hideyuki; Groarke, John; Takamura, Kazuhisa; Fujimoto, Shinichiro; Rybicki, Frank J; Kumamaru, Kanako K

    2014-01-01

    Arrhythmias can compromise image quality and increase radiation exposure during coronary CT angiography (CTA). However, premature ventricular contractions (PVCs) can occur in a predictable recurrent and regular pattern (ie, bigeminy, trigeminy, quadrigeminy) with post-PVC compensatory pauses. Electrocardiographic (ECG) electrode repositioning can achieve relative amplification of the R waves of PVCs compared with R waves of sinus beats. This technical note describes how simple ECG electrode repositioning, combined with an absolute-delay strategy, facilitated selective R waves of PVC ECG triggering of image acquisition in 6 patients with PVC bigeminy or quadrigeminy at the time of 320-row coronary CTA. All 6 studies were single heartbeat acquisition scans with excellent image quality and a median effective radiation dose of 2.9 mSv (interquartile range, 2.1-3.8 mSv). Standard ECG electrode positions used for 2 patients with PVC bigeminy undergoing coronary CTA were associated with an acquisition over 2 heartbeats and effective radiation doses of 6.8 and 10.3 mSv, respectively. In conclusion, ECG electrode repositioning combined with an absolute-delay strategy for regularly recurring PVCs, such as ventricular bigeminy, facilitates high image quality and lower radiation dose during coronary CTA. This simple and straightforward technique can be considered for all patients with regular and recurrent PVCs undergoing coronary CTA.

  9. Coronary Motion Modeling for CTA to X-Ray Angiography Registration

    NARCIS (Netherlands)

    C.T. Metz (Coert)

    2011-01-01

    textabstractThe goal of the work described in this thesis is to develop and validate techniques to make 3D coronary computed tomography angiography available during percutaneous coronary interventions. The accurate alignment of the preoperative image with the intraoperative situation is very challen

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

    Energy Technology Data Exchange (ETDEWEB)

    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. [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Herrmann, Eva [Clinic of the Goethe University, Department of Biostatistics, Frankfurt (Germany)

    2012-01-15

    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.)

  11. High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Korn, A.; Fenchel, M.; Bender, B.; Danz, S.; Ernemann, U. [Department of Diagnostic und Interventional Neuroradiology, Tuebingen (Germany); Thomas, C.; Ketelsen, D.; Claussen, C.D.; Heuschmid, M. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Moonis, G. [Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Krauss, B. [Siemens AG, Imaging and Therapy Division, Forchheim (Germany); Brodoefel, H. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (United States)

    2013-04-15

    High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 {+-} 16.5 versus 57.3 {+-} 14.8; p = 0.50) and venous segments (15.8 {+-} 6.7 versus 18.9 {+-} 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35 % (218.2 {+-} 30 versus 141.8 {+-} 20 mGy x cm). Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis. (orig.)

  12. Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements - initial experience with a novel physician-driven algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, Stefan [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); University Medical Centre Mannheim (UMM), University of Heidelberg, First Department of Medicine, Faculty of Medicine Mannheim, Mannheim (Germany); Wang, Rui [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Beijing Anzhen Hospital, Capital Medical University, Department of Radiology, Beijing (China); Schoepf, U.J.; Steinberg, Daniel H.; Spearman, James V.; Bayer, Richard R. [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Hamm, Christian W. [Giessen University, Department of Internal Medicine I, Cardiology/Angiology, Giessen (Germany); Renker, Matthias [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Giessen University, Department of Internal Medicine I, Cardiology/Angiology, Giessen (Germany)

    2015-04-01

    The present study aimed to determine the feasibility of a novel fractional flow reserve (FFR) algorithm based on coronary CT angiography (cCTA) that permits point-of-care assessment, without data transfer to core laboratories, for the evaluation of potentially ischemia-causing stenoses. To obtain CT-based FFR, anatomical coronary information and ventricular mass extracted from cCTA datasets were integrated with haemodynamic parameters. CT-based FFR was assessed for 36 coronary artery stenoses in 28 patients in a blinded fashion and compared to catheter-based FFR. Haemodynamically relevant stenoses were defined by an invasive FFR ≤0.80. Time was measured for the processing of each cCTA dataset and CT-based FFR computation. Assessment of cCTA image quality was performed using a 5-point scale. Mean total time for CT-based FFR determination was 51.9 ± 9.0 min. Per-vessel analysis for the identification of lesion-specific myocardial ischemia demonstrated good correlation (Pearson's product-moment r = 0.74, p < 0.0001) between the prototype CT-based FFR algorithm and invasive FFR. Subjective image quality analysis resulted in a median score of 4 (interquartile ranges, 3-4). Our initial data suggest that the CT-based FFR method for the detection of haemodynamically significant stenoses evaluated in the selected population correlates well with invasive FFR and renders time-efficient point-of-care assessment possible. (orig.)

  13. Duplex ultrasonography for the detection of vertebral artery stenosis: A comparison with CT angiography.

    Science.gov (United States)

    Rozeman, Anouk D; Hund, Hajo; Westein, Michel; Wermer, Marieke J H; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Schimsheimer, Robert-Jan; Algra, Ale

    2017-08-01

    Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and compared it with CT angiography (CTA). We gathered data on 337 consecutive patients who had DUS because of posterior circulation stroke or TIA. Matching CTA studies were retrieved and used as reference. Stenosis on CTA was considered "significant" if >50%, at DUS if Peak Systolic Velocity (PSV) > 140 cm/s for the V1 segment and PSV > 125 cm/s for the V2 segment. We determined the area under the ROC curve (AUROC). In addition, we calculated which PSV cut-off value resulted in highest sensitivity with acceptable specificity. DUS was able to make an adequate measurement in 378 of 674 V1 segments and 673 of 674 V2 segments. DUS detected a significant stenosis in 52 of 378 V1 segments; 12 were confirmed by CTA (AUROC 0.73, 95% Confidence Interval 0.63-0.83). The optimal DUS PSV cut-off value for this segment was 90 cm/s. For the V2 segment there were too few stenoses to allow reliable assessment of diagnostic characteristics of DUS. Although DUS has a fair AUROC for detecting significant stenosis, adequate assessment of the V1 segment is often not possible due to anatomic difficulties. Assessment of the V2 segment is feasible but yielded few stenoses. Hence, we consider usefulness of DUS for screening of extracranial vertebral artery stenosis limited.

  14. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding.

    Science.gov (United States)

    Chua, A E; Ridley, L J

    2008-08-01

    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 x 2 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 (chi(2) = 3.5, P = 0.6) and (chi(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.

  15. CT angiography by means of intra-arterial contrast infusion

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Junichiro; Watanabe, Hiroshi; Shiogai, Toshiyuki; Konishi, Yoshifumi; Hara, Mitsuhiro (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1983-10-01

    CT angiography (CT-AG) by means of intra-arterial contrast infusion was carried out, and its clinical usefulness was evaluated in various intracranial lesions. The practical and diagnostic merits of CT-AG are as follows: a selective enhancement of the cerebral vessels by an extremely small amount of the contrast substance, accompanied by a satisfactory resolution of fine arterioles and arteries. The excellent ability of the CT to detect differences in the X-ray absorption coefficients surpasses that of cerebral angiography. An intracranial aneurysm which was not visualized by the angiography appeared between arterial branches upon CT-AG. The three-dimensional configuration of the aneurysmal body and its related artery, the pointing direction of the aneurysm, and the angle between the aneurysmal axis and the afferent artery were clearly shown. The fine structure of arteriovenous malformation could be shown concurrently with the cerebral tissue and the ventricle. The axial view of the circle of Willis gives important information for surgical intervention. Concerning brain tumors, the structural correlation between the tumor and the cerebral arteries became apparent when the CT-AG was carried out immediately after a conventional contrast-enhancement. Such a ''double contrast'' allows safe surgical access to the intracranial tumor. CT-AG in the case of ''Moyamoya'' disease visualized fine moyamoya vessels extending all over the cerebral hemisphere; those vessels were less prominent in the ordinary angiograms. The vascular networks of the arteriovenous malformation, which were not evident in the ordinary angiograms, were also revealed by the CT-AG. For the patient with poor prospects, CT-AG will be were valid as a screening study than ordinary angiography because of its less invasive procedure using a small amount of the contrast substance. CT-AG on a dynamic scan mode possible optimal timing in the visualization of the

  16. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Kawiorski, Michal M.; Alonso de Lecinana, Maria [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Martinez-Sanchez, Patricia; Fuentes, Blanca; Sanz-Cuesta, Borja E.; Marin, Begona; Ruiz-Ares, Gerardo; Diez-Tejedor, Exuperio [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Garcia-Pastor, Andres; Diaz-Otero, Fernando [Hospital Universitario Gregorio Maranon, IiSGM, Universidad Complutense de Madrid, Madrid (Spain); Calleja, Patricia [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Lourido, Daniel; Vicente, Agustina; Fandino, Eduardo [Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Sierra-Hidalgo, Fernando [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid (Spain)

    2016-05-15

    Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability). Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %). CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies. (orig.)

  17. 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

    OpenAIRE

    van Asch, Charlotte J. J.; Birgitta K Velthuis; Rinkel, Gabriël J E; Algra, Ale; de Kort, Gerard A. P.; Witkamp, Theo D.; de Ridder, Johanna C M; van Nieuwenhuizen, Koen M.; De Leeuw, Frank Erik; Schonewille, Wouter J.; de Kort, Paul L. M.; Dippel, Diederik W; Raaymakers, Theodora W M; Hofmeijer, Jeannette; Wermer, Marieke J. H.

    2015-01-01

    Study 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 prospective diagnostic study enrolled 298 adults (18-70 years) treated in 22 hospitals in the Netherlands over six years. CT angiography was performed within seven days of haemorrhage. If the result was negative, MRI/MR...

  18. Prognostic and accuracy data of multidetector CT coronary angiography in an established clinical service

    Energy Technology Data Exchange (ETDEWEB)

    Van Lingen, R. [Department of Cardiology, Derriford Hospital, Plymouth, Devon (United Kingdom)], E-mail: Robin.vanLingen@rcht.cornwall.nhs.uk; Kakani, N.; Veitch, A.; Manghat, N.E.; Roobottom, C.A. [Department of Clinical Radiology, Derriford Hospital, Plymouth, Devon (United Kingdom); Morgan-Hughes, G.J. [Department of Cardiology, Derriford Hospital, Plymouth, Devon (United Kingdom)

    2009-06-15

    Aim: To assess the accuracy of clinical coronary computed tomography angiography (CTA) data compared to invasive coronary angiography, and to determine the prognostic value of a negative coronary CTA examination in symptomatic, intermediate-risk patients. Methods: Thirty-seven months of coronary CTA data were audited. Seventy-eight patients were identified who had undergone coronary CTA followed by invasive coronary angiography (ICA) to determine the accuracy of CTA versus ICA. One hundred and seventy-eight patients were identified who had a 'negative' coronary CTA to enable evaluation of the prognostic value of a negative CTA examination. Results: Of the 78 patients in the accuracy analysis group there were 43 true-negative, two false-negative, 26 true-positive, and seven false-positive results producing a sensitivity of 92.9%, specificity of 86%, negative predictive value of 95.6%, and positive predictive value of 78.8%. The 178 patients who had a negative coronary CTA examination were followed up for a mean of 366 days and were all alive (0% mortality) with no episodes of myocardial infarction or unstable angina; two patients underwent elective revascularization procedures (1.1%). Conclusion: According to medium-term analysis, the accuracy of the clinical coronary CTA programme is in line with published trial data, producing excellent sensitivity and negative predictive values. The finding of a negative coronary CTA in symptomatic, intermediate-risk patients appears to confer a good prognosis, at mean follow-up of 1 year, with no deaths or episodes of myocardial infarction or unstable angina. This suggests that the prognostic value of a negative coronary CTA may be similar to that conferred by negative myocardial perfusion scintigraphy or stress echocardiography.

  19. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  20. Computer-aided stenosis detection at coronary CT angiography: effect on performance of readers with different experience levels

    Energy Technology Data Exchange (ETDEWEB)

    Thilo, Christian [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Herzzentrum Augsburg-Schwaben, Department of Cardiology, Klinikum Augsburg, Augsburg (Germany); Gebregziabher, Mulugeta [Medical University of South Carolina, Department of Biostatistics, Bioinformatics and Epidemiology, Charleston, SC (United States); Meinel, Felix G.; Arnoldi, Elisabeth M. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Goldenberg, Roman [Rcadia Medical Imaging, Haifa (Israel); Nance, John W.; Soma, Lashonda D.; Ebersberger, Ullrich; Blanke, Philip; Coursey, Richard L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Rosenblum, Michael A.; Zwerner, Peter L. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2014-10-15

    To evaluate the effect of a computer-aided detection (CAD) algorithm for coronary CT angiography (cCTA) on the performance of readers with different experience levels. We studied 50 patients (18 women, 58 ± 11 years) who had undergone cCTA and quantitative coronary angiography (QCA). Eight observers with varying experience levels evaluated all studies for ≥50 % coronary artery stenosis. After 3 months, the same observers re-evaluated all studies, this time guided by a CAD system. Their performance with and without the CAD system (sensitivity, specificity, positive predictive value and negative predictive value) was assessed using the Likelihood Ratio Χ{sup 2} test both at the per-patient and per-vessel levels. The sensitivity of the CAD system alone for stenosis detection was 71 % per-vessel and 100 % per-patient. There were 54 false positive (FP) findings within 199 analyzed vessels, most of them associated with non-obstructive (<50 %) lesions. With CAD, one (out of three, 33 %) inexperienced reader's per-patient sensitivity and negative predictive value significantly improved from 79 % to 100 % (P = 0.046) and from 90 % to 100 % (P = 0.034), respectively. Other readers' performance indices showed no statistically significant change. Our results suggest that CAD can improve some inexperienced readers' sensitivity for diagnosing coronary artery stenosis at cCTA. (orig.)

  1. Catheter Angiography

    Medline Plus

    Full Text Available ... medical conditions. Angiography uses one of three imaging technologies and, in most cases, a contrast material injection ... Angiography (CTA) X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored ...

  2. Time-resolved CT angiography in aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Meinel, Felix G., E-mail: felix.meinel@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Nikolaou, Konstantin, E-mail: konstantin.nikolaou@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Weidenhagen, Rolf, E-mail: rolf.weidenhagen@med.uni-muenchen.de [Department of Surgery, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Hellbach, Katharina, E-mail: katharina.hellbach@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Helck, Andreas, E-mail: andreas.helck@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Bamberg, Fabian, E-mail: fabian.bamberg@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Reiser, Maximilian F., E-mail: maximilian.reiser@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Sommer, Wieland H., E-mail: wieland.sommer@med.uni-muenchen.de [Department of Clinical Radiology, Ludwig Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany)

    2012-11-15

    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.

  3. Acute gastrointestinal bleeding: CT angiography with multi-planar reformatting.

    Science.gov (United States)

    Steiner, Kate; Gollub, Frank; Stuart, Sam; Papadopoulou, Anthie; Woodward, Nick

    2011-04-01

    Acute gastrointestinal bleeding is a common medical emergency, which carries a significant mortality. CT Angiography is an important non-invasive diagnostic tool, which can be used to plan subsequent endovascular or surgical management. The cases presented demonstrate that a meticulous and systematic approach to image interpretation is necessary, in particular, to detect focal sites of contrast extravasation and small pseudoaneurysms.

  4. Cancerogenesis Risks between 64 and 320 Row Detector CT for Coronary CTA Screening

    Directory of Open Access Journals (Sweden)

    Atif N Khan

    2014-01-01

    Full Text Available Objectives: This study compares cancerogenesis risks posed by the 64 row detector and the 320 row detector computed tomography scanners used during coronary computed tomography angiography (CCTA following decennial screening guidelines. Material and Methods: Data of the radiation absorbed after CCTA by lung, thyroid, and female breast in patients between 50 and 70 years of age obtained from prior published literature for the 64 row CT scanner were compared with data from our study using 320 row detector CT scanner. Data from the 64 row and the 320 row detector CT scanners was used to determine lifetime attributable risks (LAR of cancer based on the biological effects of ionizing radiation (BEIR VII report. Results: The relative reduction of LAR (% for 50-, 60-, and 70-year-old patients undergoing scanning with the 320 row detector CT scanner was 30% lower for lung, and more than 50% lower for female breast when compared with results from 64 row detector CT scanner. The use of 320 row detector CT would result in a combined cumulative cancer incidence of less than 1/500 for breast in women and less than 1/1000 for lung in men; By comparison, this is much lower than other more common risk factors: 16-fold for lung cancer in persistent smokers, 2-fold for breast cancer with a first degree family member history of breast cancer, and 10-fold for thyroid cancer with a family member with thyroid cancer. Decennial screening would benefit at least 355,000 patients from sudden cardiac death each year, 94% of whom have significant coronary artery disease, with at least one stenosis >75%. LAR for thyroid cancer was negligible for both scanners. Conclusion: Lung and female breast LAR reductions with 320 row detector compared with 64 row detector CT are substantial, and the benefits would outweigh increased cancer risks with decennial screening in the age group of 50-70 years.

  5. Evaluation of CT-angiography of lower limb arteries: a preliminary study; Interet de l'arterio-scanner dans le bilan des arteriopathies des membres inferieurs: etude preliminaire

    Energy Technology Data Exchange (ETDEWEB)

    Walter, F.; Leyder, B.; Fays, J.; Blum, A.; Roland, J. [Hopital Central, Service d' Imagerie Guilloz, 54 - Nancy (France); Bronner, J.F.; Lehalle, B. [Centre Hospitalier Universitaire Nancy-Brabois, 54 - Vandoeuvre-les-Nancy (France)

    2001-04-01

    The purpose of this study was to assess the feasibility of CT Angiography (CTA) with a single row of detectors and to compare it to digital subtraction angiography (DSA) in the evaluation of lower limb peripheral arterial disease. A total of 22 patients underwent 24 lower limb Helical CTA using a Somatom Plus 4A (Siemens) and 24 DSA using an Angiostar unit (Siemens). CT angiography was performed in one acquisition (collimation 3 mm/couch motion 9 mm/ interval 2 mm) with tube rotation time of 0.75 sec from the aortic bifurcation to the calf. DSA was performed after catheterization of a common femoral artery using the Seldinger technique. Arteries were classified in four categories (normal or stenosis <50%, stenosis >50%, occlusion, aneurysm). VRT images and axial source images were assessed by two independent radiologists whereas digital angiographies were read by a vascular radiologist. Global interobserver agreement was good (Kappa=0.71). The degree of agreement between CTA and DSA ranged from low to excellent (0.25 to 0.97) depending on the artery. Lower limb CT angiography is a promising non invasive technique. VRT allows quick evaluation. However, is not accurate enough to replace digital angiography. (authors)

  6. Intraobserver and interobserver variability in CT angiography and MR angiography measurements of the size of cerebral aneurysms

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    Kim, Hye Jeong [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Yoon, Dae Young; Lee, Hyung Jin [Hallym University College of Medicine, Department of Radiology, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of); Kim, Eun Soo [Hallym University College of Medicine, Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do (Korea, Republic of); Jeon, Hong Jun; Lee, Jong Young; Cho, Byung-Moon [Hallym University College of Medicine, Department of Neurosurgery, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of)

    2017-05-15

    Accurate and reliable measurement of aneurysm size is important for treatment planning. The purpose of this study was to determine intraobserver and interobserver variability of CTA and MRA for measurement of the size of cerebral aneurysms. Thirty patients with 33 unruptured cerebral aneurysms (saccular, >3 mm in their maximal dimension, with no daughter sacs or lobulations) who underwent 256-row multislice CTA, 3-D TOF MRA at 3.0T, and 3D rotational angiography (3DRA) were retrospectively analyzed. Three independent observers measured the neck, height, and width of the aneurysms using the CTA and MRA images. Intraobserver and interobserver variability of CTA and MRA measurements was evaluated using the standardized difference and intraclass correlation coefficient, with 3DRA measurements as the reference standard. In addition, the mean values of the measurements using CTA and MRA were compared with those using 3DRA. The overall intraobserver and interobserver standardized differences in CTA/MRA were 12.83-15.92%/13.48-17.45% and 14.08-17.00%/12.08-17.67%, respectively. The overall intraobserver and interobserver intraclass correlation coefficients of CTA/MRA were 0.88-0.98/0.84-0.96 and 0.86-0.98/0.85-0.95, respectively. Compared to the height and width measurements, measurements of the neck dimensions showed higher intraobserver and interobserver variability. The sizes of the cerebral aneurysms measured by CTA and MRA were 1.13-9.26 and 5.20-9.67% larger than those measured by 3DRA, respectively; however, these differences were not statistically significant. There were no noticeable differences between intraobserver and interobserver variability for both CTA- and MRA-based measurements of the size of cerebral aneurysms. (orig.)

  7. The emerging role of multidetector row CT angiography in the diagnosis of cervical arterial dissection: preliminary study

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    Elijovich, Lucas [NYU Medical Center, Department of Neurology, New York, NY (United States); Kazmi, Khuram [NYU Medical Center, Department of Neurology, New York, NY (United States); NYU Medical Center, Department of Radiology, New York, NY (United States); Gauvrit, Jean Y. [NYU Medical Center, Department of Radiology, New York, NY (United States); Hopital Salengro, Department of Neuroradiology, Lille (France); Law, Meng [NYU Medical Center, Department of Radiology, New York, NY (United States)

    2006-09-15

    Cervical artery dissection is an important cause of ischemic stroke, particularly in young patients. The diagnosis can be made with invasive catheter angiography or non-invasive imaging, either with MRI in conjunction with MR angiography (MRA) or CT angiography (CTA). Both modalities have been shown to have a high specificity and sensitivity. New developments such as multi-slice CTA (MSCTA) are emerging as an alternative methods for imaging the cervical and intracranial arteries. However, the contribution of modern MSCTA to carotid artery dissection has not been reported. We present a retrospective series of seven patients in whom both MSCTA and cervical axial T1 MRI and MRA were performed in the acute to subacute setting of internal carotid artery dissection. Carotid artery dissection was identified in all seven patients by MSCTA. The combination of MRI and MRA identified dissection in five of the seven patients. Additionally, a pseudoaneurysm was identified by MSCTA that was missed by MRI and MRA. Our findings confirm that MSCTA is a complementary technique in comparison to cervical axial T1 MRI and cervical MRA for diagnosing carotid artery dissection, and at times may provide additional information that can impact patient management. (orig.)

  8. CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

    Science.gov (United States)

    Brouwers, H Bart; Raffeld, Miriam R; van Nieuwenhuizen, Koen M; Falcone, Guido J; Ayres, Alison M; McNamara, Kristen A; Schwab, Kristin; Romero, Javier M; Velthuis, Birgitta K; Viswanathan, Anand; Greenberg, Steven M; Ogilvy, Christopher S; van der Zwan, Albert; Rinkel, Gabriel J E; Goldstein, Joshua N; Klijn, Catharina J M; Rosand, Jonathan

    2014-09-02

    To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH). In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression. A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; ≥1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8). The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials. © 2014 American Academy of Neurology.

  9. CT angiography after carotid artery stenting: assessment of the utility of adaptive statistical iterative reconstruction and model-based iterative reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kuya, Keita; Shinohara, Yuki; Fujii, Shinya; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Yonago (Japan); Sakamoto, Makoto; Watanabe, Takashi [Tottori University, Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Yonago (Japan); Iwata, Naoki; Kishimoto, Junichi [Tottori University, Division of Clinical Radiology Faculty of Medicine, Yonago (Japan); Kaminou, Toshio [Osaka Minami Medical Center, Department of Radiology, Osaka (Japan)

    2014-11-15

    Follow-up CT angiography (CTA) is routinely performed for post-procedure management after carotid artery stenting (CAS). However, the stent lumen tends to be underestimated because of stent artifacts on CTA reconstructed with the filtered back projection (FBP) technique. We assessed the utility of new iterative reconstruction techniques, such as adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR), for CTA after CAS in comparison with FBP. In a phantom study, we evaluated the differences among the three reconstruction techniques with regard to the relationship between the stent luminal diameter and the degree of underestimation of stent luminal diameter. In a clinical study, 34 patients who underwent follow-up CTA after CAS were included. We compared the stent luminal diameters among FBP, ASIR, and MBIR, and performed visual assessment of low attenuation area (LAA) in the stent lumen using a three-point scale. In the phantom study, stent luminal diameter was increasingly underestimated as luminal diameter became smaller in all CTA images. Stent luminal diameter was larger with MBIR than with the other reconstruction techniques. Similarly, in the clinical study, stent luminal diameter was larger with MBIR than with the other reconstruction techniques. LAA detectability scores of MBIR were greater than or equal to those of FBP and ASIR in all cases. MBIR improved the accuracy of assessment of stent luminal diameter and LAA detectability in the stent lumen when compared with FBP and ASIR. We conclude that MBIR is a useful reconstruction technique for CTA after CAS. (orig.)

  10. Procedural success of CTO recanalization: Comparison of the J-CTO score determined by coronary CT angiography to invasive angiography.

    Science.gov (United States)

    Li, Yuehua; Xu, Nan; Zhang, Jiayin; Li, Minghua; Lu, Zhigang; Wei, Meng; Lu, Bin; Zhang, Yang

    2015-01-01

    The J-CTO score is based on invasive angiography, combines several parameters of chronic total coronary occlusions (CTO), and is well established to predict the likelihood of success of percutaneous recanalization. The purpose of this study was to evaluate and validate a J-CTOCT score derived from coronary computed tomography angiography (coronary CTA). Between April 2011 and December 2014, 159 consecutive patients were retrospectively included. All had at least one CTO in invasive angiography, had coronary CTA performed at an interval of no more than one week from invasive angiography, and had an attempt at percutaneous coronary intervention (PCI) following coronary CTA In parallel to the angiographic J-CTO score, the J-CTOCT score was determined by awarding one point each for a blunt vessel stump, bending > 45°, occlusion length ≥ 20 mm, presence of calcium covering > 50% of any vessel cross-section within the occlusion, or a previously failed attempt at PCI. a. Both scores were compared regarding their ability to predict successful recanalization. A total of 171 CTO lesions were analyzed. Intraobserver (k = 0.814, p CTO score (mean: 1.8 ± 1.3, r = 0.856, p CTO score (area under curve: 0.868, p CTO score. . Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  11. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in ...

  12. [CT coronary angiography: indications, image acquisition, and interpretation].

    Science.gov (United States)

    Schoepf, U J; Thilo, C; Fernández, M J; Costello, P

    2008-01-01

    Intense scientific and clinical evaluation have brought about great improvements in cardiac CT. This is no longer merely an experimental technique, rather it has become a clinical application that is ready to fulfill its promise of replacing invasive cardiac catheterization in certain patient populations. Among the proven indications is the evaluation of patients with atypical chest pain, the morphological evaluation of the coronary arteries in cases of suspected congenital anomalies, and before surgical intervention, as well as the evaluation of coronary revascularizations. The use of CT angiography for the exhaustive evaluation of cardiac and non-cardiac pathology in patients with acute chest pain in the emergency department is currently being investigated. Because the heart is continuously moving, CT coronary angiography represents a greater technical challenge than other applications of CT. On the other hand, rapid technical development requires acquisition protocols to be adjusted constantly. However, users that know the general techniques of computed tomography can overcome these challenges. The aim of this article is to provide those interested and involved in CT angiography with a manual to enable them to follow our method step by step. We include considerations regarding the correct selection of patients, patient medication, radiological protection, contrast enhancement, acquisition and reconstruction parameters, image display, image analysis techniques, and the radiological report. Our recommendations are based on our experience, which runs from the evolution of multiple-row detector CT scanners for cardiac applications from its beginnings to the most modern presentations of advanced acquisition modalities, including dual-source CT, which we consider to be the precursor of this test in routine clinical practice.

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

    Energy Technology Data Exchange (ETDEWEB)

    Hyare, Harpreet [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)]. E-mail: hhyare@doctors.org.uk; Desigan, Sharmini [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Nicholl, Helen [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Guiney, Michael J. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Brookes, Jocelyn A. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Lees, William R. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)

    2006-08-15

    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.

  14. Impact of organ-specific dose reduction on the image quality of head and neck CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Schimmoeller, L.; Lanzman, R.S.; Heusch, P.; Dietrich, S.; Miese, F.; Aissa, J.; Heusner, T.A.; Antoch, G.; Kroepil, P. [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf (Germany)

    2013-06-15

    Organ-specific dose reduction (OSDR) algorithms can reduce radiation on radiosensitive organs up to 59 %. This study evaluates the influence of a new OSDR algorithm on image quality of head and neck computed tomographic angiography (CTA) in clinical routine. Sixty-two consecutive patients (68 {+-} 13 years) were randomised into two groups and imaged using 128-row multidetector CT. Group A (n = 31) underwent conventional CTA and group B (n = 31) CTA with a novel OSDR algorithm. Subjective and objective image quality were statistically compared. Subjective image quality was rated on a five-point scale. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated with region-of-interest measurements. The SNR of the common carotid artery and middle cerebral artery was 53.6 {+-} 22.7 and 43.3 {+-} 15.3 (group A) versus 54.1 {+-} 20.5 and 46.2 {+-} 14.6 (group B). The CNR was 40.0 {+-} 19.3 and 29.7 {+-} 12.0 (group A) compared with 40.7 {+-} 16.8 and 32.9 {+-} 10.9 (group B), respectively. Subjective image quality was excellent in both groups (mean score 4.4 {+-} 0.7 versus 4.4 {+-} 0.6). Differences between the two groups were not significant. The novel OSDR algorithm does not compromise image quality of head and neck CTA. Its application can be recommended for CTA in clinical routine to protect the thyroid gland and ocular lenses from unnecessary high radiation. (orig.)

  15. Estimation of radiation exposure of retrospective gated and prospective triggered 128-slice triple-rule-out CT angiography.

    Science.gov (United States)

    Ketelsen, Dominik; Fenchel, Michael; Thomas, Christoph; Buchgeister, Markus; Boehringer, Nadine; Tsiflikas, Ilias; Kaempf, Michael; Claussen, Claus D; Heuschmid, Martin

    2011-09-01

    CT has become an important role in the differential diagnosis of acute chest pain to exclude an aortic dissection, pulmonary embolism and acute coronary artery syndrome. However, the additional radiation exposure is a cause of concern and dose saving strategies should be applied, if possible. To estimate effective dose of retrospective gated and prospective ECG-triggered triple-rule-out computed tomography angiography (TRO-CTA). An Alderson-Rando-phantom equipped with thermoluminescent dosimeters was used for dose measurements. Exposure was performed on a 128-slice single source scanner. The following scan parameters were used (retrospective ECG-gated): 120 kV, 190 mAs/rot., collimation 128x0.6 mm, rotation time 0.3 s. Protocols with a simulated heart rate (HR) of 60 and 100 bpm were performed using the standard ECG-pulsing as well as MinDose. Additionally, a prospective triggered TRO-CTA was acquired (HR 60 bpm). The estimated effective dose of retrospective ECG-gated TRO-CTA ranged from 7.4-13.4 mSv and from 10.1-17.5 mSv for men and women, respectively. Due to radiosensitive breast tissue, women received a significant increased effective dose of up to 64.7% ± 0.03% (p = 0.028) compared to men. MinDose reduces radiation exposure of up to 33.0% ± 6.5% in comparison to standard ECG-pulsing (p TRO-CTA showed an effective dose of 5.9 mSv and 8.2 mSv for men and women, respectively. Compared to retrospective ECG-gated TRO-CTA a significant dose reduction was observed (p < 0.001). Due to the significant different dose exposure, scan protocols should be specifically adapted in a patient- and problem-oriented manner.

  16. (18)F-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.

  17. Cardiac CT angiography in children with congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Siripornpitak, Suvipaporn, E-mail: ssiripornpitak@yahoo.com [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Pornkul, Ratanaporn [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Khowsathit, Pongsak [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Layangool, Thanarat; Promphan, Worakan [Pediatric Cardiology Unit, Queen Sirikit National Institute of Child Health, Bangkok (Thailand); Pongpanich, Boonchob [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand)

    2013-07-15

    Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.

  18. Noninvasive detection of vertebral artery stenosis: a comparison of contrast-enhanced MR angiography, CT angiography, and ultrasound.

    Science.gov (United States)

    Khan, Sofia; Rich, Philip; Clifton, Andrew; Markus, Hugh S

    2009-11-01

    Vertebral stenosis is associated with a high risk of recurrent stroke, but noninvasive imaging techniques to identify it have lacked sensitivity. Contrast-enhanced MR angiography and CT angiography have been recently developed and appear to have better sensitivity. However, no prospective studies have compared both of these techniques with ultrasound against the gold standard of intra-arterial angiography in the same group of patients. Forty-six patients were prospectively recruited in whom intra-arterial angiography was being performed. Contrast-enhanced MR angiography, CT angiography, and duplex ultrasound were also performed. Angiographic images were analyzed blinded to patient identity by 2 experienced neuroradiologists. Contrast-enhanced MR angiography had the highest sensitivity and specificity (Radiologist 1, 0.83 and 0.91, respectively; Radiologist 2, 0.89 and 0.87) for detecting >or=50% stenosis. CT angiography had good sensitivity (Radiologist 1, 0.68; Radiologist 2, 0.58) and excellent specificity (Radiologist 1, 0.92; Radiologist 2, 0.93), whereas duplex had low sensitivity (0.44) but excellent specificity (0.95). For vertebral origin stenosis >or=50%, sensitivities were similar for contrast-enhanced MR angiography (Radiologist 1, 0.91; Radiologist 2, 0.82) but relatively higher for CT angiography (Radiologist 1, 0.82; Radiologist 2, 0.82) and duplex (0.67). Contrast-enhanced MR angiography is the most sensitive noninvasive technique to detect vertebral artery stenosis and also has high specificity. CT angiography has good sensitivity and high specificity. In contrast, ultrasound has low sensitivity and will miss many vertebral stenoses.

  19. Clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Il Bong; Dong, Kyung Rae [Dept. Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of); Goo, Eun Hoe [Dept. Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

    2016-11-15

    The purpose of this study was to assess clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans. From January to July 2016, 30 patients (mean age, 68) were studied with lower extremity CTA and lower extremity perfusion CT. 128 channel multi-detector row CT scans were acquired with a CT scanner (SOMATOM Definition Flash, Siemens medical solution, Germany) of lower extremity perfusion CT and lower extremity CTA. Acquired images were reconstructed with 3D workstation (Leonardo, Siemens, Germany). Site of lower extremity arterial occlusive and stenosis lesions were detected superficial femoral artery 36.6%, popliteal artery 23.4%, external iliac artery 16.7%, common femoral artery 13.3%, peroneal artery 10%. The mean total DLP comparison of lower extremity perfusion CT and lower extremity CTA, 650 mGy-cm and 675 mGy-cm, respectively. Lower extremity perfusion CT and lower extremity CTA were realized that were never be two examination that were exactly the same legions. Future through the development of lower extremity perfusion CT soft ware programs suggest possible clinical applications.

  20. Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

    Energy Technology Data Exchange (ETDEWEB)

    Noergaard, B.L.; Jensen, J.M. [Aarhus University Hospital Skejby, Department of Cardiology B, Aarhus N (Denmark); Leipsic, J. [St. Paul' s Hospital, Department Radiology, Vancouver, British Columbia (Canada)

    2015-08-15

    Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the ''holy grail'' in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFR{sub CT}). This review summarizes the clinical evidence for the use of FFR{sub CT} in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. (orig.)

