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Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes. 冠状动脉CT血管造影衍生的血流储备分数对糖尿病和非糖尿病患者下游管理和临床结果的影响。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-10-19 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.220276
Gaurav S Gulsin, Georgios Tzimas, Kenneth-Royce Holmes, Hidenobu Takagi, Stephanie L Sellers, Philipp Blanke, Lynne M H Koweek, Bjarne L Nørgaard, Jesper Jensen, Mark G Rabbat, Gianluca Pontone, Timothy A Fairbairn, Kavitha M Chinnaiyan, Pamela S Douglas, Whitney Huey, Hitoshi Matsuo, Niels P R Sand, Koen Nieman, Jeroen J Bax, Tetsuya Amano, Tomohiro Kawasaki, Takashi Akasaka, Campbell Rogers, Daniel S Berman, Manesh R Patel, Bernard De Bruyne, Sarah Mullen, Jonathon A Leipsic

Purpose: To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM).

Materials and methods: This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM.

Results: The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity.

Conclusion: Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.

目的:比较冠状动脉CT血管造影术(CCTA)衍生的血流储备分数(FFR)在糖尿病(DM)患者和非糖尿病患者中的临床应用。材料和方法:该二次分析包括来自前瞻性、多中心、,国际无创CT-FFR在冠状动脉护理(ADVANCE)注册中心(ClinicalTrials.gov标识符,NCT02499679)的诊断价值评估,这些患者使用CT-FFR评估疑似冠状动脉疾病(CAD),CCTA图像上有一个或多个冠状动脉狭窄≥30%。比较了糖尿病患者和非糖尿病患者的CCTA和CT-FFR结果、90天的治疗策略以及1年随访的临床结果。结果:该研究包括4290名参与者(平均年龄,66岁±10[SD];66%的男性参与者;22%的糖尿病参与者)。患有糖尿病的参与者有更多的阻塞性CAD(一个或多个冠状动脉狭窄≥50%;78.8%vs 70.6%,P<.001)、多支血管CAD(三支血管阻塞性CAD;18.9%vs 11.2%,P<.001),并且CT-FFR≤0.8的血管按比例增加(74.3%vs 64.6%,P<.001)。三分之二的参与者通过CT-FFR进行治疗重新分类,无论是否存在糖尿病,这都是一致的。两组冠状动脉血运重建的增加程度与CT-FFR的下降程度相似。1年时,糖尿病的存在与更高的主要心血管不良事件发生率相关(危险比,2.2;95%可信区间:1.2,4.1;P=0.01)。然而,根据狭窄严重程度进行分层时,没有观察到组间差异(结论:解剖CCTA结果和CT-FFR均显示,糖尿病患者与非糖尿病患者的CAD模式更复杂。无论是否存在糖尿病,治疗的重新分类率都是相似的,并且当根据直径狭窄和CT-FFR进行调整时,糖尿病不是一个不良预后指标。临床试验注册号:NCT 02499679关键词:血流储备分数、CT血管造影、糖尿病、冠状动脉疾病补充材料可用于本文。另见本期Ghoshhajra的评论。©RSNA,2023年。
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引用次数: 0
Coronary CT Angiography with CT Fractional Flow Reserve in Individuals with and without Diabetes Mellitus: Is It Time to Treat Patients the Same? 糖尿病患者和非糖尿病患者的冠状动脉CT血管造影和CT血流储备分数:是时候对患者进行同样的治疗了吗?
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-10-19 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.230283
Brian Ghoshhajra
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引用次数: 0
Pulmonary Alveolar Proteinosis-associated Pulmonary Fibrosis: Evolutional Changes and Radiologic-Pathologic Correlation. 肺泡蛋白病相关肺纤维化:进化变化和放射学病理学相关性。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-10-19 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.230040
Eileen Hu-Wang, Lydia Chelala, Luis Landeras, Huihua Li, Aliya N Husain, Mary E Strek, Jonathan H Chung

