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Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review. 心脏骤停后的心脏磁共振成像:系统回顾。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230216
Bernhard Scharinger, E. Boxhammer, R. Rezar, Stefan Hecht, S. Wernly, Tobias Widhalm, M. Lichtenauer, U. Hoppe, K. Hergan, Bernhard Wernly, Bernhard Strohmer, R. Kaufmann
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (≥18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries (www.osf.io/nxaev), and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: (a) cardiac MRI led to a new or alternative diagnosis in patients with SCA; (b) cardiac MRI identified pathologic or arrhythmogenic substrates; (c) cardiac MRI helped detect myocardial edema (potentially reversible); (d) cardiac MRI provided evidence for the occurrence of adverse events; and (e) functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Keywords: Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
目的 对心脏骤停 (SCA) 后心脏 MRI 的诊断和预后价值进行系统性回顾评估。材料和方法 系统检索了 PubMed 和 Cochrane Library 数据库中有关成年患者(年龄≥18 岁)SCA 后心脏 MRI 的研究。研究时间跨度为 2012 年 1 月至 2023 年 1 月。研究方案已在 OSF Registries (www.osf.io/nxaev) 上预先注册,并按照系统综述和荟萃分析首选报告项目 (PRISMA) 指南进行了系统综述。纳入研究的质量采用纽卡斯尔-渥太华质量评估量表进行评估。结果 共纳入 14 项研究,涉及 1367 人,其中 1257 人(91.9%)接受了心脏磁共振成像检查。关于心脏磁共振成像特异性结果的诊断价值,研究结果并不一致。纳入的研究显示了以下主要结果:(a) 心脏 MRI 可为 SCA 患者提供新的或替代诊断;(b) 心脏 MRI 可确定病理或心律失常基质;(c) 心脏 MRI 有助于检测心肌水肿(可能是可逆的);(d) 心脏 MRI 可提供不良事件发生的证据;(e) 少数研究认为功能标记或心室尺寸与预后相关。本系统性综述面临的相关挑战是缺乏与心脏磁共振成像作为指标检测相关的参照物和参考标准,以及患者选择偏差。结论 SCA 后的心脏磁共振成像有助于诊断过程,并为治疗计划提供必要的补充信息。该综述的局限性包括研究的参照标准不足以及患者选择可能存在偏差。系统综述注册链接:osf.io/nxaev 关键词: 心脏 MRI、心血管疾病心脏磁共振成像、心血管疾病、心肌病、缺血、心肌水肿、心脏骤停 © RSNA, 2024.
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引用次数: 0
Myocardial Fibrosis in the Indeterminate Form of Chagas Disease: Harbinger of Cardiomyopathy or Silent Vestige? 南美锥虫病不确定型的心肌纤维化:心肌病的先兆还是无声的象征?
