Journal of Cardiovascular Computed Tomography - Articles in Press

Atrial Isomerism: A Pictorial Review - Accepted Manuscript

Anu Balan — 2012-01-30

Abstract: Heterotaxy or situs ambiguous describes discordance of the normal arrangement of visceral organs within the chest and abdomen due to a looping defect in embryological development. The broad spectrum of abnormalities can be complex and includes right and left isomerism. This is often associated with asplenia (Ivermarks syndrome) and polysplenia respectively. MDCT and MRI are widely available techniques that may be used to define the cardiothoracic and abdominal anatomy, relations and connection in this complex group of conditions. This pictorial review describes the broad spectrum of findings in heterotaxy suggesting a sequential approach to image evaluation, and illustrates the most common situs disorders.

Comparison of Cardiac Computed Tomography Exam Appropriateness under the 2010 Revised versus the 2006 Original Appropriate Use Criteria - Accepted Manuscript

2012-01-30

Abstract: Background: The 2006 Cardiac CT (CT) Appropriate Use Criteria (AUC) were recently revised in 2010. In addition to rating an expanded number of indications, the new criteria adjusted the appropriateness of existing indications to reflect changes in clinical practice and new evidence since 2006.Objective: We sought to determine how the appropriateness of cardiac CT exams performed at a tertiary-care hospital changed under the revised criteria as compared to the original AUC.Methods: Data were collected from the medical records and personal interview of 267 consecutive patients referred for cardiac CT in 2008. Using the 2010 and 2006 AUC, two physicians designated each exam’s indication as appropriate, inappropriate, uncertain, or “not classified” if exam indication could not be assigned.Results: Using the new 2010 AUC, there was a highly significant change in the classification of exam appropriateness (p<.001), with 40% of exams changing appropriateness level compared to the 2006 AUC. Under the 2010 AUC, there were an increased proportion of both appropriate exams (59% vs. 45%, p<.001) and inappropriate exams (15% vs. 10%, p<.001), and approximately the same proportion with uncertain appropriateness (13% vs. 16%, p=0.33). Consequently, the proportion of exams that were “not classified” was significantly reduced under the 2010 AUC (29% vs. 13%, p<.001).Conclusion: The revision of the AUC for cardiac CT had a significant impact on exam appropriateness. In comparison to the 2006 AUC, the 2010 AUC provided improved clarification of exam appropriateness. This shift was due to the inclusion of many previously unaddressed indications and the d esignation of more exams as either appropriate or inappropriate.

Left Ventricular Thrombus Attenuation Characterization in Cardiac Computed Tomography Angiography - Accepted Manuscript

2012-01-30

Primary Cardiac Lymphoma Diagnosed by Multiphase Gated Cardiac CT and CT-Guided Percutaneous Trans-sternal Biopsy - Accepted Manuscript

Ripal N. Shah, Tony W. Simmons, J. Jeffrey Carr, Daniel W. Entrikin — 2012-01-30

Apical sparing variant of stress cardiomyopathy: Integrative analysis with multidetector cardiac computed tomography in dual energy mode - Accepted Manuscript

Sung Taek Kim, Heon Lee — 2012-01-30

Abstract: Stress cardiomyopathy is a unique reversible cardiac syndrome that is frequently precipitated by a physical or emotionally stressful event and has a clinical presentation that is indistinguishable from a myocardial infarction. We describe the case of a patient with apical sparing variant of stress cardiomyopathy in whom dual energy cardiac CT identified characteristic regional wall motion abnormality without concomitant coronary artery disease and myocardial perfusion defects.

Cardiac CT in Women: Clinical Application and Considerations - Accepted Manuscript

Lauren A. Simprini, Allen J. Taylor — 2012-01-30

Abstract: Cardiac Computed Tomography (CCT) has special considerations and applications in women for the evaluation of coronary heart disease (CHD). Unique aspects of cardiovascular disease (CVD) in women include atypical symptoms and a later presentation of CHD. Disparities exist in mortality trends of CVD between men and women along with a lack of patient awareness of CVD as a significant cause of mortality for women. Differences have also become evident amongst plaque characteristics between the two sexes, with a relative increased prevalence of noncalcified plaque in women. Traditional risk prediction models, such as the Framingham Risk Score (FRS), have limitations in this population. Coronary artery calcium scoring (CACS) contributes significantly to the accuracy of CHD detection on top of traditional cardiovascular risk factors in asymptomatic women. Cardiac CT angiography (CCTA) has proven accurate for the diagnosis of significant CHD as well as cost effective in the evaluation of symptomatic women. The safety issue of radiation exposure with CCT warrants special consideration for women. Concern for radiation-related cancer risks and organ specific dose delivered to the breast is being addressed by radiation-reducing techniques. Future technological advances in CT may allow for simultaneous screening for CHD and other disease processes, such as osteoporosis, breast cancer, and visceral adiposity in one routine test.

