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preliminary evaluation of different dose reduction algorithms in abdominal Computed Tomography Angiography (CTA) with standard scan protocols at 120kV vs. 80kV.prospective, randomized, crossover study. 60 consecutive patients who underwent CTA of the abdomen (Sensation 64, Siemens; Iomeprol 400 mgl/ml Bracco) for suspected or diagnosed Abdominal Aortic Aneurysm (AAA) were enrolled in the study. A standard 120kV/200mAs scan protocol was acquired in all patients (reference tube current modulated with Automatic Exposure Control). In each patient a second scan with 80kV/300mAs (Group 1; n. 20), 80kV/400mAs (Group 2; n. 20), 80kV/500mAs (Group 3; n. 20) was acquired. We used the same scan/reconstruction parameters with the same amount and kind of contrast medium. The radiation dose, the aortic attenuation values, the noise and the signal/noise ratio (S/N) were evaluated.the mean dose was 9.7±2.7mSv for 120kV (all patients), 3.6±0.8mSv in Group1 (80kV), 5.0±0.6mSv in Group 2 (80kV) and 5.9±1.2mSv in Group 3 (80kV), respectively. The aortic attenuation was 350±59HU (120kV) vs. 534±100HU (80kV), 12±3.5 (120kV) vs. 8.8±3.6 (80kV) for the whole population. Aortic attenuation and S/N were: 328±40HU (120kV) vs. 494±61HU (80kV), 11±2 (120kV) vs. 7±2 (80kV) in Group1; 353±77HU (120kV) vs. 551±117HU (80kV), 11±2.8HU (120kV) vs. 8.4±2.6 (80kV) in Group 2; 389±55HU (120kV) vs. 598±117HU (80kV), 15±5 (120kV) vs. 12±5 (80kV) in Group 3, respectively (plt;0.05).in abdominal CTA, the 80kV/400mAs scan protocol allows a radiation dose reduction of 50% without a significant reduction of S/N ratio.

Coronary artery disease (CAD) is one of the leading causes of death in developed countries. Recent literature confirmed multi detector computed tomography (MDCT) as a noninvasive imaging technique able to rule out and rule in CAD with a very high accuracy compared with Conventional Coronary Angiography (CCA). However the plaque burden and stenosis severity on MDCT is usually visually assessed with sequent inherent limitations. Recent technologies have permitted a real quantitative assessment of CAD.

To evaluate the role of Computed Tomography Colonography (CTC) in patients who failed an Optical Colonoscopy (OC).Sixtyeight patients (48 female, 20 male; mean age 60,4 years) with a previous incomplete OC underwent CTC.A complete CTC examination was achieved in all 68 patients. We classified the detected polyps in relation to the diameter in small (5mm), medium (from 5 to 10mm) and large (10mm). In 19 patients (27,9%) any pathological finding was observed. In 11 patients (16,2%) one or more polyps not detected with the previous OC have been found.Only in one case the number of detected polyps corresponded to the OC findings. In 18 (26,4%) patients a diverticular disease was observed, and in 15 of them it was diagnosed by the previous OC (26,5%). In 8 patients (11,8%) the diverticular disease was associated to the presence of polyps. In 12 patients (17,6%) colonic stenosis or masses have been observed.CTC was performed in all patients with a previous incomplete OC, obtaining a complete and accurate visualization of the colon whithout any patient's discomfort.

To compare image quality of iterative reconstruction algorithm(IRIS) vs. standard filtered back projection(FBP) reconstruction in CT Coronary Angiography (CTCA).Thirty-four consecutive patients underwent CTCA for suspected or known CAD with Dual-Source CT (DSCT-Flash, Siemens). All datasets were reconstructed with 0.75/0.4 and 0.6/0.4 mm slice thickness/increment, using three standard FBP kernels (B26-B30-B46) and three comparable IRIS algorithms (I26-I30-I46). Vascular attenuation and noise were measured. CT vascular attenuation values [HU] were measured in: ascending aorta (Ao), right (RCA) and left (LCA) coronary artery, respectively. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratio were calculated. A p-valuelt;0.05 was considered significant.There was no significant difference between the vascular attenuation values measured with FBP (Ao:458HU, RCA:448HU, LAD:444HU) and IRIS (Ao:456HU, RCA:446HU, LAD:442HU). Difference in noise was significant between FBP (24±SD) and IRIS (19±SD) (r=0.34;plt;0.05). Lowest noise was found for IRIS using 0.6 mm (17HU). IRIS provided a SNR and CNR significantly higher with increasing kernel sharpness. SNR was 33.3±25.1, 77.3±51.7, 37.2±36.6, 64.4±59.2, while CNR was 25.32±19.8, 58.0±36.0, 28.6±23.5, 47.6±47.3 for 0.75B, 0.75I, 0.6B and 0.6I, respectively. IRIS showed an improvement in SNR of 57% and 56% for 0.75 mm and 0.6 mm, respectively, and an improvement in CNR of 42% and 40% for 0.75 mm and 0.6 mm.In CTCA, iterative reconstructions provide a significant higher image quality compared with the conventional FBP reconstructions. (www.actabiomedica.it).

Computed tomography coronary angiography (CTCA) has reached very high standards both in terms of diagnostic performance and radiation dose reduction. This commentary follows a report on CTCA using less than 0.1 mSv in selected patients. This is an extraordinary accomplishment, both for technology and for medicine. The difficult task is now to implement this tool in clinical practice so it can play the best possible role. CTCA can improve diagnostic pathways, can save money for healthcare systems and could even improve pharmacological therapy. All of this may happen, but it will require the combined effort of all the experienced operators in this field, including the referring clinicians. In times of financial constraint, CTCA may also help to restrict ineffective medical expenses.