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.240031
S. A. Gómez-Ochoa, Luis E Echeverría
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引用次数: 0
Coronary Artery Disease Assessment via On-Site CT Fractional Flow Reserve in Patients Undergoing Transcatheter Aortic Valve Replacement. 通过现场 CT 分数血流储备评估接受经导管主动脉瓣置换术患者的冠状动脉疾病。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230096
Alexandra Steyer, Valentina O Puntmann, Eike Nagel, David M Leistner, Vitali Koch, Mariuca Vasa-Nicotera, Parveen Kumar, Christian Booz, Thomas J Vogl, Silvia Mas-Peiro, Simon S Martin

Purpose To examine the clinical feasibility of workstation-based CT fractional flow reserve (CT-FFR) for coronary artery disease (CAD) evaluation during preprocedural planning in patients undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods In this retrospective single-center study, 434 patients scheduled for TAVR between 2018 and 2020 were screened for study inclusion; a relevant proportion of patients (35.0% [152 of 434]) was not suitable for evaluation due to insufficient imaging properties. A total of 112 patients (mean age, 82.1 years ± 6.7 [SD]; 58 [52%] men) were included in the study. Invasive angiography findings, coronary CT angiography results, and Agatston score were acquired and compared with on-site CT-FFR computation for evaluation of CAD and prediction of major adverse cardiovascular events (MACE) within a 24-month follow-up. Results Hemodynamic relevant CAD, as suggested by CT-FFR of 0.80 or less, was found in 41 of 70 (59%) patients with stenosis of 50% or more. MACE occurred in 23 of 112 (20.5%) patients, from which 14 of 23 had stenoses with CT-FFR of 0.80 or less (hazard ratio [HR], 3.33; 95% CI: 1.56, 7.10; P = .002). CT-FFR remained a significant predictor of MACE after inclusion in a multivariable model with relevant covariables (HR, 2.89; 95% CI: 1.22, 6.86; P = .02). An Agatston score of 1000 Agatston units or more (HR, 2.25; 95% CI: 0.98, 5.21; P = .06) and stenoses of 50% or more determined via invasive angiography (HR, 0.94; 95% CI: 0.41, 2.17; P = .88) were not significant predictors of MACE. Conclusion Compared with conventional CAD markers, CT-FFR better predicted adverse outcomes after TAVR. A relevant portion of the screened cohort, however, was not suitable for CT-based CAD evaluation. Keywords: CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Coronary Arteries, Outcomes Analysis © RSNA, 2024 See also the commentary by Weir-McCall and Pugliese in this issue.

目的 探讨在接受经导管主动脉瓣置换术(TAVR)的患者进行术前规划时,基于工作站的 CT 分数血流储备(CT-FFR)用于冠状动脉疾病(CAD)评估的临床可行性。材料与方法 在这项回顾性单中心研究中,筛选了 2018 年至 2020 年期间计划接受 TAVR 的 434 例患者作为研究对象;由于成像特性不足,有一定比例的患者(35.0% [434 例中的 152 例])不适合接受评估。共有 112 名患者(平均年龄 82.1 岁 ± 6.7 [SD];男性 58 [52%])被纳入研究。研究人员获取了有创血管造影结果、冠状动脉 CT 血管造影结果和 Agatston 评分,并将其与现场 CT-FFR 计算结果进行比较,以评估 CAD 和预测 24 个月随访期间的主要不良心血管事件 (MACE)。结果 在 70 名血管狭窄程度达到或超过 50%的患者中,有 41 人(59%)发现了血流动力学相关的 CAD(CT-FFR 为 0.80 或更低)。112名患者中有23名(20.5%)发生了MACE,其中14名患者的血管狭窄程度为CT-FFR 0.80或以下(危险比[HR],3.33;95% CI:1.56,7.10;P = .002)。在纳入包含相关协变量的多变量模型后,CT-FFR仍是MACE的重要预测因素(HR,2.89;95% CI:1.22,6.86;P = .02)。Agatston评分达到或超过1000 Agatston单位(HR,2.25;95% CI:0.98,5.21;P = .06)以及通过有创血管造影确定的血管狭窄达到或超过50%(HR,0.94;95% CI:0.41,2.17;P = .88)并不能显著预测MACE。结论 与传统的 CAD 标志物相比,CT-FFR 更能预测 TAVR 后的不良预后。然而,在接受筛查的人群中,有相当一部分人不适合进行基于 CT 的 CAD 评估。关键词CT、经导管主动脉瓣植入/置换术(TAVI/TAVR)、心脏、冠状动脉、结果分析 © RSNA, 2024 另请参阅本期 Weir-McCall 和 Pugliese 的评论。