Pulmonary alveolar proteinosis (PAP) is a rare disease with frequently favorable outcomes. In a minority of patients with primary or secondary PAP, the disease course may be complicated by pulmonary fibrosis (PF) despite appropriate management. Imaging and histopathologic manifestations of uncomplicated PAP are well-known. In contrast, radiologic-pathologic descriptions of PAP-associated PF (PAP-PF) are limited. The current manuscript presents three cases of PAP-PF, each with serial high-resolution CT imaging demonstrating the longitudinal progression of this unusual complication, with concordant pathologic findings in two patients. Much remains to be known regarding adverse prognostic factors contributing to PAP-PF. Early recognition of radiologic-pathologic manifestations would allow timely diagnosis and management optimization. Keywords: CT, Lung, Inflammation, Pathology © RSNA, 2023.

肺泡蛋白沉积症(PAP)是一种罕见的疾病,通常有良好的预后。在少数原发性或继发性PAP患者中,尽管进行了适当的治疗,但病程可能会因肺纤维化(PF)而复杂化。无并发症PAP的影像学和组织病理学表现是众所周知的。相反,PAP相关PF(PAP-PF)的放射学病理学描述有限。目前的手稿介绍了三例PAP-PF,每个病例都有一系列高分辨率CT成像,显示了这种不寻常并发症的纵向进展,两名患者的病理结果一致。关于导致PAP-PF的不良预后因素还有很多未知之处。早期识别放射学病理表现将有助于及时诊断和优化管理。关键词:CT,肺,炎症,病理学©RSNA,2023。
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引用次数: 0
Quantification of Low-Attenuation Plaque Burden from Coronary CT Angiography: A Head-to-Head Comparison with Near-Infrared Spectroscopy Intravascular US. 冠状动脉CT血管造影低衰减斑块负荷的量化:与近红外光谱血管内超声的头对头比较。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-10-12 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.230090
Hiroki Tanisawa, Hidenari Matsumoto, Sebastien Cadet, Satoshi Higuchi, Hidefumi Ohya, Koji Isodono, Daisuke Irie, Kyoichi Kaneko, Arihiro Sumida, Takaho Hirano, Yuka Otaki, Ryoji Kitamura, Piotr J Slomka, Damini Dey, Toshiro Shinke

Purpose: To determine the association between low-attenuation plaque (LAP) burden at coronary CT angiography (CCTA) and plaque morphology determined with near-infrared spectroscopy intravascular US (NIRS-IVUS) and to compare the discriminative ability for NIRS-IVUS-verified high-risk plaques (HRPs) between LAP burden and visual assessment of LAP.

Materials and methods: This Health Insurance Portability and Accountability Act-compliant retrospective study included consecutive patients who underwent CCTA before NIRS-IVUS between October 2019 and October 2022 at two facilities. LAPs were visually identified as having a central focal area of less than 30 HU using the pixel lens technique. LAP burden was calculated as the volume of voxels with less than 30 HU divided by vessel volume. HRPs were defined as plaques with one of the following NIRS-IVUS-derived high-risk features: maximum 4-mm lipid core burden index greater than 400 (lipid-rich plaque), an echolucent zone (intraplaque hemorrhage), or echo attenuation (cholesterol clefts). Multivariable analysis was performed to evaluate NIRS-IVUS-derived parameters associated with LAP burden. The discriminative ability for NIRS-IVUS-verified HRPs was compared using receiver operating characteristic analysis.

Results: In total, 273 plaques in 141 patients (median age, 72 years; IQR, 63-78 years; 106 males) were analyzed. All the NIRS-IVUS-derived high-risk features were independently linked to LAP burden (P < .01 for all). LAP burden increased with the number of high-risk features (P < .001) and had better discriminative ability for HRPs than plaque attenuation by visual assessment (area under the receiver operating characteristic curve, 0.93 vs 0.89; P = .02).

