Journal of Cardiovascular Computed Tomography - Articles in Press

Society News - Uncorrected Proof

2010-03-11

Is it a Monet or a Picasso? The Problems with ‘Close Up’ Plaque Quantitation Using MDCT - Accepted Manuscript

David A. Fein, John A. Rumberger — 2010-03-08

Infarct detection or infarct characterization? Non-contrast CT and its implications for characterizing chronic myocardial scar - Accepted Manuscript

Richard T. George, Albert C. Lardo — 2010-03-08

Training in Cardiac CT: A changing paradigm. - Accepted Manuscript

Ron Blankstein — 2010-03-08

Viability imaging by cardiac computed tomography - Uncorrected Proof

2010-02-22

Abstract: First-pass perfusion and delayed enhancement cardiac imaging have been shown to be feasible by cardiac CT. However, questions remain about its reliability, and ideal scanning parameters have yet to be fully established. In general, scar imaging with cardiac CT typically requires 2 scans, with first-pass perfusion information derived from the same data set used to visualize the coronary arteries. Reduced contrast enhancement on first-pass cardiac CT images represents reduced perfusion. Higher doses of contrast are required to perform viability imaging by cardiac CT. Approximately 10 minutes after contrast administration, viability information is obtained by performing a second (noncontrast) scan. In addition to the concepts of perfusion and viability imaging by cardiac CT, we review parameters such as scan timing, tube settings, contrast delivery, reconstruction, and postprocessing techniques, as well as the associated pitfalls and technical limitations in perfusion and viability imaging by cardiac CT.

64-Slice MDCT imaging of endocardial cushion defect associated with other cardiac and extracardiac abnormalities - Uncorrected Proof

2010-02-22

Abstract: Electrocardiographic-gated 64-slice multidetector computed tomography (MDCT) was performed on a 30-year-old man who presented with a complete endocardial cushion defect (ECD) and severe pulmonary hypertension diagnosed when he was 3 years old. Multiplanar reconstruction image showed the common atrium without an atrial septum, a large ventricular septum defect, and a small right ventricle due to a complete atrioventricular canal defect. Three-dimensional CT volume-rending imaging showed a patent ductus arteriosus, dilation of the ascending aorta, and a malignant anomalous-origin right coronary artery. This patient also had heterotaxy syndrome with polysplenia and azygos continuation. MDCT proved to be a good noninvasive imaging method for the evaluation of ECD associated with cardiac as well as extracardiac abnormalities.

Study of hemodynamics of abdominal aortic dissection with ECG-gated CT: Letter to the Editor - Uncorrected Proof

Farhood Saremi — 2010-02-08

The case report by Bolen et al about the dynamic effect of dissection on the right renal artery flow shows clearly that all arteries, including celiac, superior mesenteric, and both renal arteries, are mainly supplied by the true lumen. In none of the images is the false lumen filled with enough contrast at the time of data acquisition (arterial phase). The fact that we are able to see the right renal artery favors its origin from the true lumen and not the false lumen.

Study of hemodynamics of abdominal aortic dissection with ECG-gated CT: Letter to the Editor, Author response - Uncorrected Proof

Michael A. Bolen — 2010-02-08

We are glad you found our case interesting. In response to your comments: We agree there is some plaque at the ostium of the artery; however, within the word limits of our submission we could not detail every finding. We do not agree that simply seeing the right renal artery favors its origin from true lumen. Your argument of low diastolic flow in renal arteries because of low resistive indices as a primary cause is also inconsistent within the comparison of the right and left renal artery, the latter of which is briskly opacified in all phases.

Computed tomography of pulmonary venous variants and anomalies - Uncorrected Proof

Prabhakar Rajiah, Jeffrey P. Kanne — 2010-01-29

Abstract: Radiofrequency ablation of the pulmonary veins is a well-established technique in the management of atrial fibrillation. Computed tomography (CT) plays an important role in the evaluation of these patients, especially delineating pulmonary venous anatomy, anatomic variations, and complications after radiofrequency ablation. CT scan is characterized by high spatial and temporal resolutions, multiplanar reconstruction capabilities, and wide field of view. Knowledge of the normal pulmonary venous anatomy, anatomic variants, and optimal scanning protocol is essential for preablation planning and for evaluation of postablation complications. In this pictorial review, the CT appearance of various pulmonary venous variants and anomalies are discussed and illustrated.

Adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual-source computed tomography: Concepts and first experiences - Uncorrected Proof

2010-01-28

Abstract: Recent research suggests that multidetector-row CT may have potential as a standalone modality for integrative imaging of coronary heart disease, including the assessment of the myocardial blood supply. However, the technical prerequisites for volumetric, time-resolved imaging of the passage of a contrast medium bolus through the myocardium have only been met with latest generation wide-detector CT scanners. Second-generation dual-source CT enables performing electrocardiographic (ECG)–synchronized dynamic myocardial perfusion imaging by a dedicated “shuttle” mode. With this acquisition mode, image data can be acquired during contrast medium infusion at 2 alternating table positions with the table shuttling back and forth between the 2 positions covering a 73-mm anatomic volume. We applied this acquisition technique for detecting differences in perfusion patterns between healthy and diseased myocardium and for quantifying myocardial blood flow under adenosine stress in 3 patients with coronary heart disease. According to our initial experience, the addition of adenosine stress volumetric dynamic CT perfusion to a cardiac CT protocol comprising coronary artery calcium quantification, prospectively ECG-triggered coronary CT angiography, and delayed acquisition appears promising for the comprehensive assessment of coronary artery luminal integrity, cardiac function, perfusion, and viability with a single modality.

A bullet wandering through the heart - Uncorrected Proof

2010-01-21

Abstract: We report a case of young male with a penetrating chest trauma due to a gunshot. The bullet was detected by conventional X-ray and localized within the lateral wall of the left ventricle by CT. During surgery the bullet was not found. Thereafter conventional X-ray showed migration of the bullet within the lung parenchyma.

Cardiac computed tomography in the emergency department: A patient with acute epigastric pain - Uncorrected Proof

2010-01-21

Abstract: We report the application of coronary CT angiogram in urgent assessment of a patient presenting to the emergency department with acute and nonspecific cardiothoracic symptoms.

Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque - Uncorrected Proof

2010-01-21

Background: The computed tomographic (CT) attenuation of coronary atherosclerotic plaque has been proposed as a marker for tissue characterization and may thus potentially contribute to the assessment of plaque instability.Objective: We analyzed the influence of reconstruction parameters on CT attenuation measured within noncalcified coronary atherosclerotic lesions.Methods: Seventy-two patients were studied by contrast-enhanced dual-source CT coronary angiography (330 millisecond rotation time, 2 × 64 × 0.6 mm collimation, 120 kV, 400 mAs, 80 mL contrast agent intravenously at 6 mL/s), and a total of 100 distinct noncalcified coronary atherosclerotic plaques were identified. Image data sets were reconstructed with a soft (B20f), medium soft (B26f), and sharp (B46f) reconstruction kernel. With the medium soft kernel, image data sets were reconstructed with a slice thickness/increment of 0.6/0.3 mm, 0.75/0.4 mm, and 1.0/0.5mm. Within each plaque, CT attenuation was measured.Results: Mean CT attenuation using the medium soft kernel was 109 ± 58 HU (range, −16 to 168 HU). Using the soft kernel, mean density was 113 ± 57 HU (range, −13 to 169 HU), and using a sharp kernel, mean density was 97 ± 49 HU (range, −23 to 131 HU). Similarly, reconstructed slice thickness had a significant influence on the measured CT attenuation (mean values for medium soft kernel: 102 ± 52 HU versus 109 ± 58 HU versus 113 ± 57 HU for 0.6-mm, 0.75-mm, and 1.0-mm slice thickness). The differences between 0.75-mm and 0.6-mm slice thickness (P = 0.05) and between medium sharp and sharp kernels (P = 0.02) were statistically significant.Conclusions: Image reconstruction significantly influences CT attenuation of noncalcified coronary atherosclerotic plaque. With decreasing spatial resolution (softer kernel or thicker slices), CT attenuation increases significantly. Using absolute CT attenuation values for plaque characterization may therefore be problematic.

Coronary distensibility index measured by computed tomography is associated with the severity of coronary artery disease - Uncorrected Proof

