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An approach to evaluate myocardial perfusion defect assessment for projection-based DECT: A phantom study.

基于投影的DECT评价心肌灌注缺损的方法: 体模研究。

  • 影响因子:1.26
  • DOI:10.1016/j.clinimag.2019.09.016
  • 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
  • 发表时间:2020-07-01
Abstract

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.

摘要

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。

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影响因子:2.41
发表时间:2020-06-12
DOI:10.4244/EIJ-D-18-01138
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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.

关键词: 暂无
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影响因子:1.67
发表时间:2020-01-01
DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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