238 results on '"Schuijf JD"'
Search Results
2. Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: A meta-analysis
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Carrabba, N, Schuijf, JD, de Graaf, FR, Parodi, G, Maffei, E, Valenti, R, Palumbo, AA, Weustink, A.C., Mollet, Nico, Accetta, G, Cademartiri, F., Antoniucci, D, Bax, JJ, Carrabba, N, Schuijf, JD, de Graaf, FR, Parodi, G, Maffei, E, Valenti, R, Palumbo, AA, Weustink, A.C., Mollet, Nico, Accetta, G, Cademartiri, F., Antoniucci, D, and Bax, JJ
- Abstract
We sought to evaluate the diagnostic accuracy of 64-slice multi-detector row computed tomography (MDCT) compared with invasive coronary angiography for in-stent restenosis (ISR) detection. MEDLINE, Cochrane library, and BioMed Central database searches were performed until April 2009 for original articles. Inclusion criteria were (1) 64-MDCT was used as a diagnostic test for ISR, with > 50% diameter stenosis selected as the cut-off criterion for significant ISR, using invasive coronary angiography and quantitative coronary angiography as the standard of reference; (2) absolute numbers of true positive, false positive, true negative, and false negative results could be derived. Standard meta-analytic methods were applied. Nine studies with a total of 598 patients with 978 stents included were considered eligible. On average, 9% of stents were unassessable (range 0-42%). Accuracy tests with 95% confidence intervals (CIs) comparing 64-MDCT vs invasive coronary angiography showed that pooled sensitivity, specificity, positive and negative likelihood ratio (random effect model) values were: 86% (95% CI 80-91%), 93% (95% CI 91-95%), 12.32 (95% CI 7.26-20.92), 0.18 (95% CI 0.12-0.28) for binary ISR detection. The symmetric area under the curve value was 0.94, indicating good agreement between 64-MDCT and invasive coronary angiography. 64-MDCT has a good diagnostic accuracy for ISR detection with a particularly high negative predictive value. However, still a relatively large proportion of stents remains uninterpretable. Accordingly, only in selected patients, 64-MDCT may serve as a potential alternative noninvasive method to rule out ISR.
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- 2010
3. Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention.
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Antoni ML, Yiu KH, Atary JZ, Delgado V, Holman ER, van der Wall EE, Schuijf JD, Bax JJ, Schalij MJ, Antoni, M Louisa, Yiu, Kai-Hang, Atary, Jael Z, Delgado, Victoria, Holman, Eduard R, van der Wall, Ernst E, Schuijf, Joanne D, Bax, Jeroen J, and Schalij, Martin J
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- 2011
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4. Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting.
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de Graaf FR, van Velzen JE, Witkowska AJ, Schuijf JD, van der Bijl N, Kroft LJ, de Roos A, Reiber JH, Bax JJ, de Grooth GJ, Jukema JW, van der Wall EE, de Graaf, Fleur R, van Velzen, Joëlla E, Witkowska, Agnieszka J, Schuijf, Joanne D, van der Bijl, Noortje, Kroft, Lucia J, de Roos, Albert, and Reiber, Johan H C
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Objectives: To evaluate the diagnostic performance of 320-slice computed tomography coronary angiography (CTA) in the evaluation of patients with prior coronary artery bypass grafting (CABG). Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.Methods: CTA studies were performed using CT equipment with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 0.35 s. All grafts, recipient and nongrafted vessels were deemed interpretable or uninterpretable. The presence of significant (≥50%) stenosis and occlusion were determined on vessel and patient basis. Results were compared to ICA using quantitative coronary angiography.Results: A total of 40 patients (28 men, 76 ± 15 years), with 89 grafts, were included in the study. On a graft analysis, the sensitivity, specificity, positive and negative predictive values in the evaluation of significant stenosis were 96%, 92%, 83% and 98% respectively. The diagnostic accuracy for the assessment of recipient and nongrafted vessels was 89% and 80%, respectively. The diagnostic accuracy for the assessment of graft, recipient and nongrafted vessel occlusion was 96%, 92% and 100%, respectively.Conclusions: 320-slice CTA allows accurate non-invasive assessment of significant graft, recipient vessel and nongrafted vessel stenosis in patients with prior CABG. [ABSTRACT FROM AUTHOR]- Published
- 2011
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5. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation.
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Nucifora G, Schuijf JD, van Werkhoven JM, Trines SA, Kajander S, Tops LF, Turta O, Jukema JW, Schreur JH, Heijenbrok MW, Gaemperli O, Kaufmann PA, Knuuti J, van der Wall EE, Schalij MJ, Bax JJ, Nucifora, Gaetano, Schuijf, Joanne D, van Werkhoven, Jacob M, and Trines, Serge A
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Atrial fibrillation (AF) has been linked to the presence of underlying coronary artery disease (CAD). However, whether the higher burden of CAD observed in AF patients translates into higher burden of myocardial ischemia is unknown. In 87 patients (71% male, mean age 61 ± 10 years) with paroxysmal or persistent AF and without history of CAD, MSCT coronary angiography and stress testing (exercise ECG test or myocardial perfusion imaging) were performed. CAD was classified as obstructive (≥50% luminal narrowing) or not. Stress tests were classified as normal or abnormal. A population of 122 patients without history of AF, similar to the AF group as to age, gender, symptomatic status and pre-test likelihood, served as a control group. Based on MSCT, 17% of AF patients were classified as having no CAD, whereas 43% showed non-obstructive CAD and the remaining 40% had obstructive CAD. A positive stress test was observed in 49% of AF patients with obstructive CAD. Among non-AF patients, 34% were classified as having no CAD, while 41% showed non-obstructive CAD and 25% had obstructive CAD (P = 0.013 compared to AF patients). A positive stress test was observed in 48% of non-AF patients with obstructive CAD. In conclusion, the higher burden of CAD observed in AF patients is not associated to higher burden of myocardial ischemia. [ABSTRACT FROM AUTHOR]
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- 2011
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6. Assessment of coronary artery calcium by using volumetric 320-row multi-detector computed tomography: comparison of 0.5 mm with 3.0 mm slice reconstructions.
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van der Bijl N, de Bruin PW, Geleijns J, Bax JJ, Schuijf JD, de Roos A, Kroft LJ, van der Bijl, Noortje, de Bruin, Paul W, Geleijns, Jacob, Bax, Jeroen J, Schuijf, Joanne D, de Roos, Albert, and Kroft, Lucia J M
- Abstract
The purpose of this study was to assess the performance of 0.5 versus 3.0 mm slice reconstructions in depicting coronary calcium with special attention to patients having zero calcium scores at 3.0 mm reconstructions by using computed tomography (CT). Imaging was performed by volumetric 320-detector row CT. Scans of 100 patients with a negative and 100 patients with a positive Agatston score at 3.0 mm reconstructions were consecutively selected. Non-overlapping volume sets with 3.0 and 0.5 mm slice thickness were reconstructed from the same raw data and Agatston and volume scores were obtained. The Wilcoxon signed ranks test was used to determine statistical differences between 3.0 and 0.5 mm calcium scores. Agatston and volume scores obtained at 0.5 mm were significantly higher than at 3.0 mm reconstructions (mean Agatston score: 266 +/- 495 vs. 231 +/- 461. Mean volume score: 223 +/- 399 vs. 206 +/- 385, both P < 0.01). In 21% of patients with zero 3.0 mm Agatston scores, a positive Agatston and/or volume score was found at 0.5 mm reconstructions. With volumetric 320-detector row CT, prospective ECG-triggered calcium scoring at 0.5 mm compared to 3.0 mm reconstructions leads to an increase in Agatston and volume scores and small amounts of coronary calcium are earlier depicted. This may be of special interest in patients with zero calcium scores with traditional 3.0 mm measures, where 0.5 mm reconstructions may help in superior depicting or ruling out coronary artery disease. [ABSTRACT FROM AUTHOR]
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- 2010
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7. Transcatheter aortic valve implantation: role of multimodality cardiac imaging.
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Delgado V, Ng AC, Shanks M, van der Kley F, Schuijf JD, van de Veire NR, Kroft L, de Roos A, Schalij MJ, Bax JJ, Delgado, Victoria, Ng, Arnold C T, Shanks, Miriam, van der Kley, Frank, Schuijf, Joanne D, van de Veire, Nico R L, Kroft, Lucia, de Roos, Albert, Schalij, Martin J, and Bax, Jeroen J
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Current evidence based on more than 8000 high-risk patients with severe aortic stenosis has demonstrated that transcatheter aortic valve implantation (TAVI) is a feasible alternative to surgical aortic valve replacement in selected patients. Despite current promising results on hemodynamic and clinical improvements, there are several unresolved safety issues, such as the frequency of vascular complications, postprocedural paravalvular leak, atrioventricular heart block and stroke. Multimodality cardiac imaging may help to minimize these complications and may play a central role before (optimizing patient selection, selection of appropriate prosthesis size and anticipating the procedural approach), during and after TAVI (evaluating the immediate and long-term procedural results). This article reviews the state-of-the-art TAVI procedures and the role that multimodality cardiac imaging plays before, during and after TAVI. [ABSTRACT FROM AUTHOR]
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- 2010
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8. Comparison of non-invasive multi-slice computed tomography coronary angiography versus invasive coronary angiography and fractional flow reserve for the evaluation of men with known coronary artery disease.