  1. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  2. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Min; Park, Kwang Bo; Kim, Keon Ha; Jeon, Pyoung; Shin, Sung Wook; Park, Hong Suk; Do, Young Soo (Dept. of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)), email: kbparksmc@skku.edu; Kim, Dong-Ik; Kim, Young-Wook (Div. of Vascular Surgery, Dept. of Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background: There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose: To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. Material and Methods: Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The post embolization MDCT follow-up findings were analyzed retrospectively. Results: The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and Postprocedural hypertension developed in two patients during the follow-up period. Conclusion: The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension

  3. Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients

    Energy Technology Data Exchange (ETDEWEB)

    Bastarrika, Gorka [Clinica Universidad de Navarra, Cardiac Imaging Unit, Pamplona (Spain); Clinica Universidad de Navarra, Department of Radiology, Pamplona (Spain); Broncano, Jordi; Arraiza, Maria; Simon-Yarza, Isabel; Pueyo, Jesus C.; Zubieta, Jose L. [Clinica Universidad de Navarra, Department of Radiology, Pamplona (Spain); Azcarate, Pedro M. [Clinica Universidad de Navarra, Cardiac Imaging Unit, Pamplona (Spain); Clinica Universidad de Navarra, Department of Cardiology, Pamplona (Spain); Levy Praschker, Beltran G.; Rabago, Gregorio [Clinica Universidad de Navarra, Department of Cardiovascular Surgery, Pamplona (Spain)

    2011-09-15

    To assess feasibility, image quality, and radiation dose of prospectively ECG-triggered coronary CT angiography (CTA) in orthotopic heart transplant (OHT) recipients. 47 consecutive OHT recipients (40 men, mean age 62.1{+-}10.9 years, mean heart rate 86.3{+-}14.4 bpm) underwent dual-source CTA to rule out coronary allograft vasculopathy in a prospectively ECG-triggered mode with data acquisition during 35% to 45% of the cardiac cycle. Two independent observers blindly assessed image quality on a per-segment and per-vessel basis using a four-point scale (1-excellent, 4-not evaluable). Scores 1-3 were considered acceptable for diagnosis. Multivariate analysis was performed to evaluate differences between image quality scores obtained at different reconstruction intervals. Effective radiation doses were calculated. 671 coronary segments were evaluated. Interobserver agreement on the image quality was {kappa}=0.75. Diagnostic image quality was observed in 93.9%, 95.5% and 93.3% of the segments at 35%, 40% and 45% reconstruction intervals. Mean image quality score was 1.5{+-}0.7 for the entire coronary tree, 1.4{+-}0.7 for the RCA, 1.6{+-}0.8 for the LCA and 1.6{+-}0.7 for the Cx at the best reconstruction interval. Estimated mean radiation dose was 4.5{+-}1.2 mSv. Systolic prospectively ECG-triggered CTA allows diagnostic image quality coronary angiograms in OHT recipients at low radiation doses. (orig.)

  4. High-resolution dynamic angiography using flat-panel volume CT: feasibility demonstration for neuro and lower limb vascular applications

    Energy Technology Data Exchange (ETDEWEB)

    Mehndiratta, Amit [Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA (United States); University of Oxford, Institute of Biomedical Engineering and Keble College, Oxford (United Kingdom); Indian Institute of Technology Delhi and All India Institute of Medical Science, Centre for Biomedical Engineering, New Delhi (India); Rabinov, James D. [Massachusetts General Hospital, Interventional Neuroradiology, Harvard Medical School, Boston, MA (United States); Grasruck, Michael [Siemens Medical Solutions, Forchheim (Germany); Liao, Eric C. [Massachusetts General Hospital, Department of Plastic and Reconstructive Surgery and Center for Regenerative Medicine, Harvard Medical School, Boston, MA (United States); Crandell, David [Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA (United States); Gupta, Rajiv [Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA (United States)

    2015-07-15

    This paper evaluates a prototype flat-panel volume CT (fpVCT) for dynamic in vivo imaging in a variety of neurovascular and lower limb applications. Dynamic CTA was performed on 12 patients (neuro = 8, lower limb = 4) using an fpVCT with 120 kVp, 50 mA, rotation time varying from 8 to 19 s, and field of view of 25 x 25 x 18 cm{sup 3}. Four-dimensional data sets (i.e. 3D images over time) were reconstructed and reviewed. Dynamic CTA demonstrated sufficient spatio-temporal resolution to elucidate first-pass and recirculation dynamics of contrast bolus through neurovasclar pathologies and phasic blood flow though lower-limb vasculature and grafts. The high spatial resolution of fpVCT resulted in reduced partial volume and metal beam-hardening artefacts. This facilitated assessment of vascular lumen in the presence of calcified plaque and evaluation of fractures, especially in the presence of fixation hardware. Evaluation of arteriovenous malformation using dynamic fpVCT angiography was of limited utility. Dynamic CTA using fpVCT can visualize time-varying phenomena in neuro and lower limb vascular applications and has sufficient diagnostic imaging quality to evaluate a number of pathologies affecting these regions. (orig.)

  5. Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

    Energy Technology Data Exchange (ETDEWEB)

    Tricarico, Francesco [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Catholic University of the Sacred Heart, ' ' A. Gemelli' ' Hospital, Department of Bioimaging and Radiological Sciences, Rome (Italy); Hlavacek, Anthony M. [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Children' s Hospital, Medical University of South Carolina, Division of Pediatric Cardiology, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Children' s Hospital, Medical University of South Carolina, Division of Pediatric Cardiology, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Ebersberger, Ullrich [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Heart Centre Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany); Nance, John W. [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Vliegenthart, Rozemarijn [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); University Medical Centre Groningen/University of Groningen, Centre for Medical Imaging - North East Netherlands, Department of Radiology, Groningen (Netherlands); Cho, Young Jun [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Konyang University School of Medicine, Department of Radiology, Daejeon (Korea, Republic of); Spears, J.R. [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); Secchi, Francesco [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Milan School of Medicine IRCCS Policlinico San Donato, Department of Medical and Surgical Sciences, Radiology Unit, Milan (Italy); Savino, Giancarlo; Marano, Riccardo; Bonomo, Lorenzo [Catholic University of the Sacred Heart, ' ' A. Gemelli' ' Hospital, Department of Bioimaging and Radiological Sciences, Rome (Italy); Schoenberg, Stefan O. [University Medical Centre Mannheim, Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Apfaltrer, Paul [Medical University of South Carolina, Ashley River Tower, Department of Radiology and Radiological Science, Charleston, SC (United States); University Medical Centre Mannheim, Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2013-05-15

    To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions. Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated. Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P < 0.001), while SNR and CNR were higher (P < 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P < 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P < 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv. IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ. (orig.)

  6. Multilevel segmentation of intracranial aneurysms in CT angiography images

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yan [Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94122 and University of Lyon, CREATIS, CNRS UMR 5220, INSERM U1206, UCB Lyon1, INSA Lyon, Lyon 69100 (France); Zhang, Yue, E-mail: y.zhang525@gmail.com [Veterans Affairs Medical Center, San Francisco, California 94121 and University of Lyon, CREATIS, CNRS UMR 5220, INSERM U1206, UCB Lyon1, INSA Lyon, Lyon 69100 (France); Navarro, Laurent [Ecole Nationale Superieure des Mines de Saint-Etienne, Saint-Etienne 42015 (France); Eker, Omer Faruk [CHU Montpellier, Neuroradiologie, Montpellier 34000 (France); Corredor Jerez, Ricardo A. [Ecole Polytechnique Federale de Lausanne, Lausanne 1015 (Switzerland); Chen, Yu; Zhu, Yuemin; Courbebaisse, Guy [University of Lyon, CREATIS, CNRS UMR 5220, INSERM U1206, UCB Lyon1, INSA Lyon, Lyon 69100 (France)

    2016-04-15

    Purpose: Segmentation of aneurysms plays an important role in interventional planning. Yet, the segmentation of both the lumen and the thrombus of an intracranial aneurysm in computed tomography angiography (CTA) remains a challenge. This paper proposes a multilevel segmentation methodology for efficiently segmenting intracranial aneurysms in CTA images. Methods: The proposed methodology first uses the lattice Boltzmann method (LBM) to extract the lumen part directly from the original image. Then, the LBM is applied again on an intermediate image whose lumen part is filled by the mean gray-level value outside the lumen, to yield an image region containing part of the aneurysm boundary. After that, an expanding disk is introduced to estimate the complete contour of the aneurysm. Finally, the contour detected is used as the initial contour of the level set with ellipse to refine the aneurysm. Results: The results obtained on 11 patients from different hospitals showed that the proposed segmentation was comparable with manual segmentation, and that quantitatively, the average segmentation matching factor (SMF) reached 86.99%, demonstrating good segmentation accuracy. Chan–Vese method, Sen’s model, and Luca’s model were used to compare the proposed method and their average SMF values were 39.98%, 40.76%, and 77.11%, respectively. Conclusions: The authors have presented a multilevel segmentation method based on the LBM and level set with ellipse for accurate segmentation of intracranial aneurysms. Compared to three existing methods, for all eleven patients, the proposed method can successfully segment the lumen with the highest SMF values for nine patients and second highest SMF values for the two. It also segments the entire aneurysm with the highest SMF values for ten patients and second highest SMF value for the one. This makes it potential for clinical assessment of the volume and aspect ratio of the intracranial aneurysms.

  7. Dynamic CT head phantom for perfusion and angiography studies

    Science.gov (United States)

    Russell, K.; Blazeski, A.; Dannecker, K.; Lee, Q. Y.; Holscher, C.; Donahue, C.; van Kampen, W.

    2010-03-01

    Contrast imaging is a compelling enhancement for the portable, flat panel-based brain CT scanner currently under development at Xoran. Due to the relative low temporal resolution of flat panel detectors, enabling tomographic imaging on such platform requires optimizing the imaging and injection protocols. A dynamic CT head phantom was designed to facilitate this task. The Dynamic Perfusion and Angiography Model (PAM), mimics tissue attenuation in CT images, provides physiological timing for angiography and perfusion studies, and moves fluid with properties similar to those of blood. The design consists of an arterial system, which contains bifurcating vessels that feed into perfusion chambers, mimicking blood flow through capillaries and smaller vessels, and a venous system, which is symmetrical to the arterial side and drains the perfusion chambers. The variation of geometry and flow rate in the phantom provides the physiological total time that fluid spends in the head, and the difference in material densities correlates to CT numbers for biological tissues. This paper discusses the design of Dynamic PAM and shows experimental results demonstrating its ability to realistically simulate blood flow. Results of dynamic imaging studies of the phantom are also presented.

  8. 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

  9. 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

    2006-01-01

    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 preoperati

  10. Preoperative CT-Angiography Predicts Ex Vivo Vein Length for Right Kidneys After Laparoscopic Donor Nephrectomy

    NARCIS (Netherlands)

    Özdemir-van Brunschot, D.M.D.; Rottier, S.J.; Ouden, J.E. den; Jagt, M.F.P. van der; D'Ancona, F.C.H.; Kloke, H.J.; Vliet, D. van der; Schultze Kool, L.J.; Warle, M.C.

    2015-01-01

    BACKGROUND Implantation of a kidney with a short renal vein is technically more challenging and therefore prone for technique-related complications. It remains unclear whether pre-operative computed tomography angiography (CTA), to assess vascular anatomy of the donor kidney, can be used to predict

  11. Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography

    DEFF Research Database (Denmark)

    Lambrechtsen, J; Egstrup, K

    2013-01-01

    To evaluate whether a simple pre-treatment regimen of sinus node inhibition by ivabradine taken at home for only 1 day resulted in a lower pre-scanning heart rate (HR) and reduced the need for intravenous beta-blockers (BB) prior to coronary computed tomography angiography (CTA)....

  12. CT Angiography for Revascularization of CTO: Crossing the Borders of Diagnosis and Treatment.

    Science.gov (United States)

    Opolski, Maksymilian P; Achenbach, Stephan

    2015-07-01

    Coronary computed tomography angiography (CTA) is increasingly used to diagnose and rule out coronary artery disease. Beyond stenosis detection, the ability of CTA to visualize and characterize coronary atherosclerotic plaque, as well as to obtain 3-dimensional coronary vessel trajectories, has generated considerable interest in the context of pre-procedural planning for revascularization of chronic total occlusions (CTOs). Coronary CTA can characterize features that influence the success rate of percutaneous coronary intervention (PCI) for CTOs such as the extent of calcification, vessel tortuosity, stump morphology, presence of multiple occlusions, and lesion length. Single features and combined scoring systems based on CTA may be used to grade the level of difficulty of the CTOs before PCI and have been shown to predict procedural success rates in several trials. In addition, the procedure itself may be facilitated by real-time integration of 3-dimensional CTA data and fluoroscopic images in the catheterization laboratory. Finally, the ability of coronary CTA to assess anatomy, perfusion, and viability in 1 single examination makes it a potential "one stop shop" that predicts not only the likelihood of successful PCI but also the clinical benefit of CTO revascularization. Further research is clearly needed, but many experienced sites have already integrated coronary CTA into the routine planning and guiding of CTO procedures. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Dual-energy CT angiography in peripheral arterial occlusive disease - accuracy of maximum intensity projections in clinical routine and subgroup analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kau, Thomas [Klinikum Klagenfurt, General Hospital of Klagenfurt, Institute of Diagnostic and Interventional Radiology, Klagenfurt (Austria); Klinikum Klagenfurt am Worthersee, Radiologie, Klagenfurt (Austria); Eicher, Wolfgang; Reiterer, Christian; Niedermayer, Martin; Rabitsch, Egon; Hausegger, Klaus A. [Klinikum Klagenfurt, General Hospital of Klagenfurt, Institute of Diagnostic and Interventional Radiology, Klagenfurt (Austria); Senft, Birgit [Section of Statistics, Reha Clinic for Mental Health, Klagenfurt (Austria)

    2011-08-15

    To evaluate the accuracy of dual-energy CT angiography (DE-CTA) maximum intensity projections (MIPs) in symptomatic peripheral arterial occlusive disease (PAOD). In 58 patients, DE-CTA of the lower extremities was performed on dual-source CT. In a maximum of 35 arterial segments, severity of the most stenotic lesion was graded (<10%, 10-49% and 50-99% luminal narrowing or occlusion) independently by two radiologists, with DSA serving as the reference standard. In DSA, 52.3% of segments were significantly stenosed or occluded. Agreement of DE-CTA MIPs with DSA was good in the aorto-iliac and femoro-popliteal regions ({kappa} = 0.72; {kappa} = 0.66), moderate in the crural region ({kappa} = 0.55), slight in pedal arteries ({kappa} = 0.10) and very good in bypass segments ({kappa} = 0.81). Accuracy was 88%, 78%, 74%, 55% and 82% for the respective territories and moderate (75%) overall, with good sensitivity (84%) and moderate specificity (67%). Sensitivity and specificity was 82% and 76% in claudicants and 84% and 61% in patients with critical limb ischaemia. While correlating well with DSA above the knee, accuracy of DE-CTA MIPs appeared to be moderate in the calf and largely insufficient in calcified pedal arteries, especially in patients with critical limb ischaemia. (orig.)

  14. Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

    Energy Technology Data Exchange (ETDEWEB)

    Tsogkas, Ioannis; Knauth, Michael; Schregel, Katharina; Behme, Daniel; Psychogios, Marios Nikos [University Medicine Goettingen, Department of Neuroradiology, Goettingen (Germany); Wasser, Katrin; Maier, Ilko; Liman, Jan [University Medicine Goettingen, Department of Neurology, Goettingen (Germany)

    2016-11-15

    CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy. Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score. Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively. CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. (orig.)

  15. 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.

  16. Grading of carotid artery stenosis in the presence of extensive calcifications: dual-energy CT angiography in comparison with contrast-enhanced MR angiography.

    Science.gov (United States)

    Korn, A; Bender, B; Brodoefel, H; Hauser, T-K; Danz, S; Ernemann, U; Thomas, C

    2015-03-01

    We investigated the agreement of dual-energy computed tomography angiography (DE-CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA)in the quantitative measurement of stenoses of the internal carotid artery in comparison with digital subtraction angiography (DSA). A total of 21 patients with stenoses of the external carotid artery were investigated with a DE-CTA and CE-MRA before undergoing carotid angioplasty. The grade of the stenoses was assessed in axial multiplanar reformations (MPR) before and multi-intensity projections (MIP) after plaque subtraction (PS) and compared with results from CE-MRA and DSA according to the North American Symptomatic Carotid Endarterectomy Trial. Average grades of stenoses were 80.7 ± 16.1 % (DSA), 81.4 ± 15.3 % (MRA), 80.0 ± 16.7 % (DE-CTA-MPR), and 85.2 ± 14.7 % (DE-CTA-PS-MIP). Of 21 stenoses, 6 were filiform (stenosis grade, 99 %) in the DSA examination. Five of these cases were identified as pseudo-occlusions in MRA, while four were considered as occlusions in DE-CTA-PS-MIP. Another four cases were identified as pseudo-occlusion in DE-CTA-PS-MIP, which were identified as 90 % stenosis in the DSA examination. In comparison with the gold standard DSA, DE-CTA-MPR had a slightly better agreement in measuring the degree of stenosis of the internal carotid arteries than CE-MRA. In DE-CTA-PS-MIP images, a systematic overestimation has to be taken into account due to partial extinction of the lumen by the PS algorithm. Nevertheless, DE-CTA should be preferred in imaging patients with carotid artery stenosis in the presence of extensive calcifications.

  17. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings.

    Science.gov (United States)

    Artigas, José M; Martí, Milagros; Soto, Jorge A; Esteban, Helena; Pinilla, Inmaculada; Guillén, Eugenia

    2013-01-01

    Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.

  18. Feasibility of low-dose contrast medium high pitch CT angiography for the combined evaluation of coronary, head and neck arteries.

    Directory of Open Access Journals (Sweden)

    Zhiwei Wang

    Full Text Available PURPOSE: To evaluate the image quality and radiation dose of combined heart, head, and neck CT angiography (CTA using prospectively electrocardiography (ECG-triggered high-pitch spiral scan protocol, compared with single coronary CTA. MATERIALS AND METHODS: 151 consecutive patients were prospectively included and randomly divided into three groups. Group 1 (n = 47 underwent combined heart, neck, and head CTA using prospectively ECG-triggered high-pitch spiral (Flash scan protocol with a single-phase intravenous injection of iodinated contrast and saline flush; Group 2 (n = 51 underwent single coronary CTA with Flash scan protocol; and Group 3 (n = 53 underwent single coronary CTA with prospective sequence scan protocol. All patients were examined on a dual source CT (Definition FLASH. The image quality was determined for each CT study. RESULTS: Patients of scanning protocol Group 1, 2, and 3 showed no significant differences in age, sex, heart rates, and BMI. Evaluation of coronary artery image quality showed comparable results in the three scanning protocol groups on a per patient-based analysis. In group 1, image quality was found to be sufficient to be diagnostic in all arterial segments of carotid arteries. The mean dose-length product (DLP for group 1 was 256.3±24.5 mGy×cm and was significantly higher in comparison with group 2 (93.4±19.9 mGy×cm; p < 0.001. However, there was no significant difference of DLP between group 1 and group 3 (254.1±69.9 mGy×cm. CONCLUSIONS: The combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose.

  19. Automatic detection of plaques with severe stenosis in coronary vessels of CT angiography

    Science.gov (United States)

    Dinesh, M. S.; Devarakota, Pandu; Kumar, Jitendra

    2010-03-01

    Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries and is the leading cause of death worldwide. Computed tomography angiography (CTA) has been proved to be very useful for accurate noninvasive diagnosis and quantification of plaques. However, the existing methods to measure the stenosis in the plaques are not accurate enough in mid and distal segments where the vessels become narrower. To alleviate this, we propose a method that consists of three stages namely, automatic extraction of coronary vessels; vessels straightening; lumen extraction and stenosis evaluation. In the first stage, the coronary vessels are segmented using a parametric approach based on circular vessel model at each point on the centerline. It is assumed that centerline information is available in advance. Vessel straightening in the second stage performs multi-planar reformat (MPR) to straighten the curved vessels. MPR view of a vessel helps to visualize and measure the plaques better. On the straightened vessel, lumen and vessel wall are segregated using a nearest neighbor classification. To detect the plaques with severe stenosis in the vessel lumen, we propose a "Diameter Luminal Stenosis" method for analyzing the smaller segments of the vessel. Proposed measurement technique identifies the segments that have plaques and reports the top three severely stenosed segments. Proposed algorithm is applied on 24 coronary vessels belonging to multiple cases acquired from Sensation 64 - slice CT and initial results are promising.

  20. Evaluation of intracranial aneurysms with CT angiography: current status and future direction

    Science.gov (United States)

    Sato, Yutaka; Sickels, William; Quets, Jerome; Crosby, Daniel; Chang, Shereen; Cook-Granroth, Janice; Hoffman, Eric A.

    1997-05-01

    Purpose: To develop a valid, reliable and accurate system of measurement of intracranial aneurysm geometry using volumetric data obtained by CT angiography. Materials and methods: A simple model of lateral saccular aneurysm was created. Three models were prepared with different size of aneurysm sac and neck. Volumetric data was acquired using a Toshiba Xpress SX helical scanner. Geometry of an aneurysm model obtained by workstation linked to the scanner applying volume rendering display and dedicated UNIX based computer applying MPR based method. These results were compared with actual caliper measurements of the model. A clinical case of lateral aneurysm arising from the supraclinoid internal carotid artery was also studied. Results: Both the volume rendered image based method and MPR based method provided accurate geometric information of an aneurysm sac and its neck. Conclusions: Volume rendering technique requires editing by a well-informed operator and subjective, while the MPR based method is more objective and better suited for quantitative analysis. Using these mutually complimentary tools, critical geometric information of an aneurysm can be extracted from volumetric data provided by CTA.

  1. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Schepis, Tiziano; Namdar, Mehdi; Valenta, Ines [University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Kalff, Victor [Alfred Hospital, Department of Nuclear Medicine, Melbourne (Australia); Stefani, Laurent [GE Healthcare Bio-Sciences, Buc Cedex (France); Desbiolles, Lotus; Leschka, Sebastian; Husmann, Lars; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2007-07-15

    Combining the functional information of SPECT myocardial perfusion imaging (SPECT-MPI) and the morphological information of coronary CT angiography (CTA) may allow easier evaluation of the spatial relationship between coronary stenoses and perfusion defects. The aim of the present study was the validation of a novel software solution for three-dimensional (3D) image fusion of SPECT-MPI and CTA. SPECT-MPI with adenosine stress/rest {sup 99m}Tc-tetrofosmin was fused with 64-slice CTA in 15 consecutive patients with a single perfusion defect and a single significant coronary artery stenosis ({>=}50% diameter stenosis). 3D fused SPECT/CT images were analysed by two independent observers with regard to superposition of the stenosed vessel onto the myocardial perfusion defect. Interobserver variability was assessed by recording the X, Y, Z coordinates for the origin of the stenosed coronary artery and the centre of the perfusion defect and measuring the distance between the two landmarks. SPECT-MPI revealed a fixed defect in seven patients, a reversible defect in five patients and a mixed defect in three patients and CTA documented a significant stenosis in the respective subtending coronary artery. 3D fused SPECT/CT images showed a match of coronary lesion and perfusion defect in each patient and the fusion process took less than 15 min. Interobserver variability was excellent for landmark detection (r = 1.00 and r = 0.99, p < 0.0001) and very good for the 3D distance between the two landmarks (r = 0.94, p < 0.001). 3D SPECT/CT image fusion is feasible, reproducible and allows correct superposition of SPECT segments onto cardiac CT anatomy. (orig.)

  2. Radiation dose in cerebral angiography and flat detector CT applications in neuroradiology; Strahlendosis bei zerebraler Angiographie und Flachdetektor-CT-Applikationen in der Neuroradiologie

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, T.; Lang, S.; Doerfler, A. [Universitaetsklinikum Erlangen, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Abteilung fuer Neuroradiologie, Erlangen (Germany); Scholz, R. [Siemens Healthcare GmbH, Forchheim (Germany); Hauer, M. [Klinikum Nuernberg Sued, Institut fuer Radiologie und Neuroradiologie, Nuernberg (Germany)

    2015-08-15

    Flat detectors (FD) have completely replaced image intensifiers in angiography. Due to this development not only the image quality of 2D digital subtraction angiography series (2-D-DSA) could be improved but also the acquisition of computed tomography (CT)-like cross-sectional images (FD-CT) within the angio suite became feasible. These techniques are now being used in daily clinical routine. Only little information about effective doses of these applications to patients has been published in the literature. We describe the effective patient dose of current applications in the field of angiography and demonstrate strategies to minimize the dose to the patient. In addition, we compare FD-CT applications to standard multislice CT applications. (orig.) [German] Flachdetektoren haben Bildverstaerker in der Angiographie vollstaendig abgeloest. Mit dieser Entwicklung verbesserte sich nicht nur die Bildqualitaet subtrahierter 2-D-Angiographieserien (2-D-DSA), sondern auch die Akquisition CT-aehnlicher Schnittbilder (FD-CT) mit unterschiedlichen Indikationen wurde moeglich. Diese Techniken werden nun in der taeglichen klinischen Routine eingesetzt. Angaben zur effektiven Patientendosis dieser Applikationen sind bis jetzt in der Literatur nur wenige publiziert worden. Wir beschreiben die effektive Patientendosis aktueller Anwendungen im Bereich der Angiographie und zeigen Strategien zur Minimierung der Dosis fuer den Patienten auf. Zudem vergleichen wir FD-CT-Applikationen mit Standard-Multislice-CT-Anwendungen. (orig.)

  3. An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial.

    Science.gov (United States)

    Albert, Timothy S E; Akahane, Masaaki; Parienty, Isabelle; Yellin, Nancy; Catalá, Violeta; Alomar, Xavier; Prot, Antoine; Tomizawa, Nobuo; Xue, Huadan; Katabathina, Venkata S; Lopera, Jorge E; Jin, Zhengyu

    2015-01-01

    The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA). Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis. Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51). Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for

  4. Cardiac CT angiography after coronary artery surgery in children using 64-slice CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Davide; Agnoletti, Gabriella [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Brunelle, Francis [University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France); Sidi, Daniel; Bonnet, Damien [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Ou, Phalla [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France)], E-mail: phalla.ou@nck.aphp.fr

    2009-09-15

    Objective: The purpose of this study was to compare the diagnostic accuracy of 64-slice CT with that of invasive angiography in the detection of graft and/or coronary angioplasty stenosis in children who had undergone coronary artery surgery. Population and methods: Fifteen consecutive children (8 male and 7 female; age 9.2 {+-} 6.1 years) underwent 64-slice CT because of chest pain or ECG changes mean 4.8 {+-} 3.7 years after surgical coronary artery surgery; 10 patients had coronary angioplasty using a patch from the saphenous vein, four had mammary artery bypass, and one had saphenous vein bypass. Six main segments of the coronary arteries and all the bypass graft considered as a single segment were analyzed and compared with invasive angiography used as the reference standard. Results: CT correctly identified the four children with coronary angioplasty and mammary graft lesions that were confirmed by conventional angiography: one patient had a significant stenosis (>50% stenosis) at the mammary bypass graft anastomosis site; three other had non-significant stenosis (<50% stenosis) including a mild lesion of the saphenous vein patch in two patients and a mild lesion at the anastomosis site of the mammary bypass in one. All segments identified as normal by CT in the other 11 children were also found to be normal by conventional angiography. Conclusion: In centers expert in this technique, 64-slice CT scanning is a promising, rapid, and useful diagnostic technique for evaluating both coronary angioplasty and bypass graft lesions in children who had undergone coronary artery surge0008.

  5. Application of dual-source 4D-CTA combined with CT perfusion imaging in diagnosis of acute cerebral ischemic diseases%双源CT 4D- CTA联合灌注成像在急性脑缺血性疾病中的应用价值

    Institute of Scientific and Technical Information of China (English)

    程有根; 杨光钊; 茅国群; 楼明芳; 魏福全

    2013-01-01

    Objective To investigate the application of dual- source four- dimensional CT angiography (4D- CTA) com-bined with CT perfusion imaging (CTPI) in diagnosis of acute cerebral ischemic diseases. Methods Thirty patients with clinical y suspected acute cerebral ischemic disease underwent head plain CT scan and whole brain CTPI examination 2~16h after onset, the images of CBF, CBV, MTT, TTP and 4D- CTA were obtained. Patients also underwent MRI examination in 1~3 d. The findings of plain CT scan, CTPI, 4D- CTA and MRI were analyzed. Results Plain CT scan found 16 ischemic lesions in 12 cases, CTPI found 32 ischemic lesions in 26 cases, MRI found 28 ischemic lesions in 25 cases, and 4D- CTA demonstrated various degree of stenosis or occlusion in supplying vessels in 20 cases. Conclusion Dual- source 4D- CTA combined with CT perfusion imaging provides comprehensive and detailed imaging information, so that has important value for early diagnosis and treatment in pa-tients with acute cerebral ischemia.%目的:探讨双源CT 4维血管造影(4D- CTA)及灌注成像(CTPI)在急性脑缺血性疾病中的应用价值。方法对30例临床拟诊为急性脑缺血性疾病的患者于发病2~24h内行头颅CT平扫和全脑CTPI检查,获得脑血流量、脑血容量、平均通过时间、达峰时间等参数图,同时获得4D- CTA图像;于发病的1~3d后行MRI检查,分析CT平扫、CTPI、4D- CTA、MRI表现。结果 CT平扫发现12例有16个缺血病灶,CTPI发现26例32个缺血病灶,MRI发现25例28个缺血病灶,4D- CTA显示有20例责任血管有不同程度的狭窄或闭塞。结论双源CT 4D- CTA联合灌注成像能为急性脑缺血患者提供全面、详细的影像学信息,对急性缺血性脑梗死的早期诊断和治疗有重要价值。

  6. Reconstructions with identical filling (RIF) of the heart: a physiological approach to image reconstruction in coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Reinartz, S.D.; Diefenbach, B.S.; Kuhl, C.K.; Mahnken, A.H. [University Hospital, RWTH Aachen University, Department of Diagnostic and Interventional Radiology, Aachen (Germany); Allmendinger, T. [Siemens Healthcare Sector, Department of Computed Tomography, Forchheim (Germany)

    2012-12-15

    To compare image quality in coronary artery computed tomography angiography (cCTA) using reconstructions with automated phase detection and Reconstructions computed with Identical Filling of the heart (RIF). Seventy-four patients underwent ECG-gated dual source CT (DSCT) between November 2009 and July 2010 for suspected coronary heart disease (n = 35), planning of transcatheter aortic valve replacement (n = 34) or evaluation of ventricular function (n = 5). Image data sets by the RIF formula and automated phase detection were computed and evaluated with the AHA 15-segment model and a 5-grade Likert scale (1: poor, 5: excellent quality). Subgroups regarding rhythm (sinus rhythm = SR; arrhythmia = ARR) and potential premedication were evaluated by a per-segment, per-vessel and per-patient analysis. RIF significantly improved image quality in 10 of 15 coronary segments (P < 0.05). More diagnostic segments were provided by RIF regarding the entire cohort (n = 693 vs. 590, P < 0.001) and all of the subgroups (e.g. ARR: n = 143 vs. 72, P < 0.001). In arrhythmic patients (n = 19), more diagnostic vessels (e.g. LAD: n = 10 vs. 3; P < 0.014) and complete data sets (n = 7 vs. 1; P < 0.001) were produced. RIF reconstruction is superior to automatic diastolic non-edited reconstructions, especially in arrhythmic patients. RIF theory provides a physiological approach for determining the optimal image reconstruction point in ECG-gated CT angiography. (orig.)

  7. Dual source multidetector CT-angiography before transcatheter aortic valve implantation (TAVI) using a high-pitch spiral acquisition mode

    Energy Technology Data Exchange (ETDEWEB)

    Wuest, W.; Anders, K.; May, M.S.; Uder, M. [University of Erlangen, Department of Radiology, Erlangen (Germany); Schuhbaeck, A.; Gauss, S.; Marwan, M.; Arnold, M.; Muschiol, G.; Daniel, W.G.; Achenbach, S. [University of Erlangen, Department of Cardiology, Erlangen (Germany); Ensminger, S. [University of Erlangen, Department of Cardiac Surgery, Erlangen (Germany)

    2012-01-15

    Transcatheter Aortic Valve Implantation (TAVI) is an alternative to surgical valve replacement in high risk patients. Angiography of the aortic root, aorta and iliac arteries is required to select suitable candidates, but contrast agents can be harmful due to impaired renal function. We evaluated ECG-triggered high-pitch spiral dual source Computed Tomography (CT) with minimized volume of contrast agent to assess aortic root anatomy and vascular access. 42 patients (82 {+-} 6 years) scheduled for TAVI underwent dual source (DS) CT angiography (CTA) of the aorta using a prospectively ECG-triggered high-pitch spiral mode (pitch = 3.4) with 40 mL iodinated contrast agent. We analyzed aortic root/iliac dimensions, attenuation, contrast to noise ratio (CNR), image noise and radiation exposure. Aortic root/iliac dimensions and distance of coronary ostia from the annulus could be determined in all cases. Mean aortic and iliac artery attenuation was 320 {+-} 70 HU and 340 {+-} 77 HU. Aortic/iliac CNR was 21.7 {+-} 6.8 HU and 14.5 {+-} 5.4 HU using 100 kV (18.8 {+-} 4.1 HU and 8.7 {+-} 2.6 HU using 120 kV). Mean effective dose was 4.5 {+-} 1.2 mSv. High-pitch spiral DSCTA can be used to assess the entire aorta and iliac arteries in TAVI candidates with a low volume of contrast agent while preserving diagnostic image quality. (orig.)

  8. MR imaging compared with CT, angiography, and myelography supplemented with CT in the diagnosis of spinal tumors

    Energy Technology Data Exchange (ETDEWEB)

    Hasuo, Kanehiro; Uchino, Akira; Matsumoto, Shunichi; Fujii, Kiyotaka; Fukui, Masashi; Masuda, Kouji (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine)

    To clarify the significance of MR imaging and the present status of CT, angiography, and myelography supplemented by CT (M-CTM), the radiological findings of 50 spinal tumors were reviewed and analyzed. MR imaging was most effective for visualizing morphological features such as the margins and/or inner structures of the tumors. CT was also effective for imaging 'dumbbell' neurinomas and extradural tumors. Angiography was necessary in one hemangioblastoma and in cervical extradural tumors. M-CTM visualized the morphology of intradural extramedullary tumors and extradural tumors, but provided no new information in most of these cases. It was concluded that when using MR the indications for CT, angiography, and M-CTM are limited and that CT or angiography should be performed only in selected cases. M-CTM appeared to be unnecessary. (author).

  9. Usefulness of helical CT angiography for diagnosis of anomalous origin of coronary artery. Comparison with coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Shinozaki, Hitoshi; Kondo, Takeshi; Ishikawa, Emiko [Fujita Health Univ., Toyoake, Aichi (Japan)] [and others

    1998-07-01

    Usefulness of helical CT angiography with reconstruction image of diastolic phase synchronized with electrocardiogram was compared with that of coronary angiography for diagnosis of anomalous origin of coronary artery. Patients were 2 males and 3 females, and average age was 66.4 year. Three cardiologists judged images and did not confirmed the origin and direction of coronary artery in 60% of cases. Helical CT was carried out with heartbeat <60/min by oral administration of propranolol (10-20 mg) one hour before the test. Half image was reconstructed by using data of diastolic phase which is 600 msec back from R-wave of an electrocardiogram. Multiplanar reconstruction (MPR) image and 3D image were provided. Two radiologists judged these images. A judgment was completed with 4 cases among 5 cases, and two judgments agreed well. For diagnosis of anomalous origin of coronary artery, helical CT had good accuracy and was more sensitive than coronary angiography. (K.H.)

  10. 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.

  11. Interleaving cerebral CT perfusion with neck CT angiography. Pt. I. Proof of concept and accuracy of cerebral perfusion values

    Energy Technology Data Exchange (ETDEWEB)

    Oei, Marcel T.H.; Meijer, Frederick J.A.; Woude, Willem-Jan van der; Smit, Ewoud J.; Ginneken, Bram van; Prokop, Mathias; Manniesing, Rashindra [Radboud University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 9101, Nijmegen (Netherlands)

    2017-06-15

    We present a novel One-Step-Stroke protocol for wide-detector CT scanners that interleaves cerebral CTP with volumetric neck CTA (vCTA). We evaluate whether the resulting time gap in CTP affects the accuracy of CTP values. Cerebral CTP maps were retrospectively obtained from 20 patients with suspicion of acute ischemic stroke and served as the reference standard. To simulate a 4 s gap for interleaving CTP with vCTA, we eliminated one acquisition at various time points of CTP starting from the bolus-arrival-time(BAT). Optimal timing of the vCTA was evaluated. At the time point with least errors, we evaluated elimination of a second time point (6 s gap). Mean absolute percentage errors of all perfusion values remained below 10 % in all patients when eliminating any one time point in the CTP sequence starting from the BAT. Acquiring the vCTA 2 s after reaching a threshold of 70HU resulted in the lowest errors (mean <3.0 %). Eliminating a second time point still resulted in mean errors <3.5 %. CBF/CBV showed no significant differences in perfusion values except MTT. However, the percentage errors were always below 10 % compared to the original protocol. Interleaving cerebral CTP with neck CTA is feasible with minor effects on the perfusion values. (orig.)

  12. Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography?