Conclusion: Quantification of LAP burden improved HRP assessment compared with visual assessment. LAP burden was associated with the accumulation of HRP morphology.Keywords: Coronary CT Angiography, Intraplaque Hemorrhage, Lipid-Rich Plaque, Low Attenuation Plaque, Near-Infrared Spectroscopy Intravascular Ultrasound Supplemental material is available for this article. See also the commentary by Ferencik in this issue.© RSNA, 2023.

目的:确定冠状动脉CT血管造影术(CCTA)中的低衰减斑块(LAP)负荷与近红外光谱血管内超声(NIRS-IVUS)确定的斑块形态之间的关系,并比较LAP负荷与LAP视觉评估之间NIRS-IV US验证的高风险斑块(HRPs)的鉴别能力。材料和方法:本健康保险符合《可携带性和责任法案》的回顾性研究包括2019年10月至2022年10月在两个机构接受NIRS-IVUS前CCTA的连续患者。使用像素透镜技术在视觉上识别出LAP具有小于30HU的中心焦点区域。LAP负荷计算为小于30HU的体素体积除以血管体积。HRPs被定义为具有以下NIRS IVUS衍生的高危特征之一的斑块:最大4mm脂质核心负荷指数大于400(富含脂质的斑块)、回声透明区(斑块内出血)或回声衰减(胆固醇裂隙)。进行多变量分析以评估NIRS IVUS衍生的与LAP负荷相关的参数。使用接收器操作特性分析来比较NIRS IVUS验证的HRP的辨别能力。结果:总共分析了141名患者(中位年龄72岁;IQR 63-78岁;106名男性)的273个斑块。所有NIRS IVUS衍生的高危特征均与LAP负荷独立相关(所有特征均P<0.01)。LAP负荷随着高危特征的数量而增加(P<.001),并且通过视觉评估对HRP的辨别能力比斑块衰减更好(受试者操作特征曲线下面积,0.93比0.89;P=.02)。结论:与视觉评估相比,LAP负荷的量化改善了HRP评估。LAP负荷与HRP形态的积累有关。关键词:冠状动脉CT血管造影,斑块内出血,富含脂质的斑块,低衰减斑块,近红外光谱血管内超声补充材料可用于本文。另请参阅费伦西克在本期的评论。©RSNA,2023年。
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引用次数: 0
Predictive Value of Deep Learning-derived CT Pectoralis Muscle and Adipose Measurements for Incident Heart Failure: Multi-Ethnic Study of Atherosclerosis. 深度学习衍生CT胸肌和脂肪测量对突发心力衰竭的预测价值:动脉粥样硬化的多民族研究。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-10-05 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.230146
Quincy Hathaway, Hamza Ahmed Ibad, David A Bluemke, Farhad Pishgar, Arta Kasaiean, Joshua G Klein, Rebecca Cogswell, Matthew Allison, Matthew J Budoff, R Graham Barr, Wendy Post, Miriam A Bredella, João A C Lima, Shadpour Demehri

Purpose: To develop a deep learning algorithm capable of extracting pectoralis muscle and adipose measurements and to longitudinally investigate associations between these measurements and incident heart failure (HF) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA).

Materials and methods: MESA is a prospective study of subclinical cardiovascular disease characteristics and risk factors for progression to clinically overt disease approved by institutional review boards of six participating centers (ClinicalTrials.gov identifier: NCT00005487). All participants with adequate imaging and clinical data from the fifth examination of MESA were included in this study. Hence, in this secondary analysis, manual segmentations of 600 chest CT examinations (between the years 2010 and 2012) were used to train and validate a convolutional neural network, which subsequently extracted pectoralis muscle and adipose (intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PAT), extramyocellular lipids and subcutaneous adipose tissue) area measurements from 3031 CT examinations using individualized thresholds for adipose segmentation. Next, 1781 participants without baseline HF were longitudinally investigated for associations between baseline pectoralis muscle and adipose measurements and incident HF using crude and adjusted Cox proportional hazards models. The full models were adjusted for variables in categories of demographic (age, race, sex, income), clinical/laboratory (including physical activity, BMI, and smoking), CT (coronary artery calcium score), and cardiac MRI (left ventricular ejection fraction and mass (% of predicted)) data.