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引用次数: 0
PREFUL MRI for Monitoring Perfusion and Ventilation Changes after Elexacaftor-Tezacaftor-Ivacaftor Therapy for Cystic Fibrosis: A Feasibility Study. PREFUL MRI 用于监测 Elexacaftor-Tezacaftor-Ivacaftor 治疗囊性纤维化后的灌注和通气变化:可行性研究
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230104
M. Dohna, A. Voskrebenzev, F. Klimeš, Till F Kaireit, Julian Glandorf, S. Pallenberg, Felix C. Ringshausen, Gesine Hansen, D. M. Renz, Frank Wacker, Anna-Maria Dittrich, Jens Vogel-Claussen
Purpose To assess the feasibility of monitoring the effects of elexacaftor-tezacaftor-ivacaftor (ETI) therapy on lung ventilation and perfusion in people with cystic fibrosis (CF), using phase-resolved functional lung (PREFUL) MRI. Materials and Methods This secondary analysis of a multicenter prospective study was carried out between August 2020 and March 2021 and included participants 12 years or older with CF who underwent PREFUL MRI, spirometry, sweat chloride test, and lung clearance index assessment before and 8-16 weeks after ETI therapy. For PREFUL-derived ventilation and perfusion parameter extraction, two-dimensional coronal dynamic gradient-echo MR images were evaluated with an automated quantitative pipeline. T1- and T2-weighted MR images and PREFUL perfusion maps were visually assessed for semiquantitative Eichinger scores. Wilcoxon signed rank test compared clinical parameters and PREFUL values before and after ETI therapy. Correlation of parameters was calculated as Spearman ρ correlation coefficient. Results Twenty-three participants (median age, 18 years [IQR: 14-24.5 years]; 13 female) were included. Quantitative PREFUL parameters, Eichinger score, and clinical parameters (lung clearance index = 21) showed significant improvement after ETI therapy. Ventilation defect percentage of regional ventilation decreased from 18% (IQR: 14%-25%) to 9% (IQR: 6%-17%) (P = .003) and perfusion defect percentage from 26% (IQR: 18%-36%) to 19% (IQR: 13%-24%) (P = .002). Areas of matching normal (healthy) ventilation and perfusion increased from 52% (IQR: 47%-68%) to 73% (IQR: 61%-83%). Visually assessed perfusion scores did not correlate with PREFUL perfusion (P = .11) nor with ventilation-perfusion match values (P = .38). Conclusion The study demonstrates the feasibility of PREFUL MRI for semiautomated quantitative assessment of perfusion and ventilation changes in response to ETI therapy in people with CF. Keywords: Pediatrics, MR-Functional Imaging, Pulmonary, Lung, Comparative Studies, Cystic Fibrosis, Elexacaftor-Tezacaftor-Ivacaftor Therapy, Fourier Decomposition, PREFUL, Free-Breathing Proton MRI, Pulmonary MRI, Perfusion, Functional MRI, CFTR, Modulator Therapy, Kaftrio Clinical trial registration no. NCT04732910 Supplemental material is available for this article. © RSNA, 2024.