    Science.gov (United States)

    Revel, Marie-Pierre; Cohen, Stéphanie; Sanchez, Olivier; Collignon, Marie-Anne; Thiam, Rokhaya; Redheuil, Alban; Meyer, Guy; Frija, Guy

    2011-02-01

    To evaluate the rate of positive, negative, and indeterminate results and the agreement between initial and expert readings for lung scintigraphy and computed tomographic (CT) angiography performed in patients suspected of having pulmonary embolism (PE) during pregnancy. Institutional review board approval was obtained. The authors retrospectively analyzed the images from lung scintigraphy and CT angiography performed in pregnant patients during the past 9 years. Images from 46 CT angiographic examinations performed in 43 patients and 91 of 94 lung scintigraphic examinations were reviewed by experts, whose readings were then compared with the initial reports. For CT angiography, the quality of opacification was graded as good, suboptimal, or poor and intraarterial attenuation was measured. The rates of positive findings (seven of 43 patients [16%] with CT angiography and 10 of 91 patients [11%] with scintigraphy, P = .36), negative findings (28 of 43 patients [65%] with CT angiography and 64 of 91 patients [70%] with scintigraphy, P = .54), and indeterminate findings (eight of 43 patients [19%] with CT angiography and 17 of 91 patients [19%] with scintigraphy, P = .99) were similar for CT angiography and lung scintigraphy. There were four discrepancies between initial and expert readings for CT angiography (κ = 0.84; confidence interval: 0.68, 0.99) and 14 for lung scintigraphy (κ = 0.75; 95% confidence interval: 0.63, 0.87). Opacification was classified as good for only 23 of the 46 CT angiographic examinations (50%). Attenuation values were significantly different among the groups with good, suboptimal, or poor opacification. Alternative diagnoses unsuspected at chest radiography were demonstrated at CT angiography in five of the 43 patients (12%). The mean maternal radiation dose was 0.9 mSv for lung scintigraphy and 7.3 mSv for CT angiography. Lung scintigraphy and CT angiography have comparable performances for PE diagnosis during pregnancy. Interobserver

  13. Magnetic resonance angiography and CT angiography of persistent primitive olfactory artery: Incidence and association rate with aneurysm in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Bo Ra; Yeo, Soo Hyun; Chang, Hyuk Won; Kim, Mi Jeong; Lee, Sung Moon; Kim, Ealmaan; Kim, Mi Kyung; Cho, Ho Chan; Kim, Hye Soon [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2012-06-15

    Japanese data indicates an incidence of persistent primitive olfactory artery (PPOA) of 0.14%. We studied the incidence of PPOA and associated cerebral vascular variation or anomalies in Korea. We retrospectively reviewed cranial magnetic resonance angiography (MRA) and computed tomography angiography (CTA) images of a total of 9841 patients of our institution. The diagnostic criterion of PPOA is extreme anterioinferior course of the proximal anterior cerebral artery, with a hairpin turn of the lateral projection. We found 29 cases (0.29%) with PPOA. The PPOA location was on the left in 19 cases, bilateral in 3 cases, and on the right in 7 cases. An aneurysm was found at the hairpin turn in 2 patients. There were aneurysms in other sites in 3 cases. There were hypoplasia of anterior cerebral artery in 3 cases, and fenestration of intracranial artery in 1 case. In Korean populations, the incidence of PPOA found in MRA and CTA was twice as high as that shown in the previous Japanese data. Within Korea, left side laterality is more common than right side or bilalterality. Aneurysmal dilatations at the hairpin turning point and aneurysms at other sites were found, and other vascular variations were observed in several cases.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Kai [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Li, Kuncheng, E-mail: cjr.likuncheng@vip.163.com [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Han, Ruijuan [Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020 (China); Li, Wenhuan; Chen, Nan; Yang, Qi; Du, Xiangying; Wang, Chen [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Liu, Guorong; Li, Yuechun [Department of Neurology Baotou Central Hospital, Inner Mongolia, Baotou 014040 (China); Zhou, Maorong [Department of Radiology, Baotou Central Hospital, Inner Mongolia, Baotou 014040 (China); Li, Ligang; Heidrun, Endt [CT BM Clinic Marketing, Siemens Healthcare, Beijing 100102 (China)

    2015-03-15

    Objectives: To explore the feasibility and diagnostic accuracy of a combined one-step high-pitch dual-source computed tomography angiography (CTA) technique for evaluation of coronary and carotid-cerebrovascular arteries. Materials and methods: 85 symptomatic patients suspected of coronary artery and cerebrovascular disease referred for simultaneous coronary and carotid-cerebrovascular CTA were included. Additional invasive angiography of the coronary and cerebral arteries was performed within 30 days in 23 and 13 patients, respectively. The objective parameters of image quality, the mean CT attenuations, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. The subjective image quality of vessels was also assessed by 2 independent radiologists blinded to the patients’ medical history and scan protocols. The diagnostic performance of CTA including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection or exclusion of significant artery stenosis was calculated using the chi-squared test of contingency and correlated with the results of invasive angiography representing the standard of reference. Results: Image quality was rated excellent (score 1) in 95.3% (1074/1127), good (score 2) in 3.3% (37/1127), adequate (score 3) in 1.0% (11/1127), and non-diagnostic (score 4) in 0.4% (5/1127) of coronary segments. Image quality of carotid and cerebral vessels was rated mostly excellent (score 1, 95.12% [78/82]; score 2, 3.66% [3/82]; score 3, 1.22% [1/82]). The sensitivity, specificity, PPV and NPV for the detection of coronary stenosis were 92.2% (81.1–97.7%), 95.2% (91.7–97.5%), 79.6% (67.1–89.1%) and 98.3% (95.8–99.5%), respectively. For the detection of carotid and cerebral artery stenosis, CTA demonstrated a sensitivity of 92.8% (80.5–98.4%), a specificity of 93.5% (88.3–96.8%), a PPV of 79.6% (65.6–89.7%) and a NPV of 97.9% (94.1–99.5%). The effective

  16. Estimation of radiation exposure of retrospective gated and prospective triggered 128-slice triple-rule-out CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, Dominik; Fenchel, Michael; Thomas, Christoph; Boehringer, Nadine; Tsiflikas, Ilias; Kaempf, Michael; Claussen, Claus D; Heuschmid, Martin (Dept. of Diagnostic and Interventional Radiology, Univ. Hospital Tuebingen, Tuebingen (Germany)), email: dominik.ketelsen@med.uni-tuebingen.de; Buchgeister, Markus (Depts. of Radiotherapy and Radiooncology, Univ. Hospital Tuebingen, Tuebingen (Germany))

    2011-09-15

    Background: CT has become an important role in the differential diagnosis of acute chest pain to exclude an aortic dissection, pulmonary embolism and acute coronary artery syndrome. However, the additional radiation exposure is a cause of concern and dose saving strategies should be applied, if possible. Purpose: To estimate effective dose of retrospective gated and prospective ECG-triggered triple-rule-out computed tomography angiography (TRO-CTA). Material and Methods: An Alderson-Rando-phantom equipped with thermoluminescent dosimeters was used for dose measurements. Exposure was performed on a 128-slice single source scanner. The following scan parameters were used (retrospective ECG-gated): 120 kV, 190 mAs/rot., collimation 128x0.6 mm, rotation time 0.3 s. Protocols with a simulated heart rate (HR) of 60 and 100 bpm were performed using the standard ECG-pulsing as well as MinDose. Additionally, a prospective triggered TRO-CTA was acquired (HR 60 bpm). Results: The estimated effective dose of retrospective ECG-gated TRO-CTA ranged from 7.4-13.4 mSv and from 10.1-17.5 mSv for men and women, respectively. Due to radiosensitive breast tissue, women received a significant increased effective dose of up to 64.7% +- 0.03% (p = 0.028) compared to men. MinDose reduces radiation exposure of up to 33.0% +- 6.5% in comparison to standard ECG-pulsing (p < 0.001). The effective dose increased significantly with lower heart rates (p < 0.001). Prospective ECG-triggered TRO-CTA showed an effective dose of 5.9 mSv and 8.2 mSv for men and women, respectively. Compared to retrospective ECG-gated TRO-CTA a significant dose reduction was observed (p < 0.001). Conclusion: Due to the significant different dose exposure, scan protocols should be specifically adapted in a patient- and problem-oriented manner

  17. 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

  18. CT angiography helps to differentiate acute from chronic carotid occlusion: the ''carotid ring sign''

    Energy Technology Data Exchange (ETDEWEB)

    Michel, Patrik; Ntaios, George [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Neurology Service, Lausanne (Switzerland); Delgado, Montserrat G. [Hospital Universitario Central de Asturias, Oviedo (Spain); Bezerra, Daniel C. [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Meuli, Reto; Binaghi, Stefano [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland)

    2012-02-15

    Currently, there is no reliable method to differentiate acute from chronic carotid occlusion. We propose a novel CTA-based method to differentiate acute from chronic carotid occlusions that could potentially aid clinical management of patients. We examined 72 patients with 89 spontaneously occluded extracranial internal carotids with CT angiography (CTA). All occlusions were confirmed by another imaging modality and classified as acute (imaging <1 week of presumed occlusion) orchronic (imaging >4 weeks), based on circumstantial clinical and radiological evidence. A neuroradiologist and a neurologist blinded to clinical information determined the site of occlusion on axial sections of CTA. They also looked for (a) hypodensity in the carotid artery (thrombus), (b) contrast within the carotid wall (vasa vasorum), (c) the site of the occluded carotid, and (d) the ''carotid ring sign'' (defined as presence of a and/or b). Of 89 occluded carotids, 24 were excluded because of insufficient circumstantial evidence to determine timing of occlusion, 4 because of insufficient image quality, and 3 because of subacute timing of occlusion. Among the remaining 45 acute and 13 chronic occlusions, inter-rater agreement (kappa) for the site of proximal occlusion was 0.88, 0.45 for distal occlusion, 0.78 for luminal hypodensity, 0.82 for wall contrast, and 0.90 for carotid ring sign. The carotid ring sign had 88.9% sensitivity, 69.2% specificity, and 84.5% accuracy to diagnose acute occlusion. The carotid ring sign helps to differentiate acute from chronic carotid occlusion. If further confirmed, this information may be helpful in studying ischemic symptoms and selecting treatment strategies in patients with carotid occlusions. (orig.)

  19. Diagnostic value of CTA and MRA in intracranial traumatic aneurysms

    Institute of Scientific and Technical Information of China (English)

    YANG Yun-jun; CHEN Wei-jian; ZHANG Yong; WU Zhe-bao; ZHONG Ming; TAN Xian-xi; WU En-fu; CHENG Jing-liang

    2007-01-01

    Objective:To investigate the diagnostic value of computerized tomographic angiography ( CTA ) and magnetic resonance angiography (MRA) for intracranial traumatic aneurysms (TAs). Methods:CTA and MRA of six patients with intracranial TAs verified by digital subtraction angiography (DSA) and surgery were retrospectively analysed. All patients were examined by nonenhanced computerized tomography (CT) and two by CTA.The source data were reconstructed by volume rendering (VR) and multi-planar reconstruction (MPR) from CTA. Four of them had maximum intensity project (MIP) from MRA.Results:Of the six patients,a total of seven TAs were detected by CTA and MRA examinations.Five cases had only one TA and one case had two TAs. The average diameter was 2.3 cm ( 1.1-3.3 cm).CTA demonstrated two TAs appeared at the cavernous segment of the internal carotid artery (ICA) and the middle cerebral artery (MCA) respectively.MCA TA was definitely and clearly demonstrated on VR images,whereas VR images failed to depict the cavernous ICA TA,which was detected on MPR images.Two TAs were found irregular saccular shape,irregular margin of parent artery and wide neck on CTA.Four MRA examinations demonstrated five TAs,including the cavernous segment ICA TAs (2 cases),the supraclinoid segment ICA TA (1 case ),and the cavernous segment associated with opposite side of the petrosal segment ICA TA (1 case).In a cavernous ICA TA,MRA only revealed aneurysm body,whereas aneurysm neck and distal segment of the parent artery were not revealed.In the remaining cases,MRA clearly depicted aneurysm body and parent artery,whereas the neck was not displayed.ICA TAs showed irregular capsule-like high signal intensity on MRA images.Four TAs exhibited irregular distal segment of the parent artery.TAs at the supraclinoid segment or MCA failed to find fracture signs on nonenhanced CT. Conclusions:Both CTA and MRA examinations are the effective non-invasive method of imageology for diagnosing intracranial TAs

  20. CT angiography of intracranial arterial vessels: impact of tube voltage and contrast media concentration on image quality.

    Science.gov (United States)

    Ramgren, Birgitta; Björkman-Burtscher, Isabella M; Holtås, Stig; Siemund, Roger

    2012-10-01

    Computed tomography angiography (CTA) of intracranial arteries has high demands on image quality. Important parameters influencing vessel enhancement are injection rate, concentration of contrast media and tube voltage. To evaluate the impact of an increase of contrast media concentration from 300 to 400 mg iodine/mL (mgI/mL) and the effect of a decrease of tube voltage from 120 to 90 kVp on vessel attenuation and image quality in CT angiography of intracranial arteries. Sixty-three patients were included into three protocol groups: Group I, 300 mgI/mL 120 kVp; Group II, 400 mgI/mL 120 kVp; Group III, 400 mgI/mL 90 kVp. Hounsfield units (HU) were measured in the internal carotid artery (ICA) and the M1 and M2 segments of the middle cerebral artery. Image quality grading was performed regarding M1 and M2 segments, volume rendering and general image impression. The difference in mean HU in ICA concerning the effect of contrast media concentration was statistically significant (P = 0.03) in favor of higher concentration. The difference in ICA enhancement due to the effect of tube voltage was statistically significant (P concentration raised the mean enhancement in ICA with 18% and the decrease of tube voltage raised the mean enhancement with 37%. Image quality grading showed a trend towards improved grading for higher contrast concentration and lower tube voltage. Statistically significant better grading was found for the combined effect of both measures except for general impression (P 0.01-0.05). The uses of highly concentrated contrast media and low tube voltage are easily performed measures to improve image quality in CTA of intracranial vessel.

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

    Energy Technology Data Exchange (ETDEWEB)

    Heusner, Till Alexander; Hahn, S.; Forsting, M.; Antoch, G. [Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitaetsklinik Essen (Germany); Hamami, M.E.; Poeppel, T.; Bockisch, A. [Klinik fuer Nuklearmedizin, Universitaetsklinik Essen (Germany); Ertle, J.; Hilgard, P. [Klinik fuer Gastroenterologie, Universitaetsklinik Essen (Germany)

    2010-07-15

    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.)

  2. 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.)

  3. Non-invasive prediction of hemodynamically significant coronary artery stenoses by contrast density difference in coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hell, Michaela M., E-mail: michaela.hell@uk-erlangen.de [Department of Cardiology, University of Erlangen (Germany); Dey, Damini [Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048 (United States); Marwan, Mohamed; Achenbach, Stephan; Schmid, Jasmin; Schuhbaeck, Annika [Department of Cardiology, University of Erlangen (Germany)

    2015-08-15

    Highlights: • Overestimation of coronary lesions by coronary computed tomography angiography and subsequent unnecessary invasive coronary angiography and revascularization is a concern. • Differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve, were assessed. • At a threshold of ≥24%, contrast density difference predicted hemodynamically significant lesions with a specificity of 75%, sensitivity of 33%, PPV of 35% and NPV of 73%. • The determination of contrast density difference required less time than transluminal attenuation gradient measurement. - Abstract: Objectives: Coronary computed tomography angiography (CTA) allows the detection of obstructive coronary artery disease. However, its ability to predict the hemodynamic significance of stenoses is limited. We assessed differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve (FFR). Methods: Lesion characteristics of 59 consecutive patients (72 lesions) in whom invasive FFR was performed in at least one coronary artery with moderate to high-grade stenoses in coronary CTA were evaluated by two experienced readers. Coronary CTA data sets were acquired on a second-generation dual-source CT scanner using retrospectively ECG-gated spiral acquisition or prospectively ECG-triggered axial acquisition mode. Plaque volume and composition (non-calcified, calcified), remodeling index as well as contrast density difference (defined as the percentage decline in luminal CT attenuation/cross-sectional area over the lesion) were assessed using a semi-automatic software tool (Autoplaq). Additionally, the transluminal attenuation gradient (defined as the linear regression coefficient between intraluminal CT attenuation and length from the ostium) was determined

  4. Coronary CT angiography: Comparison of a novel iterative reconstruction with filtered back projection for reconstruction of low-dose CT—Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Schoepf, U. Joseph, 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); Moscariello, Antonio [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Policlinico Universitario Campus Bio-Medico, Rome (Italy); Das, Marco [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Rowe, Garrett [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoenberg, Stefan O.; Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Henzler, Thomas [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2013-02-15

    Objective: To prospectively compare subjective and objective image quality in 20% tube current coronary CT angiography (cCTA) datasets between an iterative reconstruction algorithm (SAFIRE) and traditional filtered back projection (FBP). Materials and methods: Twenty patients underwent a prospectively ECG-triggered dual-step cCTA protocol using 2nd generation dual-source CT (DSCT). CT raw data was reconstructed using standard FBP at full-dose (Group{sub 1}a) and 80% tube current reduced low-dose (Group{sub 1}b). The low-dose raw data was additionally reconstructed using iterative raw data reconstruction (Group{sub 2}). Attenuation and image noise were measured in three regions of interest and signal-to-noise-ratio (SNR) as well as contrast-to-noise-ratio (CNR) was calculated. Subjective diagnostic image quality was evaluated using a 4-point Likert scale. Results: Mean image noise of group{sub 2} was lowered by 22% on average when compared to group{sub 1}b (p < 0.0001–0.0033), while there were no significant differences in mean attenuation within the same anatomical regions. The lower image noise resulted in significantly higher SNR and CNR ratios in group{sub 2} compared to group{sub 1}b (p < 0.0001–0.0232). Subjective image quality of group{sub 2} (1.88 ± 0.63) was also rated significantly higher when compared to group{sub 1}b (1.58 ± 0.63, p = 0.004). Conclusions: Image quality of 80% tube current reduced iteratively reconstructed cCTA raw data is significantly improved when compared to standard FBP and consequently may improve the diagnostic accuracy of cCTA.

  5. CT angiography and Color Doppler ultrasonography features and sensitivity in detection of carotid arteries diseases

    Directory of Open Access Journals (Sweden)

    Samir Kamenjaković

    2013-04-01

    Full Text Available Introduction: The aim of this research was to compare specifi city and sensitivity of Color Doppler ultrasonographywith CT angiography.Methods: A total of one hundred patients suffering from carotid artery disease (n=200 were tested in this research in the period from June till October, 2011. Average age of the patients was 61.5 years, and most of the patients were in the age group ranging from 55 to 65 years. The level of carotid artery stenosis is measured according to Standards of the North America Symptomatic Carotid Endarterectomy Trail study,by method of Color Doppler ultrasonography and CT angiography.Results: Stenosis <50% registered by Doppler ultrasonography was found in 62% and by CT angiography in 64% patients. Stenosis from 70 to 79% registered by Doppler ultrasonography was found in 88% and by CT angiography in 82% patients. In patients with level of stenosis 70-79% there was a tendencyof registering the stenosis to be higher by Color Doppler ultrasonography, than by CT angiography. In the case of the occlusion, there was also the similar observation, with variation of 8% carotid arteries.Conclusion: Extracranial Doppler and color duplex ultrasound enable reliable detection of both stenosis and occlusion of carotid arteries and accordingly they occupy an important place in radiological algorithm. When it comes to CT angiography it can be concluded that it can provide accurate and exact information regarding the condition of blood vessels as good as Digital Subtractive Angiography can.

  6. Iterative model reconstruction: Improved image quality of low-tube-voltage prospective ECG-gated coronary CT angiography images at 256-slice CT

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro, E-mail: seisei0430@nifty.com [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States); Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556 (Japan); Weissman, Gaby, E-mail: Gaby.Weissman@medstar.net [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States); Vembar, Mani, E-mail: mani.vembar@philips.com [CT Clinical Science, Philips Healthcare, c595 Miner Road, Cleveland, OH 44143 (United States); Weigold, Wm. Guy, E-mail: Guy.Weigold@MedStar.net [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States)

    2014-08-15

    Objectives: To investigate the effects of a new model-based type of iterative reconstruction (M-IR) technique, the iterative model reconstruction, on image quality of prospectively gated coronary CT angiography (CTA) acquired at low-tube-voltage. Methods: Thirty patients (16 men, 14 women; mean age 52.2 ± 13.2 years) underwent coronary CTA at 100-kVp on a 256-slice CT. Paired image sets were created using 3 types of reconstruction, i.e. filtered back projection (FBP), a hybrid type of iterative reconstruction (H-IR), and M-IR. Quantitative parameters including CT-attenuation, image noise, and contrast-to-noise ratio (CNR) were measured. The visual image quality, i.e. graininess, beam-hardening, vessel sharpness, and overall image quality, was scored on a 5-point scale. Lastly, coronary artery segments were evaluated using a 4-point scale to investigate the assessability of each segment. Results: There was no significant difference in coronary arterial CT attenuation among the 3 reconstruction methods. The mean image noise of FBP, H-IR, and M-IR images was 29.3 ± 9.6, 19.3 ± 6.9, and 12.9 ± 3.3 HU, respectively, there were significant differences for all comparison combinations among the 3 methods (p < 0.01). The CNR of M-IR was significantly better than of FBP and H-IR images (13.5 ± 5.0 [FBP], 20.9 ± 8.9 [H-IR] and 39.3 ± 13.9 [M-IR]; p < 0.01). The visual scores were significantly higher for M-IR than the other images (p < 0.01), and 95.3% of the coronary segments imaged with M-IR were of assessable quality compared with 76.7% of FBP- and 86.9% of H-IR images. Conclusions: M-IR can provide significantly improved qualitative and quantitative image quality in prospectively gated coronary CTA using a low-tube-voltage.

  7. Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients.

    Science.gov (United States)

    Anzidei, M; Napoli, A; Zaccagna, F; Di Paolo, P; Saba, L; Cavallo Marincola, B; Zini, C; Cartocci, G; Di Mare, L; Catalano, C; Passariello, R

    2012-02-01

    This study was undertaken to prospectively evaluate the diagnostic performance of colour Doppler ultrasonography (CDUS), first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) of the carotid arteries using digital subtraction angiography (DSA) as the reference standard. A total of 170 patients with previous cerebrovascular events and suspected carotid artery stenoses underwent CDUS, blood-pool MRA, CTA and DSA. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CDUS, FP MRA, SS MRA and CTA. The McNemar and Wilcoxon tests and receiver operating characteristic (ROC) curve analysis were used to determine significant differences (p<0.05) between the diagnostic performances of the four modalities, and the degree of stenosis was compared using linear regression. A total of 336 carotid bifurcations were studied. The area under the curve (AUC) for degree of stenosis was: CDUS 0.85±0.02, FP MRA 0.982±0.005, SS MRA 0.994±0.002 and CTA 0.997±0.001. AUC analysis showed no statistically significant difference between CTA and MRA (p=0.0174) and a statistically significant difference between CDUS and the other techniques (p<0.001). Plaque morphology analysis showed no significant difference between CTA and SS MRA; a significant difference was seen between CTA and SS MRA versus FP MRA (p=0.04) and CDUS (p=0.038). Plaque ulceration analysis showed a statistically significant difference between MRA and CTA (0.04< p<0.046) versus CDUS (p=0.019). CTA is the most accurate technique for evaluating carotid stenoses, with a slightly better performance than MRA (97% vs. 95% for SS MRA and 92% for FP MRA) and a greater accuracy than CDUS (97% vs. 76%). Blood-pool contrast-enhanced SS sequences offer improved evaluation of degree of stenosis and plaque morphology with accuracy substantially identical to CTA.

  8. Computerized detection of noncalcified plaques in coronary CT angiography: Evaluation of topological soft gradient prescreening method and luminal analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Jun, E-mail: jvwei@umich.edu; Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Agarwal, Prachi; Kuriakose, Jean; Hadjiiski, Lubomir; Patel, Smita; Kazerooni, Ella [Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109 (United States)

    2014-08-15

    Purpose: The buildup of noncalcified plaques (NCPs) that are vulnerable to rupture in coronary arteries is a risk for myocardial infarction. Interpretation of coronary CT angiography (cCTA) to search for NCP is a challenging task for radiologists due to the low CT number of NCP, the large number of coronary arteries, and multiple phase CT acquisition. The authors conducted a preliminary study to develop machine learning method for automated detection of NCPs in cCTA. Methods: With IRB approval, a data set of 83 ECG-gated contrast enhanced cCTA scans with 120 NCPs was collected retrospectively from patient files. A multiscale coronary artery response and rolling balloon region growing (MSCAR-RBG) method was applied to each cCTA volume to extract the coronary arterial trees. Each extracted vessel was reformatted to a straightened volume composed of cCTA slices perpendicular to the vessel centerline. A topological soft-gradient (TSG) detection method was developed to prescreen for NCP candidates by analyzing the 2D topological features of the radial gradient field surface along the vessel wall. The NCP candidates were then characterized by a luminal analysis that used 3D geometric features to quantify the shape information and gray-level features to evaluate the density of the NCP candidates. With machine learning techniques, useful features were identified and combined into an NCP score to differentiate true NCPs from false positives (FPs). To evaluate the effectiveness of the image analysis methods, the authors performed tenfold cross-validation with the available data set. Receiver operating characteristic (ROC) analysis was used to assess the classification performance of individual features and the NCP score. The overall detection performance was estimated by free response ROC (FROC) analysis. Results: With our TSG prescreening method, a prescreening sensitivity of 92.5% (111/120) was achieved with a total of 1181 FPs (14.2 FPs/scan). On average, six features

  9. 颅内动脉瘤320排CTA与DSA对照分析%Intracranial aneurysms:comparative analysis of 320-detector row CT angiography and digital subtraction angiography

    Institute of Scientific and Technical Information of China (English)

    汪培英; 陈霞; 王波; 李兴; 刘健; 出良钊

    2012-01-01

    目的 探讨320排CTA对颅内动脉瘤诊断的临床应用价值.方法 收集2010-04-2011-03期间行320排CTA和DSA检查的颅内动脉瘤患者33例.将CTA图像质量按颅底骨质残留及血管显示情况分为4个等级,再以DSA所见为对照,分析320排CTA诊断颅内动脉瘤的敏感性及粗符合率.结果 33例经320排CTA检出颅内动脉瘤30例33个、动静脉畸形(AVM)2例、颅内动脉瘤合并AVM 1例;经DSA证实有颅内动脉瘤30例33个、AVM 3例,其中动脉瘤"假阳性"1例;有22例行手术治疗.320排CTA诊断颅内动脉瘤敏感性为100%,粗符合率为97.0%.结论 与DSA比较,320排CTA诊断颅内动脉瘤有较高的敏感性及粗符合率,在术前筛查方面具有广泛的临床应用前景.%Objective To study the effectiveness of 320-detector row CT angiography(CTA) for intracranial aneurysms. Methods 33 cases of intracranial aneurysms were examined during April 2010 to March 2011 by using 320-detector row CTA and DSA. CTA images were ranked by four grades according to skull remaining and artery displaying. The sensitivity and crude accuracy ol 320-detector row CTA in diagnosis of intracranial aneurysms were analysed,and compared with the results of DSA. Results 33 intracranial aneurysms(30 cases) ,2 arteriovenous malformations (2 cases) and 1 intracranial aneurysm accompanied with arteriovenous malformation(1 case) were found by CTA. 33 intracranial aneurysms(30 cases) and 3 arteriovenous malformations(3 cases) were detected by DSA,among aneurysms,one was false positive;22 cases underwent surgical treatment. The sensitivity and accurate rate of CTA in diagnosis of intracranial aneurysms were 100% and 97. 0% ,respectively. Conclusion In comparison with DSA,320-detector row CTA has higher sensitivity and crude accuracy in diagnosis of intracranial aneurysms,it is of significant applied value in pre-operative screening for intracranial aneurysms.

  10. Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    朱力

    2013-01-01

    Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively in

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  12. Three-dimensional CT angiography study on the relations between the vertebral artery and atlantoaxial joint

    Institute of Scientific and Technical Information of China (English)

    DUAN Shao-yin; LU Shao-mao; YE Feng; LIN Qing-chi; CHEN Liao-bin

    2009-01-01

    Background The vertebral artery (VA) and atlantoaxial joint (AAJ), with complicated structures, are located in the depths of the head-neck boundary area, the regional anatomy of which cannot be shown globally and directly. This study aims to evaluate three-dimensional CT angiography (3DCTA) in displaying the AAJ, atlantoaxial segment of the vertebral artery (ASVA) and the identification of their interrelations.Methods Sixty-eight subjects without pathology of the ASVA and AAJ were selected from head-neck CTA examination. All the 3D images were formed with volume rendering (VR) together with techniques of separating, fusing, opacifying and false-coloring (SFOF). On the 3D images, the ASVA and AAJ were observed, and their interrelations were measured.Results All the 3DCTA images were of high quality and up to our requirements. They could cleady and directly show the ASVA, ascending along the AAJ. There were 5 curves in the course of the ASVA, of which 2 curves were away from the atlantoaxial joint, one in the 2nd curve of 0.0 mm-5.4 mm, the other in the 4th of 2.6 mm-9.2 mm. There was no significant difference in the measurements between left and dght (P>0.05). The curved parts of the ASVA slightly expanded, with the biggest diameter of 5.6 mm in the 4th curve. Statistical comparison shows that the left ASVA is larger than the right (P<0.05). Variations of the ASVA were found in 8 cases and of the AAJ in 12.Conclusions 3DCTA can globally and directly demonstrate the structures of the AAJ, ASVA and their interrelations. The 3D imaging data make up and enrich the research contents of regional anatomy and lay the foundation for related study and applications.

  13. Assessment of extracranial-intracranial bypass in Moyamoya disease using 3T time-of-flight MR angiography: comparison with CT angiography.

    Science.gov (United States)

    Chen, Qian; Qi, Rongfeng; Cheng, Xiaoqing; Zhou, Changsheng; Luo, Song; Ni, Ling; Huang, Wei

    2014-07-01

    Hintergrund: Diese Studie wurde durchgeführt, um den Wert der Time-of-Flight-MR-Angiographie (TOF-MRA) zur Beurteilung des extrakraniellen-intrakraniellen (EC-IC)-Bypasses bei der Moyamoya Krankheit im Vergleich mit der Computertomographie-Angiographie (CTA) zu bewerten. Patienten und Methoden: Eine konsekutive Serie von 23 Patienten mit Moyamoya-Erkrankung wurde retrospektiv analysiert. Bei 23 Patienten wurden 25 EC-IC Bypasses angelegt. Eine kranielle CTA wurde zur Beurteilung der Bypassdurchgängigkeit innerhalb einer Woche nach der Operation durchgeführt. Innerhalb von weiteren 24 Stunden erfolgte eine TOF MRA. Mit einer 5-Punkte-Skala (0 = schlecht bis 4 = sehr gut) wurde von zwei Radiologen die Bildqualität für drei Segmente (extrakraniell, im Bereich der Trepanation, intrakraniell) eingeschätzt. Ergebnisse: Die Bildqualität war hoch ohne statistischen Unterschied (p = 0.66) von CTA und TOF MRA (3.84 ± 0.37 und 3.8 ± 0.41). Die Mittelwerte der TOF-MRA für die Visualisierung des Bypass im intrakraniellen Segment waren höher als diejenigen für die CTA (p = 0.026). Für die extrakraniellen und die Trepanationssegmente wurden zwischen TOF-MRA und CTA keine signifikanten Unterschiede gefunden (p = 0,34). Im Bereich der Trepanation zeigte die TOF MRA Pseudoläsionen des Bypasses in 2 der 25 Fälle. Schlussfolgerungen: Die 3T TOF MRA erwies sich der CTA für die Beurteilung des EC-IC-Bypass mindestens ebenbürtig; sie schnitt sogar besser als CTA in Bezug auf die intrakraniellen Segmente ab. Die Möglichkeit von Pseudoläsionen im Trepanationssegment muss beachtet werden.

  14. 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 OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

  15. Titanium plate artefact mimicking popliteal artery dissection on digital subtraction CT angiography.

    Science.gov (United States)

    Woodacre, Timothy; Wienand-Barnett, Sophie

    2013-04-05

    Titanium plates used for the internal fixation of long bone fractures cause significant artefact on CT scans but have not been reported to affect digital subtraction CT angiography. We present a patient with clinical suspicion of popliteal artery injury following a high tibial osteotomy. The osteotomy was stabilised with a titanium locking plate. During the digital subtraction process used to produce reconstruction CT angiography, removal of artefact caused by the titanium plate produced CT images mimicking the appearance of a popliteal artery dissection. The imaging inaccuracy was realised prior to the patient undergoing further intervention. We highlight the potential error caused by titanium plates on digital subtraction CT angiography and recommend careful analysis of such images prior to further treatment.

  16. A new technique for noise reduction at coronary CT angiography with multi-phase data-averaging and non-rigid image registration

    Energy Technology Data Exchange (ETDEWEB)

    Tatsugami, Fuminari; Higaki, Toru; Nakamura, Yuko; Yamagami, Takuji; Date, Shuji; Awai, Kazuo [Hiroshima University, Department of Diagnostic Radiology, Minami-ku, Hiroshima (Japan); Fujioka, Chikako; Kiguchi, Masao [Hiroshima University, Department of Radiology, Minami-ku, Hiroshima (Japan); Kihara, Yasuki [Hiroshima University, Department of Cardiovascular Medicine, Minami-ku, Hiroshima (Japan)

    2015-01-15

    To investigate the feasibility of a newly developed noise reduction technique at coronary CT angiography (CTA) that uses multi-phase data-averaging and non-rigid image registration. Sixty-five patients underwent coronary CTA with prospective ECG-triggering. The range of the phase window was set at 70-80 % of the R-R interval. First, three sets of consecutive volume data at 70 %, 75 % and 80 % of the R-R interval were prepared. Second, we applied non-rigid registration to align the 70 % and 80 % images to the 75 % image. Finally, we performed weighted averaging of the three images and generated a de-noised image. The image noise and contrast-to-noise ratio (CNR) in the proximal coronary arteries between the conventional 75 % and the de-noised images were compared. Two radiologists evaluated the image quality using a 5-point scale (1, poor; 5, excellent). On de-noised images, mean image noise was significantly lower than on conventional 75 % images (18.3 HU ± 2.6 vs. 23.0 HU ± 3.3, P < 0.01) and the CNR was significantly higher (P < 0.01). The mean image quality score for conventional 75 % and de-noised images was 3.9 and 4.4, respectively (P < 0.01). Our method reduces image noise and improves image quality at coronary CTA. (orig.)

  17. 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.

  18. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: A meta-analysis

    Science.gov (United States)

    Wu, Lian-Ming; Xu, Jian-Rong; Yin, Yan; Qu, Xin-Hua

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if they compared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute GI bleeding. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic. RESULTS: A total of 9 studies with 198 patients were included in this meta-analysis. Data were used to form 2 × 2 tables. CT angiography showed pooled sensitivity of 89% (95% CI: 82%-94%) and specificity of 85% (95% CI: 74%-92%), without showing significant heterogeneity (χ2 = 12.5, P = 0.13) and (χ2 = 22.95, P = 0.003), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.9297. CONCLUSION: CT angiography is an accurate, cost-effective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management. PMID:20712058

  19. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Willems, Peter W.A. [Toronto Western Hospital, UHN, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada); Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Taeshineetanakul, Patamintita; Terbrugge, Karel G.; Krings, Timo [Toronto Western Hospital, UHN, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada); Schenk, Barry; Brouwer, Patrick A. [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands)

    2012-02-15

    We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA). Seventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA. 4D-CTA detected all bAVMs. With regard to the Spetzler-Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases). In this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively. (orig.)

  20. Three-dimensional reconstruction of coronary arteries and plaque morphology using CT angiography - comparison and registration with IVUS

    NARCIS (Netherlands)

    L.S. Athanasiou (Lambros S.); G. Rigas (George); A.I. Sakellarios (Antonis); T.P. Exarchos (Themis); P.K. Siogkas (Panagiotis); C.V. Bourantas (Christos); H.M. Garcia-Garcia (Hector); P.A. Lemos Neto (Pedro); B.A. Falcao (Breno A.); L.K. Michalis (Lampros); O. Parodi (Oberdan); F. Vozzi (Federico); D.I. Fotiadis (Dimitrios)

    2016-01-01

    textabstractBackground: The aim of this study is to present a new methodology for three-dimensional (3D) reconstruction of coronary arteries and plaque morphology using Computed Tomography Angiography (CTA). Methods: The methodology is summarized in six stages: 1) pre-processing of the initial raw i

  1. Dynamic cone beam CT angiography of carotid and cerebral arteries using canine model

    OpenAIRE

    Cai, Weixing; zhao,binghui; Conover, David; Liu, Jiangkun; Ning, Ruola

    2012-01-01

    Purpose: This research is designed to develop and evaluate a flat-panel detector-based dynamic cone beam CT system for dynamic angiography imaging, which is able to provide both dynamic functional information and dynamic anatomic information from one multirevolution cone beam CT scan.