2010-01-14

Background: Atherosclerotic changes within the coronary artery wall can affect vessel distensibility.Objective: This study evaluated the relationship between the coronary distensibility index (CDI) and the severity of coronary artery disease (CAD) measured by computed tomographic angiography (CTA).Methods: One hundred thirteen subjects, age 63 ± 10 years, 32% women, who underwent coronary artery calcium (CAC) scanning and CTA, were studied. Early diastolic and mid diastolic (MD) cross-section area (CSA) of the left anterior descending (LAD) artery were measured 5 mm distal to the left main bifurcation. CDI was defined as Δlumen CSA/[lumen CSA in MD × estimated central pulse pressure (eCPP)] × 103 {eCPP = 0.77 × peripheral pulse pressure}. LAD diameter measured by CTA and quantitative coronary angiography (QCA) was compared in 19 subjects without CAD. CAD was defined as normal (no stenosis and CAC 0), mild (stenosis ≤ 30%), moderate (stenosis 31%–69%), and severe (stenosis ≥ 70%) on CTA.Results: Excellent correlation was observed between CTA and QCA measured by CDI (r2 = 0.96, P = 0.0001). CDI decreased from normal coronaries (6.75 ± 1.43) to arteries with mild (5.78 ± 1.45), moderate (3.96 ± 1.06), and severe (3.31 ± 1.06) disease (P = 0.004). The risk factor adjusted odds ratio of lowest versus 2 upper tertiles of CDI was 1.28 for mild, 8.47 for moderate, and 10.59 for severe CAD compared with the normal cohort. The area under the ROC curve to predict obstructive CAD (stenosis ≥ 50%) increased significantly from 0.71 to 0.84 by addition of CDI to CAC (P < 0.05).Conclusion: CTA-measured CDI is inversely related to the severity of CAD independent of age, sex, cardiovascular risk factors, and CAC.

Intravenous leiomyoma extending into the right ventricle - Uncorrected Proof

2010-01-14

Abstract: We present a case of a retroperitoneal leiomyoma invading the inferior vena cava and extending to the right ventricle. The tumor was visualized with electrocardiographic-gated dual-source computed tomography, showing a low-density, lobulated mass invading the inferior vena cava and prolapsing through the tricuspid valve during diastole. Cardiac computed tomography is useful in assessing the extension and hemodynamic effect of intracardiac masses.

Novel variant of dual left anterior descending coronary artery - Uncorrected Proof

2010-01-14

Abstract: A 29-year-old African American man presented with atypical chest pain. Coronary computed tomographic angiography (64-slice) showed a previously not described variant of dual (duplicated) left anterior descending artery (LAD). Duplication of LAD is a rare anomaly and has been categorized into 4 angiographic subtypes based on the origin, course, and termination of the short and long LAD. Our case is unique in that, unlike previous subtypes, the short LAD originates independently from the left coronary sinus and that the long LAD arises from the right coronary sinus and has an intramyocardial course before reaching the distal interventricular groove. It can be, thus, considered a new variant of dual LAD (type V).

Suture-induced right coronary artery stenosis - Corrected Proof

Martin Seltmann, Stephan Achenbach, Gerd Muschiol, Richard Feyrer — 2010-01-11

Abstract: An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

A meandering mesenteric artery - Corrected Proof

2010-01-11

Abstract: An 83-year-old woman with a history of peripheral vascular disease presented for evaluation of lower left extremity discomfort. A peripheral multidetector CT angiography showed a dilated inferior mesenteric artery acting as an important source of retrograde collateral perfusion secondary to a celiac axis stenosis.

Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions - Corrected Proof

2009-12-18

Background: Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.Objective: We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT.Methods: Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined.Results: Eighty-three patients (mean age, 61.5±12.5 years; n=67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53–0.77), 100% (95% CI, 0.76–1.00), 100% (95% CI, 0.90–1.00), and 41% (95% CI, 0.26–0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51–0.64), 100% (95% CI, 0.99–1.00), 99% (95% CI, 0.94–1.00), and 92% (95% CI, 0.90–0.93), respectively, to detect myocardial hypoenhancement.Conclusions: Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions.

Training in cardiovascular computer tomography: The Fellows-In-Training perspective - Corrected Proof

Ritesh Dhar, Sanjay Bhojraj, Mouaz H. Al-Mallah — 2009-11-30

Background: Cardiovascular computed tomography angiography (CCTA) is an emerging diagnostic technique in the evaluation of patients with suspected coronary artery disease. The recent CoCATS guidelines recommend that all cardiovascular fellows be exposed to CCTA in their training programs; however, not all programs have the ability to provide such training.Objective: This study aims to describe the present opinions of Fellows-in-Training (FIT) toward CCTA training.Methods: Cardiovascular FITs in the state of Michigan were contacted through the American College of Cardiology, Michigan chapter, e-mail list and were asked to complete a 12-question anonymous survey examining attitudes toward CCTA.Results: Sixty (54%) of 112 FITs completed the survey. Ninety-one percent of respondents had a CCTA program at their hospital and 52 (87%) considered CCTA important toward increasing their professional competitiveness. In addition, 93% had interest in obtaining at least level 2 training irrespective of their future career plans. The most important factors influencing their choice of third-party courses were cost, number of live cases, and student-to-faculty ratio. Finally, 47% supported creating an additional fourth year of training in advanced imaging, and 40% would pursue such training.Conclusion: Most cardiovascular FITs are interested in seeking advanced training in CCTA. Cardiovascular training programs should incorporate CCTA in their core curriculum to meet the increasing interest in CCTA among trainees.