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van Werkhoven JM, Schuijf JD, Jukema JW, Pundziute G, de Roos A, Schalij MJ, van der Wall EE, Bax JJ, van Werkhoven, Jacob M, Schuijf, Joanne D, Jukema, J Wouter, Pundziute, Gabija, de Roos, Albert, Schalij, Martin J, van der Wall, Ernst E, and Bax, Jeroen J
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Multislice computed tomographic coronary angiography (MSCT) can accurately detect the presence of atherosclerosis noninvasively. However, a discrepancy has been observed between MSCT and noninvasive functional imaging. The purpose of the present study was to evaluate the correlation between MSCT and invasive fractional flow reserve (FFR) in men with known coronary artery disease. Thirty-three patients (mean age 57 +/- 11 years) clinically referred for coronary angiography underwent MSCT and FFR analysis. Coronary angiography and MSCT were evaluated for nonsignificant (30% to 50% luminal narrowing) and significant (>50% luminal narrowing) stenosis. Abnormal FFR was defined as < or =0.75. A total of 36 vessels were evaluated for FFR, with 8 (22%) showing reduced FFR. Results on MSCT were normal (completely normal or <30% luminal narrowing in 11 vessesl [31%], nonsignificant lesions in 13 vessels [36%], and significant stenoses in 12 vessels [33%]). Abnormal FFR was observed in only 58% of vessels with lesions >50% on MSCT. Nevertheless, the agreement between normal results on MSCT and normal FFR was excellent; FFR was normal in all 11 vessels with normal results on MSCT. In conclusion, significant stenoses on MSCT frequently do not result in reduced FFR. Normal results on MSCT, however, can accurately rule out the presence of hemodynamically significant lesions in men with known coronary artery disease. [ABSTRACT FROM AUTHOR]
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- 2009
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9. Head-to-head comparison between bicycle exercise testing and coronary calcium score and coronary stenoses on multislice computed tomography.
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Pundziute G, Schuijf JD, van Werkhoven JM, Nucifora G, van der Wall EE, Wouter Jukema J, Bax JJ, Pundziute, Gabija, Schuijf, Joanne D, van Werkhoven, Jacob M, Nucifora, Gaetano, van der Wall, Ernst E, Wouter Jukema, J, and Bax, Jeroen J
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- 2009
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10. Non-significant left main disease; truly non-significant?
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van der Wall EE, Schuijf JD, Jukema JW, Bax JJ, Schalij MJ, van der Wall, E E, Schuijf, J D, Jukema, J W, Bax, J J, and Schalij, M J
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- 2009
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11. Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease.
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Pundziute G, Schuijf JD, Jukema JW, van Werkhoven JM, Boersma E, de Roos A, van der Wall EE, Bax JJ, Pundziute, G, Schuijf, J D, Jukema, J W, van Werkhoven, J M, Boersma, E, de Roos, A, van der Wall, E E, and Bax, J J
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Objective: To compare the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography between female and male patients using conventional coronary angiography as the reference standard.Design: Diagnostic accuracy study.Setting: University hospital.Patients: 103 consecutive patients (51 men, 52 women, mean (SD) age 60 (10) years) with known and suspected coronary artery disease underwent 64-slice MSCT.Main Outcome Measures: Diagnostic accuracy of 64-slice MSCT to detect obstructive (>or=50% luminal narrowing) stenoses in men and women.Results: One male and two female patients were excluded from the analysis owing to non-diagnostic MSCT scans as a result of increased heart rate and breathing during the scan. Accordingly, on segmental level, 728/762 coronary segments were of sufficient quality in women (96% (95% CI 95% to 97%)) and 704/723 segments were interpretable in men (97% (95% CI 96% to 98%)). In the remaining 100 patients included in the further analyses, the sensitivity and specificity on a segmental level in women and men were 85% (95% CI 75% to 95%) vs 85% (95% CI 78% to 92%) and 99% (95% CI 98% to 100%) vs 99% (95% CI 98% to 100%), respectively. On a patient level, the sensitivity in women and men was 95% (95% CI 87% to 100%) vs 100%, specificity 93% (95% CI 83% to 100%) vs 89% (95% CI 74% to 100%), positive predictive value 91% (95% CI 79% to 100%) vs 94% (95% CI 86% to 100%), and negative predictive value 96% (95% CI 89% to 100%) vs 100%, respectively.Conclusion: The findings confirm the high diagnostic accuracy of 64-slice MSCT coronary angiography in both male and female patients. [ABSTRACT FROM AUTHOR]- Published
- 2008
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12. Prognostic value of multislice computed tomography coronary angiography.
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Schuijf JD, Pundziute G, and Bax JJ
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- 2007
13. Noninvasive coronary angiography with multislice computed tomography and myocardial perfusion imaging.
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Schuijf JD and Bax JJ
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- 2007
14. Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus: implications for percutaneous mitral annuloplasty.
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Tops LF, Van de Veire NR, Schuijf JD, de Roos A, van der Wall EE, Schalij MJ, Bax JJ, Tops, Laurens F, Van de Veire, Nico R, Schuijf, Joanne D, de Roos, Albert, van der Wall, Ernst E, Schalij, Martin J, and Bax, Jeroen J
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- 2007
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15. Can coronary calcification define the warranty period of a normal myocardial perfusion study?
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Bax JJ, Schuijf JD, Bax, Jeroen J, and Schuijf, Joanne D
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- 2008
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16. Nonobstructive coronary plaque matters.
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Wijns W, Schuijf JD, Wijns, William, and Schuijf, Joanne D
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- 2011
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17. The role of non-invasive imaging in patient selection.
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Van de Veire NR, Delgado V, Schuijf JD, van der Wall EE, Schalij MJ, Bax JJ, Van de Veire, Nico R, Delgado, Victoria, Schuijf, Joanne D, van der Wall, Ernst E, Schalij, Martin J, and Bax, Jeroen J
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Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced heart failure, depressed left ventricular (LV) function and wide QRS complex. A substantial amount of patients do not respond to CRT. Recent studies suggest that assessment of mechanical dyssynchrony may allow identification of potential CRT responders. In addition, presence of scar tissue and venous anatomy may play a role in the selection of candidates. This article summarizes the role of non-invasive cardiac imaging modalities addressing these issues in the selection of CRT candidates. [ABSTRACT FROM AUTHOR]
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- 2009
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18. Magnetic resonance imaging and computed tomography in assessing cardiac veins and scar tissue.
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Van de Veire NR, Schuijf JD, Bleeker GB, Schalij MJ, Bax JJ, Van de Veire, Nico R, Schuijf, Joanne D, Bleeker, Gabe B, Schalij, Martin J, and Bax, Jeroen J
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The success of cardiac resynchronization therapy is influenced by several issues including cardiac venous anatomy and myocardial scar tissue. This article discusses non-invasive imaging modalities that could contribute significantly to the selection process of cardiac resynchronization therapy (CRT) candidates: multi-slice computed tomography to depict the coronary sinus tributaries and magnetic resonance imaging to identify scar tissue. [ABSTRACT FROM AUTHOR]
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- 2008
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19. The difficulty of adequate risk stratification for patients with asymptomatic diabetes.
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Scholte AJ, Schuijf JD, Stokkel MP, de Roos A, and Bax JJ
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- 2008
20. Noninvasive imaging of cardiac venous anatomy with 64-slice multi-slice computed tomography and noninvasive assessment of left ventricular dyssynchrony by 3-dimensional tissue synchronization imaging in patients with heart failure scheduled for cardiac resynchronization therapy.
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Van de Veire NR, Marsan NA, Schuijf JD, Bleeker GB, Wijffels MCE, van Erven L, Holman ER, De Sutter J, van der Wall EE, Schalij MJ, and Bax JJ
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- 2008
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21. Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound.