Results: In 1781 participants (median age, 68 (IQR,61, 75) years; 907 [51%] females), 41 incident HF events occurred over a median 6.5-year follow-up. IMAT predicted incident HF in unadjusted (hazard ratio [HR]:1.14; 95% CI: 1.03-1.26) and fully adjusted (HR:1.16, 95% CI: 1.03-1.31) models. PAT also predicted incident HF in crude (HR:1.19; 95% CI: 1.06-1.35) and fully adjusted (HR:1.25; 95% CI: 1.07-1.46) models.

Conclusion: The study demonstrates that fast and reliable deep learning-derived pectoralis muscle and adipose measurements are obtainable from conventional chest CT, which may be predictive of incident HF.©RSNA, 2023.

目的:开发一种能够提取胸肌和脂肪测量值的深度学习算法,并纵向研究这些测量值与动脉粥样硬化多民族研究(MESA)参与者发生心力衰竭(HF)之间的关系。材料和方法:MESA是一项亚临床心血管疾病特征和六个参与中心的机构审查委员会批准的进展为临床显性疾病的风险因素(ClinicalTrials.gov标识符:NCT00005487)。所有从MESA第五次检查中获得足够影像学和临床数据的参与者都被纳入本研究。因此,在这项二次分析中,使用600次胸部CT检查的手动分割(2010年至2012年)来训练和验证卷积神经网络,该网络随后提取胸肌和脂肪(肌间脂肪组织(IMAT)、肌周脂肪组织(PAT),肌细胞外脂质和皮下脂肪组织)面积测量。接下来,使用粗略和调整后的Cox比例风险模型,对1781名没有基线HF的参与者进行了纵向调查,以了解基线胸肌和脂肪测量与HF事件之间的关联。根据人口统计学(年龄、种族、性别、收入)、临床/实验室(包括体力活动、BMI和吸烟)、CT(冠状动脉钙评分)和心脏MRI(左心室射血分数和质量(预测的%))数据的类别对完整模型进行了调整。结果:1781名参与者(中位年龄68岁(IQR,61,75);907[51%]女性),在平均6.5年的随访中发生41例HF事件。IMAT在未调整(危险比[HR]:1.14;95%CI:1.03-12.6)和完全调整(HR:1.16,95%CI:1.03-1.31)模型中预测了HF事件。PAT还预测了原油(HR:1.19;95%CI:1.06-1.35)和完全调整(HR:1.25;95%CI:1.07-1.46)模型中的HF事件。结论:该研究表明,通过常规胸部CT可以获得快速可靠的深度学习获得的胸肌和脂肪测量,这可能是HF事件的预测。©RSNA,2023。
{"title":"Predictive Value of Deep Learning-derived CT Pectoralis Muscle and Adipose Measurements for Incident Heart Failure: Multi-Ethnic Study of Atherosclerosis.","authors":"Quincy Hathaway, Hamza Ahmed Ibad, David A Bluemke, Farhad Pishgar, Arta Kasaiean, Joshua G Klein, Rebecca Cogswell, Matthew Allison, Matthew J Budoff, R Graham Barr, Wendy Post, Miriam A Bredella, João A C Lima, Shadpour Demehri","doi":"10.1148/ryct.230146","DOIUrl":"10.1148/ryct.230146","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a deep learning algorithm capable of extracting pectoralis muscle and adipose measurements and to longitudinally investigate associations between these measurements and incident heart failure (HF) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA).</p><p><strong>Materials and methods: </strong>MESA is a prospective study of subclinical cardiovascular disease characteristics and risk factors for progression to clinically overt disease approved by institutional review boards of six participating centers (ClinicalTrials.gov identifier: NCT00005487). All participants with adequate imaging and clinical data from the fifth examination of MESA were included in this study. Hence, in this secondary analysis, manual segmentations of 600 chest CT examinations (between the years 2010 and 2012) were used to train and validate a convolutional neural network, which subsequently extracted pectoralis muscle and adipose (intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PAT), extramyocellular lipids and subcutaneous adipose tissue) area measurements from 3031 CT examinations using