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

    NARCIS (Netherlands)

    Wolterink, Jelmer M.; Leiner, Tim; Viergever, Max A.; Isgum, I

    2015-01-01

    The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. Non-contrast enhanced cardiac CT is considered a reference for quantification of CAC. Recently, it has been shown that CAC may be quantified in cardiac CT angiography (CCTA). We present

  3. The clinical application of combined dualenergy CT pulmonary angiography and indirect venography

    Institute of Scientific and Technical Information of China (English)

    富青

    2013-01-01

    Objective To assess the usefulness of combined dual-energy CT pulmonary angiography (DE-CTPA) and indirect CT venography(CTV) in the diagnosis of venous thromboembolism(VTE). Methods Forty-nine patients with leg swelling suspected of pulmonary embolism(PE) underwent both DE-CTPA combined with CTV and lower

  4. Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Halil; Serifov, Elman; Kahriman, Guven [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Durak, Ahmet Candan [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Menkue, Ahmet [University of Erciyes, School of Medicine, Department of Neurosurgery, Kayseri (Turkey)

    2011-11-15

    Purpose: The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). Materials and methods: One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA reader's interpretation was accepted as the reference standard. Results: A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3 mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. Conclusion: This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3 mm, and it also reveals 100% detection rate for ruptured aneurysms.

  5. Differentiation between right tubo-ovarian abscess and appendicitis using CT-A diagnostic challenge

    Energy Technology Data Exchange (ETDEWEB)

    Eshed, I., E-mail: iriseshed@gmail.com [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Halshtok, O. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Erlich, Z. [Computer Science Department, Open University, Tel Aviv (Israel); Mashiach, R. [Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Hertz, M.; Amitai, M.M.; Portnoy, O.; Guranda, L. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel); Hiller, N. [Department of Radiology, Hadassah-Hebrew University Medical Center, Mount Scopus (Israel); Apter, S. [Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv (Israel)

    2011-11-15

    Aim: To determine CT features that can potentially differentiate right tubo-ovarian abscess (TOA) from acute appendicitis (AA; including abscess formation). Materials and methods: The abdominal computed tomography (CT) images of 48 patients with right-sided TOA (average age 39.3 {+-} 9.8 years) and 80 patients (average age 53.5 {+-} 19.9 years) with AA (24 with peri-appendicular abscess) were retrospectively evaluated. Two experienced radiologists evaluated 12 CT signs (including enlarged, thickened wall ovary, appendix diameter and wall thickness, peri-appendicular fluid collection, adjacent bowel wall thickening, fat stranding, free fluid, and extraluminal gas) in consensus to categorize the studies as either TOA or AA. The diagnosis and the frequency of each of the signs were correlated with the surgical and clinical outcome. Results: Reviewers classified 92% cases correctly (TOA = 85%, AA = 96.3%), 3% incorrectly (TOA = 6.3%, AA = 1.3%); 5% were equivocal (TOA = 8.3%, AA = 2.5%). In the peri-appendicular abscess group reviewers were correct in 100%. Frequent findings in the TOA group were an abnormal ovary (87.5%), peri-ovarian fat stranding (58.3%), and recto-sigmoid wall thickening (37.5%). An abnormal appendix was observed in 2% of TOA patients. Frequent findings in the AA group were a thickened wall (32.5%) and distended (80%) appendix. Recto-sigmoid wall thickening was less frequent in AA (12.5%). The appendix was not identified in 45.8% of the TOA patients compared to 15% AA. Conclusions: In the presence of a right lower quadrant inflammatory mass, peri-ovarian fat stranding, thickened recto-sigmoid wall, and a normal appearing caecum, in young patients favour the diagnosis of TOA. An unidentified appendix does not contribute to the differentiation between TOA and peri-appendicular abscess.

  6. Multidetector-row CT angiography of upper- and lower-extremity peripheral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Willmann, J.K.; Wildermuth, S. [Inst. of Diagnostic Radiology, Univ. Hospital Zurich, Zurich (Switzerland)

    2005-11-15

    With the introduction of multidetector-row CT (MDCT) technology indications for MDCT angiography have expanded to include assessment of the peripheral arteries of the upper and lower extremities. Combined with patient- and scanner-adjusted CT data acquisition and contrast medium application strategies, an accurate and reliable evaluation of the peripheral arteries of the upper and lower extremities is possible. MDCT angiography is cost-effective and accurate for detection of arterial stenosis and occlusion in patients with peripheral arterial disease (PAD). MDCT angiography allows postoperative assessment of peripheral arterial bypass grafts, including bypass graft stenosis and occlusion, as well as presence of aneurysms or arteriovenous fistulas. In addition, MDCT angiography is helpful in particular for visualization of arterial bypass grafts with a complicated extra-anatomical course. Furthermore, pre-operative peripheral vascular mapping can be performed by using MDCT angiography. Finally, due to the integration of MDCT scanners in many trauma centres, MDCT angiography is increasingly being used for assessment of traumatic arterial injuries. This article gives an overview of technical aspects of peripheral MDCT angiography, including scanning parameters, contrast medium application, image postprocessing and radiation exposure, and summarizes the most frequent acute and non-acute indications of MDCT angiography for assessment of the upper- and lower-extremity peripheral arteries. (orig.)

  7. Minimally invasive post-mortem CT-angiography in a case involving a gunshot wound.

    Science.gov (United States)

    Ruder, Thomas D; Ross, Steffen; Preiss, Ulrich; Thali, Michael J

    2010-05-01

    Non-contrast post-mortem computed tomography (pm-CT) is useful in the evaluation of bony pathologies, whereas minimally invasive pm-CT-angiography allows for the detection of subtle vascular lesions. We present a case of an accidentally self-inflicted fatal bullet wound to the chest where pm-CT-angiography revealed a small laceration of the anterior interventricular branch of the left coronary artery and a tiny disruption of the right ventricle with pericardial and pleural effusion. Subsequent autopsy confirmed our radiological findings. Post-mortem CT-angiography has a great potential for the detection of vascular lesions and can be considered equivalent to autopsy for selected cases in forensic medicine.

  8. 320-detector CT angiography in diagnosis of aortic dissection%320排CT血管造影诊断主动脉夹层

    Institute of Scientific and Technical Information of China (English)

    刘琦; 陈德基; 谭理连; 王广宇

    2012-01-01

    目的 探讨320排CTA在主动脉夹层(AD)诊断中的价值.方法 回顾分析59例临床诊断AD患者的320排CTA检查资料,对比其与16排CTA、MRA及DSA的差异.结果 59例AD患者中,3种方法共诊断AD 43例,胸主动脉瘤4例,真性腹主动脉瘤9例,假性腹主动脉瘤3例.320排CTA诊断AD破口位置的准确率(75/77,97.40%)高于16排CTA(47/53,88.68%,x2=4.14,P<0.05)及MRA(40/46,86.96%,x2=5.17,P<0.05);其电离辐射剂量[(849.62±44.73)mGy]低于16排CTA[(927.11±39.47)mGy,t=2.84,P<0.05]及DSA[(976.85±54.21)mGy](t=2.51,P<0.05),并可清晰显示内膜片、真假腔、血栓形成及主要内脏动脉分支受累情况.结论 320排CTA是诊断AD的安全、快捷、有效且无创的方法,对临床制定治疗方案有重要应用价值.%Objective To explore the value of 320-detector CT angiography (CTA) in diagnosis of aortic dissection (AD). Methods A total of 59 consecutive patients with suspected AD were enrolled. The results of 320-detector CTA with 16-detector CTA, MRA and DSA were compared. Results Totally 43 patients were diagnosed with 3 methods as AD, 4 with thoracic aorta aneurysm, 9 with abdominal aorta aneurysm and 3 with false abdominal aorta aneurysm. The diagnostic accuracy rate for preoperative revealing of the tears of 320-detector CTA {75/77, 97. 40%) was higher than that of 16-detector CTA (47/53, 88. 68%, χ2=4. 14, P<0. 05) and MRA (40/46, 86. 96%,χ2=5. 17, P<0. 05). The dose of radiation in examination of 320-detector CTA ([849. 62±44. 73]mGy) was lower than that of 16-detector CTA ([927. 11 + 39. 47]mGy, t=2. 84, P<0. 05) and DSA ([976. 85 + 54. 21]mGy, t=2. 51, P<0. 05). In addition, 320-detector CTA was able to display the intimal flap, the real and false lumen, the thrombus in false lumen and detail of significant branches of aorta. Conclusion 320-detector CTA is secure, quick, effective and noinvasive in diagnosing AD, thus has important clinical value in drawing up the treatment plan of

  9. Computed tomography angiography of carotid and coronary artery via a single-bolus injection protocol: a feasibility study using 320-row multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, WeiGuo [The First Affiliated Hospital of Soochow University, Department of Radiology, SuZhou (China); Fudan University, Department of Radiology, Zhongshan Hospital, Shanghai (China); Jin, Hang; Chen, Gang; Chen, Wenfang; Gu, Junying; Zeng, Mengsu [Fudan University, Department of Radiology, Zhongshan Hospital, Shanghai (China)

    2014-07-15

    To investigate the feasibility of using a single-dose injection protocol in CT angiography (CTA) of the carotid and coronary artery with 320-row multidetector CT. A total of 82 consecutive patients with suspected carotid artery disease underwent an original CTA protocol aiming at capturing the extra-cranial carotid arteries and coronary arteries simultaneously using 320-row MDCT. The image quality, attenuation, and CNRs of the carotid and coronary arteries were assessed. The lag time (between two separated volumetric acquisitions) was compared between patients with and without cardiac venous opacification (CVO). The contrast medium volume and radiation dose were recorded. The image quality was 99.4 % diagnostic in carotid and 86.9 % in coronary artery segments. The mean attenuation of carotid and coronary arteries ranged from 462.2 Hu to 533.7 Hu, 415.9 Hu to 454.7 Hu respectively. The mean CNR of the carotid and coronary artery ranged from 15.8 to 18.9 and 17.7 to 20.4 respectively. The lag time in patients with and without CVO was 5.75 ± 1.64 s vs. 4.21 ± 1.14 s (p < 0.05). The mean radiation dose was 6.6 ± 4.1 mSv.The mean contrast media volume was 71.9 ± 9.1 ml. The carotid and coronary artery can be imaged simultaneously via our original single-dose injection CTA protocol using 320-row CT with adequate image quality. (orig.)

  10. 颈内动脉血泡样动脉瘤的CTA诊断%CT angiography in the diagnosis of internal carotid artery blister-like aneuryms

    Institute of Scientific and Technical Information of China (English)

    陈状; 李林; 崔静; 公方和; 王伟民

    2012-01-01

    Objective To explore the utility ofCT angiography (CTA) in the identification and characterization of internal carotid artery (ICA) blood blister-like aneuryms (BBA). Methods All the 143 patients with spontaneous subarachnoid hemorrhage (SAH) who had been managed in our department from January 2008 to December 2009 were analyzed retrospectively.All of them underwent CTA prior to digital subtraction angiography (DSA) for evaluation of spontaneous SAH.The reports from the CTA and DSA were reviewed to determine whether the ICA BBA had been correctly and prospectively diagnosed. A retrospective review of the CTA and DSA images was also performed.Results All patients were diagnosed with spontaneous SAH by plain scan CT.We identified 6 cases of ICA BBA on initial DSA imaging.Of the 6 blister-like aneurysms,4 (67%) were identified prospectively and 5 (86%) retrospectively on CTA.In one case that had been confirmed by DSA as ICA BBA,the retrospective CTA failed to find the abnormity.All the 6 patients underwent endovascular treatment with stent placement.All patients were followed up for an average of 8.3 months (range,6-18 months) simply by DSA after treatment. Conclusion If CTA identifies a spontaneous SAH but fails to identify the cause,a careful DSA should be performed to detect a possible presence of ICA BBA.%目的 分析颈内动脉血泡样动脉瘤(BBA)CT三维血管重建(CTA)的诊断价值及形态特征. 方法 回顾性分析广州军区广州总医院神经外科自2008年1月至2009年12月收治的143例自发性蛛网膜下腔出血(SAH)患者资料.所有患者均先后行CTA及DSA检查,并对结果进行对比分析. 结果 所有患者经平扫CT诊断为自发性SAH,其中6例经DSA确诊为颈内动脉BBA.该6例患者中4例在DSA检查之前即经CTA确诊,未经CTA确诊的2例患者中1例后虽经DSA检查明确,但回顾分析CTA仍未发现明确病变.全部6例患者均经血管内支架治疗,术后均单

  11. [Examination of reducing misregistration for lower tube voltage of the mask image in CT angiography using subtraction method].

    Science.gov (United States)

    Nakatani, Kasumi; Fukunishi, Yasunobu

    2015-05-01

    Computed tomographic angiography (CTA) has been used recently for the evaluation of intracerebral aneurysms, but it is difficult to use this technique to visualize aneurysms near the base of the skull because of the presence of bone. So, subtracted CTA has been used to separate vessels from bony structures. However, we see some misregistration when using subtraction method because of the patient moving, the disaccord of the X-ray tube orbit between the mask image and the live image, the expanding focus, and the bed bending. So, attentioning the difference of bone CT number in any tube voltages, we examined to make the image containing less misregistration by changing the tube voltage of mask image. Making a sham blood vessel, we examined the bone misregistration, the blood vessel volume, and the smoothness when changing the tube voltages of mask images. Comparing with 120 kV, as the tube voltage of the mask image was 80 kV, the bone misregistration decreased significantly, however the blood vessel volume decreased. As for the tube voltage of 100 kV, the bone misregistration decreased significantly, and the blood vessel volume and the smoothness were not significantly different so we could get coordinative image of 120 kV. When the tube voltage of the mask image becomes lower than that of the live image and the effective energy becomes different, the effect of misregistration is less. This method deals with changing the tube voltage only. So, it may be easy to make volume rendering (VR) image and this method may be used in every facility.

  12. High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

    Energy Technology Data Exchange (ETDEWEB)

    Karlo, Christoph; Leschka, Sebastian; Goetti, Robert Paul; Feuchtner, Gudrun; Desbiolles, Lotus; Stolzmann, Paul; Marincek, Borut; Baumueller, Stephan [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Plass, Andre; Falk, Volkmar [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Massachusetts General Hospital, Harvard Medical School, Cardiac MR PET CT Group, Boston, MA (United States)

    2011-01-15

    To compare image quality and radiation dose of high-pitch computed tomography angiography(CTA) of the aortic valve-aortic root complex with and without prospective ECG-gating compared to a retrospectively ECG-gated standard-pitch acquisition. 120 patients(mean age 68 {+-} 13 years) were examined using a 128-slice dual-source CT system using prospectively ECG-gated high-pitch(group A; n = 40), non-ECG-gated high-pitch(group B; n = 40) or retrospectively ECG-gated standard-pitch(C; n = 40) acquisition techniques. Image quality of the aortic root, valve and ascending aorta including the coronary ostia was assessed by two independent readers. Image noise was measured, radiation dose estimates were calculated. Interobserver agreement was good({kappa} = 0.64-0.78). Image quality was diagnostic in 38/40 patients(group A), 37/40(B) and 38/40(C) with no significant difference in number of patients with diagnostic image quality among all groups (p = 0.56). Significantly more patients showed excellent image quality in group A compared to groups B and C(each, p < 0.01). Average image noise was significantly different between all groups(p < 0.05). Mean radiation dose estimates in groups A and B(each; 2.4 {+-} 0.3 mSv) were significantly lower compared to group C(17.5 {+-} 4.4 mSv; p < 0.01). High-pitch dual-source CTA provides diagnostic image quality of the aortic valve-aortic root complex even without ECG-gating at 86% less radiation dose when compared to a standard-pitch ECG-gated acquisition. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yoo Jin; Lee, Jong Min; Lee, Hui Joong; Park, Ji Won [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2010-01-15

    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.

  14. Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction.

    Science.gov (United States)

    Hell, Michaela M; Bittner, Daniel; Schuhbaeck, Annika; Muschiol, Gerd; Brand, Michael; Lell, Michael; Uder, Michael; Achenbach, Stephan; Marwan, Mohamed

    2014-01-01

    Low tube voltage reduces radiation exposure in coronary CT angiography (CTA). Using 70 kVp tube potential has so far not been possible because CT systems were unable to provide sufficiently high tube current with low voltage. We evaluated feasibility, image quality (IQ), and radiation dose of coronary CTA using a third-generation dual-source CT system capable of producing 450 mAs tube current at 70 kVp tube voltage. Coronary CTA was performed in 26 consecutive patients with suspected coronary artery disease, selected for body weight Image noise was lower in IR vs FBP (60 ± 10 HU vs 74 ± 8 HU; P < .001). In patients <100 kg and with a regular heart rate <60 beats/min, third-generation dual-source CT using high-pitch spiral acquisition and 70 kVp tube voltage is feasible and provides both robust IQ and very low radiation exposure. Copyright © 2014 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  15. Reliability of visual assessment of non-contrast CT, CT angiography source images and CT perfusion in patients with suspected ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Tom van Seeters

    Full Text Available BACKGROUND AND PURPOSE: Good reliability of methods to assess the extent of ischemia in acute stroke is important for implementation in clinical practice, especially between observers with varying experience. Our aim was to determine inter- and intra-observer reliability of the 1/3 middle cerebral artery (MCA rule and the Alberta Stroke Program Early CT Score (ASPECTS for different CT modalities in patients suspected of acute ischemic stroke. METHODS: We prospectively included 105 patients with acute neurological deficit due to suspected acute ischemic stroke within 9 hours after symptom onset. All patients underwent non-contrast CT, CT perfusion and CT angiography on admission. All images were evaluated twice for presence of ischemia, ischemia with >1/3 MCA involvement, and ASPECTS. Four observers evaluated twenty scans twice for intra-observer agreement. We used kappa statistics and intraclass correlation coefficient to calculate agreement. RESULTS: Inter-observer agreement for the 1/3 MCA rule and ASPECTS was fair to good for non-contrast CT, poor to good for CT angiography source images, but excellent for all CT perfusion maps (cerebral blood volume, mean transit time, and predicted penumbra and infarct maps. Intra-observer agreement for the 1/3 MCA rule and ASPECTS was poor to good for non-contrast CT, fair to moderate for CT angiography source images, and good to excellent for all CT perfusion maps. CONCLUSION: Between observers with a different level of experience, agreement on the radiological diagnosis of cerebral ischemia is much better for CT perfusion than for non-contrast CT and CT angiography source images, and therefore CT perfusion is a very reliable addition to standard stroke imaging.

  16. Persistent hypoglossal artery and its variants diagnosed by CT and MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Kozawa, Eito; Nishi, Naoko; Mizukoshi, Waka; Inoue, Kaiji; Nakajima, Reiko; Takahashi, Masahiro [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2013-01-15

    Persistent hypoglossal artery (PHA) is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. We evaluated the prevalence of PHA on computed tomography (CT) angiography. We also evaluated characteristic features of PHA and its variants on magnetic resonance (MR) angiography. We retrospectively reviewed our database of 2,074 CT angiographic images obtained using either of two 64-slice multidetector CT scanners. We also reviewed our database of 7,646 MR angiographic images obtained using either of two 1.5-T or one 3.0-T imager. We could not determine the exact number of patients whose MR angiography included the hypoglossal canal. Most patients had or were suspected of having cerebrovascular diseases. We found six usual PHAs arising from the cervical internal carotid artery on CT angiography among 2,074 patients. On MR angiography, we also found six additional usual PHAs (total 12, right/left = 6/6, male/female = 3/9), three right PHAs originating from the external carotid artery (ECA), and two posterior inferior cerebellar arteries (PICAs) arising from the ECA without connection to the vertebral artery. The prevalence of usual PHA diagnosed by CT angiography was 0.29 %, slightly higher than that reported for angiography and may be due to selection bias in the examined patients. We propose naming usual PHA ''type 1 PHA''; PHA originating from the ECA, of which we found three, ''type 2 PHA''; and PICA arising from the ECA, of which we found two, ''type 2 PHA variant''. (orig.)

  17. Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates

    DEFF Research Database (Denmark)

    Winther, Simon; Svensson, My; Jørgensen, Hanne Skou

    2017-01-01

    , but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT...

  18. Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Lell, Michael; Anders, Katharina [University of Erlangen, Diagnostic Radiology, Erlangen (Germany); Marwan, Mohamed; Schepis, Tiziano; Pflederer, Tobias; Kuettner, Axel; Ropers, Dieter; Daniel, Werner G.; Achenbach, Stephan [University of Erlangen, Department of Cardiology, Erlangen (Germany); Flohr, Thomas [CT Division, Siemens Healthcare, Forchheim (Germany); Eberhard-Karls-University, Institute of Diagnostic Radiology, Tuebingen (Germany); Allmendinger, Thomas; Thierfelder, Carsten [CT Division, Siemens Healthcare, Forchheim (Germany); Kalender, Willi; Ertel, Dirk [University of Erlangen, Institute of Medical Physics, Erlangen (Germany)

    2009-11-15

    We evaluated radiation exposure and image quality of a new coronary CT angiography protocol, high-pitch spiral acquisition, using dual source CT (DSCT). Coronary CTA was performed in 25 consecutive patients with a stable heart rate of 60 bpm or less after premedication, using 2 x 128 0.6-mm sections, 38.4-mm collimation width and 0.28-s rotation time. Tube settings were 100 kV/320 mAs and 120 kV/400 mAs for patients below and above 100-kg weight, respectively. Data acquisition was prospectively ECG-triggered at 60% of the R-R interval using a pitch of 3.2 (3.4 for the last 10 patients). Images were reconstructed with 75-ms temporal resolution, 0.6-mm slice thickness and 0.3-mm increment. Image quality was evaluated using a four-point scale (1 = excellent, 4 = unevaluable). Mean range of data acquisition was 113 {+-} 22 mm, mean duration was 268 {+-} 23 ms. Of 363 coronary artery segments, 327 had an image quality score of 1, and only 2 segments were rated as ''unevaluable''. Mean dose-length product (DLP) was 71 {+-} 23 mGy cm, mean effective dose was 1.0 {+-} 0.3 mSv (range 0.78-2.1 mSv). For 21 patients with a body weight below 100 kg, mean DLP was 63 {+-} 5 mGy cm (0.88 {+-} 0.07 mSv; range 0.78-0.97 mSv). Prospectively ECG-triggered high-pitch spiral CT acquisition provides high and stable image quality at very low radiation dose. (orig.)

  19. Multidetector CT angiography of renal vasculature: normal anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Tuerkvatan, Aysel; Oezdemir, Mustafa; Cumhur, Turhan; Oelcer, Tuelay [Tuerkiye Yueksek ihtisas Hospital, Department of Radiology, Sihhiye, Ankara (Turkey)

    2009-01-15

    Knowledge of the variations in renal vascular anatomy is important before laparoscopic donor or partial nephrectomy and vascular reconstruction for renal artery stenosis or abdominal aortic aneurysm. Recently, multidetector computed tomographic (MDCT) angiography has become a principal imaging investigation for assessment of the renal vasculature and has challenged the role of conventional angiography. It is an excellent imaging technique because it is a fast and non-invasive tool that provides highly accurate and detailed evaluation of normal renal vascular anatomy and variants. The number, size and course of the renal arteries and veins are easily identified by MDCT angiography. The purpose of this pictorial essay is to illustrate MDCT angiographic appearance of normal anatomy and common variants of the renal vasculature. (orig.)

  20. Comparing Measurements of CT Angiography, TEE, and Fluoroscopy of the Left Atrial Appendage for Percutaneous Closure.

    Science.gov (United States)

    Saw, Jacqueline; Fahmy, Peter; Spencer, Ryan; Prakash, Roshan; McLaughlin, Patrick; Nicolaou, Savvas; Tsang, Michael

    2016-04-01

    Left atrial appendage (LAA) closure requires accurate preprocedural measurements, and trans-esophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy can be utilized. However, correlations between these measurements remain inadequately assessed. Patients who underwent LAA closure at Vancouver General Hospital who had baseline LAA measurements by CCTA, TEE, and fluoroscopy were included in this analysis. CCTAs were performed with prospective-ECG-gating with Toshiba 320-detector or Siemens second generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation.™ LAA maximal dimensions were obtained for all patients at: (1) Amplatzer Cardiac Plug (ACP)/Amulet landing zone 10 mm within orifice, (2) WATCHMAN ostium, and (3) WATCHMAN depth measurements. Correlations and agreements were compared. We report 50 consecutive patients who underwent LAA closure (8 ACP, 10 Amulet, 32 WATCHMAN). Average age was 75.2 ± 8.7 years, mean CHADS2 score 3.0 ± 1.3, and CHA2 DS2 -VASc 4.7 ± 1.5. Procedural device implantation success was 100%. For ACP landing zone, mean maximal measurements were 24.1 ± 4.7 mm with CCTA, 22.3 ± 4.9 mm TEE, and 19.9 ± 5.6 mm fluoroscopy (P < 0.001); R value 0.81 fluoroscopy/CTA, 0.67 fluoroscopy/TEE, and 0.80 CTA/TEE. For WATCHMAN ostium, mean maximal measurements were 25.8 ± 4.7 mm CCTA (P < 0.001 vs. fluoroscopy, P = 0.16 vs. TEE), 25.1 ± 4.4 mm TEE (P = 0.016 vs. fluoroscopy), and 23.8 ± 4.9 mm fluoroscopy; R value 0.71 fluoroscopy/CTA, 0.65 fluoroscopy/TEE, and 0.74 CTA/TEE. Depth measurements were 34.3 ± 5.7 mm with CCTA, 31.1 ± 6.5 mm TEE, and 27.8 ± 7.1 mm fluoroscopy (all P < 0.01); and correlations with R value 0.28 fluoroscopy/CTA, 0.22 fluoroscopy/TEE, and 0.56 CTA/TEE. All 3 imaging modalities correlated with ACP landing zone and WATCHMAN ostium measurements, with CCTA providing the largest measurements, followed by TEE and fluoroscopy. © 2016 Wiley Periodicals, Inc.

  1. Dual-energy CT angiography of chronic thromboembolic disease: Can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects?

    Energy Technology Data Exchange (ETDEWEB)

    Renard, Benoit [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Remy-Jardin, Martine, E-mail: mremy-jardin@chru-lille.fr [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Santangelo, Teresa; Faivre, Jean-Baptiste; Tacelli, Nunzia; Remy, Jacques [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Duhamel, Alain [Department of Biostatistics, University Centre of Lille (EA 2694), 59037 Lille cedex (France)

    2011-09-15

    Purpose: To evaluate whether dual-energy CT angiography (DE-CTA) could identify links between morphologic and functional abnormalities in chronic pulmonary thromboembolism (CPTE). Materials and methods: Seventeen consecutive patients with CPTE without underlying cardio-respiratory disease were investigated with DE-CTA. Two series of images were generated: (a) transverse diagnostic scans (i.e., contiguous 1-mm thick averaged images from both tubes), and (b) perfusion scans (i.e., images of the iodine content within the microcirculation; 4-mm thick MIPs). Two radiologists evaluated by consensus the presence of: (a) pulmonary vascular features of CPTE and abnormally dilated systemic arteries on diagnostic CT scans, and (b) perfusion defects of embolic type on perfusion scans. Results: Diagnostic examinations showed a total of 166 pulmonary arteries (166/833; 19.9%) with features of CPTE, more frequent at the level of peripheral than central arteries (8.94 vs 0.82; p < 0.0001), including severe stenosis with partial (97/166; 58.4%) or complete (20/166; 12.0%) obstruction, webs and bands (37/166; 22.3%), partial filling defects without stenosis (7/166; 4.2%), focal stenosis (4/166; 2.4%) and abrupt vessel narrowing (1/166; 0.6%). Perfusion examinations showed 39 perfusion defects in 8 patients (median number: 4.9; range: 1-11). The most severe pulmonary arterial features of CPTE were seen with a significantly higher frequency in segments with perfusion defects than in segments with normal perfusion (p < 0.0001). Enlarged systemic arteries were observed with a significantly higher frequency ipsilateral to lungs with perfusion defects (9/12; 75%) compared with lungs without perfusion defects (5/22; 22.7%) (p = 0.004). Conclusion: Dual-energy CTA demonstrates links between the severity of pulmonary arterial obstruction and perfusion impairment, influenced by the degree of development of the systemic collateral supply.

  2. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study.

    Science.gov (United States)

    Ke, Jia; Cai, Jiawei; Wen, Xiaofeng; Wu, Xianrui; He, Zhen; Zou, Yifeng; Qiu, Jianping; He, Xiaowen; He, Xiaosheng; Lian, Lei; Wu, Xiaojian; Zhou, Zhiyang; Lan, Ping

    2017-05-01

    To demonstrate the clinical applicability of 3-dimensional CT angiography (3D-CTA) in evaluating the anatomic variations of inferior mesenteric artery (IMA) and left colic artery (LCA), to help make pre-operative strategies of rectal cancer surgery. 188 patients with abdominal and pelvic contrast-enhanced CT scan were retrospectively enrolled and 3D-CTA was reconstructed. The origin and branching patterns of IMA, tracking patterns of LCA, intersectional patterns among IMA, LCA and inferior mesenteric vein (IMV) were examined, and their associations with clinical features were analyzed. The origin of IMA was located 42.1 ± 7.7 mm above iliac artery bifurcation, 64.4% within the area of the 3rd lumbar vertebra. 47.3% of LCA arose independently from IMA, 27.1% arose at the root of sigmoid artery (SA), 20.7% shared a common trunk with SA while 4.8% of LCA was absent. As for track of LCA before anastomosis with marginal artery, 53.2% went straight upward while medial to the inner border of left kidney (Type A), 27.1% traveled diagonally across left kidney (Type B) and14.9% went infero-laterally to the lower border of left kidney (Type C). Short IMA trunk was independently associated with type A LCA and lower site of IMA origin. At the horizontal level of IMA origin, 29% of the LCA went distant from IMV, while 71% (21% medial, 50% lateral) were mutually close, and the close type was independently associated with type A LCA. Preoperative understanding of the vascular variations and the mutual relationship among LCA, IMA and IMV could be obtained by 3D-CTA, which would further help surgeons to set detailed plans for laparoscopic rectal cancer surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Radiation exposure and image quality in staged low-dose protocols for coronary dual-source CT angiography: a randomized comparison

    Energy Technology Data Exchange (ETDEWEB)

    Pflederer, Tobias; Jakstat, Josy; Marwan, Mohamed; Schepis, Tiziano; Bachmann, Sven; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Achenbach, Stephan [University of Erlangen, Department of Internal Medicine 2, Erlangen (Germany); Kuettner, Axel; Anders, Katharina; Lell, Michael [University of Erlangen, Institute of Diagnostic Radiology, Erlangen (Germany)

    2010-05-15

    To evaluate staged low-dose approaches for coronary CT angiography (CTA) in which a standard sequence was added if the low-dose sequence did not allow reliable rule-out of coronary stenosis. A total of 176 consecutive patients referred for dual-source CTA were randomized to three protocols: group 1 using prospective ECG-triggering (100 kV, 330 mAs), group 2 a retrospectively gated ''MinDose'' sequence (100 kV, 330 mAs) and group 3 a standard spiral sequence (120 kV, 400 mAs). If image quality in low-dose groups 1 or 2 was non-diagnostic, an additional standard CT examination (as in group 3) was performed. Non-diagnostic image quality was found in 11/56, 4/55, and 2/65 patients (46/896, 4/880 and 3/1,040 coronary segments) in groups 1, 2 and 3, respectively. Median (interquartile ranges) volumes of contrast material, CTDI{sub vol}, DLP and effective dose for low-dose groups 1 and 2 and for standard group 3 were 92.5 (11.3), 75.0 (2.5) and 75.0 (9.0) ml; 8.0 (1.4), 16.8 (4.8) and 48.1 (14.2) mGy; 108.0 (27.3), 246.0 (93.0) and 701.0 (207.8) mGy cm; and 1.5 (0.4), 3.4 (1.3) and 9.8 (2.9) mSv, respectively. A staged coronary CTA protocol with an initial low-dose approach and addition of a standard sequence - should image quality be too low - can lead to a substantial reduction in radiation exposure. (orig.)

  4. Coronary CT angiography: IVUS image fusion for quantitative plaque and stenosis analyses

    Science.gov (United States)

    Marquering, Henk A.; Dijkstra, Jouke; Besnehard, Quentin J. A.; Duthé, Julien P. M.; Schuijf, Joanne D.; Bax, Jeroen J.; Reiber, Johan H. C.

    2008-03-01

    Rationale and Objective: Due to the limited temporal and spatial resolution, coronary CT angiographic image quality is not optimal for robust and accurate stenosis quantification, and plaque differentiation and quantification. By combining the high-resolution IVUS images with CT images, a detailed representation of the coronary arteries can be provided in the CT images. Methods: The two vessel data sets are matched using three steps. First, vessel segments are matched using anatomical landmarks. Second, the landmarks are aligned in cross-sectional vessel images. Third, the semi-automatically detected IVUS lumen contours are matched to the CTA data, using manual interaction and automatic registration methods. Results: The IVUS-CTA fusion tool facilitates the unique combined view of the high-resolution IVUS segmentation of the outer vessel wall and lumen-intima transitions on the CT images. The cylindrical projection of the CMPR image decreases the analysis time with 50 percent. The automatic registration of the cross-vessel views decreases the analyses time with 85 percent. Conclusions: The fusion of IVUS images and their segmentation results with coronary CT angiographic images provide a detailed view of the lumen and vessel wall of coronary arteries. The automatic fusion tool makes such a registration feasible for the development and validation of analysis tools.

  5. 16层CT血管造影对主动脉假性动脉瘤的诊断价值%Application of 16-slice CT angiography in evaluation of pseudoaneurysm of aorta

    Institute of Scientific and Technical Information of China (English)

    郑海军; 周海军; 张任华; 王向日; 曹勇军; 罗学军

    2010-01-01

    @@ 主动脉假性动脉瘤(pseudoaneurysm of aorta, PAA)较为少见,其临床表现无特异性,诊断主要依赖于影像学检查.CT血管造影(CT angiography, CTA)是一种无创性血管成像技术,已经广泛应用于临床[1],16层CT扫描速度更快,使得CTA检查更为简单实用[2].

  6. Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis.

    Science.gov (United States)

    Morales-Uribe, Carlos; Ramírez, Ana; Suarez-Poveda, Tatiana; Ortiz, Margarita; Sanabria, Alvaro

    2016-10-01

    This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.

  7. Image Quality in Reduced-Dose Coronary CT Angiography

    NARCIS (Netherlands)

    Gagarina, Nina V.; Irwan, Roy; Gordina, Galina; Fominykh, Ekaterina; Sijens, Paul E.

    2011-01-01

    Rationale and Objectives: Concerns for patient's risk of radiation-induced cancer have increased demand for reduced-dose coronary computed tomography angiography (CCTA). Previous comparisons of full and reduced-dose CCTA were not conclusive, because results were compared in different groups of patie

  8. A newly developed technique involving the optimization of flow velocity compensation for lower extremity CT angiography

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lei; XU Dong; LI KunCheng; JIN ErHu; BARNES Bret

    2013-01-01

    Advanced computed tomography (CT) technology has allowed for faster and more robust imaging.However,it has been a technical challenge to correctly synchronize CT acquisition with adequate and uniform arterial enhancement in the entire peripheral arterial tree.In this summary,we introduce a method of injection/acquisition optimization strategy based on a velocity-compensated CT angiography technique for the peripheral artery system,which is currently used in the United States.We believe that this imaging technique will provide additional information for our daily CT services in China.

  9. Coronary Computed Tomography Angiography (CTA)

    Science.gov (United States)

    ... You may also be asked to remove hearing aids and removable dental work. Women will be asked to remove bras ... both diagnosis and treatment in a single session. Patients with a high risk of coronary artery disease and typical symptoms might ...

  10. Coronary Computed Tomography Angiography (CTA)

    Science.gov (United States)

    ... may increase the risk of an unusual adverse effect. On the day before and day of your exam, you may be asked to avoid: diet pills and caffeinated drinks such as coffee, tea, energy drinks or sodas. These may increase heart rate ...

  11. Whole-brain dynamic CT angiography and perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Orrison, W.W. [CHW Nevada Imaging Company, Nevada Imaging Centers, Spring Valley, Las Vegas, NV (United States); College of Osteopathic Medicine, Touro University Nevada, Henderson, NV (United States); Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Department of Medical Education, University of Nevada School of Medicine, Reno, NV (United States); Snyder, K.V.; Hopkins, L.N. [Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Buffalo, NY (United States); Roach, C.J. [School of Life Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States); Ringdahl, E.N. [Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV (United States); Nazir, R. [Shifa International Hospital, Islamabad (Pakistan); Hanson, E.H., E-mail: eric.hanson@amigenics.co [College of Osteopathic Medicine, Touro University Nevada, Henderson, NV (United States); Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV (United States); Advanced Medical Imaging and Genetics (Amigenics), Las Vegas, NV (United States)

    2011-06-15

    The availability of whole brain computed tomography (CT) perfusion has expanded the opportunities for analysing the haemodynamic parameters associated with varied neurological conditions. Examples demonstrating the clinical utility of whole-brain CT perfusion imaging in selected acute and chronic ischaemic arterial neurovascular conditions are presented. Whole-brain CT perfusion enables the detection and focused haemodynamic analyses of acute and chronic arterial conditions in the central nervous system without the limitation of partial anatomical coverage of the brain.