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van Velzen JE, de Graaf FR, Jukema JW, de Grooth GJ, Pundziute G, Kroft LJ, de Roos A, Reiber JH, Bax JJ, Schalij MJ, Schuijf JD, van der Wall EE, van Velzen, Joëlla E, de Graaf, Fleur R, Jukema, J Wouter, de Grooth, Greetje J, Pundziute, Gabija, Kroft, Lucia J, de Roos, Albert, and Reiber, Johan H C
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A considerable number of patients with an acute coronary syndrome (ACS) who present with a 0 or low calcium score (CS) still demonstrate coronary artery disease (CAD) and significant stenosis. The aim of the present study was to evaluate the relation between the CS and the degree and character of atherosclerosis in patients with suspected ACS versus patients with stable CAD obtained by computed tomography angiography and virtual histology intravascular ultrasound (VH IVUS). Overall 112 patients were studied, 53 with ACS and 59 with stable CAD. Calcium scoring and computed tomography angiography were performed and followed by VH IVUS. On computed tomography angiography each segment was evaluated for plaque and classified as noncalcified, mixed, or calcified. Vulnerable plaque characteristics on VH IVUS were defined by percent necrotic core and presence of thin-cap fibroatheroma. If the CS was 0, patients with ACS had a higher mean number of plaques (5.0 ± 2.0 vs 2.0 ± 1.9, p <0.05) and noncalcified plaques (4.6 ± 3.5 vs 1.3 ± 1.9, p <0.05) on computed tomography angiography than those with stable CAD. If the CS was 0, VH IVUS demonstrated that patients with ACS had a larger amount of necrotic core area (0.58 ± 0.73 vs 0.22 ± 0.43 mm(2), p <0.05) and a higher mean number of thin-cap fibroatheromas (0.6 ± 0.7 vs 0.1 ± 0.3, p <0.05) than patients with stable CAD. In conclusion, even in the presence of a 0 CS, patients with ACS have increased plaque burden and increased vulnerability compared to patients with stable CAD. Therefore, absence of coronary calcification does not exclude the presence of clinically relevant and potentially vulnerable atherosclerotic plaque burden in patients with ACS. [ABSTRACT FROM AUTHOR]
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- 2011
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22. Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology
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Gianmario Sambuceti, Ernst E. van der Wall, Philip A. Kaufmann, Joanne D. Schuijf, Stephan Achenbach, Pasquale Perrone-Filardi, Michael J. Zellweger, Stefan Möhlenkamp, Juhani Knuuti, Zeljko Reiner, Stephen Schroeder, University of Zurich, Perrone-Filardi, P, PERRONE FILARDI, Pasquale, Achenbach, S, Möhlenkamp, S, Reiner, Z, Sambuceti, G, Schuijf, Jd, Van der Wall, E, Kaufmann, Pa, Knuuti, J, Schroeder, S, and Zellweger, Mj
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medicine.medical_specialty ,Functional testing ,Ischemia ,Medizin ,610 Medicine & health ,Coronary Artery Disease ,Disease ,Single-photon emission computed tomography ,Risk Assessment ,Asymptomatic ,142-005 142-005 ,2705 Cardiology and Cardiovascular Medicine ,Hyperlipoproteinemia Type II ,Diabetes mellitus ,Internal medicine ,Myocardial perfusion scintigraphy ,Humans ,Medicine ,medicine.diagnostic_test ,business.industry ,Age Factors ,Myocardial Perfusion Imaging ,Calcinosis ,Prognosis ,medicine.disease ,Pedigree ,Early Diagnosis ,Diabetes Mellitus, Type 2 ,cardiac computed tomography ,myocardial perfusion scintigraphy ,Disease Progression ,Cardiology ,570 Life sciences ,biology ,Kidney Diseases ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Diabetic Angiopathies - Abstract
Cardiovascular events remain one of the most frequent causes of mortality and morbidity worldwide. The majority of cardiac events occur in individuals without known coronary artery disease (CAD) and in low- to intermediate-risk subjects. Thus, the development of improved preventive strategies may substantially benefit from the identification, among apparently intermediate-risk subjects, of those who have a high probability for developing future cardiac events. Cardiac computed tomography and myocardial perfusion scintigraphy (MPS) by single photon emission computed tomography may play a role in this setting. In fact, absence of coronary calcium in cardiac computed tomography and inducible ischaemia in MPS are associated with a very low rate of major cardiac events in the next 3-5 years. Based on current evidence, the evaluation of coronary calcium in primary prevention subjects should be considered in patients classified as intermediate-risk based on traditional risk factors, since high calcium scores identify subjects at high-risk who may benefit from aggressive secondary prevention strategies. In addition, calcium scoring should be considered for asymptomatic type 2 diabetic patients without known CAD to select those in whom further functional testing by MPS or other stress imaging techniques may be considered to identify patients with significant inducible ischaemia. From available data, the use of MPS as first line testing modality for risk stratification is not recommended in any category of primary prevention subjects with the possible exception of first-degree relatives of patients with premature CAD in whom MPS may be considered. However, the Working Group recognizes that neither the use of computed tomography for calcium imaging nor of MPS have been proven to significantly improve clinical outcomes of primary prevention subjects in prospective controlled studies. This information would be crucial to adequately define the role of imaging approaches in cardiovascular preventive strategies.
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- 2011
23. Energy-integrating detector based ultra-high-resolution CT with deep learning reconstruction for the assessment of calcified lesions in coronary artery disease.
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Sone M, Orii M, Ota Y, Chiba T, Schuijf JD, Akino N, and Yoshioka K
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Background: The aim of this study to compare of the image quality of calcified lesions in coronary artery disease between deep learning reconstruction (DLR) and model-based iterative reconstruction (MBIR) on energy-integrating detector (EID) based ultra-high-resolution CT (UHRCT)., Methods: We performed a phantom study on EID-based UHRCT using a dedicated insert for calcifications and obtained the derivative values for DLR and MBIR. In the clinical study, the derivative values were compared between DLR and MBIR across 73 calcified lesions in 62 patients. Edge sharpness of calcifications and contrast resolution at the coronary lumen side were quantified by the maximum and minimum derivative values. Two radiologists independently analyzed image quality of the calcified lesions using a 5-point Likert scale., Results: In the phantom study, the edge sharpness of the 3-mm calcifications on DLR (median, 924 HU/mm; IQR, 580-1741 HU/mm) was significantly higher than on MBIR (median, 835 HU/mm; IQR, 484-1552; p < 0.001). In the clinical study, the image quality of the calcified lesions was significantly better on DLR with significantly reduced reconstruction time (p < 0.001). The contrast resolution at the coronary lumen side on DLR (median, -99.1 HU/mm; IQR, -209 to -34.3 HU/mm) was significantly higher than on MBIR (median, -41.8 HU/mm; IQR, -121 to 22.3 HU/mm, p < 0.001) although the edge sharpness of calcifications was similar between DLR and MBIR (p = 0.794) in the clinical setting., Conclusion: EID-based UHRCT reconstructed using DLR represents better image quality of calcified lesions in coronary artery disease compared with MBIR, with significantly reduced reconstruction time., Competing Interests: Declaration of competing interest Kunihiro Yoshioka received a research grant from Canon Medical Systems Co. Ltd. Other authors declare that they have no conflict of interest., (Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
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- 2024
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24. Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE-PRECISION multicenter study.
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Scarpa Matuck BR, Akino N, Bakhshi H, Cox C, Ebrahimihoor E, Ishida M, Lemos PA, Lima JAC, Matheson MB, Orii M, Ostovaneh A, Ostovaneh MR, Schuijf JD, Szarf G, Trost JC, Yoshioka K, and Arbab-Zadeh A
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- Humans, Prospective Studies, Reproducibility of Results, Multicenter Studies as Topic, Coronary Circulation, Vascular Calcification diagnostic imaging, Vascular Calcification physiopathology, Female, Male, United States, Europe, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease physiopathology, Coronary Angiography, Computed Tomography Angiography, Predictive Value of Tests, Hemodynamics, Coronary Vessels diagnostic imaging, Coronary Vessels physiopathology, Severity of Illness Index
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Background: Direct coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis., Methods: The CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories., Results: The primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others., Conclusion: CORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment., (Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
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- 2024
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25. Coronary artery disease grading by cardiac CT for predicting outcome in patients with stable angina.
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Oeing CU, Matheson MB, Ostovaneh MR, Rochitte CE, Chen MY, Pieske B, Kofoed KF, Schuijf JD, Niinuma H, Dewey M, di Carli MF, Cox C, Lima JAC, and Arbab-Zadeh A
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- Humans, Calcium, Computed Tomography Angiography methods, Coronary Angiography methods, Multidetector Computed Tomography, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors, Angina, Stable diagnostic imaging, Angina, Stable therapy, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Plaque, Atherosclerotic
- Abstract
Background: The coronary atheroma burden drives major adverse cardiovascular events (MACE) in patients with suspected coronary heart disease (CHD). However, a consensus on how to grade disease burden for effective risk stratification is lacking. The purpose of this study was to compare the effectiveness of common CHD grading tools to risk stratify symptomatic patients., Methods: We analyzed the 5-year outcome of 381 prospectively enrolled patients in the CORE320 international, multicenter study using baseline clinical and cardiac computer-tomography (CT) imaging characteristics, including coronary artery calcium score (CACS), percent atheroma volume, "high-risk" plaque, disease severity grading using the CAD-RADS, and two simplified CAD staging systems. We applied Cox proportional hazard models and area under the curve (AUC) analysis to predict MACE or hard MACE, defined as death, myocardial infarction, or stroke. Analyses were stratified by a history of CHD. Additional forward selection analysis was performed to evaluate incremental value of metrics., Results: Clinical characteristics were the strongest predictors of MACE in the overall cohort. In patients without history of CHD, CACS remained the only independent predictor of MACE yielding an AUC of 73 (CI 67-79) vs. 64 (CI 57-70) for clinical characteristics. Noncalcified plaque volume did not add prognostic value. Simple CHD grading schemes yielded similar risk stratification as the CAD-RADS classification. Forward selection analysis confirmed prominent role of CACS and revealed usefulness of functional testing in subgroup with known CHD., Conclusion: In patients referred for invasive angiography, a history of CHD was the strongest predictor of MACE. In patients without history of CHD, a coronary calcium score yielded at least equal risk stratification vs. more complex CHD grading., (Copyright © 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
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- 2023
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26. Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography.