individualized thresholds for adipose segmentation. Next, 1781 participants without baseline HF were longitudinally investigated for associations between baseline pectoralis muscle and adipose measurements and incident HF using crude and adjusted Cox proportional hazards models. The full models were adjusted for variables in categories of demographic (age, race, sex, income), clinical/laboratory (including physical activity, BMI, and smoking), CT (coronary artery calcium score), and cardiac MRI (left ventricular ejection fraction and mass (% of predicted)) data.</p><p><strong>Results: </strong>In 1781 participants (median age, 68 (IQR,61, 75) years; 907 [51%] females), 41 incident HF events occurred over a median 6.5-year follow-up. IMAT predicted incident HF in unadjusted (hazard ratio [HR]:1.14; 95% CI: 1.03-1.26) and fully adjusted (HR:1.16, 95% CI: 1.03-1.31) models. PAT also predicted incident HF in crude (HR:1.19; 95% CI: 1.06-1.35) and fully adjusted (HR:1.25; 95% CI: 1.07-1.46) models.</p><p><strong>Conclusion: </strong>The study demonstrates that fast and reliable deep learning-derived pectoralis muscle and adipose measurements are obtainable from conventional chest CT, which may be predictive of incident HF.©RSNA, 2023.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"5 5","pages":"e230146"},"PeriodicalIF":7.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71426406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison. 新冠肺炎大流行期间美国的心血管测试:容量恢复和全球比较。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-21 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.220288
Cole B Hirschfeld, Sharmila Dorbala, Leslee J Shaw, Todd C Villines, Andrew D Choi, Nathan Better, Rodrigo J Cerci, Ganesan Karthikeyan, João V Vitola, Michelle C Williams, Mouaz Al-Mallah, Daniel S Berman, Adam Bernheim, Robert W Biederman, Paco E Bravo, Matthew J Budoff, Renee P Bullock-Palmer, Marcus Y Chen, Michael P DiLorenzo, Rami Doukky, Maros Ferencik, Jeffrey B Geske, Fadi G Hage, Robert C Hendel, Lynne Koweek, Venkatesh L Murthy, Jagat Narula, Patricia F Rodriguez Lozano, Nishant R Shah, Amee Shah, Prem Soman, Randall C Thompson, David Wolinsky, Yosef A Cohen, Eli Malkovskiy, Michael J Randazzo, Juan Lopez-Mattei, Purvi Parwani, Mrinali Shetty, Thomas N B Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Andrew J Einstein

Purpose: To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak.

Materials and methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis.

Results: Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, P = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, P = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, P = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, P = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline.

Conclusion: The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.Keywords: SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing Supplemental material is available for this article. © RSNA, 2023.