目的 评估使用相位分辨肺功能(PREFUL)核磁共振成像监测 elexacaftor-tezacaftor-ivacaftor (ETI) 疗法对囊性纤维化(CF)患者肺通气和肺灌注影响的可行性。材料与方法 这项多中心前瞻性研究的二次分析于 2020 年 8 月至 2021 年 3 月进行,纳入了 12 岁或以上的 CF 患者,他们在 ETI 治疗前和治疗后 8-16 周接受了 PREFUL MRI、肺活量测定、氯化汗试验和肺清除指数评估。为了提取 PREFUL 导出的通气和灌注参数,使用自动定量管道对二维冠状动态梯度回波 MR 图像进行了评估。T1和T2加权核磁共振图像和PREFUL灌注图通过目测进行半定量艾兴格评分。Wilcoxon 符号秩检验比较了 ETI 治疗前后的临床参数和 PREFUL 值。参数的相关性以 Spearman ρ 相关系数计算。结果 共纳入 23 名参与者(中位年龄 18 岁 [IQR:14-24.5 岁];13 名女性)。经过 ETI 治疗后,PREFUL 定量参数、艾辛格评分和临床参数(肺清除指数 = 21)均有显著改善。区域通气缺陷百分比从 18% (IQR: 14%-25%) 降至 9% (IQR: 6%-17%) (P = .003) ,灌注缺陷百分比从 26% (IQR: 18%-36%) 降至 19% (IQR: 13%-24%) (P = .002)。与正常(健康)通气和灌注相匹配的区域从 52%(IQR:47%-68%)增加到 73%(IQR:61%-83%)。视觉评估的灌注评分与 PREFUL 灌注(P = .11)和通气-灌注匹配值(P = .38)不相关。结论 该研究证明了 PREFUL MRI 用于半自动定量评估 CF 患者对 ETI 治疗的灌注和通气变化的可行性。关键词儿科 磁共振功能成像 肺部 比较研究 囊性纤维化 Elexacaftor-Tezacaftor-Ivacaftor 治疗 傅立叶分解 PREFUL 自由呼吸质子磁共振成像 肺部磁共振成像 灌注 功能性磁共振成像 CFTR 调制器治疗 Kaftrio 临床试验注册号.NCT04732910 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Coronary Volume-to-Myocardial Mass Ratio Giving Additional Insights in Coronary Artery Disease Pathophysiology. 冠状动脉容积与心肌质量比为冠状动脉疾病病理生理学提供更多启示
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.240049
M. van Assen, C. Onnis
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引用次数: 0
Associations between 3D-based Left Atrial Volumetric and Blood Flow Parameters in a Single-Site Cohort of the Multi-Ethnic Study of Atherosclerosis. 多种族动脉粥样硬化研究单点队列中基于三维的左心房容积参数和血流参数之间的关联。
IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-04-01 DOI: 10.1148/ryct.230148
Maurice Pradella, Justin J Baraboo, Anthony Maroun, Sophia Z Liu, Amanda L DiCarlo, Stanley H Chu, Julia M Hwang, Mitchell A Collins, Rod Passman, Susan R Heckbert, Philip Greenland, Michael Markl

Purpose To investigate associations between left atrial volume (LAV) and function with impaired three-dimensional hemodynamics from four-dimensional flow MRI. Materials and Methods A subcohort of participants from the Multi-Ethnic Study of Atherosclerosis from Northwestern University underwent prospective 1.5-T cardiac MRI including whole-heart four-dimensional flow and short-axis cine imaging between 2019 and 2020. Four-dimensional flow MRI analysis included manual three-dimensional segmentations of the LA and LA appendage (LAA), which were used to quantify LA and LAA peak velocity and blood stasis (% voxels < 0.1 m/sec). Short-axis cine data were used to delineate LA contours on all cardiac time points, and the resulting three-dimensional-based LAVs were extracted for calculation of LA emptying fractions (LAEFtotal, LAEFactive, LAEFpassive). Stepwise multivariable linear models were calculated for each flow parameter (LA stasis, LA peak velocity, LAA stasis, LAA peak velocity) to determine associations with LAV and LAEF. Results This study included 158 participants (mean age, 73 years ± 7 [SD]; 83 [52.5%] female and 75 [47.4%] male participants). In multivariable models, a 1-unit increase of LAEFtotal was associated with decreased LA stasis (β coefficient, -0.47%; P < .001), while increased LAEFactive was associated with increased LA peak velocity (β coefficient, 0.21 cm/sec; P < .001). Furthermore, increased minimum LAV indexed was most associated with impaired LAA flow (higher LAA stasis [β coefficient, 0.65%; P < .001] and lower LAA peak velocity [β coefficient, -0.35 cm/sec; P < .001]). Conclusion Higher minimum LAV and reduced LA function were associated with impaired flow characteristics in the LA and LAA. LAV assessment might therefore be a surrogate measure for LA and LAA flow abnormalities. Keywords: Atherosclerosis, Left Atrial Volume, Left Atrial Blood Flow, 4D Flow MRI Supplemental material is available for this article. © RSNA, 2024.