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Møller MB, Schuijf JD, Oyama-Manabe N, Linde JJ, Kühl JT, Lima JAC, and Kofoed KF
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- Humans, Coronary Angiography methods, Prospective Studies, Computed Tomography Angiography methods, Predictive Value of Tests, Coronary Artery Disease diagnostic imaging, Myocardial Perfusion Imaging methods, Coronary Stenosis
- Abstract
Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality., Competing Interests: Mathias B. Møller has received grants from The Research Council of Rigshopitalet anm The Research Council of the Heart Center, Rigshospitalet. Joanne D. Schuijf is an employee of Canon Medical Systems Europe. Noriko Oyama-Manabe has received grants from, Canon Medical Systems Corporation, and from the Japan Society for the Promotion of Science (JSPS) KAKENHI # 26461780, has activities as a consultant for Canon Medical Systems, and received payment for lectures from Daiichi-Sankyo, Philips Medical Systems, Eisai, Bayer Healthcare, GE Healthcare, Nihon Medi-Physics Co. Ltd and Canon Medical Systems. Jørgen T. Kühl has received funding from the Research Council of Rigshospitalet. Jesper J. Linde has received grants from The Danish Research Foundation and The Research Council of Rigshospitalet. Klaus F. Kofoed AP Moller og hustru Chastine McKinney Mollers Fond, The John and Birthe Meyer Foundation, The Danish Agency for Science, Technology and Innovation, The Lundbeck Foundation, GE Healthcare, Canon Medical Systems, The Danish Heart Foundation, The University of Copenhagen, and is on the Speakers Bureau of Canon Medical Systems Corporation. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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27. CT imaging with ultra-high-resolution: Opportunities for cardiovascular imaging in clinical practice.
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Schuijf JD, Lima JAC, Boedeker KL, Takagi H, Tanaka R, Yoshioka K, and Arbab-Zadeh A
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- Artifacts, Computed Tomography Angiography methods, Coronary Angiography methods, Humans, Predictive Value of Tests, Coronary Artery Disease diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Cardiovascular computed tomography (CT) angiography has become an established alternative to invasive catheter angiography. However, imaging artifacts due to partial volume effects with current systems hinder accurate evaluation of calcified or stented segments. Increased spatial resolution may allow to overcome these barriers to precise delineation of vascular disease. Recent developments in CT hardware and reconstruction have enabled CT angiography with ultra-high spatial resolution (UHRCT). In this review we aim to describe the methods to achieve greater spatial resolution in CT that are either in clinical or preclinical stage. In addition, we provide an overview of the available clinical evidence including diagnostic accuracy studies supporting improved vascular assessment with this technology. The benefits that can be gleaned from the initial experiences with UHRCT are promising. Using UHRCT, more patients may receive non-invasive characterization of coronary atherosclerosis by overcoming the limitations of current CT spatial resolution in visualizing and quantifying calcified, stented or small diameter segments. UHRCT may potentially impact existing management pathways as well as contribute to better understanding of the underlying pathophysiology of both macro- and microvascular disease., Competing Interests: Declaration of competing interest Joanne D. Schuijf, PhD and Kirsten L. Boedeker, PhD are employees of Canon Medical Systems. João A. C. Lima, MD and Armin Arbab-Zadeh, MD PhD MPH are supported by a research grant from Canon Medical Systems., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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28. Detailed CAD Phenotyping by Angiography, Dynamic Perfusion and Scar Imaging Sharpens CT Prognostic Power.
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Lima JAC and Schuijf JD
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- Coronary Angiography, Humans, Perfusion, Predictive Value of Tests, Prognosis, Tomography, X-Ray Computed, Cicatrix, Myocardial Perfusion Imaging
- Published
- 2020
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29. Ischemia and No Obstructive Stenosis (INOCA) at CT Angiography, CT Myocardial Perfusion, Invasive Coronary Angiography, and SPECT: The CORE320 Study.
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Schuijf JD, Matheson MB, Ostovaneh MR, Arbab-Zadeh A, Kofoed KF, Scholte AJHA, Dewey M, Steveson C, Rochitte CE, Yoshioka K, Cox C, Di Carli MF, and Lima JAC
- Subjects
- Aged, Female, Heart diagnostic imaging, Humans, Male, Middle Aged, Prospective Studies, Computed Tomography Angiography methods, Coronary Angiography methods, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging methods, Tomography, Emission-Computed, Single-Photon methods
- Abstract
Background CT allows evaluation of atherosclerosis, coronary stenosis, and myocardial ischemia. Data on the characterization of ischemia and no obstructive stenosis (INOCA) at CT remain limited. Purpose This was an observational study to describe the prevalence of INOCA defined at coronary CT angiography with CT perfusion imaging and associated clinical and atherosclerotic characteristics. The analysis was also performed for the combination of invasive coronary angiography (ICA) and SPECT as a secondary aim. Materials and Methods The prospective CORE320 study ( ClinicalTrials.gov : NCT00934037) enrolled participants between November 2009 and July 2011 who were symptomatic and referred for clinically indicated ICA. Participants underwent CT angiography, rest-adenosine stress CT perfusion, and rest-stress SPECT prior to ICA. For this ancillary study, the following three phenotypes were considered, using either CT angiography/CT perfusion or ICA/SPECT data: (a) participants with obstructive (≥50%) stenosis, (b) participants with no obstructive stenosis but ischemia (ie, INOCA) on the basis of abnormal perfusion imaging results, and (c) participants with no obstructive stenosis and normal perfusion imaging results. Clinical characteristics and CT angiography atherosclerotic plaque measures were compared by using the Pearson χ
2 or Wilcoxon rank-sum test. Results A total of 381 participants (mean age, 62 years [interquartile range, 56-68 years]; 129 [34%] women) were evaluated. A total of 31 (27%) of 115 participants without obstructive (≥50%) stenosis at CT angiography had abnormal CT perfusion findings. The corresponding value for ICA/SPECT was 45 (30%) of 151. The prevalence of INOCA was 31 (8%) of 381 (95% confidence interval [CI]: 5%, 11%) with CT angiography/CT perfusion and 45 (12%) of 381 (95% CI: 9%, 15%) with ICA/SPECT. Participants with CT-defined INOCA had greater total atheroma volume (118 vs 60 mm3 , P = .008), more positive remodeling (13% vs 1%, P = .006), and greater low-attenuation atheroma volume (20 vs 10 mm3 , P = .007) than participants with no obstructive stenosis and no ischemia. Comparisons for ICA/SPECT showed similar trends. Conclusion In CORE320, ischemia and no obstructive stenosis (INOCA) prevalence was 8% and 12% at CT angiography/CT perfusion and invasive coronary angiography/SPECT, respectively. Participants with INOCA had greater atherosclerotic burden and more adverse plaque features at CT compared with those with no obstructive stenosis and no ischemia. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by François in this issue.- Published
- 2020
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30. Cardiovascular ultrashort echo time to map fibrosis-promises and challenges.
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Schuijf JD, Ambale-Venkatesh B, Kassai Y, Kato Y, Kasuboski L, Ota H, Caruthers SD, and Lima JA
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- Artifacts, Contrast Media, Fibrosis pathology, Gadolinium, Humans, Time Factors, Cardiovascular System pathology, Magnetic Resonance Angiography methods
- Abstract
Increased collagen, or fibrosis, is an important marker of disease and may improve identification of patients at risk. In addition, fibrosis imaging may play an increasing role in guiding therapy and monitoring its effectiveness. MRI is the most frequently used modality to detect, visualize and quantify fibrosis non-invasively. However, standard MRI techniques used to phenotype cardiac fibrosis such as delayed enhancement and extracellular volume determination by T
1 mapping, require the administration of gadolinium-based contrast and are particularly difficult to use in patients with cardiac devices such as pacemakers and automatic defibrillators. Therefore, such methods are limited in the serial evaluation of cardiovascular fibrosis as part of chronic disease monitoring. A method to directly measure collagen amount could be of great clinical benefit. In the current review we will discuss the potential of a novel MR technique, ultrashort echo time (UTE) MR, for fibrosis imaging. Although UTE imaging is successfully applied in other body areas such as musculoskeletal applications, there is very limited experience so far in the heart. We will review the established methods and currently available literature, discuss the technical considerations and challenges, show preliminary in vivo images and provide a future outlook on potential applications of cardiovascular UTE.- Published
- 2019
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31. Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study.
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Lo-Kioeng-Shioe MS, Vavere AL, Arbab-Zadeh A, Schuijf JD, Rochitte CE, Chen MY, Rief M, Kofoed KF, Clouse ME, Scholte AJ, Miller JM, Betoko A, Blaha MJ, Cox C, Deckers JW, and Lima JAC
- Subjects
- Aged, Aged, 80 and over, Coronary Artery Disease epidemiology, Coronary Artery Disease metabolism, Coronary Vessels metabolism, Female, Follow-Up Studies, Global Health, Humans, Incidence, Male, Middle Aged, Myocardial Perfusion Imaging, Predictive Value of Tests, Prospective Studies, Risk Factors, Survival Rate trends, Vascular Calcification epidemiology, Vascular Calcification metabolism, Calcium metabolism, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Artery Disease diagnosis, Coronary Vessels diagnostic imaging, Risk Assessment methods, Vascular Calcification diagnosis
- Abstract
Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.
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- 2019
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32. Contemporary Discrepancies of Stenosis Assessment by Computed Tomography and Invasive Coronary Angiography.