目的:描述新冠肺炎首次爆发后一年美国和非美国机构心血管诊断程序量的恢复情况。材料和方法:国际原子能机构(IAEA)协调了一项名为“IAEA新冠肺炎无创心脏病学协议研究”的全球研究 2(INCAPS COVID 2),从107个国家的669家机构收集数据,其中包括美国34个州的93家机构,以确定疫情对心血管诊断程序量的影响。参与者报告了2019年3月(基线)、2020年4月和2021年4月在其设施使用的每种诊断成像模式的体积。这项对INCAPS COVID 2的二次分析评估了美国和非美国设施之间以及美国地区之间手术量变化的差异。在多变量回归分析中,还分析了与美国恢复到疫情前容量相关的因素。结果:与基线相比,2020年4月美国和非美国机构的手术量减少情况相似(-66%对-71%,P=.27)。美国机构报告称,2021年4月的基线恢复率高于所有非美国机构(4%对-6%,P=.008),但在将美国设施与非美国高收入国家(NUHIC)设施进行比较时,没有证据表明存在差异(4%对0%,P=.18)。在中西部(11%)、东北部(9%)、南部(1%)和西部(-7%,P=.03)之间观察到美国地区回归基线的差异,但没有任何研究因素是2021年疫情前基线变化的重要预测因素。结论:在美国和NUHIC,疫情早期心脏检测的减少在一年内恢复到疫情前的基线水平,而在低收入国家,手术量仍然低迷。关键词:SPECT,心脏,流行病学,血管造影,CT血管造影,CT,超声心动图,SPECT/CT,MR成像,放射性核素研究,新冠肺炎,心血管成像,心血管诊断程序,心血管疾病,心脏测试补充材料可用于本文。©RSNA,2023年。
{"title":"Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison.","authors":"Cole B Hirschfeld, Sharmila Dorbala, Leslee J Shaw, Todd C Villines, Andrew D Choi, Nathan Better, Rodrigo J Cerci, Ganesan Karthikeyan, João V Vitola, Michelle C Williams, Mouaz Al-Mallah, Daniel S Berman, Adam Bernheim, Robert W Biederman, Paco E Bravo, Matthew J Budoff, Renee P Bullock-Palmer, Marcus Y Chen, Michael P DiLorenzo, Rami Doukky, Maros Ferencik, Jeffrey B Geske, Fadi G Hage, Robert C Hendel, Lynne Koweek, Venkatesh L Murthy, Jagat Narula, Patricia F Rodriguez Lozano, Nishant R Shah, Amee Shah, Prem Soman, Randall C Thompson, David Wolinsky, Yosef A Cohen, Eli Malkovskiy, Michael J Randazzo, Juan Lopez-Mattei, Purvi Parwani, Mrinali Shetty, Thomas N B Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Andrew J Einstein","doi":"10.1148/ryct.220288","DOIUrl":"10.1148/ryct.220288","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak.</p><p><strong>Materials and methods: </strong>The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis.</p><p><strong>Results: </strong>Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, <i>P</i> = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, <i>P</i> = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, <i>P</i> = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, <i>P</i> = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline.</p><p><strong>Conclusion: </strong>The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.<b>Keywords:</b> SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing <i>Supplemental material is available for this article.</i> © RSNA, 2023.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"5 5","pages":"e220288"},"PeriodicalIF":7.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71426394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiac MRI-derived Myocardial Fibrosis and Ventricular Dyssynchrony Predict Response to Cardiac Resynchronization Therapy in Patients with Nonischemic Dilated Cardiomyopathy. 心脏MRI衍生的心肌纤维化和心室不同步预测非缺血性扩张型心肌病患者对心脏再同步治疗的反应。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-21 eCollection Date: 2023-10-01 DOI: 10.1148/ryct.220127
Yanyan Song, Xiuyu Chen, Kai Yang, Zhixiang Dong, Chen Cui, Kankan Zhao, Huaibing Cheng, Keshan Ji, Minjie Lu, Shihua Zhao

Purpose: To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM).

Materials and methods: This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT-derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters.

Results: Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], P = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], P = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], P = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], P = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%]).

Conclusion: Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis.Keywords: MR Imaging, Cardiac, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2023.