  12. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel S.); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment str

  13. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment stra

  14. Bilateral internal carotid agenesis: value of CT angiography and correlation to embryogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Pilleul, F.; Rouviere, O. [Dept. of Radiology, Hopital Edouard Herriot, Lyon (France); Guibaud, L.; Pracros, J.P. [Dept. of Pediatric Imaging, Hopital Debrousse, Lyon (France); Badinand, N. [Dept. of Pediatric Neurology, Hopital Debrousse, Lyon (France)

    2001-05-01

    Bilateral internal carotid artery agenesis is an uncommon disease, difficult to differentiate from bilateral carotid artery thrombosis. A few case reports have described the contribution of conventional angiogram to make the diagnosis and recognize the anatomic details of this rare malformation. Advantages of CT angiography as a non-invasive radiologic tool are discussed in this case report. (orig.)

  15. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment stra

  16. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel S.); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment str

  17. Reproducibility of semi-automatic coronary plaque quantification in coronary CT angiography with sub-mSv radiation dose

    DEFF Research Database (Denmark)

    Øvrehus, Kristian Altern; Schuhbaeck, Annika; Marwan, Mohamed

    2015-01-01

    or response to medical therapies. The reproducibility from repeated assessment of such quantitative measurements from low-radiation dose coronary CTA has not been previously assessed. Purpose: To evaluate the interscan, interobserver and intraobserver reproducibility for coronary plaque volume assessment...... using semi-automatic plaque analyses algorithm in low radiation dose coronary CTA. Methods: In 50 consecutive patients undergoing two 128-slice dual source CT scans within 12 days with a mean radiation dose of 0.7 mSv per coronary CTA, the interscan, interobserver and intraobserver reproducibility.......6% and +/- 32.1%, respectively. Conclusion: A semi-automatic plaque assessment algorithm in repeated low radiation dose coronary CTA allows for high reproducibility of coronary plaque characterization and quantification measures. (C) 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc...

  18. Quantification of the myocardial area at risk using coronary CT angiography and Voronoi algorithm-based myocardial segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Akira; Kono, Atsushi; Coenen, Adriaan; Saru-Chelu, Raluca G.; Krestin, Gabriel P. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Sakamoto, Tsuyoshi [AZE inc, Development Division, Chiyoda, Tokyo (Japan); Kido, Teruhito; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Higashino, Hiroshi [Yotsuba Circulation Clinic, Department of Radiology, Matsuyama, Ehime (Japan); Abe, Mitsunori [Yotsuba Circulation Clinic, Department of Cardiology, Matsuyama, Ehime (Japan); Feyter, Pim J. de; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands)

    2015-01-15

    The purpose of this study was to estimate the myocardial area at risk (MAAR) using coronary computed tomography angiography (CTA) and Voronoi algorithm-based myocardial segmentation in comparison with single-photon emission computed tomography (SPECT). Thirty-four patients with coronary artery disease underwent 128-slice coronary CTA, stress/rest thallium-201 SPECT, and coronary angiography (CAG). CTA-based MAAR was defined as the sum of all CAG stenosis (>50 %) related territories (the ratio of the left ventricular volume). Using automated quantification software (17-segment model, 5-point scale), SPECT-based MAAR was defined as the number of segments with a score above zero as compared to the total 17 segments by summed stress score (SSS), difference (SDS) score map, and comprehensive SPECT interpretation with either SSS or SDS best correlating CAG findings (SSS/SDS). Results were compared using Pearson's correlation coefficient. Forty-nine stenoses were observed in 102 major coronary territories. Mean value of CTA-based MAAR was 28.3 ± 14.0 %. SSS-based, SDS-based, and SSS/SDS-based MAAR was 30.1 ± 6.1 %, 20.1 ± 15.8 %, and 26.8 ± 15.7 %, respectively. CTA-based MAAR was significantly related to SPECT-based MAAR (r = 0.531 for SSS; r = 0.494 for SDS; r = 0.814 for SSS/SDS; P < 0.05 in each). CTA-based Voronoi algorithm myocardial segmentation reliably quantifies SPECT-based MAAR. (orig.)

  19. Accuracy of coronary plaque detection and assessment of interobserver agreement for plaque quantification using automatic coronary plaque analysis software on coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Laqmani, A.; Quitzke, M.; Creder, D.D.; Adam, G.; Lund, G. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclearmedicine; Klink, T. [Wuerzburg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology

    2016-10-15

    To evaluate the accuracy of automatic plaque detection and the interobserver agreement of automatic versus manually adjusted quantification of coronary plaques on coronary CT angiography (cCTA) using commercially available software. 10 cCTA datasets were evaluated using plaque software. First, the automatically detected plaques were verified. Second, two observers independently performed plaque quantification without revising the automatically constructed plaque contours (automatic approach). Then, each observer adjusted the plaque contours according to plaque delineation (adjusted approach). The interobserver agreement of both approaches was analyzed. 32 of 114 automatically identified findings were true-positive plaques, while 82 (72 %) were false-positive. 20 of 52 plaques (38 %) were missed by the software (false-negative). The automatic approach provided good interobserver agreement with relative differences of 0.9 ± 16.0 % for plaque area and -3.3 ± 33.8 % for plaque volume. Both observers independently adjusted all contours because they did not represent the plaque delineation. Interobserver agreement decreased for the adjusted approach with relative differences of 25.0 ± 24.8 % for plaque area and 20.0 ± 40.4 % for plaque volume. The automatic plaque analysis software is of limited value due to high numbers of false-positive and false-negative plaque findings. The automatic approach was reproducible but it necessitated adjustment of all constructed plaque contours resulting in deterioration of the interobserver agreement.

  20. Computer-based automated left atrium segmentation and volumetry from ECG-gated coronary CT angiography data. Comparison with manual slice segmentation and ultrasound planimetric methods

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, R.W.; Kraus, B.; Kerl, J.M.; Lehnert, T.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Bernhardt, D.; Vega-Higuera, F. [Siemens AG, Healthcare Sector, Forchheim (Germany). Computed Tomography; Ackermann, H. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Biostatistik und Mathematische Modellierung

    2010-12-15

    Purpose: Enlargement of the left atrium is a risk factor for cardiovascular or cerebrovascular events. We evaluated the performance of prototype software for fully automated segmentation and volumetry of the left atrium. Materials and Methods: In 34 retrospectively ECG-gated coronary CT angiography scans, the end-systolic (LAVsys) and end-diastolic (LAVdia) volume of the left atrium was calculated fully automatically by prototype software. Manual slice segmentation by two independent experienced radiologists served as the reference standard. Furthermore, two independent observers calculated the LAV utilizing two ultrasound planimetric methods ('area length' and 'prolate ellipse') on CTA images. Measurement periods were compared for all methods. Results: The left atrial volumes calculated with the prototype software were in excellent agreement with the results from manual slice segmentation (r = 0.97 - 0.99; p < 0.001; Bland-Altman) with excellent interobserver agreement between both radiologists (r = 0.99; p < 0.001). Ultrasound planimetric methods clearly showed a higher variation (r = 0.72 - 0.86) with moderate interobserver agreement (r = 0.51 - 0.79). The measurement period was significantly lower with the software (267 {+-} 28 sec; p < 0.001) than with ultrasound methods (431 {+-} 68 sec) or manual slice segmentation (567 {+-} 91 sec). Conclusion: The prototype software showed excellent agreement with manual slice segmentation with the least time consumption. This will facilitate the routine assessment of the LA volume from coronary CTA data and therefore risk stratification. (orig.)

  1. Preoperative planning for endovascular aortic repair of abdominal aortic aneurysms: feasibility of nonenhanced MR angiography versus contrast-enhanced CT angiography.

    Science.gov (United States)

    Goshima, Satoshi; Kanematsu, Masayuki; Kondo, Hiroshi; Kawada, Hiroshi; Kojima, Toshihisa; Sakurai, Kota; Watanabe, Haruo; Shimabukuro, Katsuya; Matsuno, Yukihiro; Ishida, Narihiro; Takemura, Hirofumi; Bae, Kyongtae T

    2013-06-01

    To compare vascular measurements to determine stent types and configurations for abdominal endovascular aneurysm repair (EVAR) by comparing results of contrast material-enhanced computed tomographic (CT) angiography and nonenhanced magnetic resonance (MR) angiography. This prospective study was institutional review board approved, and all patients provided written informed consent. Fifty patients (45 men and five women; mean age, 76.0 years) admitted for elective abdominal EVAR underwent preoperative abdominal CT angiography (triplanar reformatted images; section thickness of 1-3 mm) and nonenhanced MR angiography (triplanar two-dimensional single-shot turbo field-echo images; section thickness of 6 mm). Two observers independently completed standard measurement and device selection forms for endovascular stent planning for CT and MR angiography. Pearson and intraclass correlation coefficients were calculated to evaluate intermodality and interobserver differences. No significant difference was found in aortic neck diameter (observer 1: CT, 18.5 mm; MR, 19.0 mm; P = .43) (observer 2: CT, 19.6 mm; MR, 19.3 mm; P = .59), aortic neck diameter 15 mm distal to the lowest renal artery (observer 1: CT, 19.2 mm; MR, 19.2 mm; P = .38) (observer 2: CT, 19.6 mm; MR, 19.6 mm; P = .91), aortic neck length (observer 1: CT, 43.6 mm; MR, 43.6 mm; P = .85) (observer 2: CT, 44.4 mm; MR, 44.0 mm; P = .93), or other key vascular measurements (P = .23-.99) for preoperative planning. These included aneurysm diameter, lowest renal artery to aortic bifurcation length, aortic bifurcation diameter, common iliac artery diameters, external iliac artery diameters, length between orifices of lower renal and internal iliac arteries, and iliac artery sealing length. CT and MR angiography measurements showed very strong correlation (r = 0.92-0.99). Intraclass correlation coefficients between observers ranged from 0.90 to 0.98. Stent types and configurations determined with CT measurements remained

  2. Reduced radiation dose and improved image quality at cardiovascular CT angiography by automated attenuation-based tube voltage selection: intra-individual comparison

    Energy Technology Data Exchange (ETDEWEB)

    Krazinski, Aleksander W.; Silverman, Justin R. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Meinel, Felix G.; Geyer, Lucas L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Canstein, Christian [Siemens Healthcare, CT Division, Malvern, PA (United States); De Cecco, Carlo N. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' - Polo Pontino, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy)

    2014-11-15

    To evaluate the effect of automated tube voltage selection on radiation dose and image quality at cardiovascular CT angiography (CTA). We retrospectively analysed paired studies in 72 patients (41 male, 60.5 ± 16.5 years), who had undergone CTA acquisitions of the heart or aorta both before and after the implementation of an automated x-ray tube voltage selection algorithm (ATVS). All other parameters were kept identical between the two acquisitions. Subjective image quality (IQ) was rated and objective IQ was measured by image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure of merit (FOM). Image quality parameters and effective dose were compared between acquisitions. Overall subjective image quality improved with the percentage of cases scored as adequate or higher increasing from 79 % to 92 % after implementation of ATVS (P = 0.03). SNR (14.1 ± 5.9, 15.7 ± 6.1, P = 0.009), CNR (11.6 ± 5.3, 13.2 ± 5.6, P = 0.011), and FOM (19.9 ± 23.3, 43.8 ± 51.1, P < 0.001) were significantly higher after implementation of ATVS. Mean image noise (24.1 ± 8.4 HU, 22.7 ± 7.1 HU, P = 0.048) and mean effective dose (10.6 ± 5.9 mSv, 8.8 ± 5.0 mSv, P = 0.003) were significantly lower after implementation of ATVS. Automated tube voltage selection can operator-independently optimize cardiovascular CTA image acquisition parameters with improved image quality at reduced dose. (orig.)

  3. Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia

    DEFF Research Database (Denmark)

    Sørgaard, Mathias Holm; Kofoed, Klaus Fuglsang; Linde, Jesper James

    2016-01-01

    : Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography...

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  6. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

    NARCIS (Netherlands)

    Seeters, T. van; Biessels, G.J.; Schaaf, I.C. van der; Dankbaar, J.W.; Horsch, A.D.; Luitse, M.J.; Niesten, J.M.; Mali, W.P.Th.; Kappelle, L.J.; Graaf, Y. van der; Velthuis, B.K.; Dijk, E.J. van

    2014-01-01

    BACKGROUND: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We

  7. Evaluation of spinal cord vessels using multi-slice CT angiography

    Institute of Scientific and Technical Information of China (English)

    陈爽; 钱建国; 冯晓源

    2004-01-01

    @@ Compared with the large number of head and neck vascular studies, computer tomography (CT) angiography of spinal vascular lesions has received relatively little attention. Several series and a few isolated cases of spinal vascular malformations demonstrated with magnetic resonance (MR) angiography have been reported.1-3 Selective digital subtraction angiography (DSA) is gold standard for diagnosis of spinal vascular lesions.4 However, it is invasive, time consuming, expensive, and dependent on the skills of the operator. Based on the DSA appearance and the surgical findings, spinal vascular malformations are generally, although not universally, classified as intradural (intramedullary and/or extramedullary) arteriovenous malformation (AVM) or arteriovenous fistula (AVF), and dural AVF. Recommended treatments of dural AVF consist of surgical obliteration and/or embolization.5-8

  8. Two-dimensional versus three-dimensional CT angiography in analysis of anatomical suitability for stentgraft repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Pitoulias, Georgios A.; Aslanidou, Eleni A.; Papadimitriou, Dimitrios K. (G Gennimatas Hospital, 2nd Surgical Dept. - Division of Vascular Surgery, Aristotle Univ. of Thessaloniki, Thessaloniki (Greece)), e-mail: pitoulias@yahoo.com; pitoulias@med.auth.gr; Donas, Konstantinos P. (Dept. of Vascular Surgery, St Franziscus Hospital, Muenster (Germany)); Schulte, Stefan (Center for Vascular Medicine and Vascular Surgery, MediaPark Klinik, Cologne (Germany))

    2011-03-15

    Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) plays an important role in long-term outcomes. Post-imaging analysis of computed tomographic angiography (CTA) by three-dimensional reconstruction with central lumen line detection (CLL 3D-CTA) enables measurements to be made in orthogonal slices. This might be more precise than equal post-imaging analysis in axial slices by two-dimensional computed tomographic angiography (2D-CTA). Purpose To evaluate the intra- and interobserver variability of CLL 3D-CTA and 2D-CTA post-imaging analysis methods and the agreement between them in pre-EVAR suitability analysis of patients with abdominal aortic aneurysm (AAA). Material and Methods Anonymized CTA data-sets from 70 patients with AAA were analyzed retrospectively. Length measurements included proximal and distal aortic neck lengths and total distance from the lower renal artery to the higher iliac bifurcation. Width measurements included proximal and distal neck diameters, maximum AAA diameter and common iliac diameters just above the iliac bifurcations. The measurements were performed in random order by two vascular surgeons, twice per method with 1-month interval between readings. In the CLL 3D-CTA method we used semi-automated CLL detection by software and manual measurements on CTA slices perpendicular to CLL. The equal measurements in 2D-CTA were performed manually on axial CTA slices using a DICOM viewer workstation. The intra- and interobserver variability, as well as the agreement between the two methods were assessed by Bland-Altman test and bivariate correlation analysis. Results The intraobserver variability was significantly higher in 2D-CTA measurements for both readers. The interobserver variability was significant in 2D-CTA measurements of proximal neck dimensions while the agreement in CLL 3D-CTA analysis between the two readers was excellent in all studied parameters. The agreement between the two suitability

  9. One-stop shop assessment for atrial septal defect closure using 256-slice coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Yuzo; Kamitani, Takeshi; Sagiyama, Koji; Yamanouchi, Torahiko; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka (Japan); Nagao, Michinobu; Kawanami, Satoshi [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Fukuoka (Japan); Sakamoto, Ichiro [Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka (Japan); Yamamura, Kenichiro [Kyushu University, Department of Pediatrics, Graduate School of Medical Sciences, Fukuoka (Japan); Yabuuchi, Hidetake [Kyushu University, Department of Health Sciences, Graduate School of Medical Sciences, Fukuoka (Japan)

    2017-02-15

    To investigate the feasibility and accuracy of measurement of the pulmonary to systemic blood flow ratio (Qp/Qs) and defect and rim sizes in secundum atrial septal defects (ASDs) using 256-slice CT, compared to the reference transoesophageal echocardiography (TEE) and right heart catheterization (RHC) measurements. Twenty-three consecutive adult patients with secundum ASDs who underwent retrospective ECG-gated coronary CT angiography (CCTA), TEE and RHC were enrolled in this study. Right ventricular (RV) and left ventricular (LV) stroke volumes (SV) were calculated by biventricular volumetry of CCTA. Qp/Qs-CT was defined as RVSV/LVSV. The sizes of the defect and rim were measured by multi-planar reconstruction CT images. Correlations between Qp/Qs-CT and Qp/Qs-RHC and between the defect diameter obtained by CT and TEE were analyzed by Pearson's coefficient analysis. Rim sizes by CT and TEE were compared by paired t-test. Qp/Qs-CT was significantly correlated with Qp/Qs-RHC (r = 0.83, p < 0.0001), and the defect diameter by CT was significantly correlated with that by TEE (r = 0.95, p < 0.0001). There was no significant difference between CT and TEE in measurements of rim size. 256-slice CCTA allows measuring Qp/Qs and size of defects and rims in patients with secundum ASDs, accomplishing pretreatment evaluation non-invasively and comprehensively. (orig.)

  10. Carotid and cerebral CT angiography using low volume of iodinated contrast material and low tube voltage.

    Science.gov (United States)

    Kayan, M; Demirtas, H; Türker, Y; Kayan, F; Çetinkaya, G; Kara, M; Orhan Çelik, A; Umul, A; Yılmaz, Ö; Recep Aktaş, A

    2016-11-01

    To evaluate image quality of carotid computed tomography angiography (CTA) using a low voltage (80kV) and low amount of iodinated contrast material. A total of 101 patients referred for carotid CTA were randomly assigned to receive a specific protocol. In group A patients received intravenous administration of contrast material at a dose of 1mL/kg and CTA examinations were performed at 100kV. In group B, patients received intravenous administration of contrast material at a dose of 0.5mL/kg and CTA examinations were performed at 80kV. The same nonionic iodinated contrast material containing 370mg of iodine per mL was used in both groups. Attenuation values were measured from the center of specific arterial segments using regions of interest. Attenuation values above 300HU were accepted as significant. Institutional review board approval was obtained. A total of 50 patients were included in group A (38 men, 12 women; mean age, 63.56 years±13.18 [SD]) and 51 patients in group B (33 men, 18 women; mean age, 59.60 years±16.63 [SD]). A total of 1615 arterial segments (1515 common carotid artery-middle cerebral artery and 101 aortic arches) were analyzed. Venous contamination was not observed in either group. The mean attenuation values of all arterial segments in both groups were greater than 300HU. Mean arterial attenuation value in group B (499.22HU±97.25 [SD]) was significantly greater than in group A (374.36HU±73.79 [SD]) (P70%) was detected in 2 segments in group A and in 3 segments in group B, while grade IV stenosis (occlusion) was detected in 2 segments in group B. Distal common carotid artery dissection was detected in 1 patient and aortic dissection was detected in 1 patient in group B. Total dose-length product (DLP) value was significantly greater in group A (225.74mGy·cm±21.80 [SD]) than in group B (116.60mGy·cm±21.22 [SD]) (Pmaterial. This provides good image quality with low radiation dose. Copyright © 2016 Editions françaises de radiologie

  11. Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial

    Energy Technology Data Exchange (ETDEWEB)

    Achenbach, Stephan [Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Department of Cardiology, Erlangen (Germany); Paul, Jean-Francois [Centre Chirurgical Marie Lannelongue, Department of Radiology, Le Plessis Robinson (France); Laurent, Francois [University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux (France); CHU de Bordeaux, Service d' Imagerie Thoracique et Cardiovasculaire, Pessac (France); Becker, Hans-Christoph [University Hospital Grosshadern, Department of Clinical Radiology, Munich (Germany); Rengo, Marco [Sapienza - University of Rome, ICOT Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Caudron, Jerome [University Hospital of Rouen, Department of Radiology, Rouen (France); Leschka, Sebastian [Saint Gallen Hospital, Department of Radiology, Saint Gallen (Switzerland); Vignaux, Olivier [Cochin Hospital, Department of Radiology, Paris (France); Knobloch, Gesine [La Charite, Department of Radiology, Berlin (Germany); Benea, Giorgio [Ospedale del Delta, Ferrara (Italy); Schlosser, Thomas [Elisabeth-Krankenhaus Hospital, Essen (Germany); Andreu, Jordi [Hospital Vall d' Hebron, Barcelona (Spain); Cabeza, Beatriz [Hospital Clinico San Carlos, Madrid (Spain); Jacquier, Alexis [La Timone Adult Hospital, Department of Radiology, Marseille (France); Souto, Miguel [Complejo Hospitalario Universitario, Santiago de Compostela (Spain); Revel, Didier [Louis Pradel Hospital, Department of Radiology, Lyon (France); Qanadli, Salah Dine [University of Lausanne, Department of Radiology, Lausanne (Switzerland); Cademartiri, Filippo [Giovanni XXIII Hospital, Department of Radiology, Monastier di Treviso (Italy); Collaboration: X-ACT Study Group

    2017-02-15

    To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses. In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0. Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups. With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment. (orig.)

  12. Study on the value of 128 slice spiral CT angiography in the evaluation of the symptomatic supra-aortic arteries stenosis dis- ease%128层螺旋 CT 血管造影评价症状性主动脉弓以上动脉狭窄的价值研究

    Institute of Scientific and Technical Information of China (English)

    张磊; 陈静静

    2016-01-01

    目的:以数字减影血管造影(DSA)结果为对照标准,评价128层螺旋 CT 血管造影(CTA)判断主动脉弓以上动脉狭窄程度的准确性。方法收集2014年1月至2015年2月临床怀疑主动脉弓以上动脉狭窄性病变患者21例,均行主动脉弓以上 CTA 检查,并在2周内行 DSA 检查,将 CTA 与 DSA 检出结果进行对比,观察 CTA 的敏感度和特异度,评价128层螺旋 CT 血管造影诊断主动脉弓以上动脉狭窄的准确性。结果21例362段血管 CTA 和 DSA 诊断符合数为353段(97.5%),128层螺旋 CT 血管造影诊断主动脉弓以上动脉狭窄的总的敏感度为100%,特异度为99.66%,阳性预测值为98.57%,阴性预测值为100%。结论128层 CTA 作为一种无创或微创性检查,有较高的敏感度和特异度,可用于主动脉弓以上动脉狭窄的术前诊断、术后效果评价。%Objective To evaluate the accuracy of 128 slice spiral CT angiography in the evaluation of the supra-aortic arter-ies stenosis disease in comparison with DSA results. Methods From January 2014 to February 2015,21 patients with suspected supra-aortic arteries stenosis disease were selected. The patients underwent cerebral and carotid CTA examination and DSA exam-ination in two weeks. The sensitivity and specifility of CTA were analyzed compared with DSA,the accuracy of 128-slice CTA in diagnosis of cerebral and carotid arterious stenosis was evaluated. Results The CTA readings correlated with DSA findings in 353 vessels(97. 5% ),the sensitivity of 128-sile CTA in diagnosis supra-aortic arteries was 100% ,the specialty was 99. 66% , the positive predictive value was 98. 57% ,and the negative predictive value was 100% . Conclusion 128-silce spiral CTA is a noninvasive or minimally invasive inspection,which has high sensitivity and specificity. CTA can be used for preoperative diagni-sis,post-operative evaluation and epidemiological investigation of supra-aortic arteries

  13. Comparative Study in the Diagnosis of Intracranial Aneurysms with 64 Slice CTA-and 3D DSA%64层CTA-MIP、CTA-VR与3D-DSA对颅内动脉瘤诊断价值的对比研究

    Institute of Scientific and Technical Information of China (English)

    刘善平

    2012-01-01

    目的 对比评价64层螺旋CT最大密度投影(CTA-MIP),CTA容积再现(CTA-VR)与三维数字血管造影(3D-DSA)对颅内动脉瘤(CA)的诊断价值.资料与方法 回顾性分析32例经手术及DSA确诊的CA 64层CT血管成像资料,并与DSA进行对照.结果 32例共40个动脉瘤,CTA-MIP发现35个动脉瘤,CTA-VR发现37个动脉瘤,3D-DSA发现39个动脉瘤.40个动脉瘤中11个位于后交通动脉,16个位于大脑中动脉,4个位于基底动脉,1个位于椎动脉,2个位于大脑前动脉,3个位于大脑后动脉,3个位于颈内动脉.3 D-DSA与CTA比较,差异无统计学意义.结论 在CA影像学诊断上,CTA-MIP、CTA-VR和3D-DSA各有优势,CTA可作为外科治疗或介入治疗的筛选方法.%Objective To evaluate the role of 64 slice computed tomography angiography maximum intensity projection (CTA,MIP) , computed tomography angiography volume rendering (CTA,VR) and 3 dimensional digital subtraction angiogtaphy(3D-DSA) ) in the diagnosis of intracranial aneurysms. Materials and Methods The CT and DSA imaging findings of 32 patients with aneurysms were retrospectively analyzed and compared. Results 40 aneurysms in 32 patients were found by DSA and/or operation. 35 aneurysms were found by CTA MIP. 37 aneurysms were found by CTA VR. 39 aneurysms were found by DSA. 11 aneurysms were at posterior communicating artery, 16 aneurysms at middle cerebral artery, 4 aneurysms at basilar artery, 1 aneurysms at vertebary artery, 2 aneurysms at anterior cerebral artery, 3 aneurysms at posterior cerebral artery, 3 aneurysms at internal carotid artery. There was no significant difference in detecting aneurysms between CTA and 3D DSA. Conclusion CTA MIP, CTA VR and 3D-DSA examination have their own advantage in diagnosis of intracranial aneurysms. CTA can be used as the method in screening intracranial aneurysms for surgery and interventional therapy.

  14. Changes in Medical Management after Coronary CT Angiography

    Directory of Open Access Journals (Sweden)

    Vânia Mairi Naue

    2015-01-01

    Full Text Available Abstract Introduction: Coronary computed tomography angiography (CCTA allows for non-invasive coronary artery disease (CAD phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. Objective: To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC levels. Methods: We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. Results: A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18% patients had no CAD, 38 (39% had non-obstructive (< 50% lesions and 41 (42% had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32. We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001. We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Conclusion: Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

  15. Changes in Medical Management after Coronary CT Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Naue, Vânia Mairi, E-mail: vania_naue@yahoo.com.br; Camargo, Gabriel; Sabioni, Letícia Roberto; Lima, Ronaldo de Souza Leão; Derenne, Maria Eduarda; Lorenzo, Andréa Rocha de; Freire, Monica Di Calafiori; Azevedo Filho, Clério Francisco; Resende, Elmiro Santos; Gottlieb, Ilan [CDPI - Clínica de Diagnóstico por Imagem (Brazil)

    2015-10-15

    Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels. We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

  16. Sex Differences in Functional Stress Test Versus CT Angiography in Symptomatic Patients With Suspected CAD: Insights From PROMISE

    Science.gov (United States)

    Pagidipati, Neha J.; Hemal, Kshipra; Coles, Adrian; Mark, Daniel B.; Dolor, Rowena J.; Pellikka, Patricia A.; Hoffmann, Udo; Litwin, Sheldon E.; Udelson, James; Daubert, Melissa A.; Shah, Svati H.; Martinez, Beth; Lee, Kerry L.; Douglas, Pamela S.

    2016-01-01

    Background Risk stratification is an important goal of cardiac noninvasive tests (NITs), yet little contemporary data exist on the prognostic value of different NITs by patient sex. Objectives To compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease. Methods In 8966 PROMISE trial patients tested as randomized (4500 computed tomographic angiography [CTA], 52% female; 4466 stress testing, 53% female), we assessed the relationship between sex and NIT results using logistic regression, and the relationship between sex and a composite of death, myocardial infarction, and unstable angina hospitalization using Cox proportional hazards models. Results In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test (8% vs. 12%, adjusted OR 0.67 [95% CI 0.55-0.82]). Compared with negative tests, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test (CTA adjusted HR 5.86 [95% CI 3.32-10.35]; stress adjusted HR 2.27 [95% CI 1.21-4.25]; adjusted p=0.028). Men were more likely to have a positive CTA than stress test (16% vs. 14%, adjusted OR 1.23 [95% CI 1.04-1.47]). Compared with negative tests, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test in men, although this difference was not statistically significant (CTA adjusted HR 2.80 [95% CI 1.76-4.45]; stress adjusted HR 4.42 [95% CI 2.77-7.07]; adjusted p=0.168). Negative CTA and stress tests were equally likely to predict an event in both sexes (adjusted p-values=NS). A significant interaction between sex, NIT type, and test result (p=0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events. Conclusions The prognostic value of an NIT result varies by test type and patient sex. Women appear to derive more prognostic information from a CTA, while men

  17. Diagnosis of Persistent Primitive Olfactory Artery Using CT Angiography: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yeo, Soo Hyun; Rho, Byung Hak; Kim, Eal Maan; Chang, Hyuk Won [Keimyung University College of Medicine, Daegu (Korea, Republic of); Sohn, Chul Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2009-09-15

    A persistent primitive olfactory artery is a rare vascular anomaly and is incidentally found without any associated symptom for the most part. However, it has clinical significance in view of its high association with the development of cerebral aneurysms occurring at the hairpin turn. We present a case of a persistent primitive olfactory artery incidentally diagnosed by a CT angiography as well as a literature review of related previous articles

  18. 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.

  19. Application of CT angiography in diagnosis of swollen hand syndrome in maintenance hemodialysis patients%CT血管成像在诊断和评价维持性血液透析患者肿胀手综合症中的应用

    Institute of Scientific and Technical Information of China (English)

    张宏涛; 赵显国

    2012-01-01

    目的 探讨CT 血管成像在诊断和评价血液透析患者肿胀手综合症中的应用价值.方法 对10例应用自体动静脉内瘘并形成前臂或上肢整个肿胀维持性血液透析患者,应用64排CT 血管成像技术(CT angiography,CTA)进行检查,观察瘘体血管的血栓形成部位、狭窄程度及侧支循环情况.结果 10例患者经CTA技术后均明确内瘘病变的部位.头静脉狭窄3例,其中轻度1例,中度1例,重度1例;锁骨下静脉狭窄2例,轻、重度各1例,无名静脉中度狭窄1例,闭塞1例.上腔静脉重度狭窄1例,闭塞2例.结论 当维持性血液透析患者发生肿胀手综合征时,64排CT血管成像技术不仅对诊断并可对手术干预提供很有价值的帮助.%Objective To explore the effect of CT angiography (CTA) in the assessment of swollen hand syndrome in patients on maintenance hemodialysis. Methods Data of 10 maintenance hemodiaiysis patients who had swollen hand syndrome and underwent 64 - detector CTA was retrospectively collected and analyzed. CTA was taken to detect the posi-tionand degree of vascular stenosis, thrombosis, and collateral circulation around AVF. Results CTA can clearly show the lesion location of AVF in all eases enrolled. Three cases Had cephalic vein stenosis ( one with mild stenosis,one. with moderate stenosis, and one with severe stenosis). Three cases had subclavian vein (one with mild stenosis, one with severe ). One case had innominate veins moderate stenosis. One case had innominate veins thrombosis. One case had superior vena cava severe stenosis. One case had superior vena cava obstruction. Conclusions CT angiography ( CTA) is effective in the assessment of swollen hand syndrome in patients with maintenance hemodialysis.

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

    Energy Technology Data Exchange (ETDEWEB)

    Sun Zhonghua [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, WA (Australia)], E-mail: z.sun@curtin.edu.au; Almutairi, Abdulrahman Marzouq D. [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, WA (Australia)

    2010-02-15

    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.

  1. CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli.

    Directory of Open Access Journals (Sweden)

    Andrew J Schissler

    Full Text Available BACKGROUND: It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA utilization has resulted in increased detection of pulmonary emboli (PEs with a less severe disease spectrum. METHODS: Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV abnormalities (dysfunction or dilatation and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression. RESULTS: 268 CTPAs (6.6% were positive for acute PE, and 3,780 (93.4% demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.07, P<0.01. There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95-1.11, P = 0.49. The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10-1.75, P = 0.01. CONCLUSIONS: CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs.

  2. Multidetector CT angiography with volumetric three-dimentional rendering to evaluate bronchial arteries in primary lung cancer

    Institute of Scientific and Technical Information of China (English)

    YU Hong; LI Hui-min; LIU Shi-yuan; XIAO Xiang-sheng; TAO Xiao-feng

    2006-01-01

    Objective:To evaluate the imageologic characteristics of the bronchial arteries (BAs) in primary lung cancer (PLC) with multidetector CT (MDCT) angiography. Methods: Thin-section enhanced CT scanning (with an Toshiba Aquilion 16 scanner) was performed in 164 PLC patients, of whom 123were confirmed by pathology and the remaining 41 were confirmed by typical radiological and clinical findings. Another 46 patients with normal thoracic CT presentations were served as control. Three-dimensional (3D) images of the BAs were processed at workstation (Vitrea 2, Vital Corp, USA). Spatial anatomical characters of the BAs were observed using volume rendering (VR) and multiplanar reconstruction (MPR) or maximum intensity projection (MIP). Results: At least one bronchial artery was displayed clearly on VR in 152 (92.7%) of the 164 PLC patients and 32 (69.6%) of the 46 controls. There were 48. 92% of the right BAs originating from the descending aorta and 46. 24% from the right intercostal artery. 97.53% of the left BAs originated from the descending aorta, and 94.87% of the common trunk from the descending aorta. There were 10 distribution patterns of the BAs, with one on the right and one on the left predominating (48. 68%). More BA branches were found to reach far from the segmental bronchi or enter into the lesions in the PLC group than those in the control group (25.8% vs 1.7%), and also the ipsilateral side of the PLC than the contralateral side (40% vs 8.8% ). The diameter and the total transaxial areas of the BAs on the ipsilateral side of the PLC lesions were significantly larger than those on the contralateral side or those of the control group (P<0.05). Conclusion:The anatomic characters and pathologic changes can be depicted in vivo stereographically and clearly by CTA with volumetric 3D rendering. Dilation of the BAs and increase of total blood flow in patients with PLC can be evaluated quantitatively, which may be useful in the diagnosis and assessment of PLC, and

  3. Efficiency of ultrasonography and CT angiography in follow-up studies of carotid stent and percutaneous transluminal angioplasty

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    Ryu, Chang Woo; Lee, Byung Hee; Chung, Bong Sub; Ahn, Jung Yong; Heo, Kyung; Kho, Young Sik [Pundang CHA General Hospital, Pochon CHA Univ. College of Medicine, Pochon (Korea, Republic of)

    1999-12-01

    The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. Eleven carotid arteries of seven patients(men:5, women:2, mean age:56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven (mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverberation artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hardbeam artifact of the stent(11/11) and motion artifact(3/11). US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-invasive follow-up studies of carotid stenting.

  4. Time-resolved assessment of collateral flow using 4D CT angiography in large-vessel occlusion stroke

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    Froelich, Andreas M.J.; Wolff, Sarah Lena; Psychogios, Marios N.; Schramm, Ramona; Knauth, Michael; Schramm, Peter [University Medical Centre Goettingen, Department of Neuroradiology, Goettingen (Germany); Klotz, Ernst [Computed Tomography H IM CR R and D PA, Siemens AG, Forchheim (Germany); Wasser, Katrin [University Medical Centre Goettingen, Department of Neurology, Goettingen (Germany)

    2014-02-15

    In acute stroke patients with large vessel occlusion, collateral blood flow affects tissue fate and patient outcome. The visibility of collaterals on computed tomography angiography (CTA) strongly depends on the acquisition phase, but the optimal time point for collateral imaging is unknown. We analysed collaterals in a time-resolved fashion using four-dimensional (4D) CTA in 82 endovascularly treated stroke patients, aiming to determine which acquisition phase best depicts collaterals and predicts outcome. Early, peak and late phases as well as temporally fused maximum intensity projections (tMIP) were graded using a semiquantitative regional leptomeningeal collateral score, compared with conventional single-phase CTA and correlated with functional outcome. The total extent of collateral flow was best visualised on tMIP. Collateral scores were significantly lower on early and peak phase as well as on single-phase CTA. Collateral grade was associated with favourable functional outcome and the strength of this relationship increased from earlier to later phases, with collaterals on tMIP showing the strongest correlation with outcome. Temporally fused tMIP images provide the best depiction of collateral flow. Our findings suggest that the total extent of collateral flow, rather than the velocity of collateral filling, best predicts clinical outcome. (orig.)

  5. Peripheral arterial occlusive disease: diagnostic performance and effect on therapeutic management of 64-section CT angiography.