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Song YB, Arbab-Zadeh A, Matheson MB, Ostovaneh MR, Vavere AL, Dewey M, Rochitte C, Niinuma H, Laham R, Schuijf JD, Cox C, Brinker J, di Carli M, Lima JAC, and Miller JM
- Subjects
- Aged, Coronary Stenosis physiopathology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Severity of Illness Index, Computed Tomography Angiography, Coronary Angiography methods, Coronary Circulation, Coronary Stenosis diagnostic imaging, Multidetector Computed Tomography, Myocardial Perfusion Imaging methods, Tomography, Emission-Computed, Single-Photon
- Abstract
Background Ongoing advancements of coronary computed tomographic angiography (CTA) continue to challenge the role of invasive coronary angiography (ICA) as the gold standard for the evaluation of coronary artery disease (CAD). We sought to investigate the diagnostic accuracy of 320-slice CTA for detecting obstructive CAD in reference to ICA and nuclear myocardial perfusion imaging using single-photon emission computed tomography. Methods For the CORE320 study (Coronary Artery Evaluation Using 320-Row Multidetector Computed Tomography Angiography and Myocardial Perfusion), 381 patients at 16 centers underwent CTA, nuclear myocardial perfusion imaging by single-photon emission computed tomography, and ICA for the evaluation of CAD. Imaging studies were analyzed in blinded core laboratories, and a stenosis of ≥50% by quantitative coronary angiography was considered obstructive, whereas a stress difference score of ≥1 indicated inducible myocardial ischemia. The area under the receiver operating characteristic curve was used to evaluate diagnostic accuracy. Results Of 381 patients, 229 (60%) had obstructive CAD by quantitative coronary angiography. Diagnostic accuracy of CTA on a per-patient analysis revealed an area under the receiver operating characteristic curve of 0.90 (95% CI, 0.87-0.93). Per-vessel and per-segment analysis revealed lower area under the receiver operating characteristic curve of 0.87 (0.84-0.90) and 0.81 (0.78-0.83), respectively. Median radiation dose was lower for CTA versus ICA: 3.16 (interquartile range, 2.82-3.59) versus 11.97 (interquartile range, 7.60-17.8) mSv ( P<0.001). Accuracy for identifying patients with inducible myocardial ischemia by SPECT-MPI was similar for CTA and ICA (area under the receiver operating characteristic curve, 0.68 versus 0.71 by quantitative coronary angiography and 0.68 by visual angiographic assessment; P>0.05). Furthermore, accuracy for identifying patients who subsequently underwent clinically driven coronary revascularization also was similar for CTA (0.76 [0.71-0.81]) and ICA (0.78 [0.74-0.83]; P=0.20). Conclusions Contemporary CTA accurately identifies patients with obstructive CAD by ICA at lower radiation exposure; however, agreement is lower in vessel- and segment-level analyses. Both CTA and ICA perform similarly for predicting clinically driven revascularization and for detecting myocardial ischemia by myocardial perfusion imaging using single-photon emission computed tomography, suggesting that limitations by both CTA and ICA contribute to variability of stenosis quantification. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00934037.
- Published
- 2019
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33. Ultra-high-resolution subtraction CT angiography in the follow-up of treated intracranial aneurysms.
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Meijer FJA, Schuijf JD, de Vries J, Boogaarts HD, van der Woude WJ, and Prokop M
- Abstract
In subtraction CT angiography (CTA), a non-contrast CT acquisition is subtracted from a contrast-enhanced CTA acquisition. Subtraction CTA can be applied in the detection, classification, and follow-up of intracranial aneurysms and is advantageous over conventional angiography because of its non-invasive nature, shorter examination time, and lower costs. Recently, an ultra-high-resolution CT scanner has been introduced in clinical practice offering an in-plane spatial resolution of up to 0.234 mm, approaching the resolution as seen during conventional invasive digital subtraction angiography (DSA). The twofold increase in spatial resolution as compared to a conventional CT scanner could improve the evaluation of small vascular structures and, coupled with dedicated post-processing techniques, further reduce metal artifacts. Technical considerations using a state-of-the-art high-resolution subtraction CTA protocol are discussed for application in the follow-up of surgical and endovascular treated intracranial aneurysms.
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- 2019
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34. Novel developments in non-invasive imaging of peripheral arterial disease with CT: experience with state-of-the-art, ultra-high-resolution CT and subtraction imaging.
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Tanaka R, Yoshioka K, Takagi H, Schuijf JD, and Arakita K
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- Arterial Occlusive Diseases diagnostic imaging, Humans, Angiography, Digital Subtraction methods, Computed Tomography Angiography methods, Peripheral Arterial Disease diagnostic imaging, Radiographic Image Enhancement methods
- Abstract
Despite advances, challenges remain for less invasive imaging of peripheral arterial occlusive disease (PAOD) using computed tomography (CT) angiography. The application of dual-energy imaging to PAOD has been reported to improve the diagnostic accuracy of this application; however, severe arteriosclerosis with heavy arterial wall calcification still hampers definitive lesion characterisation, especially in distal and smaller arteries. Recently an ultra-high resolution scanner has been introduced. In combination with advances in post-processing, such as subtraction techniques, these developments may overcome some of the current challenges and allow far more detailed characterisation of PAOD non-invasively. The aim of this review is to describe our current experience with ultra-high resolution CT in combination with subtraction and discuss the potential advantages of their application for peripheral angiography., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
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35. Systematic evaluation of collateral pathways to the artery of Adamkiewicz using computed tomography.
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Yoshioka K, Tanaka R, Takagi H, Ueyama Y, Sugawara T, Chiba T, Arakita K, and Schuijf JD
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- Adult, Aged, Aged, 80 and over, Female, Humans, Imaging, Three-Dimensional methods, Male, Middle Aged, Multidetector Computed Tomography methods, Observer Variation, Postoperative Complications prevention & control, Preoperative Care methods, Retrospective Studies, Spinal Cord diagnostic imaging, Spinal Cord Injuries prevention & control, Aortic Aneurysm, Thoracic surgery, Collateral Circulation, Computed Tomography Angiography methods, Spinal Cord blood supply
- Abstract
Objectives: Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury in patients undergoing thoracic and thoraco-abdominal aortic aneurysm repair. Although several studies have shown the feasibility of evaluating the artery of Adamkiewicz using multidetector row computed tomography (MDCT), no detailed investigations regarding the collateral circulation to the artery of Adamkiewicz have been performed. The purpose of this study was to investigate the collateral circulation to the artery of Adamkiewicz using MDCT in patients with thoracic and thoraco-abdominal aortic aneurysms., Methods: Our institutional review board approved this study. Sixty-four patients with descending thoracic and thoraco-abdominal aortic aneurysms associated with the occlusion of the segmental artery from which the artery of Adamkiewicz originated were scanned using 64- or 320-detector row computed tomography. Two independent observers evaluated the MDCT images based on the degree of visualization of the artery of Adamkiewicz and its collateral circulation using a 4-point scale., Results: The average visualization score was 2.8 ± 0.6. In 53 of the 64 (83%) patients, image quality was judged to be diagnostic. MDCT demonstrated 75 collateral pathways to the artery of Adamkiewicz in these 53 patients. Sixty-four of the 75 (85%) pathways were collaterals around the spinal column, and the remaining 11 (15%) pathways were collateral arteries in the thoracic wall., Conclusions: MDCT revealed the collateral pathways to the artery of Adamkiewicz around the spinal column and in the thoracic wall in 83% of our patients with thoracic and thoraco-abdominal aortic aneurysms.
- Published
- 2018
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36. Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study.
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Ostovaneh MR, Vavere AL, Mehra VC, Kofoed KF, Matheson MB, Arbab-Zadeh A, Fujisawa Y, Schuijf JD, Rochitte CE, Scholte AJ, Kitagawa K, Dewey M, Cox C, DiCarli MF, George RT, and Lima JAC
- Subjects
- Aged, Aged, 80 and over, Area Under Curve, Asia, Automation, Computed Tomography Angiography standards, Coronary Angiography standards, Coronary Artery Disease physiopathology, Coronary Vessels physiopathology, Europe, Female, Humans, Logistic Models, Male, Middle Aged, Multidetector Computed Tomography standards, Myocardial Perfusion Imaging standards, North America, Observer Variation, Predictive Value of Tests, Prospective Studies, ROC Curve, Radiographic Image Interpretation, Computer-Assisted standards, Reference Standards, Reproducibility of Results, Severity of Illness Index, South America, Tomography, Emission-Computed, Single-Photon, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Coronary Circulation, Coronary Vessels diagnostic imaging, Multidetector Computed Tomography methods, Myocardial Perfusion Imaging methods, Radiographic Image Interpretation, Computer-Assisted methods
- Abstract
Aims: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging., Methods: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC)., Results: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all)., Conclusion: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD., (Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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37. Accuracy of coronary artery calcium scoring with tube current reduction by 75%, using an adaptive iterative reconstruction algorithm.
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Luhur R, Schuijf JD, Mews J, Blobel J, Hamm B, and Lembcke A
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- Aged, Algorithms, Female, Humans, Male, Radiation Dosage, Risk Assessment, Coronary Disease diagnostic imaging, Radiographic Image Interpretation, Computer-Assisted methods, Tomography, X-Ray Computed methods, Vascular Calcification diagnostic imaging
- Abstract
Objective: To assess the accuracy of an iterative reconstruction (IR) technique for coronary artery calcium scoring with reduced radiation dose., Methods: 163 consecutive patients underwent twofold scanning by 320-row detector CT at 120 kVp. A low-dose scan at 25% tube current but with standard scan length (14 cm) was followed by a standard dose scan with routine tube current but reduced scan length (10 cm). Reduced dose images were constructed using filtered back-projection (FBP) and IR (adaptive iterative dose reduction in three dimensions). The standard dose scan reconstructed with FBP served as the gold standard for comparisons. Image noise and Agatston coronary calcium scores were determined and compared between the groups., Results: Compared with FBP at standard dose, noise at reduced dose increased markedly with FBP but remained low with IR. Mean Agatston score with FBP at reduced dose showed a significant increase as compared with FBP at standard dose. No significant difference was observed when applying IR at reduced dose. At reduced dose, 38 (23.3%) patients were reassigned to a different cardiovascular risk category with FBP but only 8 (4.9%) with IR. Out of 47 patients with a zero Agatston score, 15 patients (31.9%) were false-positive with FBP at reduced dose, but no false positives were found with IR., Conclusion: IR allows accurate coronary artery calcium scoring with a radiation dose reduced by 75%. Advances in knowledge: The application of adaptive iterative dose reduction in three dimensions allows the maintenance of accurate Agatston scores and risk stratification at significantly reduced tube current, thus reducing the patient's exposure to ionizing radiation.
