An approach to evaluate myocardial perfusion defect assessment for projection-based DECT: A phantom study.
- 作者列表："Han D","Shah S","Lee JH","Elmore K","Gransar H","Danad I","Kumar V","Raman S","Hartaigh BÓ","Dunham S","Lin FY","Min JK
INTRODUCTION:Dual-energy CT (DECT) can improve the accuracy of myocardial perfusion CT with projection-based monochromatic (DECT-MCE) and quantification of myocardial iodine in material decomposition (DECT-MD) reconstructions. However, evaluation of multiple reconstructions is laborious and the optimal reconstruction to detect myocardial perfusion defects is unknown. METHODS:Left ventricular (LV) phantoms with artificial perfusion defects were scanned using DECT and single energy cardiac computed tomography angiography (SECT). Reconstructions of DECT-MCE at 40, 70, 100 and 140 keV, DECT-MD pairs of water, iodine, iron and fat, and SECT were evaluated using a 17-segment myocardial model. The diagnostic performance of each reconstruction was calculated on a per-segment basis and compared across DECT reconstructions. RESULTS:Over 34 phantoms with artificial perfusion defects were found in 64/578 (11%) of segments, the sensitivity of DECT-MCE at 40, 70, 100, and 140 keV was 100% (95% confidence interval (CI): 93-100), 100% (95% CI: 93-100), 71% (95% CI: 56-83), and 25% (95% CI: 14-40), respectively, with a significant decline between 70 keV and 100 keV (p < 0.001). The specificity of DECT-MCE was 100% at all energies (95% CI: 99-100). As a group, the DECT-MD iodine background reconstructions had significantly lower sensitivity than the remaining modes (2.1% [95% CI, 0.05-11.1], vs. 100% [95% CI, 92.6-100], p < 0.001). Specificity of all material pair modes remained 100%. CONCLUSIONS:Using LV phantom models, the approach with the best sensitivity and specificity to assess myocardial perfusion defects with DECT are reconstructions of DECT-MCE at 40 or 70 KeV and DECT-MD without iodine background.
简介: 双能量CT (DECT) 可以提高基于投影的单色 (dect-mce) 和材料分解中心肌碘定量 (dect-md) 重建的心肌灌注CT的准确性。然而，多重重建的评估是费力的，并且检测心肌灌注缺陷的最佳重建是未知的。 方法: 使用DECT和单能量心脏ct血管造影 (SECT) 扫描人工灌注缺损的左心室 (LV) 体模。在40、70、100和140 keV重建dect-mce，使用17段心肌模型评估水、碘、铁和脂肪的dect-md对和SECT。在每个节段的基础上计算每个重建的诊断性能，并跨DECT重建进行比较。 结果: 在64/578 (11%) 的节段中发现超过34个人工灌注缺陷的体模，dect-mce在40、70、100和140 keV下的灵敏度为100% (95% 置信区间 (CI): 93-100)，100% (95% CI: 93-100)，71% (95% CI: 56-83)，和25%(95% CI: 14-40)，分别在70 kev和100 keV之间显著下降 (p <0.001)。Dect-mce在所有能量下的特异性为100% (95% CI: 99-100)。作为一组，dect-md碘背景重建的灵敏度显著低于其余模式 (2.1% [95% CI，0.05-11.1]，vs. 100% [95% CI，92.6-100]，p <0.001)。所有材料对模式的特异性保持100%。 结论: 使用LV体模模型，评估DECT心肌灌注缺损具有最佳灵敏度和特异性的方法是在40或70 KeV下重建dect-mce和无碘背景的dect-md。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.