    Science.gov (United States)

    Napoli, Alessandro; Anzidei, Michele; Zaccagna, Fulvio; Cavallo Marincola, Beatrice; Zini, Chiara; Brachetti, Giulia; Cartocci, Gaia; Fanelli, Fabrizio; Catalano, Carlo; Passariello, Roberto

    2011-12-01

    To evaluate the diagnostic performance and effect on therapeutic management of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with peripheral arterial disease (PAD), with conventional digital subtraction angiography (DSA) as the reference standard. The study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 212 patients with symptomatic PAD underwent CT angiography and subsequent DSA. For stenosis analysis (≥ 70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Interobserver agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In addition, according to the TransAtlantic Inter-Society Consensus (TASC) Document on Management of Peripheral Arterial Disease guidelines, treatment recommendations based on CT angiographic and DSA findings were compared. McNemar test was used to prove significant differences between CT angiographic and DSA findings. A total of 7420 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (3072 of 3113 segments and 4141 of 4279 segments, respectively), with an accuracy of 98% (7213 of 7392 segments), a PPV of 96% (3072 of 3187 segments), an NPV of 99% (3141 of 3187 segments), a PLR of 36.7, and an NLR of 0.013. There was no significant difference between CT angiographic and DSA findings (P = .62-.87). In accordance with TASC II guidelines, 49 patients were referred for conservative treatment, 87 underwent endovascular procedures, 38 underwent surgery, and 17 received hybrid treatment. Therapy recommendations based on CT angiographic findings

  6. Color-coded cerebral computed tomographic angiography: implementation of a convolution-based algorithm and first clinical evaluation in patients with acute ischemic stroke.

    Science.gov (United States)

    Thierfelder, Kolja M; Havla, Lukas; Beyer, Sebastian E; Ertl-Wagner, Birgit; Meinel, Felix G; von Baumgarten, Louisa; Janssen, Hendrik; Ditt, Hendrik; Reiser, Maximilian F; Sommer, Wieland H

    2015-05-01

    The objective of this study was to develop a new method of displaying dynamic cerebral computed tomographic (CT) angiography (CTA) data sets in which the time delay to maximum enhancement (Tdelay) is displayed in a range of colors (color-coded CT angiography [cCTA]). This institutional review board-approved study included multiparametric CT data sets from 16 patients with different types of supra-aortic large vessel occlusions. Color-coded CT angiography was reconstructed from CT perfusion raw data sets. All voxel enhancement curves were fitted to f(t) = α · AIFmtt(t - Δt), with AIFmtt(t), indicating enhancement of AIF dilated by convolution with boxcar function (with mean transit time [mtt]); α, scaling factor; and [INCREMENT]t, transition along the time. The time delay to maximum enhancement was defined as Tdelay = Δt +0.5 · mtt. Values of Tdelay were color-coded and superimposed on temporal maximum intensity projections CTA resulting in colored angiographic composite images. For a pilot clinical evaluation, diagnostic confidence in determining the pathology, quality of the visualization of leptomeningeal collaterals, and additional diagnostic information were assessed. The reconstruction of cCTA was technically feasible in all 16 patients. Both diagnostic confidence (P < 0.01) and the quality of the visualization of collaterals (P < 0.0001) were significantly higher when using the combination of single-phase CTA and cCTA compared with single-phase CTA alone. Additional diagnostic information was obtained with cCTA regarding occlusion type (reader 1: 5 cases and reader 2: 4 cases), differentiation between arteries and veins (11/13), differentiation between antegrade and retrograde filling (12/13), as well as leptomeningeal collateralization (13/14). Color-coded CT angiography is a technically feasible technique that provides additional information on cerebral hemodynamics in ischemic stroke patients.

  7. CT perfusion imaging and CT subtraction angiography in the diagnosis of ischemic cerebrovascular disease within 24 hours

    Institute of Scientific and Technical Information of China (English)

    管小亭; 于学英; 刘翔; 龙洁; 戴建平

    2003-01-01

    Objective To evaluate the value of the clinical use of CT perfusion imaging (CTPI) and CT subtraction angiography (CTSA) for diagnosing acute ischemic cerebrovascular disease (AICVD). Methods Twenty-four patients with AICVD onset within 24 hours were examined with regular CT, CTPI, and CTSA. Some cases received CTPI, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or single photon emission computer tomography (SPECT) during follow-up examinations.Results Of the 24 cases, 11 had negative results from regular CT scans 3-6 hours after onset of stroke in 6 cases, 6-12 hours in 3 cases, and 12-24 hours in 2 cases. Ten of these cases were then confirmed by CTPI as having ischemic lesions, 2 with middle cerebral artery occlusion (MCAO), and 1 case with transient ischemic attack (TIA) with CTPI negative. Of the 24 cases, 13 had positive results from regular CT, 9 were diagnosed with ischemic lesions larger by using CTPI than regular CT, 1 case had MCAO and 1 had internal carotid artery occlusion (ICAO). There were 4 cases with ischemic lesions observed with regular CT having nearly the same range as that of lacunar infarctions using CTPI. Another 4 cases had more than 2 lesion areas. The peak time (PT), mean transit time (MTT) and relative flow (RF) of 24 cases were markedly different. The sides of ischemic lesions compared to each other and the core of the lesion compared to peripheral zones were also altered significantly (P<0.01).Conclusions Combined CTPI with CTSA can detect acute ischemic lesions at early and hyper-early stages and could distinguish between TIA, lacunar infarction and a larger area of infarction. Using semiquantitative blood perfusion analysis status, CTPI with CTSA could define position, area and range of the ischemic lesion and penumbra. These scans can also analyze the brain blood perfusion status. It is important to early diagnose the occlusion of the entire division of the internal

  8. Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT.

    Directory of Open Access Journals (Sweden)

    Jun Zhang

    Full Text Available BACKGROUND/AIMS: The 256-slice CT enables the entire brain to be scanned in a single examination. We evaluated the application of 256-slice whole-brain CT perfusion (CTP in determining graft patency as well as investigating cerebral hemodynamic changes in Moyamoya disease before and after surgical revascularization. METHODS: Thirty-nine cases of Moyamoya disease were evaluated before and after surgical revascularization with 256-slice CT. Whole-brain perfusion images and dynamic 3D CT angiographic images generated from perfusion source data were obtained in all patients. Cerebral blood flow (CBF, cerebral blood volume (CBV, time to peak (TTP and mean transit time (MTT of one hemisphere in the region of middle cerebral artery (MCA distribution and contralateral mirroring areas were measured. Relative CTP values (rCBF, rCBV, rTTP, rMTT were also obtained. Differences in pre- and post- operation perfusion CT values were assessed with paired t test or matched-pairs signed-ranks test. RESULTS: Preoperative CBF, MTT and TTP of potential surgical side were significantly different from those of contralateral side (P<0.01 for all. All graft patencies were displayed using the 3D-CTA images. Postoperative CBF, rCBF and rCBV values of surgical side in the region of MCA were significantly higher than those before operation (P<0.01 for all. Postoperative MTT, TTP, rMTT and rTTP values of the surgical side in the region of MCA were significantly lower than those before operation (P<0.05 for all. CONCLUSION: The 256-slice whole-brain CTP can be used to evaluate cerebral hemodynamic changes in Moyamoya disease before and after surgery and the 3D-CTA is useful for assessing the abnormalities of intracranial arteries and graft patencies.

  9. 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.)

  10. Use of coronary CT angiography in the diagnosis of patients with suspected coronary artery disease: findings and clinical indications

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun; Yu-Pin Liu; Dong-Jin Zhou; Yan Qi

    2012-01-01

    Objective To investigate the clinical applications of coronary CT angiography in patients with suspected coronary artery disease and identify factors that affect CT findings. Methods Medical records of patients suspected of coronary artery disease over a period of 12 months from a tertiary teaching hospital were retrospectively reviewed. Patient age, sex (male/female), duration of symptoms and abnormal rates of coronary CT angiography scans were analysed to investigate the relationship among these parameters. The patients by age were duration of symptoms was also classified into five groups: less than one week, one week to one month, one to three months, three to six months and more than six months. Results Of the 880 patient records reviewed, 800 met the above study criteria. Five hundred and forty nine patients demonstrated abnormal CT findings (68.6%). There was no significant difference in the percentage of abnormal CT findings based on patient sex and the duration of symptoms (P = 0.14). The abnormal rates of coronary CT angiography, however, increased significantly with increasing age (P < 0.001); with patients over 65 years of age 2.5 times more likely to have an abnormal CT scan relative to a patient under 45 years. A significant difference was found between abnormal coronary CT angiography and the duration of symptoms (P = 0.012). Conclusions Our results indicate coronary CT angiography findings are significantly related to the patient age group and duration of symptoms. Clinical referral for coronary CT angiography of patients with suspected coronary artery disease needs to be justified with regard to the judicious use of this imaging modality.

  11. Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography.

    Science.gov (United States)

    Kim, Hoon; Jin, Seon Tak; Kim, Young Woo; Kim, Seong Rim; Park, Ik Seong; Jo, Kwang Wook

    2015-03-01

    Patients with middle cerebral artery (MCA) infarction accompanied by MCA occlusion with or without internal carotid artery (ICA) occlusion have a poor prognosis, as a result of brain cell damage caused by both the infarction and by space-occupying and life-threatening edema formation. Multiple treatments can reduce the likelihood of edema formation, but tend to show limited efficacy. Decompressive hemicraniectomy with duroplasty has been promising for improving functional outcomes and reducing mortality, particularly improved functional outcomes can be achieved with early decompressive surgery. Therefore, identifying patients at risk for developing fatal edema is important and should be performed as early as possible. Sixty-four patients diagnosed with major MCA infarction with MCA occlusion within 8 hours of symptom onset were retrospectively reviewed. Early clinical, laboratory, and computed tomography angiography (CTA) parameters were analyzed for malignant brain edema (MBE). Twenty of the 64 patients (31%) had MBE, and the clinical outcome was poor (3month modified Rankin Scale >2) in 95% of them. The National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score, Clot Burden Score, and Collateral Score (CS) showed statically significant differences in both groups. Multivariable analyses adjusted for age and sex identified the independent predictors of MBE: NIHSS score >18 (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 1.2-16.0, p=0.023) and CS on CTA <2 (OR: 7.28, 95% CI: 1.7-30.3,p=0.006). Our results provide useful information for selecting patients in need of aggressive treatment such as decompressive surgery.

  12. Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Plank, Fabian [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Innsbruck Medical University, Department of Internal Medicine III - Cardiology, Innsbruck (Austria); Burghard, Philipp; Mayr, Agnes; Klauser, Andrea; Feuchtner, Gudrun [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Friedrich, Guy; Dichtl, Wolfgang [Innsbruck Medical University, Department of Internal Medicine III - Cardiology, Innsbruck (Austria); Wolf, Florian [Vienna Medical University, Department of Cardiovascular and Interventional Radiology, Vienna (Austria)

    2016-11-15

    To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization. 160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8). 210 coronary segments were included (59 % positive). MLA of ≤1.8 mm{sup 2} was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94-0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm{sup 2} sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88-95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84-93, c = 0.87; 95 % CI 0.82-92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67-81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84. MLA ≤1.8 mm{sup 2} and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis. (orig.)

  13. Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how.

    Science.gov (United States)

    Geffroy, Yann; Rodallec, Mathieu H; Boulay-Coletta, Isabelle; Jullès, Marie-Christine; Fullès, Marie-Christine; Ridereau-Zins, Catherine; Zins, Marc

    2011-01-01

    Acute gastrointestinal (GI) bleeding remains an important cause of emergency hospital admissions, with substantial related morbidity and mortality. Bleeding may relate to the upper or lower GI tract, with the dividing anatomic landmark between these two regions being the ligament of Treitz. The widespread availability of endoscopic equipment has had an important effect on the rapid identification and treatment of the bleeding source. However, the choice of upper or lower GI endoscopy is largely dictated by the clinical presentation, which in many cases proves misleading. Furthermore, there remains a large group of patients with negative endoscopic results or failed endoscopy, in whom additional techniques are required to identify the source of GI bleeding. Multidetector computed tomography (CT) with its speed, resolution, multiplanar techniques, and angiographic capabilities allows excellent visualization of both the small and large bowel. Multiphasic multidetector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for visualization of the bleeding source and its characterization. Thus, multidetector CT angiography provides a time-efficient method for directing and planning therapy for patients with acute GI bleeding. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105206/-/DC1.

  14. [Comparative assessment of ct-bypass angiography and invasive coronary angiography in patients after coronary bypass surgery in the late postoperative period].

    Science.gov (United States)

    Men'kov, I A; Trufanov, G E; Zhelezniak, I S; Rud', S D; Kniazev, E A

    2013-10-01

    The aim of the study was to evaluate the diagnostic accuracy of ct-bypass angiography in the evaluation of significant stenosis and occlusion of grafts, recipient and nongrafted vessels in patients after coronary bypass surgery in the late postoperative period. Ct-bypass angiography was performed on 64-slice ct scanner with a slice thickness of 0.5 mm and a gantry rotation time of 0.4 s. All results were compared with quantitative invasive coronary angiography. 43 patients with 113 grafts were included in the study. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy for the evaluation of significant stenosis were 94%, 95%, 88%, 98%, 95%, respectively. Diagnostic accuracy for the evaluation of significant stenosis in the recipient and nongrafted vessels were 91% and 90%, respectively. The diagnostic accuracy for the evaluation graft occlusion, recipient and nongrafted vessels was 100%, 100% and 98%, respectively. Ct-bypass angiography allows accurate non-invasive assessment of significant stenosis and occlusion of coronary bypass grafts and native coronary arteries in patients after coronary bypass surgery in the late postoperative period.

  15. Determining the organ of origin of large pelvic masses in females using multidetector CT angiography and three-dimensional volume rendering CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Li, YangKang; Chen, JunWei; Chen, XueYin; Lin, JianBang; Cai, AiQun; Zhou, XiuGuo [Cancer Hospital, Shantou University Medical College, Department of Radiology, Shantou, Guangdong Province (China); Zheng, Yu [Cancer Hospital, Shantou University Medical College, Department of Clinical Pharmacology, Shantou (China)

    2015-04-01

    To study the value of tumour feeding arteries and the ovarian vein in determining the organ of origin of large pelvic tumours in females using multidetector CT. One hundred and thirty patients with 131 pathologically proven tumours (>6.5 cm) were retrospectively reviewed. Conventional CT images and CT angiography were evaluated, with focus on assessing the value of tumour feeding arteries and the ovarian vein in differentiating ovarian from non-ovarian tumours. For 97 ovarian tumours, the feeding arteries included the ovarian artery (n = 51) and the ovarian branch of uterine artery (n = 64). For 34 non-ovarian tumours, the feeding arteries included the ovarian artery (n = 2), the uterine artery (n = 21), the mesenteric artery (n = 5), and the internal iliac artery (n = 1). The ovarian vein was identified in 86 ovarian tumours and 12 non-ovarian tumours. When the feeding arteries and the ovarian vein were combined to confirm ovarian origin, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.8 %, 84.2 %, 93.8 %, 94.1 %, and 93.9 %, respectively. The accuracy was significantly higher than that of independently using the ovarian vein or the ovarian feeding arteries. Combined application of tumour feeding arteries and the ovarian vein is valuable to differentiate large ovarian from non-ovarian tumours. (orig.)

  16. Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, K Fuglsang; Dalsgaard, M

    2013-01-01

    BACKGROUND: In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA......) was evaluated in patients with aortic valve stenosis referred for surgical AVR. METHODS: Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses...... with disagreement between ICA and coronary CTA in univariate analysis. CONCLUSION: In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients...

  17. Fatty degeneration of the rotator cuff muscles on pre- and postoperative CT arthrography (CTA): is the Goutallier grading system reliable?

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eugene; Choi, Jung-Ah; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeongi-do (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Oh, Joo Han [Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seongnam-si, Gyeongi-do (Korea, Republic of); Ahn, Soyeon [Seoul National University Bundang Hospital, Medical Research Collaborating Center, Seongnam-si, Gyeongi-do (Korea, Republic of); Hong, Sung Hwan [Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Chai, Jee Won [SMG-SNU Boramae Medical Center, Department of Radiology, 425 Shindaebang-dong, Dongjak-gu, Seoul (Korea, Republic of)

    2013-09-15

    To retrospectively evaluate fatty degeneration (FD) of rotator cuff muscles on CTA using Goutallier's grading system and quantitative measurements with comparison between pre- and postoperative states. IRB approval was obtained for this study. Two radiologists independently reviewed pre- and postoperative CTAs of 43 patients (24 males and 19 females, mean age, 58.1 years) with 46 shoulders confirmed as full-thickness tears with random distribution. FD of supraspinatus, infraspinatus/teres minor, and subscapularis was assessed using Goutallier's system and by quantitative measurements of Hounsfield units (HUs) on sagittal images. Changes in FD grades and HUs were compared between pre- and postoperative CTAs and analyzed with respect to preoperative tear size and postoperative cuff integrity. The correlations between qualitative grades and quantitative measurements and their inter-observer reliabilities were also assessed. There was statistically significant correlation between FD grades and HU measurements of all muscles on pre- and postoperative CTA (p < 0.05). Inter-observer reliability of fatty degeneration grades were excellent to substantial on both pre- and postoperative CTA in supraspinatus (0.8685 and 0.8535) and subscapularis muscles (0.7777 and 0.7972), but fair in infraspinatus/teres minor muscles (0.5791 and 0.5740); however, quantitative Hounsfield units measurements showed excellent reliability for all muscles (ICC: 0.7950 and 0.9346 for SST, 0.7922 and 0.8492 for SSC, and 0.9254 and 0.9052 for IST/TM). No muscle showed improvement of fatty degeneration after surgical repair on qualitative and quantitative assessments; there was no difference in changes of fatty degeneration after surgical repair according to preoperative tear size and post-operative cuff integrity (p > 0.05). The average dose-length product (DLP, mGy . cm) was 365.2 mGy . cm (range, 323.8-417.2 mGy . cm) and estimated average effective dose was 5.1 mSv. Goutallier grades

  18. Multislice CT angiography in aortic stent grafting: Relationship between image noise and body mass index

    Energy Technology Data Exchange (ETDEWEB)

    Sun Zhonghua [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845 (Australia)]. E-mail: z.sun@curtin.edu.au

    2007-03-15

    Purpose: To investigate the correlation between image noise and body mass index (BMI) in multislice CT angiography (MSCT) for patients with abdominal aortic aneurysm (AAA) treated with endovascular stent grafts. Materials and methods: Seventeen patients who underwent MSCT following endovascular repair of AAA were included in the study. Image noise (standard deviation of the CT attenuation: S.D.) and signal to noise ratio (SNR) were plotted against BMI to demonstrate the correlation using a linear regression method. Image quality of 3D reconstructions was correlated to the SNR and BMI. Results: The r-value of linear regression between S.D. and BMI was 0.578 (p < 0.05), 0.835 and 0.802 (p < 0.001), respectively, at the level of renal artery, aortic aneurysm and common iliac artery. The r-value of linear regression between SNR and BMI was 0.332, 0.516 and 0.552 (p < 0.05), respectively, at above three levels. Image quality of 3D reconstructions was compromised in five patients and diagnosis was affected in two patients with BMI more than 30. Conclusion: A significant correlation was observed between image noise and BMI in MSCT angiography of endovascular repair of AAA. Our findings are valuable for optimisation of MSCT angiography scanning protocols and reduction of radiation dose in MSCT examinations.

  19. Arterial enhancement at abdominal CT angiography: Low- versus high-osmolality contrast media

    Energy Technology Data Exchange (ETDEWEB)

    Rouviere, O.; Berger, P.; Pangaud, C.; Lyonnet, D. [Hopital E. Herriot, Lyon (France). Dept. of Vascular and Genitourinary Radiology; Ecochard, R. [Hospices Civils de Lyon (France). Dept of Biostatistics; Fontaine, B. [Laboratoire Guerbet, Roissy (France)

    2000-09-01

    Purpose: To evaluate the effects of contrast media pharmokinetic differences on aortic enhancement at abdominal CT angiography and to determine whether these effects are of clinical relevance. Material and Methods: Two hundred and twelve patients referred for abdominal CT angiography were included in the study. All abdominal CT angiograms were performed with the same parameters (collimation 3 mm, pitch ratio 1.7, scan delay 30 s) after i.v. injection of 120 ml of contrast medium at 3 ml/s. After randomization, patients received either iobitridol 300 (low-osmolar, 300 mg I/ml), iobitridol 350 (low-osmolar, 350 mg I/ml) or ioxithalamate 350 (high-osmolar, 350 mg I/ml). The time attenuation curves obtained with the three contrast media were compared. Results: The time attenuation curve obtained with ioxithalamate 350 was not parallel to those obtained with iobitridol 300 and iobitridol 350. Mean peak enhancements obtained with iobitridol 350 and ioxithalamate 350 were not significantly different but iobitridol 350 provided higher mean peak enhancement than iobitridol 300. Mean delays of the peak enhancements were the same with the three contrast media. After peak enhancement, the decrease of aortic opacification under a selected threshold of 200 HU was significantly slower with iobitridol 350 than with iobitridol 300 and ioxithalamate 350, whereas iobitridol 300 and ioxithalamate 350 showed no significant differences. Conclusion: For a given iodine concentration, low-osmolality contrast media provide longer aortic opacification and may be recommended for CT angiography when long acquisition times are needed.

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

    NARCIS (Netherlands)

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

    2017-01-01

    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

  1. Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika; Rixe, Johannes; Hamm, Christian [University of Giessen, Department of Cardiology, Giessen (Germany); Marwan, Mohamed; Gauss, Soeren; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Achenbach, Stephan [University of Erlangen, Department of Cardiology, Erlangen (Germany); Schneider, Christian [University of Giessen, Department of Radiology, Giessen (Germany); Lell, Michael [University of Erlangen, Department of Radiology, Erlangen (Germany)

    2012-07-15

    We compared the interobserver variability concerning the detection of calcified and non-calcified plaque in two different low-dose and standard retrospectively gated protocols for coronary CTA. 150 patients with low heart rates and less than 100 kg body weight were randomised and examined by contrast-enhanced dual-source CT coronary angiography (100 kV, 320 mAs). 50 patients were examined with prospectively ECG-triggered axial acquisition, 50 patients with prospectively ECG-triggered high pitch spiral acquisition, and 50 patients using spiral acquisition with retrospective ECG gating. Two investigators independently analysed the datasets concerning the presence of calcified and non-calcified plaque on a per-segment level. Mean effective dose was 1.4 {+-} 0.2 mSv for axial, 0.8 {+-} 0.07 mSv for high-pitch spiral, and 5.3 {+-} 2.6 mSV for standard spiral acquisition (P < 0.0001). In axial acquisition, interobserver agreement concerning the presence of atherosclerotic plaque was achieved in 650/749 coronary segments (86.8%). In high-pitch spiral acquisition, agreement was achieved in 664/748 segments (88.8%, n.s.). In standard spiral acquisition, agreement was achieved in 672/738 segments (91.0%, P < 0.0001). Interobserver agreement was significantly higher for calcified than for non-calcified plaque in all data acquisition modes. Low-dose coronary CT angiography permits the detection of coronary atherosclerotic plaque with good interobserver agreement. (orig.)

  2. Dynamic cone beam CT angiography of carotid and cerebral arteries using canine model

    Energy Technology Data Exchange (ETDEWEB)

    Cai Weixing; Zhao Binghui; Conover, David; Liu Jiangkun; Ning Ruola [Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Department of Radiology, Shanghai 6th People' s Hospital, 600 Yishan Road, Xuhui, Shanghai (China); Koning Corporation, Lennox Tech Enterprise Center, 150 Lucius Gordon Drive Suite 112, West Henrietta, New York 14586 (United States); Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642 (United States) and Koning Corporation, Lennox Tech Enterprise Center, 150 Lucius Gordon Drive Suite 112, West Henrietta, New York 14586 (United States)

    2012-01-15

    Purpose: This research is designed to develop and evaluate a flat-panel detector-based dynamic cone beam CT system for dynamic angiography imaging, which is able to provide both dynamic functional information and dynamic anatomic information from one multirevolution cone beam CT scan. Methods: A dynamic cone beam CT scan acquired projections over four revolutions within a time window of 40 s after contrast agent injection through a femoral vein to cover the entire wash-in and wash-out phases. A dynamic cone beam CT reconstruction algorithm was utilized and a novel recovery method was developed to correct the time-enhancement curve of contrast flow. From the same data set, both projection-based subtraction and reconstruction-based subtraction approaches were utilized and compared to remove the background tissues and visualize the 3D vascular structure to provide the dynamic anatomic information. Results: Through computer simulations, the new recovery algorithm for dynamic time-enhancement curves was optimized and showed excellent accuracy to recover the actual contrast flow. Canine model experiments also indicated that the recovered time-enhancement curves from dynamic cone beam CT imaging agreed well with that of an IV-digital subtraction angiography (DSA) study. The dynamic vascular structures reconstructed using both projection-based subtraction and reconstruction-based subtraction were almost identical as the differences between them were comparable to the background noise level. At the enhancement peak, all the major carotid and cerebral arteries and the Circle of Willis could be clearly observed. Conclusions: The proposed dynamic cone beam CT approach can accurately recover the actual contrast flow, and dynamic anatomic imaging can be obtained with high isotropic 3D resolution. This approach is promising for diagnosis and treatment planning of vascular diseases and strokes.

  3. First results of computerised tomographic angiography using electron beam tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lehmann, K.J.; Weisser, G.; Neff, K.W.; Mai, S.K.; Denk, S.; Georgi, M. [Inst. fuer Klinische Radiologie, Universitaetsklinikum Mannheim, Heidelberg (Germany)

    1999-05-01

    The aim of this study was to evaluate the suitability of electron beam tomography (EBT) with fast continuous volume scanning for CT angiography (CTA) in chest and abdomen. An Evolution XP EBT scanner with a new software version (12.34) was used. One hundred forty images per study can be acquired in 17 s using 3-mm collimation and overlapping image reconstruction. Study protocols for five different clinical applications of EBT CTA were established and evaluated. The EBT CTA technique was performed in 155 patients. High- and homogeneous density values were achieved along the whole course of the vessels; the mean density in the aorta was > 240 HU. Coeliac axis, superior and inferior mesenteric artery, renal and lumbar arteries were visualised in all cases. Maximum intensity projection and shaded surface display reconstruction demonstrated the relation between aneurysm and aortic branches very well due to an excellent resolution along the z-axis. In large scan volumes overlapping image reconstruction demonstrated better resolution along the z-axis than is available with helical CT. The EBT CTA technique proved to be very well suited excellent suitability for evaluation of pulmonary vessels. Compared with helical CT, EBT CTA offers a shorter scan time, which allows higher contrast enhancement in pulmonary vessels. The identification of intraluminal emboli and mural thrombi has improved. The EBT CTA technique is a very reliable tool for evaluation of aortic disease and pulmonary vessels. (orig.) With 3 figs., 9 refs.

  4. Technical innovation: Multidimensional computerized software enabled subtraction computed tomographic angiography.

    Science.gov (United States)

    Bhatia, Mona; Rosset, Antoine; Platon, Alexandra; Didier, Dominique; Becker, Christoph D; Poletti, Pierre-Alexandre

    2010-01-01

    Computed tomographic angiography (CTA) is a frequent noninvasive alternative to digital subtraction angiography. We previously reported the development of a new subtraction software to overcome limitations of adjacent bone and calcification in CT angiographic subtraction. Our aim was to further develop and improve this fast and automated computerized software, universally available for free use and compatible with most CT scanners, thus enabling better delineation of vascular structures, artifact reduction, and shorter reading times with potential clinical benefits. This computer-based free software will be available as an open source in the next release of OsiriX at the Web site http://www.osirix-viewer.com.

  5. Pitfalls in post-mortem CT-angiography--intravascular contrast induces post-mortem pericardial effusion.

    Science.gov (United States)

    Berger, Nicole; Martinez, Rosita; Winklhofer, Sebastian; Flach, Patricia M; Ross, Steffen; Ampanozi, Garyfalia; Gascho, Dominic; Thali, Michael J; Ruder, Thomas D

    2013-11-01

    We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.

  6. Initial experience with prospectively triggered, sequential CT coronary angiography on a 128-slice scanner; Erste Erfahrungen mit der sequenziellen, prospektiv getriggerten CT-Koronarangiografie an einem 128-Schicht-Computertomografen

    Energy Technology Data Exchange (ETDEWEB)

    Anders, K.; Baum, U.; Kuefner, M.A.; Kuettner, A.; Uder, M. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.; Gauss, S.; Achenbach, S.; Daniel, W.G.; Ropers, D. [Universitaetsklinikum Erlangen (Germany). Medizinische Klinik 2

    2009-04-15

    Purpose: Spiral CT angiography (CTA) of the coronaries using low-pitch scanning and ECG-gated image reconstruction is a robust method for detecting or excluding relevant coronary plaque. However, the resulting dose exposure is considerable. The aim of the present study was to evaluate image quality and artifacts as well as to record dose values for sequential coronary CTA using a 128-slice scanner with a temporal resolution of 150 ms. Materials und Methods: 20 patients with a regular heart rate and without contraindications for oral/I.V. beta blockers, who were referred for CTA of the coronaries for exclusion or detection of relevant plaques, were examined by sequential CTA with the following parameters: 120 kV, 200 ref mAs, collimation 2 x 64 x 0.6, table feed of 34.5 mm at a detector width of 38.4 mm. A total acquisition time of 380 ms per table position allowed for mild shifting of the reconstruction window within the cardiac cycle of {+-} 5 %. 50 ml of contrast agent were injected at 5 ml/s followed by a 50 ml split bolus (20 % contrast). The individual start delay was determined by a test bolus scan (10 ml contrast + 50 ml saline flush at 5 ml/s). The image quality for each segment, coronary artery, and patient was determined on a 4-point scale. Dose values were estimated based on the individual dose length product as provided by the scanner's patient protocol. Artifacts were evaluated to determine the cause (calcium vs. motion). Results: All patients received beta blocker pretreatment. The mean heart rate was 62 {+-} 5 beats/min. 5 % (13/286) of all segments in 5/20 patients were rated as non-diagnostic. The mean dose length product was 213 mGy x cm, and the mean effective dose was 3.6 mSv. Calcifications were the major cause of non-diagnostic images. However breathing or other motion artifacts occurred as well. (orig.)

  7. Dynamic CT myocardial perfusion imaging.

    Science.gov (United States)

    Caruso, Damiano; Eid, Marwen; Schoepf, U Joseph; Jin, Kwang Nam; Varga-Szemes, Akos; Tesche, Christian; Mangold, Stefanie; Spandorfer, Adam; Laghi, Andrea; De Cecco, Carlo N

    2016-10-01

    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.

  8. CT Angiography for Living Kidney Donors: Accuracy, Cause of Misinterpretation and Prevalence of Variation

    Energy Technology Data Exchange (ETDEWEB)

    Chai, Jee Won; Lee, Whal; Yin, Yong Hu; Jae, Hwan Jun; Chung, Jin Wook; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Hyeon Hoe [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-08-15

    To determine the accuracy of the use of multi-detector row CT (MDCT) to predict vascular anatomy in living kidney donors and to reveal the prevalence of vascular variations in a Korean population. A total of 153 living kidney donors that had undergone preoperative CT and nephrectomy, either with open or laparoscopic surgery, were selected retrospectively. The initial CT results were compared with the surgical findings and repeated review sessions of CT scans were performed to determine the causes of mismatches in discordant cases. The accuracy of CT angiography was 95% to predict the number of renal vessels. Four arteries and two veins were missed during the initial CT interpretation due to perception errors (for two arteries and two veins) and technical limitations (two arteries). The prevalence of multiple renal arteries and veins, early branching of a renal artery and late confluence of a renal vein were 31%, 5%, 12%, 17%, respectively. The circumaortic renal vein and the bilateral inferior vena cava were found in two cases each (1.3%). One case (0.7%) each of a retroaortic renal vein and a supradiaphragmatic originated renal artery were found. MDCT provides a reliable method to evaluate the vascular anatomy and variations of living kidney donors.

  9. Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Oliver; Jeltsch, Martin; Feuerlein, Sebastian; Brunner, Horst; Brambs, Hans-Juergen; Hoffmann, Martin H.K. [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Ulm (Germany); Nagel, Hans-Dieter [Philips Healthcare, Department of Science and Technology, Hamburg (Germany); Walker, Matthew J. [CT Clinical Science, Philips Healthcare, Cleveland, OH (United States)

    2009-04-15

    To assess image quality and radiation exposure with prospectively gated axial CT coronary angiography (PGA) compared to retrospectively gated helical techniques (RGH). Forty patients with suspected coronary artery disease (CAD) and a stable heart rate below 65 bpm underwent CT coronary angiography (CTCA) using a 64-channel CT system. The patient cohort consisted of 20 consecutive patients examined using a PGA technique and 20 patients examined using a standard RGH technique. Both groups were matched demographically according to age, gender, body mass index, and heart rate. For both groups, two independent observers assessed image quality for all coronary segments on an ordinal scale from 1 (nonassessable) to 5 (excellent quality). Image quality and radiation exposure were compared between patient groups. There were no significant differences in vessel-based image quality between the two groups (P > 0.05). Mean ({+-} SD) effective radiation exposure in the PGA group was 3.7 {+-} 0.8 mSv compared to 18.9 {+-} 3.8 mSv in the RGH group without ECG-based tube current modulation (P < 0.001). Preliminary experience shows PGA technique to be a promising approach for CTCA resulting in a substantial reduction in radiation exposure with image quality comparable to that of standard RGH technique. (orig.)

  10. Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  11. Volume rendering versus maximum intensity projection in CT angiography: what works best, when, and why.

    Science.gov (United States)

    Fishman, Elliot K; Ney, Derek R; Heath, David G; Corl, Frank M; Horton, Karen M; Johnson, Pamela T

    2006-01-01

    The introduction and widespread availability of 16-section multi-detector row computed tomographic (CT) technology and, more recently, 64-section scanners, has greatly advanced the role of CT angiography in clinical practice. CT angiography has become a key component of state-of-the-art imaging, with applications ranging from oncology (eg, staging of pancreatic or renal cancer) to classic vascular imaging (eg, evaluation of aortic aneurysms and renal artery stenoses) as well as newer techniques such as coronary artery imaging and peripheral runoff studies. With an average of 400-1000 images in each volume data set, three-dimensional postprocessing is crucial to volume visualization. Radiologists now have workstations that provide capabilities for evaluation of these data sets by using a range of software programs and processing tools. Although different systems have unique capabilities and functionality, all provide the options of volume rendering and maximum intensity projection for image display and analysis. These two postprocessing techniques have different advantages and disadvantages when used in clinical practice, and it is important that radiologists understand when and how each technique should be used. Copyright RSNA, 2006.

  12. The frequency of intracranial arterial fenestrations: A study with 64-detector CT-angiography

    Energy Technology Data Exchange (ETDEWEB)

    Bayrak, Aylin Hasanefendioglu, E-mail: aylin_has@yahoo.com [Dicle University, School of Medicine, Radiology Department, Diyarbakir (Turkey); Senturk, Senem, E-mail: ssenturk@dicle.edu.tr [Dicle University, School of Medicine, Radiology Department, Diyarbakir (Turkey); Akay, Hatice Ozturkmen, E-mail: hozturkmen@gmail.com [Veni Vidi Hospital, Diyarbakir (Turkey); Ozmen, Cihan Akgul, E-mail: cihanakgul@dicle.edu.tr [Dicle University, School of Medicine, Radiology Department, Diyarbakir (Turkey); Bukte, Yasar, E-mail: ybukte@dicle.edu.tr [Dicle University, School of Medicine, Radiology Department, Diyarbakir (Turkey); Nazaroglu, Hasan, E-mail: hnazarog@dicle.edu.tr [Dicle University, School of Medicine, Radiology Department, Diyarbakir (Turkey)

    2011-03-15

    Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

  13. Digital subtraction angiography in the diagnosis of invasive hydatidiform mole. Comparison with PAG, CT and USG

    Energy Technology Data Exchange (ETDEWEB)

    Ikuma, Kenichiro; Daimon, Michiko; Muranaka, Junko; Suno, Shigeo; Takayasu, Yukio; Shibahara, Hiroaki; Sawai, Hideaki

    1987-11-01

    Pelvic angiography (PAG) by Seldinger is one of the most useful examinations for the diagnosis of trophoblastic disease and also for the assessment of the therapeutic results. This technique, however, causes some stress to the patient. Therefore, noninvasive method, such as computed tomography (CT) and ultrasonography (USG) have recently been introduced. In the 1980s, digital subtraction angiography (DSA) was developed. It is now being used increasingly in the fields of Obstetrics and Gynecology as a substitute for the conventional PAG. In this report, the results of DSA, PAG, CT and USG which were carried out before and after chemotherapy in a patient with invasive hydatidiform mole were compared. In terms of the location, size and shape of the lesion, the CT findings were almost the same as those of USG. In terms of the angiographic findings in the affected area, intravenous DSA (IVDSA) was a sufficiently substitutional examination for conventional PAG. With IVDSA, arterial images can be obtained following the intravenous injection of a contrast medium. Therefore, this technique is excellent in terms of simplicity and safety. From now on, DSA will be utilized instead of PAG as an effective diagnostic method for trophoblastic disease and for follow-up such cases.