- Published
- 2018
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38. Diagnostic performance of coronary CT angiography with ultra-high-resolution CT: Comparison with invasive coronary angiography.
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Takagi H, Tanaka R, Nagata K, Ninomiya R, Arakita K, Schuijf JD, and Yoshioka K
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- Aged, Computed Tomography Angiography methods, Computed Tomography Angiography standards, Coronary Angiography methods, Female, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed methods, Coronary Angiography standards, Coronary Stenosis diagnostic imaging
- Abstract
Purpose: Recently, ultra-high-resolution computed tomography (U-HRCT) with a 0.25 mm × 128-row detector was introduced. The purpose of this study was to evaluate the diagnostic performance of coronary CT angiography (CCTA) using U-HRCT., Methods: This retrospective study included 38 consecutive patients with suspected coronary artery disease (CAD) who underwent CCTA with U-HRCT followed by invasive coronary angiography (ICA). Per-segment diameter stenosis was calculated. Diagnostic performance of CCTA relative to ICA as the reference standard was determined. For segments with >30% diameter stenosis, the correlation and agreement of percent diameter stenosis between CCTA and ICA were calculated., Results: Obstructive CAD was observed in 65 segments (12%) of 51 vessels (45%) in 32 patients (84%) during ICA. The per-patient, vessel, and segment analyses showed a sensitivity of 100% (95% confidence interval [CI], 95%-100%), 96% (95% CI: 89%-99%) and 95% (95% CI: 89%-98%), respectively, and a specificity of 67% (95% CI: 38%-67%), 81% (95% CI: 75%-83%) and 96% (95% CI: 96%-97%), respectively. The percentage of diameter stenosis, as determined by CCTA, demonstrated an excellent correlation with ICA (R = 0.90; 95% CI: 0.83-0.95) and a slight significant overestimation (mean: 4% ± 7%, p < .01), with the agreed range of limits being ± 16%. The median effective radiation dose for CCTA was 5.4 mSv (range: 2.9-18.0 mSv)., Conclusions: CCTA with U-HRCT demonstrated an excellent correlation and agreement with ICA in the quantification of coronary artery stenosis., (Copyright © 2018 Elsevier B.V. All rights reserved.)
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- 2018
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39. Fractional flow reserve and myocardial perfusion by computed tomography: a guide to clinical application.
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Schuijf JD, Ko BS, Di Carli MF, Hislop-Jambrich J, Ihdayhid AR, Seneviratne SK, and Lima JAC
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- Coronary Artery Disease physiopathology, Female, Humans, Male, Middle Aged, Practice Guidelines as Topic, Sensitivity and Specificity, Coronary Artery Disease diagnostic imaging, Fractional Flow Reserve, Myocardial physiology, Image Interpretation, Computer-Assisted, Myocardial Perfusion Imaging methods, Tomography, X-Ray Computed methods
- Abstract
The aim of this paper is to provide a guide to the clinical application of the functional computed tomography (CT) techniques fractional flow reserve (CT FFR) and myocardial perfusion (CTP) in patients presenting for the evaluation of coronary artery disease (CAD). Both techniques have recently been introduced to complement coronary CT angiography (CTA) with physiological information. Evidence supporting their diagnostic accuracy accumulates at a fast pace, and both techniques are moving from research tools to clinical applications for specific subgroups of patients. As a consequence, the question that now emerges is how to optimally implement these techniques in the daily clinical workflow to maximize the benefit to patients. Given the inherent differences between both techniques in their underlying physical principles and methodology, as well as the types of pathophysiological information they provide, these techniques are not interchangeable. Rather, within the broad spectrum of patients presenting for CAD evaluation, both CT FFR and CTP may have their own optimized application where the highest benefit at the lowest risk and cost may be achieved. Therefore, we will review the physical principles and available clinical evidence of each technique, and propose how this information can be applied to the individual patient. Moreover, as techniques continue to mature, the combination of coronary CTA with CT FFR and/or CTP likely will become a powerful and accessible diagnostic tool for the detailed characterization of atherosclerotic disease providing a potentially more precise and personalized approach to patients with suspected CAD., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)
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- 2018
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40. Ultra-high-resolution CT angiography of the artery of Adamkiewicz: a feasibility study.
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Yoshioka K, Tanaka R, Takagi H, Ueyama Y, Kikuchi K, Chiba T, Arakita K, Schuijf JD, and Saito Y
- Subjects
- Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Male, Middle Aged, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Signal-To-Noise Ratio, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Computed Tomography Angiography methods, Spine blood supply
- Abstract
Purpose: Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury following thoracic and thoracoabdominal aortic repair. Several studies have demonstrated the feasibility of evaluating the artery of Adamkiewicz using multi-detector row computed tomography (CT), but precise visualization remains a challenge. The present study was conducted to evaluate the usefulness of ultra-high-resolution CT for visualizing the artery of Adamkiewicz with a slice thickness of 0.25 versus 0.5 mm in patients with aortic aneurysms., Methods: Our institutional review board approved this study. Twenty-four patients with thoracic and thoracoabdominal aneurysms were scanned with beam collimation of 0.25 mm × 128. Images were reconstructed with slice thicknesses of 0.25 and 0.5 mm. The signal-to-noise ratio (SNR) of the aorta and contrast-to-noise ratio (CNR) between the anterior spinal artery and spinal cord were measured. Two independent observers evaluated visualization of the artery of Adamkiewicz and its continuity between the anterior spinal artery and the aorta using a four-point scale., Results: No significant differences in the SNR of the aorta or CNR of the anterior spinal artery were observed between 0.25- and 0.5-mm slices. The average visualization score was significantly higher for 0.25-mm slices (3.58 ± 0.78) than for 0.5-mm slices (3.13 ± 0.99) (p = 0.01). The percentage of patients with nondiagnostic image quality was significantly lower for 0.25-mm slices (8.3%) than for 0.5-mm slices (33.3%) (p = 0.03)., Conclusion: In patients with aortic aneurysms, ultra-high-resolution CT with 0.25-mm slices significantly improves visualization of the artery of Adamkiewicz compared to 0.5-mm slices.
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- 2018
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41. The Effect of Heart Rate on Exposure Window and Best Phase for Stress Perfusion Computed Tomography: Lessons From the CORE320 Study.
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Steveson C, Schuijf JD, Vavere AL, Mather RT, Caton T, Mehra V, Betoko A, Cox C, Lima JA, and George RT
- Subjects
- Adrenergic beta-1 Receptor Antagonists, Aged, Coronary Artery Disease physiopathology, Electrocardiography methods, Electrocardiography statistics & numerical data, Female, Humans, Male, Metoprolol, Middle Aged, Prospective Studies, Tomography, X-Ray Computed statistics & numerical data, Coronary Artery Disease diagnostic imaging, Exercise Test, Heart Rate, Tomography, X-Ray Computed methods
- Abstract
Objectives: The aim of this study is to evaluate the effect of heart rate on exposure window, best phase, and image quality for stress computed tomography perfusion (CTP) in the CORE320 study., Methods: The CTP data sets were analyzed to determine the best phase for perfusion analysis. A predefined exposure window covering 75% to 95% of the R-R cycle was used., Results: Of the 368 patients included in the analysis, 93% received oral β blockade before the rest scan. The median heart rate during the stress acquisition was 69 bpm (interquartile range [IQR], 60-77). The median best phase was 81% (IQR, 76-90), and length of exposure window was 22% (IQR, 19-24). The best phase was significantly later in the cardiac cycle with higher heart rates (P < 0.001), and higher heart rates resulted in a small, but higher number of poor quality scans (6%, P < 0.001). The median effective dose of the stress scan was 5.3 mSv (IQR, 3.8-6.1)., Conclusions: Stress myocardial CTP imaging can be performed using prospective electrocardiography triggering, an exposure window of 75% to 95%, and β-blockade resulting in good or excellent image quality in the majority (80%) of patients while maintaining a low effective radiation dose.
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- 2017
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42. Calibration of coronary calcium scores determined using iterative image reconstruction (AIDR 3D) at 120, 100, and 80 kVp.