This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; a parts per thousand yen50% lumen reduction) in intermediate/high-risk asymptomatic patients. A total of 183 consecutive asymptomatic individuals (92 men; mean age 54 +/- 11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (a parts per thousand yen50% lumen reduction). Mean calcium score was 177 +/- 432, mean heart rate during the CT-CA scan was 58 +/- 8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90-100), 98% (96-99), 97% (85-99), 100% (97-100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively. CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.

Background: There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). Methods: We enrolled 204 consecutive symptomatic patients (mean age: 61 +/- 10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. Results: CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p < 0.01; HR 1.2, CI 1.08-1.42, p < 0.01; HR 1.2, CI 1.08-1.42, p < 0.01, respectively). A cut-off value >1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. Conclusions: CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

PURPOSE: This study was done to assess the prognostic value of computed tomography coronary angiography (CTCA) in a large multicentre population of patients with suspected coronary artery disease (CAD) and, in particular, its incremental value compared with traditional methods for risk stratification. MATERIALS AND METHODS: This is a retrospective observational study that began in January 2003 conducted on patients with suspected CAD assessed with CTCA on the basis of symptoms (chest pain, dyspnoea) and/or abnormal or equivocal stress test and/or a high cardiovascular risk profile. The participating centres will provide data obtained with CTCA performed with 16-slice or higher equipment. Exclusion criteria are renal insufficiency, allergy to iodinated contrast material, pregnancy and previous myocardial infarction or revascularisation (percutaneous coronary intervention and/or coronary artery bypass graft). All patients are stratified by means of clinical assessment and/or data retrieved from a clinical database. Risk factors considered are hypertension, dyslipidaemia, diabetes mellitus, smoking, family history and obesity. Symptoms are classified as absent, typical chest pain, atypical chest pain and dyspnoea. Primary endpoints are death, major adverse cardiovascular events (cardiac death, unstable angina requiring hospitalisation, acute myocardial infarction) and shifting of cardiovascular risk category on the basis of coronary plaque burden. The secondary endpoint is coronary revascularisation. Telephone interviews and/or clinical databases are used for the follow-up. The study will be conducted on a population >1,000 patients. CONCLUSIONS: The information collected from the Prognostic Registry for Coronary Artery Disease (PRORECAD) will provide insight into the prognostic value of CTCA in addition to demographic and clinical features. The results will allow for better use and interpretation of CTCA for prognostic purposes.

In 10 years, computed tomography coronary angiography (CTCA) has shifted from an investigational tool to clinical reality. Even though CT technologies are very advanced and widely available, a large body of evidence supporting the clinical role of CTCA is missing. The reason is that the speed of technological development has outpaced the ability of the scientific community to demonstrate the clinical utility of the technique. In addition, with each new CT generation, there is a further broadening of actual and potential applications. In this review we examine the state of the art on CTCA. In particular, we focus on issues concerning technological development, radiation dose, implementation, training and organisation.

Purpose To determine the relationship between established cardiovascular risk factors, clinical presentation and the extent of coronary artery disease (CAD), as described with computed tomography coronary angiography. Material and methods In this cross-sectional study, we included 567 symptomatic individuals without a history of CAD who consecutively underwent 64-slice computed tomography coronary angiography for evaluation of suspected CAD. We analyzed the prevalence of CAD depending on sex, age, symptoms and risk factors. Results A total of 8542 segments were analyzed. No evidence of CAD was observed in 225 patients (40%), nonsignificant CAD in 221 patients (39%) and significant CAD (luminal narrowing >50%) in the remaining 121 patients (21%). CAD increased with advancing age, significantly above 50 years (P

Aim: To evaluate the feasibility of coronary artery calcium score (CACS) on low-dose non-gated chest CT (ngCCT). Methods: Sixty consecutive individuals (30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed tomography (gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner (Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores (Volume, Mass, Agatston) as previously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered significant. Results: Mean CACS values were significantly higher for gCCT as compared to ngCCT (Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high (Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2 (33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1 (33%) showed an Agatston score of 0 in the ngCCT. Overall, 23 (38%) patients were reclassified in a different cardiovascular risk category, mostly (18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT (DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01). Conclusion: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed. This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k). Inter-observer agreement between the study reviewers was moderate to good (0.4–0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p

Purpose: The aim of the study was to evaluate the prevalence of collateral findings detected in computed tomography coronary angiography (CTCA) in a multi-center registry. Materials and methods: We performed a retrospective review of 4303 patients (2719 males, mean age 60.3 ± 10.2 years) undergoing 64-slice CTCA for suspected or known coronary artery disease (CAD) at various academic institutions between 01/2006 and 09/2010. Collateral findings were recorded and scored as: non-significant (no signs of relevant pathology, not necessary to be reported), significant (clear signs of pathology, mandatory to be reported), or major (remarkable pathology, mandatory to be reported and further investigated). Results: We detected 6886 non-cardiac findings (1.6 non cardiac finding per patient). Considering all centers, only 865/4303 (20.1 %) patients were completely without any additional finding. Overall, 2095 (30.4 %) non-significant, 4486 (65.2 %) significant, and 305 (4.4 %) major findings were detected. Among major findings, primary lung cancer was reported in 21 cases. In every center, most prevalent significant findings were mediastinal lymph nodes >1 cm. In 256 patients, collateral findings were clinically more relevant than coexisting CAD and justified the symptoms of patients. Conclusions: The prevalence of significant and major collateral findings in CTCA is high. Radiologists should carefully evaluate the entire scan volume in each patient.