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

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Katsuya; Shimada, Kazuhiro [Chiba Univ. (Japan). School of Medicine; Tadokoro, Hiroyuki (and others)

    1999-10-01

    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)

  15. Intracranial aneurysm segmentation in 3D CT angiography: method and quantitative validation

    Science.gov (United States)

    Firouzian, Azadeh; Manniesing, R.; Flach, Z. H.; Risselada, R.; van Kooten, F.; Sturkenboom, M. C. J. M.; van der Lugt, A.; Niessen, W. J.

    2010-03-01

    Accurately quantifying aneurysm shape parameters is of clinical importance, as it is an important factor in choosing the right treatment modality (i.e. coiling or clipping), in predicting rupture risk and operative risk and for pre-surgical planning. The first step in aneurysm quantification is to segment it from other structures that are present in the image. As manual segmentation is a tedious procedure and prone to inter- and intra-observer variability, there is a need for an automated method which is accurate and reproducible. In this paper a novel semi-automated method for segmenting aneurysms in Computed Tomography Angiography (CTA) data based on Geodesic Active Contours is presented and quantitatively evaluated. Three different image features are used to steer the level set to the boundary of the aneurysm, namely intensity, gradient magnitude and variance in intensity. The method requires minimum user interaction, i.e. clicking a single seed point inside the aneurysm which is used to estimate the vessel intensity distribution and to initialize the level set. The results show that the developed method is reproducible, and performs in the range of interobserver variability in terms of accuracy.

  16. Optimal image reconstruction intervals for non-invasive coronary angiography with 64-slice CT

    Energy Technology Data Exchange (ETDEWEB)

    Leschka, Sebastian; Husmann, Lars; Desbiolles, Lotus M.; Boehm, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Gaemperli, Oliver; Schepis, Tiziano; Koepfli, Pascal [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Center for Integrative Human Physiology, Zurich (Switzerland)

    2006-09-15

    The reconstruction intervals providing best image quality for non-invasive coronary angiography with 64-slice computed tomography (CT) were evaluated. Contrast-enhanced, retrospectively electrocardiography (ECG)-gated 64-slice CT coronary angiography was performed in 80 patients (47 male, 33 female; mean age 62.1{+-}10.6 years). Thirteen data sets were reconstructed in 5% increments from 20 to 80% of the R-R interval. Depending on the average heart rate during scanning, patients were grouped as <65 bpm (n=49) and {>=}65 bpm (n=31). Two blinded and independent readers assessed the image quality of each coronary segment with a diameter {>=}1.5 mm using the following scores: 1, no motion artifacts; 2, minor artifacts; 3, moderate artifacts; 4, severe artifacts; and 5, not evaluative. The average heart rate was 63.3{+-}13.1 bpm (range 38-102). Acceptable image quality (scores 1-3) was achieved in 99.1% of all coronary segments (1,162/1,172; mean image quality score 1.55{+-}0.77) in the best reconstruction interval. Best image quality was found at 60% and 65% of the R-R interval for all patients and for each heart rate subgroup, whereas motion artifacts occurred significantly more often (P<0.01) at other reconstruction intervals. At heart rates <65 bpm, acceptable image quality was found in all coronary segments at 60%. At heart rates {>=}65 bpm, the whole coronary artery tree could be visualized with acceptable image quality in 87% (27/31) of the patients at 60%, while ten segments in four patients were rated as non-diagnostic (scores 4-5) at any reconstruction interval. In conclusion, 64-slice CT coronary angiography provides best overall image quality in mid-diastole. At heart rates <65 bpm, diagnostic image quality of all coronary segments can be obtained at a single reconstruction interval of 60%. (orig.)

  17. Dose reduction during CT coronary angiography; La reduction de dose en coroscanographie

    Energy Technology Data Exchange (ETDEWEB)

    Willoteaux, S.; Sibileau, E.; Caroff, J.; Nedelcu, C.; Thouveny, F. [Service de Radiologie, Hopital Larrey, CHU d' Angers, 49 - Angers (France); Abi Kalil, W.; Delepine, S. [Service de Cardiologie, Hopital Larrey, CHU d' Angers, 49 - Angers (France)

    2010-11-15

    Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate. (authors)

  18. Lung cancer risk prediction to select smokers for screening CT--a model based on the Italian COSMOS trial.

    Science.gov (United States)

    Maisonneuve, Patrick; Bagnardi, Vincenzo; Bellomi, Massimo; Spaggiari, Lorenzo; Pelosi, Giuseppe; Rampinelli, Cristiano; Bertolotti, Raffaella; Rotmensz, Nicole; Field, John K; Decensi, Andrea; Veronesi, Giulia

    2011-11-01

    Screening with low-dose helical computed tomography (CT) has been shown to significantly reduce lung cancer mortality but the optimal target population and time interval to subsequent screening are yet to be defined. We developed two models to stratify individual smokers according to risk of developing lung cancer. We first used the number of lung cancers detected at baseline screening CT in the 5,203 asymptomatic participants of the COSMOS trial to recalibrate the Bach model, which we propose using to select smokers for screening. Next, we incorporated lung nodule characteristics and presence of emphysema identified at baseline CT into the Bach model and proposed the resulting multivariable model to predict lung cancer risk in screened smokers after baseline CT. Age and smoking exposure were the main determinants of lung cancer risk. The recalibrated Bach model accurately predicted lung cancers detected during the first year of screening. Presence of nonsolid nodules (RR = 10.1, 95% CI = 5.57-18.5), nodule size more than 8 mm (RR = 9.89, 95% CI = 5.84-16.8), and emphysema (RR = 2.36, 95% CI = 1.59-3.49) at baseline CT were all significant predictors of subsequent lung cancers. Incorporation of these variables into the Bach model increased the predictive value of the multivariable model (c-index = 0.759, internal validation). The recalibrated Bach model seems suitable for selecting the higher risk population for recruitment for large-scale CT screening. The Bach model incorporating CT findings at baseline screening could help defining the time interval to subsequent screening in individual participants. Further studies are necessary to validate these models.

  19. Preoperative diagnosis of the thoracic aortic aneurysm by three-dimensional CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Hideo; Ino, Takashi; Ide, Hirofumi; Mizuhara, Akihiro; Yamaguchi, Atsushi; Kawahito, Koji; Kobayashi, Yasuyuki; Nagai, Jun (Jichi Medical School, Minamikawachi, Tochigi (Japan))

    1993-09-01

    Serial eight patients with thoracic aortic aneurysms were evaluated by a newly developed three-dimensional CT angiography (3D-CT) from December 1992 to January 1993. The patients include 3 aortic dissections, 3 aortic arch aneurysms, one descending aortic aneurysm and one thoraco-abdominal aortic aneurysm. The surgical treatment was performed after the evaluation of 3D-CT, and the operative findings were compared to the three-dimensional images reconstructed by 3D-CT in all patients. Three-dimensional displays were achieved using the unique method of data collection of the helical (spinal) scanner with continuous tube rotation and continuous table feed. An intravenous contrast material was used to image the thoracic aorta and major aortic branches with the single-breath-hold technique. Two and three-dimensional images reconstructed by 3D-CT were displayed within 10-20 minutes after the scanning. These three-dimensional images of the aortic lesions could be displayed in any angle we chose. Three-dimensional structures of the thoracic aorta and major aortic branches were clearly visualized and easily recognized by 3D-CT. These images were similar to the intraoperative findings and were quite useful to determine the operative procedure. The successful repair of thoracic aortic aneurysm was achieved in all cases. 3D-CT is a new and attractive modality to assess the vascular system. Although our experience is limited, 3D-CT may be a useful and powerful diagnostic method for the surgical treatment of thoracic aortic aneurysm. (author).

  20. Comparative Study on 16-slice CT Coronary Angiography vs Conventional Coronary Angiography-A Report of 38 Cases

    Institute of Scientific and Technical Information of China (English)

    Yan CHEN; Ping HAN; Bo LIANG; Huimin LIANG; Ziqiao LEI; Zhiliang TIAN; Gansheng FENG; Jie XIAO

    2008-01-01

    The clinical application of 16-slice CT coronary angiography (CTCA) and the impact of plaques differently characterized on assessing coronary artery stenosis were evaluated. Thirty-eight patients with coronary artery disease diagnosed by conventional coronary angiography (CAG) un- derwent 16-slice CTCA (collimation: 16×0.75 mm; rotation time: 420 msec; kernel: 35f; effective current: 500 mAs; tube voltage: 120 kV). The interval between CTCA and CAG was within one month. CTCA was evaluated by consensus of two independent experienced radiologists unknowing CAG findings. Original images, maximum intensity projections and multiplanar reconstructions were used to assess coronary artery stenosis. For a determined plaque an attenuation value≥130 HU was considered as calcified, and <130 HU noncalcified. The plaques were then classified into significant calcification (extensive calcification), medium calcification (small isolated calcification) and noncal- cification. The diagnostic accuracy of 16-slice CTCA findings as well as to detect ≥50% stenoses caused by plaques was evaluated respectively regarding CAG as the standard of reference. In com- parison with CAG findings, the sensitivity, specificity, positive and negative predictive value derived from CTCA for mild stenosis (<50%) were 72.7%, 38.5%, 50%, 62.5%, respectively; for moderate stenosis (50%-75%) 82.4%, 72.7%, 70%, 84.2%, resepctively; and for severe coronary stenosis (>75%) 85%, 90.5%, 81%, 92.7% respectively. With the increase of stenoses degree, the value of CTCA was greater. For the classification of the plaque calcification with ≥50% stenosis CTCA at- tained the sensitivity, specificity, positive and negative predictive value for severe calcificatoin 73.3%, 22.2%, 61.1% and 33.3%, respectively; for moderate calcification 70%, 55.6%, 63.6% and 62.5%, respectively; for noncalcification 93.8%, 85.7%, 93.8% and 85.7% respectively. CTCA was restricted in assessing coronary artery stenosis in the

  1. 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...

  2. 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.

  3. Diagnosis of the thoracic aortic aneurysm by three-dimensional CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Hideo; Ino, Takafumi; Kobayashi, Yasuyuki; Nagai, Jun; Ide, Hirofumi; Mizuhara, Akihiro; Yamaguchi, Atsushi; Kawahito, Koji (Jichi Medical School, Minamikawachi, Tochigi (Japan))

    1993-07-01

    Twenty patients with thoracic aortic aneurysms were evaluated by a newly developed three-dimensional CT angiography (3D-CT) from December 1992 to February 1993. The patients included 12 aortic dissections, 7 true thoracic aortic aneurysms and one thoraco-abdominal aortic aneurysm. Three-dimensional displays were achieved rapidly in all cases using helical (spinal) CT which is a new technology with continuous tube rotation and continuous table feed. An intravenous contrast material was used to image the thoracic aortic aneurysm and the major aortic branches with single-breath-hold technique. Surgical treatment was performed in eight of 20 patients, and the aortic lesions in three cases were confirmed intraoperatively. Three-dimensional structures of the thoracic aorta and major branches were clearly visualized by 3D-CT and these images were useful to determine the operative procedure in surgical cases. 3D-CT is a new modality of evaluating the vascular system and may be a powerful and useful diagnostic method for the surgical intervention of thoracic aortic aneurysm. (author).

  4. Dose reduction potential of iterative reconstruction algorithms in neck CTA-a simulation study.

    Science.gov (United States)

    Ellmann, Stephan; Kammerer, Ferdinand; Allmendinger, Thomas; Brand, Michael; Janka, Rolf; Hammon, Matthias; Lell, Michael M; Uder, Michael; Kramer, Manuel

    2016-10-01

    This study aimed to determine the degree of radiation dose reduction in neck CT angiography (CTA) achievable with Sinogram-affirmed iterative reconstruction (SAFIRE) algorithms. 10 consecutive patients scheduled for neck CTA were included in this study. CTA images of the external carotid arteries either were reconstructed with filtered back projection (FBP) at full radiation dose level or underwent simulated dose reduction by proprietary reconstruction software. The dose-reduced images were reconstructed using either SAFIRE 3 or SAFIRE 5 and compared with full-dose FBP images in terms of vessel definition. 5 observers performed a total of 3000 pairwise comparisons. SAFIRE allowed substantial radiation dose reductions in neck CTA while maintaining vessel definition. The possible levels of radiation dose reduction ranged from approximately 34 to approximately 90% and depended on the SAFIRE algorithm strength and the size of the vessel of interest. In general, larger vessels permitted higher degrees of radiation dose reduction, especially with higher SAFIRE strength levels. With small vessels, the superiority of SAFIRE 5 over SAFIRE 3 was lost. Neck CTA can be performed with substantially less radiation dose when SAFIRE is applied. The exact degree of radiation dose reduction should be adapted to the clinical question, in particular to the smallest vessel needing excellent definition.

  5. CT coronary angiography: new risks for low-risk chest pain.

    Science.gov (United States)

    Radecki, Ryan Patrick

    2013-10-01

    Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk-stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.

  6. 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)

  7. Non-ECG-gated CT pulmonary angiography and the prediction of right ventricular dysfunction in patients suspected of pulmonary embolism

    DEFF Research Database (Denmark)

    Gutte, Henrik; Mortensen, Jann; Mørk, Mette Louise;

    2016-01-01

    PURPOSE: Right ventricular dysfunction (RVD) is an important prognostic factor of 30-day mortality in patients with acute pulmonary embolism (PE). The aim of our study was to evaluate whether non-electrocardiogram (ECG)-gated cardiovascular parameters attained during computed tomography pulmonary...... angiography (CTPA) could predict RVD in patients suspected of PE using ECG-gated cardiac CT angiography as reference. METHODS: Consecutive patients suspected of PE were referred to a ventilation/perfusion single-photon emission tomography (V/Q-SPECT) as first-line imaging procedure. Patients had a V....../Q-SPECT/CT, a CTPA and an ECG-gated cardiac CT angiography performed the same day. RESULTS: A total of 71 patients were available for analysis. Seventeen patients (24%) had RVD. The non-ECG-gated dimensions of left and right ventricle and the major vessels were correlated with ECG-gated cardiac dimensions. The size...

  8. Value of CT enterography and CTA in diagnosis of intestinal Crohn′s disease%克罗恩病的小肠CTE联合CTA诊断

    Institute of Scientific and Technical Information of China (English)

    周敏清; 谢宝君

    2015-01-01

    Objective:To investigate the value of CT enterography (CTE)and CTA in diagnosis of intestinal Crohn′s disease (CD).Methods:Retrospective analysis was made on 22 patients with CD,all of them underwent CTE and CTA examination and several reconstruction methods were used for image post-processing.The imaging characteristics of CD were analyzed by two radiologists,and the accuracy of CTE and CTE combined with CTA for localization diagnosis of CD was compared.Results:33 segments of small bowel in the 22 CD patients were involved,among which 22 segments were di-agnosed correctly by CTE,and 29 segments were diagnosed correctly by CTE combined with CTA,there was significant difference between the two methods(χ2= 4.2,P<0.05).The accuracy of the CTE combined with CTA method positioning in small bowel lesions are higher than the conventional CTE fractionation method.The major CT findings:intestinal wall thickening (20/22),obvious enhancement of intestinal wall (17/22)or mucosa (10/22),lumen stenosis (10/22),engorged vasa recta (7/22),mesenteric lymph nodes hyperplasia (4/22).Extra-enteric complications included fistulas (1/22),absces-ses (1/22),and renal stones (1/22).Conclusion:CTE combined with CTA can accurately display the main features of intes-tinal Crohn′s disease,and is superior to conventional CTE for the localization diagnosis of CD.%目的:探讨CT小肠造影(CTE)联合肠系膜血管成像对克罗恩病的诊断价值。方法:回顾性分析22例经临床确诊的克罗恩病患者的CT资料,所有患者均行小肠CTE联合肠系膜血管重组检查,并采用多种图像后处理技术进行图像重组,由两位放射医师分析病变的影像学表现,并对比常规CTE和CTE结合肠系膜动脉CTA这2种方法对克罗恩病的定位诊断准确性。结果:2 2例克罗恩病患者中共33段小肠受累,采用常规CTE分组法正确诊断22段,联合CTA后正确诊断29段,两者比较差异有统计学意义(χ2=4.2

  9. Effect of saline flush on enhancement of proximal and distal segments using 320-row coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Tomizawa, Nobuo, E-mail: tomizawa-tky@umin.ac.jp [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Suzuki, Fumio; Akahane, Masaaki [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Torigoe, Rumiko [Toshiba Medical Systems Corporation, Tokyo Metropolitan Regional Office, 1-6, Tsukuda 2-Chome, Chuo-ku, Tokyo 104-0051 (Japan); Kiryu, Shigeru [Department of Radiology, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639 (Japan); Ohtomo, Kuni [Department of Radiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan)

    2013-08-15

    Objective: To investigate the effect of saline flush on coronary CT angiography of proximal, middle, and distal coronary artery segments, using 320-row CT, and to compare two injection duration protocols as to amount of contrast in the right heart chambers. Methods: This retrospective study was approved by the local ethics committee, and the requirement for informed consent to participate in this study was waived. The final study group included 108 patients who underwent coronary CT angiography. The first 36 patients received contrast medium without saline flush (group 1); the next 36 patients received contrast medium for 14 s and saline flush (group 2); the last 36 patients received contrast medium for 12 s and saline flush (group 3). The CT number, noise, contrast-to-noise ratio (CNR), and number of segments with a CT number greater than 325 Hounsfield units (HU) were recorded for proximal, middle, and distal segments. Results: The CT numbers and the CNR in groups 2 and 3 were significantly higher than that in group 1 (p < 0.005); the difference between groups 2 and 3 was not significant. The proportion of segments greater than 325 HU improved with saline flush (p < 0.05), with a larger improvement in the distal segments. Conclusions: Saline flush improves enhancement and CNR of coronary arteries, particularly of distal segments, in coronary CT angiography using 320-row CT. An average contrast medium injection of 44 mL was feasible using a saline flush.

  10. Triple-rule-out dual-source CT angiography of patients with acute chest pain: Dose reduction potential of 100 kV scanning

    Energy Technology Data Exchange (ETDEWEB)

    Krissak, Radko, E-mail: radko.krissak@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Henzler, Thomas; Prechel, Anne; Reichert, Miriam [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Gruettner, Joachim; Sueselbeck, Tim [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Schoenberg, Stefan O.; Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: To investigate the dose reduction potential of low kV triple-rule-out dual-source CT angiography (TRO-CTA) in non-obese (BMI ≤ 25 kg/m{sup 2}) patients with acute chest pain. Materials and methods: Sixty consecutive patients were randomly assigned to two different retrospectively ECG-gated TRO-CTA protocols in this prospective trial: Thirty patients were examined with a 120-kV standard protocol (320 reference mAs with automatic tube current modulation, automatically adapted pitch and ECG-pulsing) and served as the control group (group 1), an otherwise identical 100 kV protocol was used in the other thirty patients (group 2) for a radiation dose reduction. Subjective image quality was assessed on a 5 point scale (1: excellent, 5: non-diagnostic) by two blinded observers. Quantitative image analysis assessed vascular attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in different vascular segments. The effective dose was calculated from the dose length product (DLP) using a conversion coefficient of 0.017 mSv mGy{sup −1} cm{sup −1}. Results: There was no significant difference of age, BMI, heart rate, pitch or scan length between both patient groups. Subjective image quality was rated similar in both groups (group 1: 1.2 ± 0.4, group 2: average score = 1.3 ± 0.5). Vessel attenuation was significantly higher in group 2 than in group 1 (ascending aorta: 456 ± 83 HU vs. 370 ± 78 HU, p < 0.001; pulmonary artery: 468 ± 118 HU vs. 411 ± 91 HU, p = 0.03; left coronary artery: 437 ± 110 HU vs. 348 ± 89 HU, p < 0.001), however, there was no significant difference in SNR (13.2 ± 7.6 vs. 14.5 ± 7.5, p = 0.49) or CNR (13.8 ± 6.6 vs. 15.9 ± 7.7, p = 0.25). The effective radiation dose of the 100 kV protocol was significantly lower (9.6 ± 3.2 mSv vs. 18.1 ± 9.4 mSv, p < 0.0001). Conclusion: TRO-CTA with 100 kV is feasible in non-obese patients and results in diagnostic image quality and significantly reduced radiation dose.

  11. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  12. The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique,Tll level abdominal aorta was set as the target vessel and the threshold was 180-200 Hu, slice width was 3 mm and with a pitch of 4-6.Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rupture site of abdominal aorta intima and mural thrombus. Conclusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

  13. Prevalence of clinically important posterior fossa emissary veins on CT angiography

    Directory of Open Access Journals (Sweden)

    Yeliz Pekcevik

    2014-01-01

    Full Text Available Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64-slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV was not identified in 37 (22.3% patients. It was found bilaterally in 82 (49.4% and unilaterally in 47 (28.3% patients. Only six patients had more than one MEV that were very small (5 mm veins. The posterior condylar vein (PCV was not identified in 39 (23.5% patients. It was found bilaterally in 97 (58.4% and unilaterally in 30 (18.1% patients. Only 15 patients had a very large (>5 mm PCV. The petrosquamosal sinus (PSS was identified only in one patient (0.6% on the left side. The occipital sinus was found in two patients (1.2%. Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  15. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

    DEFF Research Database (Denmark)

    Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini

    2016-01-01

    tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed...... the receiver-operating characteristics curve (AUC) analysis. Ischaemia was defined by FFR or FFRCT ≤0.80. Plaque volumes were inversely related to FFR irrespective of stenosis severity. Relative risk (95% confidence interval) for prediction of ischaemia for stenosis >50%, NCP ≥185 mm(3), LD-NCP ≥30 mm(3), CP...

  16. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography

    DEFF Research Database (Denmark)

    Rochitte, Carlos E; George, Richard T; Chen, Marcus Y

    2014-01-01

    AIMS: To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed...... tomography (SPECT). METHODS AND RESULTS: We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ≥50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon...

  17. 冠状动脉CT造影SYNTAX积分可重复性及准确性研究%The repeatability and accuracy of coronary CT angiography SYNTAX score

    Institute of Scientific and Technical Information of China (English)

    王忠民; 刘煜昊; 朱绍成; 徐予; 朱中玉; 高传玉

    2015-01-01

    目的:分析冠状动脉CT造影SYNTAX积分的可重复性及准确性,为其临床应用奠定基础。方法回顾性分析2012年2月至2013年2月行冠状动脉CT造影及侵入性冠状动脉造影检查的223例患者,分别计算两种方法得出的SYNTAX积分。采用Kappa分析法评价CT冠状动脉造影SYNTAX积分的可重复性。以侵入性冠状动脉造影为金标准,进行配对样本t检验、Spearman's rank test分析及Bland-Altman法分析CT冠状动脉造影SYNTAX积分的准确性。采用双侧P<0.05为差异有统计学意义。结果 CT冠状动脉造影SYNTAX积分读者间及读者内的可重复性极好,K值均>0.75。侵入性冠状动脉造影与CT冠状动脉造影无显著统计学差异(平均值19.44vs.20.40, P=0.295)。相关分析显示两者之间显著正相关(r=0.931,P<0.001)。结论 CT冠状动脉造影SYNTAX积分可重复性好,准确性高。基于CT冠状动脉造影SYNTAX积分值得今后在临床上加以推广应用。%ObjectiveTo determine the repeatability and accuracy of coronary CT angiography SYNTAX score.Methods We evaluated 223 patients that underwent coronary CT angiography (CTA) and subsequent invasive coronary angiography (ICA). Vessel-specific SYNTAX scores, as well as global SYNTAX scores, were calculated from CTA and ICA in blinded fashion by independent and experienced investigators. Kappa analysis was used to analysis the repeatability of CTA. Paired samplet test, Spearman’s rank test analysis and Bland-Altman analysis method was used to analysis the accuracy of CTA. With double sideP0.75. There was no statistically significant difference between ICA and CTA (average: 19.44vs. 20.40,P=0.295). Correlation analysis showed significantly positive correlation between the two methods (r=0.931,P<0.931).ConclusionSYNTAX score derived from CTA demonstrate excellent repeatability and accuracy, which is worthy of clinical application.

  18. Usefulness and problems of three-dimensional CT (3D-CT) in the neurosurgical patients

    Energy Technology Data Exchange (ETDEWEB)

    Terada, Kousaku; Tajitsu, Kenichiro; Ichitsubo, Hidenori [Kaseda Hospital, Kagoshima (Japan); Moriya, Nobuhide; Kadota, Koki; Asakura, Tetsuhiko

    1997-11-01

    Helical CT scanning is a new technique that can uninterruptedly generate a volume of data. The data thus acquired with or without contrast medium is reconstructed for three-dimensional CT (3D-CT) or three-dimensional CT angiography (3D-CTA). The authors have studied 36 aneurysms, 11 aterosclerotic lesions, 16 tumors and 14 traumatic lesions in more than 60 patients with 3D-CT or 3D-CTA. Aneurysm is visualized clearly on 3D-CTA. The ability to rotate images in all planes aids in showing the aneurysm neck and dome, parent artery and surrounding bony structures. 3D-CTA can assist the surgeon in the approach to the aneurysm. Imaging of the infraclinoid portion of the internal carotid artery may be inadequate with 3D-CTA because of contrast enhancement of the cavernous sinus and the anterior portion of the lesser sphenoid wing. Stenosis or occlusion of the circle of Willis and the common carotid artery bifurcation is well identified on 3D-CTA. It is noted that 3D-CTA delineates inaccurately stenosis severity because of partial volume effects, the threshold level and the timing of scanning. Well-enhanced brain tumors such as meningioma are demonstrated clearly. The relationship of the tumor to surrounding major arteries and bony structures is well defined on enhanced 3D-CT. Marked transposition of skull fracture by head trauma is shown distinctly on 3D-CT. In conclusion, although this technique requires further development and clinical evaluation, the authors` experience with 3D-CT and 3D-CTA suggests that this may become a valuable tool in the diagnosis of neurosurgical patients. (author)

  19. 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.

  20. Blunt polytrauma: evaluation with 64-section whole-body CT angiography.

    Science.gov (United States)

    Dreizin, David; Munera, Felipe

    2012-01-01

    Blunt polytrauma remains a leading cause of death and disability worldwide. With the major advances in computed tomography (CT) technology over the past decade, whole-body CT is increasingly recognized as the emerging standard for providing rapid and accurate diagnoses within the narrow therapeutic window afforded to trauma victims with multiple severe injuries. With a single continuous acquisition, whole-body CT angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis. As its use becomes more widespread, the large volume of information inherent to whole-body CT poses new challenges to radiologists in providing efficient and timely interpretation. An awareness of trauma scoring systems and injury mechanisms is essential to maintain an appropriate level of suspicion in the search for multiple injuries, and the use of multiplanar reformation and three-dimensional postprocessing techniques is important to maximize efficiency in the search. Knowledge of the key injuries that require urgent surgical or percutaneous intervention, including major vascular injuries and active hemorrhage, diaphragmatic rupture, unstable spinal fractures, pancreatic injuries with ductal involvement, and injuries to the mesentery and hollow viscera, is also necessary.

  1. Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  2. 3-T contrast-enhanced MR angiography in evaluation of suspected intracranial aneurysm: comparison with MDCT angiography.

    Science.gov (United States)

    Nael, Kambiz; Villablanca, J Pablo; Mossaz, Léonard; Pope, Whitney; Juncosa, Alex; Laub, Gerhard; Finn, J Paul

    2008-02-01

    The purpose of this study was to prospectively evaluate a high-spatial-resolution contrast-enhanced 3-T MR angiography protocol for detection and characterization of intracranial aneurysms and to compare the results with those of MDCT angiography. Forty-one patients with suspected intracranial aneurysm underwent high-spatial-resolution 3D contrast-enhanced MR angiography and CT angiography (CTA). With a generalized autocalibrating partially parallel acquisition algorithm with an acceleration factor of 4 at 3 T, contrast-enhanced MR angiographic images were acquired over 20 seconds with a spatial-resolution of 0.7 x 0.7 x 0.8 mm. CTA images were acquired with a spatial resolution of 0.35 x 0.35 x 0.8 mm on a 16-MDCT scanner in 17 seconds. The images from the two studies were evaluated independently by two neuroradiologists for image quality, presence of aneurysm, and characterization of aneurysm. The dimensions of the aneurysm were measured independently with both techniques. A total of 25 aneurysms were identified with both contrast-enhanced MR angiography and CTA. A comparative analysis of detection and depiction of aneurysms showed excellent interobserver agreement for both contrast-enhanced MR angiography (kappa = 0.81) and CTA (kappa = 0.91) images. There was significant correlation between the techniques for both qualitative assessment of aneurysm depiction (rho = 0.92; 95% CI, 0.88-0.95) and quantitative dimensional measurement of aneurysm size (r = 0.94; 95% CI, 0.92-0.97). Contrast-enhanced MR angiography at 3 T is reliable for evaluation and characterization of intracranial aneurysms. The results are comparable with those of MDCTA.

  3. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Yavas, Ulas Savas; Calisir, Cuneyt; Ozkan; Ibrahim Ragip [Eskisehir Osmangazi University, Eskisehir (Turkmenistan)

    2008-12-15

    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.

  5. 64-Slice CT Angiography in Diagnosis of Congenital Heart Disease in Children%64排CTA在小儿先天性心脏病的应用

    Institute of Scientific and Technical Information of China (English)

    时胜利; 陈志平; 冯东曚

    2013-01-01

    Objective To investigate the value of 64-slice CT angiography(CTA) and post-processing(reconstruction) technique in the diagnosis of children with congenital heart disease.Methods The clinical and CT data of children with congenital heart disease undergoing CT angiography from April 2010 to March 2012 in our hospital were analyzed to summarize the diagnosis method of post-processing(reconstruction) technique.Results All 73 patients with congenital heart disease were confirmed by CT angiography,in which 40 cases were with complex congenital heart disease,17 cases with atrial septal defect,43 cases with ventricular septal defect,7 cases with patent ductus arteriosus,5 cases with pulmonary artery stenosis,1 case with congenital atresia of pulmonary artery,22 cases with right ventricular outflow tract obstruction,3 cases with anomalous pulmonary venous connection,2 cases with aortic stenosis,4 cases with persistent left superior vena cava,3 cases with right aortic arch.As compared with ultrasonography and surgical outcomes,there was no obvious difference among them.Conclusion 64-slice CT angiography and post-processing reconstruction technique has significant practical value in diagnosis of children congenital heart disease.%目的 探讨64排CTA对小儿先天性心脏病的诊断价值及后处理重建方法.方法 收集整理郑州市儿童医院2010年4月-2012年3月期间经64排心脏CTA检查患儿的临床及CT资料并进行分析,总结小儿先天性心脏病64排CTA后处理诊断方法.结果 73例经64排CTA检查的先天性心脏病患儿均能明确诊断,其中复杂先心病40例,有房间隔缺损者17例,有室间隔缺损者43例,有动脉导管未闭者7例,有肺动脉狭窄者5例,先天性肺动脉闭锁1例,有右室流出道狭窄者22例,有肺静脉异位引流者3例,有主动脉狭窄者2例,永存左上腔静脉4例,右位主动脉弓3例.与彩超及手术结果比较差异无统计学意义.结论 小儿先天性心脏病的64

  6. Prospectively ECG Gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: Impact on cardiac related motion artifacts and patient radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Shuman, William P., E-mail: wshuman@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Leipsic, Jonathon A., E-mail: JLeipsic@providencehealth.bc.ca [University of British Columbia and St. Paul' s Hospital, Department of Radiology, 1081 Burrard Street, Vancouver, BC, V6Z1Y6 (Canada); Busey, Janet M., E-mail: jbonny@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Green, Douglas E., E-mail: dougreen@uw.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Pipavath, Sudhakar N., E-mail: snjp@u.wwashington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States); Hague, Cameron J., E-mail: cjhague@interchange.ubc.ca [University of British Columbia and St. Paul' s Hospital, Department of Radiology, 1081 Burrard Street, Vancouver, BC, V6Z1Y6 (Canada); Koprowicz, Kent M., E-mail: kentk@u.washington.edu [Department of Radiology, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195 (United States)

    2012-09-15

    Objective: To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose. Subjects and methods: Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters. Results: Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9 mSv versus 6.8 mSv, p = 0.02). Similar results were found in the prospectively ECG gated exams from the second institution. Conclusion: Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose.

  7. Dose reduction in spiral CT angiography of thoracic outlet syndrome by anatomically adapted tube current modulation

    Energy Technology Data Exchange (ETDEWEB)

    Mastora, I.; Remy-Jardin, M.; Remy, J. [Dept. of Radiology, University Center Hospital Calmette, Lille (France); Medical Research Group, Lille (France); Suess, C.; Scherf, C. [Siemens Medical Systems, Forcheim (Germany); Guillot, J.P. [Dept. of Radiology, University Center Hospital Calmette, Lille (France)

    2001-04-01

    The aim of this study was to evaluate dose reduction in spiral CT angiography of the thoracic outlet by on-line tube-current control. Prospectively, 114 patients undergoing spiral CT angiography of the subclavian artery for thoracic outlet arterial syndromes were evaluated with and without tube-current modulation at the same session (scanning parameters for the two successive angiograms, one in the neutral position and one after the postural maneuver): 140 kV; 206 mA; scan time 0.75 s; collimation 3 mm; pitch = (1). The dose reduction system was applied in the neutral position in the first 92 consecutive patients and after postural maneuver in the remaining 22 consecutive patients. Dose reduction and image quality were analyzed in the overall study group (group 1; n = 114). The influence of the arm position was assessed in 44 of the 114 patients (group 2), matched by the transverse diameter of the upper thorax. The mean dose reduction was 33 % in group 1 (range 22-40 %) and 34 % in group 2 (range 26-40 %). In group 2 the only difference in image quality was a significantly higher frequency of graininess on low-dose scans compared with reference scans whatever the patient's arm position, graded as minimal in 38 of the 44 patients (86 %). When the low-dose technique was applied after postural maneuver in group 2: (a) the mean dose reduction was significantly higher (35 vs 32 % in the neutral position; p = 0.006); (b) graininess was less frequent (82 vs 91 % in the neutral position); and (c) the percentage of graininess graded as minimal was significantly higher (83 vs 70 % in the neutral position; p = 0.2027). On-line tube-current modulation enables dose reduction on high-quality, diagnostic spiral CT angiograms of the thoracic outlet and should be applied during data acquisition in the neutral position and after postural maneuver for optimal use. (orig.)

  8. Can segmented 3D images be used for stenosis evaluation in coronary CT angiography?

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Chunliang [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden)], e-mail: chunliang.wang@liu.se; Persson, Anders; De Geer, Jakob; Smedby, Oerjan [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden); Engvall, Jan [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Clinical Physiology, Linkoeping (Sweden); Czekierda, Waldemar; Bjoerkholm, Anders [Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden); Fransson, Sven-Goeran [Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden)

    2012-10-15

    Background Thanks to the development of computed tomography (CT) scanners and computer software, accurate coronary artery segmentation can be achieved with minimum user interaction. However, the question remains whether we can use these segmented images for reliable diagnosis. Purpose To retrospectively evaluate the diagnostic accuracy of coronary CT angiography (CCTA) using segmented 3D data for the detection of significant stenosis. Material and Methods CCTA data-sets from 30 patients were acquired with a 64-slice CT scanner and segmented using the region growing (RG) method and the 'virtual contrast injection' (VC) method. Three types of images of each patient were reviewed by different reviewers for the presence of stenosis with diameter reduction of 50% or more. The evaluation was performed on four main arteries of each patient (120 arteries in total). For the original series, the reviewer was allowed to use all the 2D and 3D visualization tools available (conventional method). For the segmented results from RG and VC, only maximum intensity projection was used. Evaluation results were compared with catheter angiography (CA) for each artery in a blinded fashion. Results Overall, 34 arteries with significant stenosis were identified by CA. The percentage of evaluable arteries, accuracy and negative predictive value for detecting stenosis were, respectively, 86%, 74%, and 93% for the conventional method, 83%, 71%, and 92% for VC, and 64%, 56%, and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (P < 0.01), whereas there was no significant difference in accuracy between the VC method and the conventional method (P = 0.22). Conclusion The diagnostic accuracy for the RG-segmented 3D data is lower than those with access to 2D images, whereas the VC method shows diagnostic accuracy similar to the conventional method.

  9. 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.