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Blobel J, Mews J, Goatman KA, Schuijf JD, and Overlaet W
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- Calibration, Humans, Male, Middle Aged, Phantoms, Imaging, Signal-To-Noise Ratio, Tomography, X-Ray Computed, Calcium metabolism, Coronary Vessels diagnostic imaging, Coronary Vessels metabolism, Imaging, Three-Dimensional methods
- Abstract
Purpose: Computed tomography (CT) radiation dose reduction is frequently achieved by applying lower tube voltages and using iterative reconstruction (IR). For calcium scoring, the reference protocol at 120 kVp with filtered back projection (FBP) is still used, because kVp and IR may influence the Agatston score (AS) and volume score (VS). The authors present a two-step method to optimize dose: first, to determine the lowest feasible exposure and highest noise thresholds; second, to define a calibration method that ensures that the AS and VS are similar to the reference protocol., Methods: AS and VS were measured for an anthropomorphic thoracic phantom that includes a calcium calibration module. The phantom was scanned on a 320-row CT scanner, at tube voltages of 120 kVp using FBP, and 120, 100, and 80 kVp using adaptive iterative dose reduction (AIDR 3D) reconstruction. The minimum CTDIs were determined based on three objective quality criteria. Calibration was performed to estimate adjusted CT number thresholds for the lower kVp acquisitions. Finally, the accuracies of the total and individual insert scores at dose level close to the minimum CTDI level were investigated and compared to low (FBPLD - 120) and high (FBPHD - 120) dose reference protocols (based on ten repeated acquisitions for each group)., Results: IR allows the exposure to be reduced by 69% at 120 kVp, with no significant effect on the total scores when averaged over all included dose steps and compared to FBP-120 (AS: 693 vs 699, p = 0.182; VS: 588 vs 587 mm(3), p = 0.569). Also when averaged over ten repeated scans and compared to FBPHD - 120 (AS: 709 vs 704, p = 0.435; VS: 604 vs 601 mm(3), p = 0.479), there is no statistical significant effect. Reducing the peak tube voltage allows even greater dose reductions: 73% at 100 kVp and 76% at 80 kVp. The calibrated CT number thresholds for analysis at 120, 100, and 80 kVp were, respectively, 130, 133, and 160 HU for the Agatston score, and 130, 132, and 140 HU for the volume score. Following the calibration, the mean scores of the four groups with dose variation were not significantly different from the reference protocol, at 100 kVp (AS: 698 vs 699, p = 0.818; VS: 584 vs 587 mm(3), p = 0.365) or at 80 kVp (AS: 698 vs 699, p = 0.996; VS: 586 vs 587 mm(3), p = 0.827). Similarly, there was no significant score difference with FBPLD - 120 during repeated scanning: 100 kVp (AS: 690 vs 694, p = 0.394; VS: 579 vs 585 mm(3), p = 0.168) and 80 kVp (AS: 703 vs 694, p = 0.115; VS: 588 vs 585 mm(3), p = 0.613). Compared to FBPHD - 120 group, the relative score deviation for the accuracy of the 400 and 800 mg/cm(3) HA inserts with 3 and 5 mm diameter is less than 7%. However, the relative deviation of the smaller 1 mm inserts is poorer (up to 41% deviations for scores <3)., Conclusions: With iterative reconstruction using AIDR 3D, deviations of the total Agatston and volume scores remain within 4% of the reference protocol. The 1 mm inserts were detected as calcification, but scores less than ten tend to be underestimated. Following the calibration process, the application of IR in combination with reduced tube voltages allows up to 76% lower radiation dose.
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- 2016
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43. The Impact of Different Levels of Adaptive Iterative Dose Reduction 3D on Image Quality of 320-Row Coronary CT Angiography: A Clinical Trial.
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Feger S, Rief M, Zimmermann E, Martus P, Schuijf JD, Blobel J, Richter F, and Dewey M
- Subjects
- Algorithms, Contrast Media, Coronary Vessels surgery, Female, Humans, Male, Middle Aged, Radiation Dosage, Signal-To-Noise Ratio, Stents, Coronary Angiography methods, Coronary Vessels diagnostic imaging, Radiographic Image Interpretation, Computer-Assisted methods, Tomography, X-Ray Computed methods
- Abstract
Purpose: The aim of this study was the systematic image quality evaluation of coronary CT angiography (CTA), reconstructed with the 3 different levels of adaptive iterative dose reduction (AIDR 3D) and compared to filtered back projection (FBP) with quantum denoising software (QDS)., Methods: Standard-dose CTA raw data of 30 patients with mean radiation dose of 3.2 ± 2.6 mSv were reconstructed using AIDR 3D mild, standard, strong and compared to FBP/QDS. Objective image quality comparison (signal, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contour sharpness) was performed using 21 measurement points per patient, including measurements in each coronary artery from proximal to distal., Results: Objective image quality parameters improved with increasing levels of AIDR 3D. Noise was lowest in AIDR 3D strong (p ≤ 0.001 at 20/21 measurement points; compared with FBP/QDS). Signal and contour sharpness analysis showed no significant difference between the reconstruction algorithms for most measurement points. Best coronary SNR and CNR were achieved with AIDR 3D strong. No loss of SNR or CNR in distal segments was seen with AIDR 3D as compared to FBP., Conclusions: On standard-dose coronary CTA images, AIDR 3D strong showed higher objective image quality than FBP/QDS without reducing contour sharpness., Trial Registration: Clinicaltrials.gov NCT00967876.
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- 2015
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44. Relationship of left ventricular mass to coronary atherosclerosis and myocardial ischaemia: the CORE320 multicenter study.
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Kishi S, Magalhaes TA, George RT, Dewey M, Laham RJ, Niinuma H, Friedman LA, Cox C, Tanami Y, Schuijf JD, Vavere AL, Kitagawa K, Chen MY, Nomura CH, Brinker JA, Rybicki FJ, Di Carli MF, Arbab-Zadeh A, and Lima JA
- Subjects
- Aged, Algorithms, Coronary Artery Disease physiopathology, Female, Humans, Hypertrophy, Left Ventricular physiopathology, Male, Middle Aged, Myocardial Ischemia physiopathology, Prospective Studies, Cardiac Imaging Techniques, Coronary Artery Disease diagnosis, Hypertrophy, Left Ventricular diagnosis, Myocardial Ischemia diagnosis
- Abstract
Aims: The aim of this study was to investigate the association of left ventricular mass (LVM) with coronary atherosclerosis and myocardial infarction (MI)., Methods and Results: Patients (n = 338) underwent 320 × 0.5 mm detector row coronary computed tomography (CT) angiography, invasive coronary angiography (ICA), and single-photon emission CT (SPECT) myocardial perfusion imaging. Quantitative coronary atheroma volume was obtained from the CT images for the entire coronary tree (19-segment model) with an arterial contour detection algorithm. Normalized total atheroma volume (NormTAV) was analysed to reflect quantitative total atheroma volume. LVM was measured on myocardial CT images and indexed to height to the power of 2.7 (LVMi). Patients with obstructive coronary artery disease (CAD) were defined as those with ≥50% diameter stenosis by quantitative ICA. Abnormal perfusion defect was defined as ≥1 abnormal myocardial segment by SPECT. The association of LVMi with coronary atherosclerosis and myocardial perfusion defect on SPECT at the patient level was determined with uni- and multivariable linear and logistic regression analyses. Obstructive CAD was present in 60.0% of enrolled patients. LVMi was independently associated with abnormal summed rest score [SRS; odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.09] and summed stress score (OR, 1.04; 95% CI, 1.01-1.07). An increase in LVMi was also independently associated with that in NormTAV (coefficient, 10.44; 95% CI, 1.50-19.39) and SRS ≥1 (OR, 1.05; 95% CI, 1.01-1.10), even after adjusting for cardiovascular risk factors in patients without previous MI., Conclusions: LVM was independently associated with the presence of coronary artery atherosclerosis and MI., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
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- 2015
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45. Determining the radiation dose reduction potential for coronary calcium scanning with computed tomography: an anthropomorphic phantom study comparing filtered backprojection and the adaptive iterative dose reduction algorithm for image reconstruction.
- Author
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Blobel J, Mews J, Schuijf JD, and Overlaet W
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- Coronary Angiography instrumentation, Humans, Phantoms, Imaging, Radiation Protection methods, Reproducibility of Results, Sensitivity and Specificity, Tomography, X-Ray Computed instrumentation, Algorithms, Calcinosis diagnostic imaging, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Radiation Dosage, Radiographic Image Interpretation, Computer-Assisted methods, Tomography, X-Ray Computed methods
- Abstract
Purpose: This study describes a method to determine the lowest possible thresholds for volume computed tomographic dose index (CTDI(min)) and maximum tolerable pixel noise (SD(max)) values for coronary calcium scanning while maintaining accurate Agatston score values. The method was applied to a comparison between the iterative reconstruction (IR) and filtered backprojection (FBP) image reconstruction algorithms in a phantom study., Materials and Methods: An anthropomorphic thoracic phantom with a calibration insert for the quantification of coronary calcium, containing 200, 400, and 800 mg HA/cm of calcium mass spheres of 1, 3, and 5 mm diameter (QRM GmbH, Moehrendorf, Germany), was scanned without (G1) and with (G2) an additional 2 cm-thick wrap of muscle-equivalent material. Electrocardiographically simulated volume scans were performed on a 320-row computed tomographic scanner (Aquilion ONE, Toshiba Medical Systems, Otawara, Japan) set to 120 kilovolt peak [kVp] and 10 to 580 mA variations in 21 steps. For the IR, the Adaptive Iterative Dose Reduction 3-dimensional algorithm (AIDR 3D) was used. Agatston scores were calculated semiautomatically on the computed tomographic console. Inclusion tests to assess the accuracy of the Agatston scores were performed to determine the CTDI(min) thresholds and the associated maximum pixel noise SD(max) for FBP and IR from identical raw data. The inclusion tests were as follows: (1) the semiautomatic identification of the 1 mm sphere with 800 mg HA/cm, (2) the exclusion of false-positive lesions, and (3) a statistical outlier test. Statistical differences between the Agatston score means from both image reconstruction algorithms were evaluated using the paired t test., Results: All Agatston scores using both reconstruction methods were normally distributed (P > 0.49). For FBP and IR, the mean ± 1σ of Agatston score, CTDI(min), and SD(max), respectively, were determined as follows: 697.8 ± 7.7, 7.5 mGy, and 24.4 Hounsfield unit (HU) (G1-FBP); 678.8 ± 14.3, 1.5 mGy, and 20.1 HU (G1-IR); 677.0 ± 11.6, 14.5 mGy, and 27.3 HU (G2-FBP); and 643.9 ± 13.4, 2.6 mGy, and 20.0 HU (G2-IR). The mean Agatston scores obtained using IR (both with and without the additional 2 cm muscle shell) were slightly (approximately 5%) but significantly lower (P ≤ 0.001) than those obtained using FBP reconstruction., Conclusions: The Adaptive Iterative Dose Reduction algorithm AIDR 3D shows potential to reduce dose exposure by approximately 80% in comparison with the dose currently applied with FBP image processing. On the basis of phantom evaluation, a target noise of 20 HU for the application of this method in coronary calcium scanning is recommended to avoid loss in accuracy.