目的 研究左心房容积(LAV)和功能与四维血流 MRI 中受损的三维血流动力学之间的关联。材料与方法 美国西北大学多种族动脉粥样硬化研究(Multi-Ethnic Study of Atherosclerosis)亚群参与者在 2019 年至 2020 年期间接受了前瞻性 1.5 T 心脏 MRI 检查,包括全心四维血流和短轴电影成像。四维血流 MRI 分析包括 LA 和 LA 附肢 (LAA) 的手动三维分割,用于量化 LA 和 LAA 峰值速度和血液淤滞(< 0.1 米/秒的体素百分比)。短轴电影数据用于勾勒所有心脏时间点的 LA 轮廓,并提取由此产生的基于三维的 LAV,用于计算 LA 排空分数(LAEFtotal、LAEFactive、LAEFpassive)。针对每个血流参数(LA淤积、LA峰值速度、LAA淤积、LAA峰值速度)计算逐步多变量线性模型,以确定与LAV和LAEF的关系。结果 本研究共纳入 158 名参与者(平均年龄为 73 岁 ± 7 [SD];女性 83 [52.5%],男性 75 [47.4%])。在多变量模型中,LAEFtotal 增加 1 个单位与 LA 淤血减少有关(β 系数,-0.47%;P < .001),而 LAEFactive 增加与 LA 峰值速度增加有关(β 系数,0.21 厘米/秒;P < .001)。此外,最小 LAV 指数增加与 LAA 血流受损关系最大(更高的 LAA 淤积率 [β系数,0.65%;P < .001] 和更低的 LAA 峰值速度 [β系数,-0.35 厘米/秒;P < .001])。结论 LAV最小值升高和LA功能减退与LA和LAA血流特征受损有关。因此,LAV评估可能是衡量LA和LAA血流异常的替代指标。关键词动脉粥样硬化 左心房容积 左心房血流 四维血流 MRI 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Selective Use of CT Fractional Flow at a Large Academic Medical Center: Insights from Clinical Implementation after 1 Year of Practice. 在一家大型学术医疗中心选择性使用 CT 分数流:临床实践一年后的启示。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230073
Mangun K Randhawa, A. Takigami, V. Thondapu, P. Ranganath, Eric Zhang, A. Parakh, Reece J. Goiffon, V. Baliyan, B. Foldyna, Michael T Lu, A. Tower-Rader, N. Meyersohn, Sandeep Hedgire, B. Ghoshhajra
Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician's discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.
目的 本特别报告概述了一项使用双源冠状动脉 CT 血管造影术(CTA)扫描进行的 CT 分数血流储备(CT-FFR)分析(无心率控制)及其对临床结果影响的回顾性观察研究。材料和方法 2020 年 8 月至 2021 年 8 月期间接受有临床指征的冠状动脉 CTA 的所有患者都纳入了这项回顾性观察研究。扫描在收缩晚期至舒张早期进行,无心率控制,由判读医生酌情分析。通过病历审查评估人口统计学、冠状动脉 CTA 特征以及 3 个月后有创冠状动脉造影术 (ICA)、经皮冠状动脉介入治疗 (PCI)、心肌梗死和全因死亡的发生率。结果 在研究期间,3098 名患者接受了冠状动脉 CTA 检查,其中 113 名接受过冠状动脉旁路移植术的患者被排除在外。在剩余的 2985 例患者中,有 292 例(9.7%)转入 CT-FFR 分析。两项研究(0.7%)被拒绝进行 CT-FFR 分析,六项分析(2.1%)未对相关病变进行评估。共有 160 名患者(56.3%)的 CT-FFR 大于 0.80。在冠状动脉 CTA 有明显狭窄的患者中,接受 CT-FFR 分析的患者接受 ICA(74.5% vs 25.5%,P = .04)和 PCI(78.9% vs 21.1%,P = .05)的比例较低。结论 CT-FFR通过使用双源冠状动脉CTA采集技术在不需要心率控制的患者中实施,并显示出在不影响安全性的情况下降低明显狭窄且平均心率为65次/分的患者的ICA和PCI率的潜力。关键词血管造影 CT CT-血管造影 分数血流储备 心脏 心脏动脉硬化 这篇文章有补充材料。© RSNA, 2024.