目的:确定心肌纤维化和左心室(LV)不同步性的关系,分别用心脏MRI与晚期钆增强(LGE)和特征跟踪(FT)测量,对非缺血性扩张型心肌病(DCM)的心脏再同步治疗(CRT)有反应。材料和方法:这项回顾性研究包括98名非缺血性扩张性心肌病患者(平均年龄,59岁±10[SD];54名男性),在CRT前用LGE心脏MRI进行评估。心脏MRI FT衍生的不同步性被定义为左心室节段在三个方向(纵向、径向和周向)上的峰值应变时间(TTP-SD)的SD。CRT反应被定义为在6个月的随访中,超声心动图显示左心室射血分数(LVEF)增加15%,然后评估长期心血管事件。似然比检验用于评估LGE和不同步参数的增量预后价值。结果:71例(72%)患者在CRT后表现出良好的LVEF反应。LGE的存在(比值比:0.14[95%CI:0.04,047],P=0.002;危险比:3.52[95%CI:1.37,9.07],P=0.01)和较低的圆周TTP-SD(比值比1.04[95%CI:10.02,007],P=0.0002;危险比0.98[95%CI:0.96,1.00],P=0.03)与LVEF无反应和长期结果独立相关。联合LGE和周向TTP-SD对LVEF无反应(受试者工作特征曲线下面积AUC:0.89[95%CI:0.81,0.94],敏感性84.5%[95%CI:74.0%,92.0%],特异性85.2%[95%CI:66.3%,95.8%])和长期结果(AUC:0.84[95%CI:0.75,0.91],敏感性76.9%[95%CI:56.4%,91.0%],特异性87.0%[95%CI:76.7%,93.9%])。关键词:磁共振成像,心脏,结果分析本文提供了补充材料。©RSNA,2023年。
{"title":"Cardiac MRI-derived Myocardial Fibrosis and Ventricular Dyssynchrony Predict Response to Cardiac Resynchronization Therapy in Patients with Nonischemic Dilated Cardiomyopathy.","authors":"Yanyan Song,&nbsp;Xiuyu Chen,&nbsp;Kai Yang,&nbsp;Zhixiang Dong,&nbsp;Chen Cui,&nbsp;Kankan Zhao,&nbsp;Huaibing Cheng,&nbsp;Keshan Ji,&nbsp;Minjie Lu,&nbsp;Shihua Zhao","doi":"10.1148/ryct.220127","DOIUrl":"https://doi.org/10.1148/ryct.220127","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM).</p><p><strong>Materials and methods: </strong>This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT-derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters.</p><p><strong>Results: </strong>Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], <i>P</i> = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], <i>P</i> = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], <i>P</i> = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], <i>P</i> = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%]).</p><p><strong>Conclusion: </strong>Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis.<b>Keywords:</b> MR Imaging, Cardiac, Outcomes Analysis <i>Supplemental material is available for this article</i>. © RSNA, 2023.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"5 5","pages":"e220127"},"PeriodicalIF":7.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71426393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Coronary Calcium Association with All-Cause Mortality in Suspected Acute Aortic Syndrome. 冠状动脉钙与疑似急性主动脉综合征患者全因死亡率的关系
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-08-31 eCollection Date: 2023-08-01 DOI: 10.1148/ryct.230171
Arosh S Perera Molligoda Arachchige
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引用次数: 0
Standardized Medical Terminology for Cardiac CT: What's in a Name? 心脏 CT 的标准化医学术语:名称有什么用?
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-08-24 eCollection Date: 2023-08-01 DOI: 10.1148/ryct.230213
James Roberts, Kate Hanneman
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引用次数: 0
Mapping the Spatial Extent of Hypoperfusion in Chronic Thromboembolic Pulmonary Hypertension Using Multienergy CT. 应用多能CT绘制慢性血栓栓塞性肺动脉高压低灌注的空间范围。
IF 7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-08-10 eCollection Date: 2023-08-01 DOI: 10.1148/ryct.220221
Elizabeth Bird, Kyle Hasenstab, Nick Kim, Michael Madani, Atul Malhotra, Lewis Hahn, Seth Kligerman, Albert Hsiao, Francisco Contijoch

Purpose: To assess if a novel automated method to spatially delineate and quantify the extent of hypoperfusion on multienergy CT angiograms can aid the evaluation of chronic thromboembolic pulmonary hypertension (CTEPH) disease severity.