  10. Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

    NARCIS (Netherlands)

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

    2015-01-01

    textabstractAim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified b

  11. Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

    NARCIS (Netherlands)

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

    2015-01-01

    textabstractAim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified b

  12. Dose reduction with adaptive bolus chasing computed tomography angiography.

    Science.gov (United States)

    Cai, Zhijun; Bai, Er-Wei; Wang, Ge; Sharafuddin, Melhem J; Abada, Hicham T

    2010-01-01

    Computed Tomography (CT) has become an effective diagnosis and evaluating tool in clinical; however, its radiation exposure has drawn great attention as more and more CT scans are performed every year. How to reduce the radiation dose and meanwhile keep the resultant CT images diagnosable becomes an important research topic. In this paper, we propose a dose reduction approach along with the adaptive bolus chasing CT Angiography (CTA) techniques, which are capable of tracking the contrast bolus peak over all the blood vessel segments during the CTA scan. By modulating the tube current (and collimator width) online, we can reduce the total radiation dose and maintain the contrast to noise ratio (CNR) of the blood vessel. Numerical experiments on reference DSA data sets show that by using the proposed dose reduction method, the effective radiation dose can be saved about 39%.

  13. 64层螺旋CT血管成像在自发性蛛网膜下腔出血中的应用价值%Application value of 64 slice spiral CT angiography in spontaneous subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    白光宇

    2016-01-01

    目的:总结、探讨64层螺旋CT血管成像在自发性蛛网膜下腔出血诊断中的应用价值。方法:收治自发性蛛网膜下腔出血患者110例,给予64层螺旋CT扫描及数字减影血管造影,再以容积再现、曲面重组、最大密度投影、多平面重组等方法处理。结果:110例 ASH 患者均经过 DSA、手术证实。动脉瘤及脑血管畸形105例,检出率95.45%,CTA 诊断符合率达100.00%。结论:64层螺旋 CT 血管成像在自发性蛛网膜下腔出血诊断中应用价值极高,可为临床疾病诊断、治疗提供有效依据。%Objective:To summarize and discuss the value of 64 slice spiral CT angiography in the diagnosis of spontaneous subarachnoid hemorrhage.Methods:110 patients with spontaneous subarachnoid hemorrhage were selected.64 slice spiral CT scanning and digital subtraction angiography were given,and then the volume rendering,surface reconstruction,maximum density projection,multi planar reconstruction and other methods were given.Results:110 cases of ASH were confirmed by DSA and operation.aneurysm and cerebral vascular malformation were 105 cases,the detection rate was 95.45% ,and the rate of CTA diagnosis was 100%.Conclusion:64 slice spiral CT angiography in the diagnosis of spontaneous subarachnoid hemorrhage is very high value.It can provide an effective basis for clinical diagnosis and treatment.

  14. Application Progress of Dual-source CT and Craniocervical CTA%双源CT头颈部CTA的应用进展

    Institute of Scientific and Technical Information of China (English)

    金欣; 韩淑祯; 张晓光

    2014-01-01

    目前双源CT是当今世界上最先进的CT设备,头颈部CTA作为一种无创性检查方法对头颈动脉血管狭窄及斑块的诊断有重要价值和帮助,其优点为检查时间短、成功率高、费用相对低廉、并发症少、安全无创等,可以作为头颈部动脉血管检查的首选和重要方法。头颈部血管病变是脑血管疾病的主要发病原因之一,尽早发现头颈部动脉病变,通过发现“罪犯血管”进行及时干预治疗和二级预防,可显著降低脑血管疾病的发病率、致残率、死亡率。%Dual-source CT is currently the most advanced CT equipment in the world. Craniocervical CTA as a noninvasive method, has significant value and assistance for the diagnosis of head and neck artery stenosis and plaque, its advantages including short time, high success rate, relatively low cost, fewer complications, safety and noninvasiveness, and can serve as a preferred and important method for head and neck arteries inspection. Craniocervical vascular disease is one of the major causes of cerebrovascular diseases, early detection of head and neck artery disease, finding“culprit vessels”and timely carrying out intervention treatment and secondary prevention, can significantly reduce the incidence of cerebrovascular diseases.

  15. Clinical application of the tracking scan technique in 16-slice spiral CT angiography%跟踪扫描技术在16层螺旋CT动脉成像中的临床应用

    Institute of Scientific and Technical Information of China (English)

    张任华; 邓波红; 龙江涛; 李强; 杨友; 陈美英

    2009-01-01

    目的 探讨跟踪扫描技术在16层螺旋CT动脉成像中的应用.方法 应用GE LightSpeed 16层螺旋CT扫描仪进行跟踪扫描、测试扫描和估算扫描各100例CTA,所有扫描图像传送至AW4.2工作站进行后处理重建,并分别由3名经验丰富的CT诊断医师采用双盲法对3种方法的图像质量进行评价,分别统计优、良、可、差.结果 跟踪扫描图像质量优级率89.00%、良7.00%、可4.00%、差0;测试扫描优级率70.00%、良11.00%、可15.00%、差4.00%;估算扫描优级率61.00%、良13.00%、可21.00%、差5.00%.结论 应用跟踪扫描技术进行16层螺旋CT动脉成像所得图像质量明显优于测试扫描和估算扫描.%Objective To explore the application of the tracking scan technique in 16-slice spiral CT angiography, in order to improve the quality of CTA. Methods Three hundred patients who were divided into three groups randomly underwent CTA in tracking, testing and estimation scan respectively with GE LightSpeed 16-slice spiral CT. The data of all patients were transmitted to the workstation (AW4.2) and reconstructed. The quality of all images were evaluated by three experienced doctors with double-blind method and divided into four grades (A, B, C and D) from optimal to poor. Results The rate of grade A, B, C and D was 89.00%, 7.00%, 4.00% and 0 respectively for tracking scan, 70.00%, 11.00%, 15.00% and 4.00% respectively for testing scan, while 61.00%, 13.00%, 21.00% and 5.00% respectively for estimation scan. Conclusion Tracking scan technique is superior to testing and estimation scan in image quality of 16-slice spiral CT angiography.

  16. Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score : systematic review and meta-analysis

    NARCIS (Netherlands)

    den Dekker, Martijn; de Smet, K.; de Bock, G.H.; Tio, R.A.; Oudkerk, M.; Vliegenthart, R.

    2012-01-01

    Objectives A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification. Methods A literature search was performed including studies describing test characteristics of CCTA for

  17. A practical approach for a patient-tailored dose protocol in coronary CT angiography using prospective ECG triggering

    NARCIS (Netherlands)

    Dijk, van J.D.; Huizing, E.D.; Jager, P.L.; Ottervanger, J.P.; Knollema, S.; Slump, C.H.; Dalen, van J.A.

    2015-01-01

    To derive and validate a practical patient-specific dose protocol to obtain an image quality, expressed by the image noise, independent of patients’ size and a better radiation dose justification in coronary CT angiography (CCTA) using prospective ECG triggering. 43 patients underwent clinically ind

  18. Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Hirokazu; Momoshima, Suketaka; Kuribayashi, Sachio [Keio University, Department of Diagnostic Radiology, School of Medicine, Tokyo (Japan); Akiyama, Takenori [Keio University, Department of Neurosurgery, School of Medicine, Tokyo (Japan)

    2013-07-15

    The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference. A total of 29 CTDSA/DSA from 25 patients with dAVF were retrospectively evaluated by two neuroradiologists. The presence, Cognard classification, and feeding arteries of dAVFs on CTDSA were assessed according to DSA. DSA depicted 33 dAVFs in 28 cases. By consensus reading, CTDSA correctly detected 32 dAVFs in 27 cases and properly graded 31 lesions. The intermodality agreement for the presence and classification of dAVFs was excellent (kappa = 0.955 and 0.921, respectively). CTDSA detected 77 of 109 feeding arteries (70.6 %) in 25 cases. The intermodality agreement for the feeding arteries was good (kappa = 0.713). Although CTDSA is limited in temporal and spatial resolution in comparison with DSA, it is an effective non-invasive tool for the detection and classification of dAVF. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  20. Influence of observer experience and training on proficiency in coronary CT angiography interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Herzog, Christopher [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425 (United States); Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Radiologie München, Burgstraße 7, 80331 Munich (Germany); Kerl, J. Matthias [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425 (United States); Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); De Rosa, Salvatore [Department of Cardiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Tekin, Tuna [Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Boehme, Eike [Department of Cardiology, Bayerwaldklinik, Cham, Klinikstraße 22, 93413 Cham (Germany); Liem, Sven [Kardiologie am Rotkreuzplatz, Volkartstr. 5, 80634 Munich (Germany); Scheuchenzuber, Miriam [Radiologie München, Burgstraße 7, 80331 Munich (Germany); Kim, He-Ri [Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Bauer, Ralf W. [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425 (United States); Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Silverman, Justin R. [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425 (United States); and others

    2013-08-15

    Purpose: To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience. Methods and materials: Nine radiologist and cardiologist observers with varying prior CCTA experience ranging from novice to expert independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50–74%, 75–99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series. Diagnostic accuracy on a per-segment basis was compared for all readers and both case series, respectively. Results: Correlation coefficients between CCTA and catheter angiography initially ranged between good (r = 0.87) and poor (r = 0.26), depending on reader experience, and significantly (p < 0.05) improved in the second case series (range: r = 0.42 to r = 0.91). Diagnostic accuracy was significantly (p < 0.05) higher for more experienced readers (range: 96.5–97.8%) as compared to less experienced observers (range: 90.7–93.6%). After completion of the second case series for less experienced readers sensitivity and PPV significantly (p < 0.05) improved (range: 62.7–67.8%/51.4–84.1%), but still remained significantly (p < 0.05) lower as compared to more experienced observers (range: 89.8–93.3%/80.6–93.3%). Conclusion: The level of experience appears to be a strong determinant of proficiency in CCTA interpretation. Limited one-time training improves proficiency in novice readers, but not to clinically satisfactory levels.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. Detection of unruptured cerebral artery aneurysms by MRA at 3.0 tesla: comparison with multislice helical computed tomographic angiography

    Energy Technology Data Exchange (ETDEWEB)

    Numminen, Jussi; Porras, Matti; Kangasniemi, Marko (Dept. of Radiology, Helsinki Medical Imaging Center, Helsinki Univ. Central Hospital, Helsinki (Finland)), email: jussi.numminen@hus.fi; Tarkiainen, Antti (Advanced Magnetic Imaging Center, Helsinki Univ. of Technology, Espoo (Finland)); Niemelae, Mika; Hernesniemi, Juha (Dept. of Neurosurgery, Helsinki Univ. Central Hospital, Helsinki (Finland))

    2011-07-15

    Background: Computed tomographic angiography (CTA) has become the primary non-invasive method for detection of cerebral artery aneurysms in many neurovascular centers. Purpose: To compare MR-angiography at a 3.0 tesla (3T) scanner to CTA in the detection of unruptured intracranial aneurysms. Material and Methods: CTA and 3T MRA data from 60 patients were evaluated. CTA was obtained with a 4-16-row helical CT-scanner after administration of 120 cc intravenous contrast agent, MRA was performed by a 3T MR-scanner using time-of-flight pulse sequence. Results: Fifty-five cerebral artery aneurysms were detected by MRA and 47 aneurysms by CTA. Most of the aneurysms detected by MRA but not by CTA were small internal carotid artery (ICA) aneurysms. Bone structures and venous enhancement deteriorated CTA accuracy, especially in skull base. In one patient a fairly large anterior communicating artery aneurysm was not visible in MRA due to spin saturation, although it was clearly visualized in CTA. After contrast injection the aneurysm was also seen in MRA. Although the overall image quality of MRA and CTA were comparable, MRA was more susceptible to artifacts and thus re-formatted surface-shaded volume rendered 3-dimensional images of aneurysms from MRA were inferior compared to those from CTA. Conclusion: MRA at 3T appears to be at least as sensitive as CTA in the detection of unruptured cerebral artery aneurysms, however image quality control is crucial and contrast agent enhances visualization of complex and large aneurysms

  3. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.

    Science.gov (United States)

    Ghoshhajra, Brian B; Takx, Richard A P; Staziaki, Pedro V; Vadvala, Harshna; Kim, Phillip; Neilan, Tomas G; Meyersohn, Nandini M; Bittner, Daniel; Janjua, Sumbal A; Mayrhofer, Thomas; Greenwald, Jeffrey L; Truong, Quyhn A; Abbara, Suhny; Brown, David F M; Januzzi, James L; Francis, Sanjeev; Nagurney, John T; Hoffmann, Udo

    2017-07-01

    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.

  4. Analysis of the anatomical relationship between the uterine artery and the bony landmarks in cesarean scar pregnancy by CT angiography and digital subtraction angiography%剖宫产瘢痕妊娠子宫动脉开口位置与骨性标志关系的 CT 血管成像与DSA 研究

    Institute of Scientific and Technical Information of China (English)

    熊浪; 王进华; 孙进; 邓美香; 郑伟增; 肖新兰

    2015-01-01

    目的:利用 CTA 与 DSA 技术,采用骶髂垂直分段定位法探讨剖宫产术后子宫瘢痕妊娠(CSP)患者子宫动脉开口位置与骨性解剖标志的关系。方法回顾性分析2013年10月—2014年6月浙江大学医学院附属妇产科医院收治的91例 CSP 患者的临床资料和 CTA、DSA 影像学资料。患者年龄23~44岁,平均(32.7±4.2)岁。在骶髂关节骶骨面中,以骶骨的最高点(如左侧 A 点)与髂骨左右两侧的最低点(a、b)为骨盆骨性解剖标志。采用骶髂垂直分段定位法连接 a、b 两点做一水平线 ab,从 A 点向 ab 水平线做一垂线,交点为 D 点,B、C 等分 AD,将骶髂垂直等分为 AB、BC、CD 和 D点远端4段,在患者 CTA 与 DSA 图片上,观察统计患者双侧子宫动脉开口位置在各段的分布情况。结果91例182支子宫动脉中,3支子宫动脉已结扎,CTA 与 DSA 均未见其显示;179支子宫动脉显影,子宫动脉开口位置左侧低于右侧,左侧在 AB、BC、CD 及 D 点远端的比例为0%(0)、3.3%(3/90)、70.0%(63/90)及26.7%(24/90),右侧的比例为0%(0)、11.2%(10/89)、85.4%(76/89)及3.4%(3/89),左右两侧均以 CD 段所占比例最多,两侧在各段分布构成情况差异有统计学意义(χ2=22.618,P <0.01)。结论 CSP 患者子宫动脉开口位置在骶髂各段中分布具有一定的特征,当 CSP患者子宫动脉栓塞治疗无法准确判断子宫动脉开口位置时,利用骶髂垂直分段定位法可为介入治疗提供新的影像学指导和参考。%Objective To investigate the anatomical relationship between the uterine artery and the adjacent bony landmarks in cesarean scar pregnancy ( CSP ) with the method of sacroiliac vertical segmentation localization using CT angiography ( CTA ) and digital subtraction angiography ( DSA ). Methods From October 2013 to June 2014, 91 patients of CSP were examined by CTA and DSA in Department of Radiology of the Women′s Hospital of Medicine Zhejiang University. The

  5. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography.

    Science.gov (United States)

    Mangold, Stefanie; De Cecco, Carlo N; Schoepf, U Joseph; Yamada, Ricardo T; Varga-Szemes, Akos; Stubenrauch, Andrew C; Caruso, Damiano; Fuller, Stephen R; Vogl, Thomas J; Nikolaou, Konstantin; Todoran, Thomas M; Wichmann, Julian L

    2016-12-01

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F_0.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F_0.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F_0.5 (16.9 ± 4.8; all p VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F_0.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. • The impact of noise-optimized virtual monochromatic imaging on stent visualization was assessed. • Virtual monochromatic imaging significantly improves stent lumen visualization and diagnostic confidence. • At 80 keV diagnostic performance for detection of in-stent restenosis was increased. • 80 keV virtual monochromatic images are recommended for stent evaluation of lower extremity vasculature.

  6. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Mangold, Stefanie [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); De Cecco, Carlo N.; Yamada, Ricardo T.; Varga-Szemes, Akos; Stubenrauch, Andrew C.; Fuller, Stephen R. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Caruso, Damiano [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Vogl, Thomas J.; Wichmann, Julian L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Nikolaou, Konstantin [Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Todoran, Thomas M. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2016-12-15

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F{sub 0}.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F{sub 0}.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F{sub 0}.5 (16.9 ± 4.8; all p < 0.0463); luminal stent diameters were increased at ≥70 keV (5.41 ± 1.8-5.92 ± 1.7 vs. 5.27 ± 1.8, all p < 0.001) and diagnostic confidence was highest at 70-80 keV-VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F{sub 0}.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. (orig.)

  7. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  8. Is urgent CT angiography necessary in cases of acute lower gastrointestinal bleeding?

    Science.gov (United States)

    Díaz, A Martín; Rodríguez, L Fernández; de Gracia, M Martí

    2017-01-06

    Acute lower gastrointestinal bleeding usually presents as hematochezia, rectal bleeding or melena and represents 1-2% of the medical appointments in the Emergency Services. Mortality reaches the 30-40% and it is highly related with the severity and associated comorbidity. Most clinical practice guidelines include colonoscopy at some point in the diagnostic and therapeutic process (urgent for severe cases and ambulatory for mild ones) and look for predictors of severity. In the last years, there have been numerous studies where is clear the relevance and complementarity of advanced diagnostic imaging techniques, gradually incorporated as an alternative or second step in severe cases. Therefore, we have made a review of current scientific evidence to establish a clinical prediction rule for optimal indication of CT angiography in these patients. However, future studies providing greater robustness and level of evidence are necessary.

  9. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnosis with CT Angiography

    Directory of Open Access Journals (Sweden)

    Guray Oncel

    2013-01-01

    Full Text Available Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA is a rare congenital anomaly. It is associated with early infant mortality and sudden death in adults. Traditionally, ALCAPA has been diagnosed by angiography or autopsy; however, the development of cardiac computed tomography (CT and magnetic resonance imaging (MRI has allowed noninvasive evaluation of the coronary anatomy by direct visualization of the origin of the left coronary artery (LCA from the pulmonary artery. We report a case of 10-year-old girl who has been on follow up for dilated cardiomyopathy for 4 years. The definitive diagnosis of ALCAPA is reached by multislice computed tomography (MSCT. The MSCT scan showed an anomalous origin of LCA from the pulmonary trunk, with a tortuous and dilated right coronary artery and right-to-left collateralization. Consequently, the patient was successfully treated with surgery.

  10. Myopericarditis diagnosed by a 64-slice coronary CT angiography "triple rule out" protocol

    Science.gov (United States)

    Ku, Bon S.; Halpern, Ethan J.

    2010-01-01

    We report a case of myopericarditis in a 30-year-old male complaining of shortness of breath. In an emergency department (ED) setting, the symptoms of myopericarditis may overlap with many disease entities and can be a challenging diagnosis to make. However, with the use of a 64-section coronary CT angiography in a “triple rule out” (TRO) protocol, we were able to detect a large pericardial effusion surrounding the heart and moderate global hypokinesis in the setting of normal-sized heart chambers and normal coronary arteries. We were further able to exclude pulmonary embolism and thoracic dissection. This is the first reported case of diagnosing myopericarditis using a TRO protocol. It demonstrates the usefulness of TRO in making an emergent diagnosis of myopericarditis while excluding other life-threatening diseases that can lead to earlier appropriate ED disposition and care. PMID:21373320

  11. Automatic segmentation of vertebral arteries in CT angiography using combined circular and cylindrical model fitting

    Science.gov (United States)

    Lee, Min Jin; Hong, Helen; Chung, Jin Wook

    2014-03-01

    We propose an automatic vessel segmentation method of vertebral arteries in CT angiography using combined circular and cylindrical model fitting. First, to generate multi-segmented volumes, whole volume is automatically divided into four segments by anatomical properties of bone structures along z-axis of head and neck. To define an optimal volume circumscribing vertebral arteries, anterior-posterior bounding and side boundaries are defined as initial extracted vessel region. Second, the initial vessel candidates are tracked using circular model fitting. Since boundaries of the vertebral arteries are ambiguous in case the arteries pass through the transverse foramen in the cervical vertebra, the circle model is extended along z-axis to cylinder model for considering additional vessel information of neighboring slices. Finally, the boundaries of the vertebral arteries are detected using graph-cut optimization. From the experiments, the proposed method provides accurate results without bone artifacts and eroded vessels in the cervical vertebra.

  12. Additional Value of Transluminal Attenuation Gradient in CT Angiography to Predict Hemodynamic Significance of Coronary Artery Stenosis

    Science.gov (United States)

    Stuijfzand, Wynand J.; Danad, Ibrahim; Raijmakers, Pieter G.; Marcu, C. Bogdan; Heymans, Martijn W.; van Kuijk, Cornelis C.; van Rossum, Albert C.; Nieman, Koen; Min, James K.; Leipsic, Jonathon; van Royen, Niels; Knaapen, Paul

    2015-01-01

    OBJECTIVES The current study evaluates the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (CCO), and TAG with exclusion of calcified coronary segments (ExC) over coronary computed tomography angiogram (CTA) alone using fractional flow reserve (FFR) as the gold standard. BACKGROUND TAG is defined as the contrast opacification gradient along the length of a coronary artery on a coronary CTA. Preliminary data suggest that TAG provides additional functional information. Interpretation of TAG is hampered by multiple heartbeat acquisition algorithms and coronary calcifications. Two correction models have been proposed based on either dephasing of contrast delivery by relating coronary density to corresponding descending aortic opacification (TAG-CCO) or excluding calcified coronary segments (TAG-ExC). METHODS Eighty-five patients with intermediate probability of coronary artery disease were prospectively included. All patients underwent step-and-shoot 256-slice coronary CTA. TAG, TAG-CCO, and TAG-ExC analyses were performed followed by invasive coronary angiography in conjunction with FFR measurements of all major coronary branches. RESULTS Thirty-four patients (40%) were diagnosed with hemodynamically-significant coronary artery disease (i.e., FFR ≤0.80). On a per-vessel basis (n = 253), 59 lesions (23%) were graded as hemodynamically significant, and the diagnostic accuracy of coronary CTA (diameter stenosis ≥50%) was 95%, 75%, 98%, and 54% for sensitivity, specificity, negative predictive value, and positive predictive value, respectively. TAG and TAG-ExC did not discriminate between vessels with or without hemodynamically significant lesions (−13.5 ± 17.1 HU [Hounsfield units] × 10 mm−1 vs. −11.6 ± 13.3 HU × 10 mm−1, p = 0.36; and 13.1 ± 15.9 HU × 10 mm−1 vs. −11.4 ± 11.7 HU × 10 mm−1, p = 0.77, respectively). TAG-CCO was lower in vessels with a hemodynamically-significant lesion (−0

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

    Science.gov (United States)

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

    2012-02-01

    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.

  14. 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.)

  15. Small vessel stents for intracranial angioplasty: in vitro evaluation of in-stent stenoses using CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Trossbach, M.; Hartmann, M.; Braun, C.; Sartor, K.; Haehnel, S. [Division of Neuroradiology of the Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg (Germany)

    2004-06-01

    Our aim was to determine whether CT angiography is suitable for the evaluation of in-stent restenoses in small vessel stents for intracranial angioplasty. Therefore, we simulated stenoses with degrees of 25, 50, 75 and 90% in a total of 12 stents with different designs (MEDTRONIC AVE; ABBOT BioDivYsio, GUIDANT Neurolink, TERUMO Tsunami, COOK V-Flex Plus) and sizes (3.0 mm, 4.0 mm). For each stenosis, the apparent stenotic degree (ASD) was measured by CT angiography. Subjective (viewing at the CT images) and objective (acquisition of a density profile) evaluations were made after the stents were filled with a solution of 0.9% NaCl and with a diluted contrast medium. It was not possible to visualize the patent lumen in any of the stenotic stent segments by viewing at the CT images. After objective evaluation, the degree of the stenoses was generally overestimated. In the group with the 3.0-mm stents, ASD ranged from 73.6 to 100% in 25% degree stenoses. With the exception of one stent, stenoses with a degree of more than 25% appeared as vessel obstruction (ASD =100%) in the 3.0-mm group. In the 4.0-mm group, the mean ASD was 60% for 25% degree stenoses, 76% for 50% degree stenoses, 91% for 75% degree stenoses and 96% for 95% degree stenoses. The minimum diameter of stents for differentiation between in-stent restenosis and vessel occlusion using CT angiography is 4.0 mm. In CT angiography, the degrees of in-stent stenoses are generally overestimated. The evaluation of in-stent restenoses only seems to be possible when CT angiographic images before and after contrast application are evaluated objectively by density profiles. (orig.)

  16. Deformable known component model-based reconstruction for coronary CT angiography

    Science.gov (United States)

    Zhang, X.; Tilley, S.; Xu, S.; Mathews, A.; McVeigh, E. R.; Stayman, J. W.

    2017-03-01

    Purpose: Atherosclerosis detection remains challenging in coronary CT angiography for patients with cardiac implants. Pacing electrodes of a pacemaker or lead components of a defibrillator can create substantial blooming and streak artifacts in the heart region, severely hindering the visualization of a plaque of interest. We present a novel reconstruction method that incorporates a deformable model for metal leads to eliminate metal artifacts and improve anatomy visualization even near the boundary of the component. Methods: The proposed reconstruction method, referred as STF-dKCR, includes a novel parameterization of the component that integrates deformation, a 3D-2D preregistration process that estimates component shape and position, and a polyenergetic forward model for x-ray propagation through the component where the spectral properties are jointly estimated. The methodology was tested on physical data of a cardiac phantom acquired on a CBCT testbench. The phantom included a simulated vessel, a metal wire emulating a pacing lead, and a small Teflon sphere attached to the vessel wall, mimicking a calcified plaque. The proposed method was also compared to the traditional FBP reconstruction and an interpolation-based metal correction method (FBP-MAR). Results: Metal artifacts presented in standard FBP reconstruction were significantly reduced in both FBP-MAR and STF- dKCR, yet only the STF-dKCR approach significantly improved the visibility of the small Teflon target (within 2 mm of the metal wire). The attenuation of the Teflon bead improved to 0.0481 mm-1 with STF-dKCR from 0.0166 mm-1 with FBP and from 0.0301 mm-1 with FBP-MAR - much closer to the expected 0.0414 mm-1. Conclusion: The proposed method has the potential to improve plaque visualization in coronary CT angiography in the presence of wire-shaped metal components.

  17. Clinical application analysis of 64-slice CT coronary CTA dynamic volume rendering diagnosis of myocardial bridge & nbsp;of the anterior descending branch%64层螺旋CT冠状动脉CTA动态容积再现辅助诊断前降支心肌桥的临床应用分析

    Institute of Scientific and Technical Information of China (English)

    郝晓光

    2013-01-01

      Objective To explore the clinical value of 64-slice CT coronary CTA dynamic volume rendering images auxiliary diagnosis of myocardial bridge. Methods 96 patients underwent coronary CTA from January 2009 to the end of December 2012, with confirm of coronary angiography, were chosen. CT images are routinely reconstructed in the best phase period and in 0-90% phase period, an interval of 10%. Reconstruction data was sent to the workstation to get the MPR, the CPR, as well as dynamic volume rendering images. Images were analyzed by the two groups of doctors of medical imaging department to determine whether the presence of myocardial bridge of the left anterior descending artery based on static images, both static and dynamic volume images, respectively. Results 96 cases with myocardial bridge of the left anterior descending artery confirmed by coronary angiography, 83 cases were diagnosed by the static CTA image, 93 cases were diagnosed by both static and dynamic volume images. The sensitivity of two groups was 93.75% and 82.29%, specificity 99.68% and 99.57%, respectively. Conclusion The comprehensive analysis of the 64-slice spiral CT coronary CTA static and dynamic volume rendering images can improve the accuracy of the diagnosis of left anterior descending artery myocardial bridge.%  目的探索64层螺旋CT冠状动脉CTA动态容积再现图像辅助诊断心肌桥的临床应用价值。方法选择我院2009年1月-2012年12月行冠状动脉CTA检查并经冠脉造影证实的心肌桥96例,所有CT图像均进行常规best phase期相重建及0-90%、间隔10%的多期相重建,重建后的数据传送至工作站进行MPR、CPR重建以及动态容积再现处理。图像由两组医师分别根据静态图像、静态加动态容积再现图像判断是否存在前降支心肌桥,诊断结果分别统计,并进行统计学分析。结果经冠脉造影证实的前降支心肌桥患者96例中,静态CTA图像诊断肌桥83例,静

  18. Multimodality evaluation of dural arteriovenous fistula with CT angiography, MR with arterial spin labeling, and digital subtraction angiography: case report.

    Science.gov (United States)

    Alexander, Matthew; McTaggart, Ryan; Santarelli, Justin; Fischbein, Nancy; Marks, Michael; Zaharchuk, Greg; Do, Huy

    2014-01-01

    Dural arteriovenous fistulae (DAVF) are cerebrovascular lesions with pathologic shunting into the venous system from arterial feeders. Digital subtraction angiography (DSA) has long been considered the gold standard for diagnosis, but advances in noninvasive imaging techniques now play a role in the diagnosis of these complex lesions. Herein, we describe the case of a patient with right-side pulsatile tinnitus and DAVF diagnosed using computed tomography angiography, magnetic resonance with arterial spin labeling, and DSA. Implications for imaging analysis of DAVFs and further research are discussed.

  19. Case series of 64 slice computed tomography-computed tomographic angiography with 3D reconstruction to diagnose symptomatic cerebral aneurysms: new standard of care?

    Directory of Open Access Journals (Sweden)

    Dietrich Jehle

    2012-02-01

    Full Text Available CT angiography (CTA has improved significantly over the past few years such that the reconstructed images of the cerebral arteries may now be equivalent to conventional digital angiography. The new technology of 64 slice multi-detector CTA can reconstruct detailed images that can reliably identify small cerebral aneurysms, even those <3mm. In addition, it is estimated that CT followed by lumbar puncture (LP misses up to 4% of symptomatic aneurysms. We present a series of cases that illustrates how CT followed by CTA may be replacing CT-LP as the standard of care in working up patients for symptomatic cerebral aneurysms and the importance of performing three dimensional (3D reconstructions. A series of seven cases of symptomatic cerebral aneurysms were identified that illustrate the sensitivity of CT-CTA versus CT-LP and the importance of 3D reconstruction in identifying these aneurysms. Surgical treatment was recommended for 6 of the 7 patients with aneurysms and strict hypertension control was recommended for the seventh patient. Some of these patients demonstrated subarachnoid hemorrhage on presentation while others had negative LPs. A number of these patients with negative LPs were clearly symptomatic from their aneurysms. At least one of these cerebral aneurysms was not apparent on CTA without 3D reconstruction. 3D reconstruction of CTA is crucial to adequately identify cerebral aneurysms. This case series helps reinforce the importance of 3D reconstruction. There is some data to suggest that 64 slice CT-CTA may be equivalent or superior to CT-LP in the detection of symptomatic cerebral aneurysms.

  20. Quantitative analysis of arterial flow properties for detection of non-calcified plaques in ECG-gated coronary CT angiography

    Science.gov (United States)

    Wei, Jun; Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Agarwal, Prachi; Kuriakose, Jean; Hadjiiski, Lubomir; Patel, Smita; Kazerooni, Ella

    2015-03-01

    We are developing a computer-aided detection system to assist radiologists in detection of non-calcified plaques (NCPs) in coronary CT angiograms (cCTA). In this study, we performed quantitative analysis of arterial flow properties in each vessel branch and extracted flow information to differentiate the presence and absence of stenosis in a vessel segment. Under rest conditions, blood flow in a single vessel branch was assumed to follow Poiseuille's law. For a uniform pressure distribution, two quantitative flow features, the normalized arterial compliance per unit length (Cu) and the normalized volumetric flow (Q) along the vessel centerline, were calculated based on the parabolic Poiseuille solution. The flow features were evaluated for a two-class classification task to differentiate NCP candidates obtained by prescreening as true NCPs and false positives (FPs) in cCTA. For evaluation, a data set of 83 cCTA scans was retrospectively collected from 83 patient files with IRB approval. A total of 118 NCPs were identified by experienced cardiothoracic radiologists. The correlation between the two flow features was 0.32. The discriminatory ability of the flow features evaluated as the area under the ROC curve (AUC) was 0.65 for Cu and 0.63 for Q in comparison with AUCs of 0.56-0.69 from our previous luminal features. With stepwise LDA feature selection, volumetric flow (Q) was selected in addition to three other luminal features. With FROC analysis, the test results indicated a reduction of the FP rates to 3.14, 1.98, and 1.32 FPs/scan at sensitivities of 90%, 80%, and 70%, respectively. The study indicated that quantitative blood flow analysis has the potential to provide useful features for the detection of NCPs in cCTA.

  1. Evaluation of an improved technique for lumen path definition and lumen segmentation of atherosclerotic vessels in CT angiography.

    Science.gov (United States)

    van Velsen, Evert F S; Niessen, Wiro J; de Weert, Thomas T; de Monyé, Cécile; van der Lugt, Aad; Meijering, Erik; Stokking, Rik

    2007-07-01

    Vessel image analysis is crucial when considering therapeutical options for (cardio-) vascular diseases. Our method, VAMPIRE (Vascular Analysis using Multiscale Paths Inferred from Ridges and Edges), involves two parts: a user defines a start- and endpoint upon which a lumen path is automatically defined, and which is used for initialization; the automatic segmentation of the vessel lumen on computed tomographic angiography (CTA) images. Both parts are based on the detection of vessel-like structures by analyzing intensity, edge, and ridge information. A multi-observer evaluation study was performed to compare VAMPIRE with a conventional method on the CTA data of 15 patients with carotid artery stenosis. In addition to the start- and endpoint, the two radiologists required on average 2.5 (SD: 1.9) additional points to define a lumen path when using the conventional method, and 0.1 (SD: 0.3) when using VAMPIRE. The segmentation results were quantitatively evaluated using Similarity Indices, which were slightly lower between VAMPIRE and the two radiologists (respectively 0.90 and 0.88) compared with the Similarity Index between the radiologists (0.92). The evaluation shows that the improved definition of a lumen path requires minimal user interaction, and that using this path as initialization leads to good automatic lumen segmentation results.

  2. Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika; Achenbach, Stephan [University of Erlangen, Department of Cardiology, Erlangen (Germany); Dey, Damini [Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles (United States); Otaki, Yuka; Slomka, Piotr; Berman, Daniel S. [Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles (United States); Kral, Brian G.; Lai, Shenghan [Johns Hopkins University, Department of Medicine, Devision of Cardiology, Baltimore (United States); Fishman, Elliott K.; Lai, Hong [Johns Hopkins University, Department of Medicine, Devision of Cardiology, Baltimore (United States); Johns Hopkins University, Department of Radiology, Baltimore (United States)

    2014-09-15

    Quantitative measurements of coronary plaque volume may play a role in serial studies to determine disease progression or regression. Our aim was to evaluate the interscan reproducibility of quantitative measurements of coronary plaque volumes using a standardized automated method. Coronary dual source computed tomography angiography (CTA) was performed twice in 20 consecutive patients with known coronary artery disease within a maximum time difference of 100 days. The total plaque volume (TP), the volume of non-calcified plaque (NCP) and calcified plaque (CP) as well as the maximal remodelling index (RI) were determined using automated software. Mean TP volume was 382.3 ± 236.9 mm{sup 3} for the first and 399.0 ± 247.3 mm{sup 3} for the second examination (p = 0.47). There were also no significant differences for NCP volumes, CP volumes or RI. Interscan correlation of the plaque volumes was very good (Pearson's correlation coefficients: r = 0.92, r = 0.90 and r = 0.96 for TP, NCP and CP volumes, respectively). Automated software is a time-saving method that allows accurate assessment of coronary atherosclerotic plaque volumes in coronary CTA with high reproducibility. With this approach, serial studies appear to be possible. (orig.)

  3. Role of Early Arterial Phase Multislice Helical CT Angiography in Evaluation of Hepatocellular Carcinoma

    Institute of Scientific and Technical Information of China (English)

    TANGBinghang; HEYaqi; LILiangcai; HUANGDecheng; WURenguo; YUYuanlong

    2005-01-01

    Objective: To investigate the clinical application of early arterial phase multislice CT angiography (MSCTA) of hepatic vessels in evaluation of middle or advanced stage hepatocellular carcinoma.Methods: Trigger Bolus program was used to carry out MSCTA in early and late arterial phases and portal vein phase with single breath holding. Hepatic vessels were reconstructed from the original images of early arterial phase by post processing. The blood supply of tumor and normal liver tissue and the appearances of venous thrombosis and arteriovenous shunts were analyzed. Results: The MSCTA with early arterial phase could perfectly display the origin, shape and amount of feeding vessels to normal liver tissue and tumor in middle or advanced stage hepatocellular carcinoma. It had the ability of displaying the arteriovenous shunts better than that in conventional dual phased liver scanning. Conclusion: MSCTA of hepatic vessels with early arterial phase acquisition using multislice helical CT in middle or advance stage hepatocellular carcinoma has favorable and promising application. It can be used as an imaging method for comprehensive assessment of the hepatocellular carcinoma before treatment.

  4. MULTIDETECTOR CT ANGIOGRAP