Low radiation coronary calcium scoring by dual-source CT with tube-current optimization based on patient body size - Accepted Manuscript

Damini Dey — 2012-01-30

Abstract: Background: Reducing tube voltage from 120 kV to 100 kV during noncontrast CT for the detection of coronary artery calcium reduces patient radiation exposure.Objective: We investigated if coronary calcium scanning by multi-detector CT can be performed at reduced tube current, resulting in lower radiation dose to the patient.Methods: Sixty-six outpatients were scanned on the same visit by dual-source CT (DSCT) with a standard protocol (120 kVp, 150 mAs), followed by a scan with reduced tube current: 85 mAs for patients with body-mass-index (BMI) ≤ 30 kg/m2 and weight ≤ 85 kg, and 120 mAs for patients with BMI > 30 kg/m2 or weight > 85 kg. Low-dose scans were scored by an experienced reader blinded to the standard scan.Results: Agatston coronary calcium scores (AS) and volume scores (VS) for standard versus low-dose scans were 236 ± 581 vs. 234 ± 586 (p = 0.65, NS), and 189 ± 460 vs. 184 ± 455 mm3 with excellent correlation (r = 1.0, p <0.0001), and no significant difference (p = 0.14, NS). Effective radiation dose for the low-dose protocol (1.0 ± 0.2 mSv) was significantly lower than for the standard protocol (1.7 ± 0.2 mSv, p <0.0001). Image noise was higher for the low-dose scan (18.8 ± 5.5 HU vs. 15.2 ± 4.8 HU, p <0.0001), but both were within target limits.Conclusion: Noncontrast CT for measurement of the coronary calcium score using lower tube-current optimized for patient body size is equivalent to standard methods at 40% lower radiation dose.

Influence of Heart Rate and Phase of the Cardiac Cycle on the Occurrence of Motion Artefact in Dual Source CT Angiography of the Coronary Arteries - Accepted Manuscript

2012-01-30

Abstract: Background: Coronary CT Angiography allows visualization of the coronary arteries. However, motion artefact can impair delineation of the coronary artery lumen and detection of coronary artery stenoses.Objective: To investigate the influence of heart rate and the segment of the cardiac cycle during which images are reconstructed on the occurrence of motion artefacts.Methods: We evaluated coronary CT angiography data sets obtained by 64-slice dual source CT in 100 consecutive patients. Data were reconstructed at 13 time instants during the cardiac cycle and evaluated concerning the presence of motion artefact.Results: Mean heart rate was 66±14 beats per minute. Overall, 98 out of 100 patients had evaluable data sets. For heat rates of up to 60 beats per minute, optimal image quality was uniformly found during late diastole (100% of cases with evaluable image quality during a time window between 65% and 75% of the cardiac cycle). With increasing heart rates, images reconstructed during late systole more frequently provided best image quality. However, image reconstruction could not be restricted to a systolic time period. In order to achieve evaluable image quality in 95% of cases, data acquired between 25% and 75% of the cardiac cycle had to be available for patients with heart rates above 60 beats per minute.Conclusion: Dual source CT provides high image quality across a wide range of heart rates. While data acquisition may be limited to diastole for patients with heart rates up to 60 beats per minute, the availability of data acquired both during systole and diastole is necessary for patients with higher heart rates.

Corrigendum - Corrected Proof

2012-01-25

In the November/December 2011 issue of Journal of Cardiovascular Computed Tomography, in the article by Vavere and colleagues titled “Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study” (2011;5:370-381; doi:10.1016/j.jcct.2011.11.001), the eighth author’s name appears incorrectly. The full author’s name is Armin Arbab-Zadeh.

Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis - Corrected Proof

2011-11-21

Background: Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable.Objectives: We performed a systematic review of diagnostic accuracy of the dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD).Methods: Eight medical databases were searched for articles published from January 2005 through March 2011. Studies compared DSCT coronary angiography (DSCT-CA) and invasive coronary angiography, as the reference standard, in consecutive patients with suspected or known CAD, and relevant data were extracted by 2 independent reviewers. Summary diagnostic accuracies were calculated, and the effect of covariates on the diagnostic performance was evaluated by meta-regression.Results: Twenty-five studies were included. In per-patient analysis (n = 2303), pooled sensitivity was 99% [95% confidence interval (CI), 97%–99%] with specificity of 89% (95% CI, 84%–92%). The summary positive (+LR) and negative (−LR) likelihood ratios were 8.6 (95% CI, 6.4–11.6) and 0.02 (95% CI, 0.01–0.03), respectively. In per-segment analysis (n = 32,615), pooled sensitivity was 94% (95% CI, 92%–96%) with specificity of 97% (95% CI, 96%–-98%). Summary +LR and −LR were 30.2 (95% CI, 22.1–43.5) and 0.06 (95% CI, 0.04–0.08), respectively.Conclusions: DSCT-CA seems to be robust to elevate heart rates while maintaining a high level of diagnostic performance.