Materials and methods: Multienergy CT angiograms obtained between January 2018 and December 2020 in 51 patients with CTEPH (mean age, 47 years ± 17 [SD]; 27 women) were retrospectively compared with those in 110 controls with no imaging findings suggestive of pulmonary vascular abnormalities (mean age, 51 years ± 16; 81 women). Parenchymal iodine values were automatically isolated using deep learning lobar lung segmentations. Low iodine concentration was used to delineate areas of hypoperfusion and calculate hypoperfused lung volume (HLV). Receiver operating characteristic curves, correlations with preoperative and postoperative changes in invasive hemodynamics, and comparison with visual assessment of lobar hypoperfusion by two expert readers were evaluated.

Results: Global HLV correctly separated patients with CTEPH from controls (area under the receiver operating characteristic curve = 0.84; 10% HLV cutoff: 90% sensitivity, 72% accuracy, and 64% specificity) and correlated moderately with hemodynamic severity at time of imaging (pulmonary vascular resistance [PVR], ρ = 0.67; P < .001) and change after surgical treatment (∆PVR, ρ = -0.61; P < .001). In patients surgically classified as having segmental disease, global HLV correlated with preoperative PVR (ρ = 0.81) and postoperative ∆PVR (ρ = -0.70). Lobar HLV correlated moderately with expert reader lobar assessment (ρHLV = 0.71 for reader 1; ρHLV = 0.67 for reader 2).

Conclusion: Automated quantification of hypoperfused areas in patients with CTEPH can be performed from clinical multienergy CT examinations and may aid clinical evaluation, particularly in patients with segmental-level disease.Keywords: CT-Spectral Imaging (Multienergy), Pulmonary, Pulmonary Arteries, Embolism/Thrombosis, Chronic Thromboembolic Pulmonary Hypertension, Multienergy CT, Hypoperfusion© RSNA, 2023.

目的:评估一种新的自动方法,在多能CT血管造影上空间描绘和量化低灌注程度,是否有助于评估慢性血栓栓塞性肺动脉高压(CTEPH)疾病的严重程度。材料和方法:将2018年1月至2020年12月期间获得的51名CTEPH患者(平均年龄,47岁±17[SD];27名女性)的多能CT血管造影照片与110名未发现肺血管异常的对照组(平均年龄51岁±16;81名女性)进行回顾性比较。使用深度学习肺叶分割自动分离骨髓间充质碘值。低碘浓度用于描绘低灌注区域并计算低灌注肺容量(HLV)。评估了受试者的操作特征曲线、与术前和术后有创血流动力学变化的相关性,以及与两名专家读者对肺叶低灌注的视觉评估的比较。结果:整体HLV正确地将CTEPH患者与对照组区分开来(受试者操作特征曲线下面积=0.84;10%HLV临界值:90%的敏感性、72%的准确性和64%的特异性),并与成像时的血液动力学严重程度(肺血管阻力[PVR],ρ=0.67;P<.001)和手术治疗后的变化适度相关(∆PVR,ρ=-0.61;P<.001)。在手术分类为节段性疾病的患者中,整体HLV与术前PVR(ρ=0.81)和术后∆PVR(ρ=-0.70)相关。肺叶HLV与专家读者肺叶评估适度相关(读者1的ρHLV=0.71;读者2的ρHLV=0.67)。结论:CTEPH患者低灌注区的自动定量可以通过临床多能CT检查进行,并可能有助于临床评估,特别是在节段性疾病患者中。关键词:CT频谱成像(多能),肺,肺动脉,栓塞/血栓形成,慢性血栓栓子性肺动脉高压,多能CT,低灌注©RSNA,2023。
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引用次数: 0
期刊
Radiology. Cardiothoracic imaging
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