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引用次数: 0
Association of Coronary Wall Thickening and Diminished Diastolic Function in Asymptomatic, Low Cardiovascular Disease-Risk Persons Living with HIV. 无症状、心血管疾病风险低的艾滋病病毒感染者冠状动脉壁增厚与舒张功能减弱之间的关系。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230102
Khaled Z. Abd-Elmoniem, Hadjira Ishaq, Julia B. Purdy, J. Matta, A. Hamimi, H. Hannoush, Colleen Hadigan, A. Gharib
Purpose To assess early subclinical coronary artery disease (CAD) burden and its relation to myocardial function in asymptomatic persons living with HIV (PLWH) who are at low risk for cardiovascular disease (CVD). Materials and Methods In this prospective, HIPAA-compliant study (ClinicalTrials.gov NCT01656564 and NCT01399385) conducted from April 2010 to May 2013, 74 adult PLWH without known CVD and 25 matched healthy controls underwent coronary MRI to measure coronary vessel wall thickness (VWT) and echocardiography to assess left ventricular function. Univariable and multivariable linear regression analyses were used to evaluate statistical associations. Results For PLWH, the mean age was 49 years ± 11 (SD), and the median Framingham risk score was 3.2 (IQR, 0.5-6.6); for matched healthy controls, the mean age was 46 years ± 8 and Framingham risk score was 2.3 (IQR, 0.6-6.1). PLWH demonstrated significantly greater coronary artery VWT than did controls (1.47 mm ± 0.22 vs 1.34 mm ± 0.18; P = .006) and a higher left ventricular mass index (LVMI) (77 ± 16 vs 70 ± 13; P = .04). Compared with controls, PLWH showed altered association between coronary artery VWT and both E/A (ratio of left ventricular-filling peak blood flow velocity in early diastole [E wave] to that in late diastole [A wave]) (P = .03) and LVMI (P = .04). In the PLWH subgroup analysis, coronary artery VWT increase was associated with lower E/A (P < .001) and higher LVMI (P = .03), indicating restricted diastolic function. In addition, didanosine exposure was associated with increased coronary artery VWT and decreased E/A ratio. Conclusion Asymptomatic low-CVD-risk PLWH demonstrated increased coronary artery VWT in association with impaired diastolic function, which may be amenable to follow-up studies of coronary pathogenesis to identify potential effects on the myocardium and risk modification strategies. Keywords: Coronary Vessel Wall Thickness, Diastolic Function, HIV, MRI, Echocardiography, Atherosclerosis Clinical trial registration nos. NCT01656564 and NCT01399385 Supplemental material is available for this article. © RSNA, 2024.