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- 2013
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46. CT coronary angiography is feasible for the assessment of coronary artery disease in chronic dialysis patients, despite high average calcium scores.
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de Bie MK, Buiten MS, Gaasbeek A, Boogers MJ, Roos CJ, Schuijf JD, Krol MJ, Rabelink TJ, Bax JJ, Schalij MJ, and Jukema JW
- Subjects
- Aged, Clinical Trials as Topic statistics & numerical data, Coronary Artery Disease complications, Coronary Artery Disease epidemiology, Feasibility Studies, Female, Humans, Male, Middle Aged, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnostic imaging, Renal Insufficiency, Chronic epidemiology, Research Design, Calcium blood, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Renal Dialysis, Renal Insufficiency, Chronic therapy, Tomography, X-Ray Computed
- Abstract
Purpose: Significant obstructive coronary artery disease (CAD) is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group., Methods: For this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861), with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1-3, 5-8, 11 and 13) by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable., Results: A total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70%) were included. The median calcium score was 623 [79, 1619]. Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01)., Conclusion: Despite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.
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- 2013
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47. Different value of coronary calcium score to predict obstructive coronary artery disease in patients with and without moderate chronic kidney disease.
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Yiu KH, de Graaf FR, van Velzen JE, Marsan NA, Roos CJ, de Bie MK, Tse HF, van der Wall EE, Schalij MJ, Bax JJ, Schuijf JD, and Jukema JW
- Abstract
Purpose: The coronary calcium score (CCS) predicts significant coronary artery disease (CAD) in the general population. While moderate chronic kidney disease (CKD) is associated with high CCS, the use of CCS to predict significant CAD in these patients is unknown., Methods: A total of 704 patients underwent computed tomography coronary angiography for the assessment of CCS and CAD. Sixty-nine (10 %) patients had moderate CKD, defined by an estimated glomerular filtration rate (eGFR) between 30 and 59 mL/min/1.73m(2), and the remaining patients were considered to be without significant CKD (eGFR ≥ 60 mL/min/1.73m(2))., Results: Patients with moderate CKD were older, had a higher CCS, and a higher prevalence of obstructive CAD than patients without significant CKD. Receiver-operator curve analysis showed that CCS predicted the presence of obstructive CAD in both patients with moderate CKD and those without significant CKD. In patients with moderate CKD, the optimal cut-off value of CCS to diagnose obstructive CAD was 140 (sensitivity 73 % and specificity of 70 %), and is 2.8 fold higher than in patients without significant CKD (cut-off value = 50; sensitivity 75 % and specificity 75 %)., Conclusion: The present results demonstrate that CCS can predict obstructive CAD in patients with moderate CKD, although the optimal cut-off value is higher than in patients without significant CKD.
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- 2013
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48. The maximum necrotic core area is most often located proximally to the site of most severe narrowing: a virtual histology intravascular ultrasound study.
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de Graaf MA, van Velzen JE, de Graaf FR, Schuijf JD, Dijkstra J, Bax JJ, Reiber JH, Schalij MJ, van der Wall EE, and Jukema JW
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- Aged, Chi-Square Distribution, Coronary Angiography, Coronary Stenosis pathology, Coronary Vessels pathology, Female, Fibrosis, Humans, Male, Middle Aged, Necrosis, Predictive Value of Tests, Prognosis, Retrospective Studies, Severity of Illness Index, Vascular Calcification diagnostic imaging, Vascular Calcification pathology, Coronary Stenosis diagnostic imaging, Coronary Vessels diagnostic imaging, Plaque, Atherosclerotic, Ultrasonography, Interventional
- Abstract
Previous angiographic studies have shown that almost two-thirds of vulnerable plaques are located in non-obstructive lesions. Possibly, the maximum necrotic core (Max NC) area is not always identical to the site of most severe stenosis. Therefore, the purpose of this study was to evaluate the potential difference in location between the maximum necrotic core area and the site of most severe narrowing as assessed by virtual histology intravascular ultrasound (VH IVUS). Overall, 77 patients (139 vessels) underwent VH IVUS. The Max NC site was defined as the cross section with the largest necrotic core area per vessel. The site of most severe narrowing was defined as the minimum lumen area (MLA). Per vessel, the distance from both the Max NC site and MLA site to the origo of the coronary artery was evaluated. In addition, the presence of a virtual histology-thin cap fibroatheroma (VH-TCFA) was assessed. The mean difference (mm) between the MLA site and Max NC site was 10.8 ± 20.6 mm (p < 0.001). Interestingly, the Max NC site was located at the MLA site in seven vessels (5%) and proximally to the MLA site in 92 vessels (66%). Importantly, a higher percentage of VH-TCFA was demonstrated at the Max NC site as compared to the MLA site (24 vs. 9%, p < 0.001). In conclusion, the present findings demonstrate that the Max NC area is rarely at the site of most severe narrowing. Most often, the Max NC area is located proximal to the site of most severe narrowing.
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- 2013
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49. Non-invasive assessment of microcirculation by sidestream dark field imaging as a marker of coronary artery disease in diabetes.
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Djaberi R, Schuijf JD, de Koning EJ, Wijewickrama DC, Pereira AM, Smit JW, Kroft LJ, Roos Ad, Bax JJ, Rabelink TJ, and Jukema JW
- Subjects
- Adult, Aged, Calcinosis diagnostic imaging, Capillaries pathology, Case-Control Studies, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease etiology, Female, Humans, Male, Microcirculation, Middle Aged, Observer Variation, Reproducibility of Results, Tomography, X-Ray Computed, Coronary Artery Disease diagnosis, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Lip blood supply, Microscopy methods
- Abstract
Purpose: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes., Methods: SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD., Results: Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04)., Conclusion: Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.
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- 2013
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50. Effect of dose reduction on image quality and diagnostic performance in coronary computed tomography angiography.
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van der Bijl N, Joemai RM, Mertens BJ, de Roos A, Veldkamp WJ, Bax JJ, Schuijf JD, Geleijns J, and Kroft LJ
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- Aged, Area Under Curve, False Negative Reactions, Female, Humans, Logistic Models, Male, Middle Aged, Observer Variation, Predictive Value of Tests, ROC Curve, Reproducibility of Results, Retrospective Studies, Severity of Illness Index, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Coronary Stenosis diagnostic imaging, Coronary Vessels diagnostic imaging, Radiation Dosage, Tomography, X-Ray Computed
- Abstract
To evaluate the effect of radiation dose reduction on image quality and diagnostic accuracy of coronary computed tomography (CT) angiography. Coronary CT angiography studies of 40 patients with (n = 20) and without (n = 20) significant (≥50 %) stenosis were included (26 male, 14 female, 57 ± 11 years). In addition to the original clinical reconstruction (100 % dose), simulated images were created that correspond to 50, 25 and 12.5 % of the original dose. Image quality and diagnostic performance in identifying significant stenosis were determined. Receiver-operator-characteristics analysis was used to assess diagnostic accuracy at different dose levels. The identification of patients with significant stenosis decreased consistently at doses of 50, 25 and 12.5 of the regular clinical acquisition (100 %). The effect was relatively weak at 50 % dose, and was strong at dose levels of 25 and 12.5 %. At lower doses a steady increase was observed for false negative findings. The number of coronary artery segments that were rated as diagnostic decreased gradually with dose, this was most prominent for smaller segments. The area-under-the-curve (AUC) was 0.90 (p = 0.4) at 50 % dose; accuracy decreased significantly with 25 % (AUC 0.70) and 12.5 % dose (AUC 0.60) (p < 0.0001), with underestimation of patients having significant stenosis. The clinical acquisition protocol for evaluation of coronary artery stenosis with CT angiography represents a good balance between image quality and patient dose. A potential for a modest (<50 %) reduction of tube current might exist. However, more substantial reduction of tube current will reduce diagnostic performance of coronary CT angiography substantially.
- Published
- 2013
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