目的 评估无症状但心血管疾病(CVD)风险较低的艾滋病病毒感染者(PLWH)的早期亚临床冠状动脉疾病(CAD)负担及其与心肌功能的关系。材料与方法 在这项于 2010 年 4 月至 2013 年 5 月进行的符合 HIPAA 标准的前瞻性研究(ClinicalTrials.gov NCT01656564 和 NCT01399385)中,74 名无已知心血管疾病的成年艾滋病病毒感染者和 25 名匹配的健康对照者接受了冠状动脉核磁共振成像检查,以测量冠状动脉血管壁厚度 (VWT),并接受超声心动图检查以评估左心室功能。采用单变量和多变量线性回归分析评估统计关联。结果 PLWH 的平均年龄为 49 岁 ± 11(标清),弗雷明汉风险评分中位数为 3.2(IQR,0.5-6.6);匹配的健康对照组的平均年龄为 46 岁 ± 8,弗雷明汉风险评分中位数为 2.3(IQR,0.6-6.1)。PLWH 的冠状动脉 VWT 明显高于对照组(1.47 mm ± 0.22 vs 1.34 mm ± 0.18;P = .006),左心室质量指数 (LVMI) 也高于对照组(77 ± 16 vs 70 ± 13;P = .04)。与对照组相比,PLWH 表现出冠状动脉 VWT 与 E/A(舒张早期左心室充盈峰值血流速度 [E 波] 与舒张晚期 [A 波] 之比)(P = .03)和 LVMI(P = .04)之间的关联性改变。在 PLWH 亚组分析中,冠状动脉 VWT 增高与较低的 E/A 值(P < .001)和较高的 LVMI 值(P = .03)相关,表明舒张功能受限。此外,地达诺辛暴露与冠状动脉 VWT 增加和 E/A 比值降低有关。结论 无症状的低心血管疾病风险 PLWH 表现出冠状动脉 VWT 增加与舒张功能受损有关,这可能适合对冠状动脉发病机制进行随访研究,以确定对心肌的潜在影响和风险调整策略。关键词:冠状动脉血管壁厚度冠状动脉血管壁厚度 舒张功能 HIV 核磁共振成像 超声心动图 动脉粥样硬化 临床试验注册编号:NCT01656564 和 NCT01656564。NCT01656564 和 NCT01399385 本文有补充材料。© RSNA, 2024.
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引用次数: 1
Multi-Energy Low-Kiloelectron Volt versus Single-Energy Low-Kilovolt Images for Endoleak Detection at CT Angiography of the Aorta. 在主动脉 CT 血管造影中,多能量低千伏与单能量低千伏图像在内膜渗漏检测中的对比。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230217
Anna Landsmann, Thomas Sartoretti, Victor Mergen, Lisa Jungblut, Matthias Eberhard, Adrian Kobe, Hatem Alkadhi, André Euler

Purpose To compare image quality, diagnostic performance, and conspicuity between single-energy and multi-energy images for endoleak detection at CT angiography (CTA) after endovascular aortic repair (EVAR). Materials and Methods In this single-center prospective randomized controlled trial, individuals undergoing CTA after EVAR between August 2020 and May 2022 were allocated to imaging using either low-kilovolt single-energy images (SEI; 80 kV, group A) or low-kiloelectron volt virtual monoenergetic images (VMI) at 40 and 50 keV from multi-energy CT (80/Sn150 kV, group B). Scan protocols were dose matched (volume CT dose index: mean, 4.5 mGy ± 1.8 [SD] vs 4.7 mGy ± 1.3, P = .41). Contrast-to-noise ratio (CNR) was measured. Two expert radiologists established the reference standard for the presence of endoleaks. Detection and conspicuity of endoleaks and subjective image quality were assessed by two different blinded radiologists. Interreader agreement was calculated. Nonparametric statistical tests were used. Results A total of 125 participants (mean age, 76 years ± 8; 103 men) were allocated to groups A (n = 64) and B (n = 61). CNR was significantly lower for 40-keV VMI (mean, 19.1; P = .048) and 50-keV VMI (mean, 16.8; P < .001) as compared with SEI (mean, 22.2). In total, 45 endoleaks were present (A: 23 vs B: 22). Sensitivity for endoleak detection was higher for SEI (82.6%, 19 of 23; P = .88) and 50-keV VMI (81.8%, 18 of 22; P = .90) as compared with 40-keV VMI (77.3%, 17 of 22). Specificity was comparable among groups (SEI: 92.7%, 38 of 41; both VMI energies: 92.3%, 35 of 38; P = .99), with an interreader agreement of 1. Conspicuity of endoleaks was comparable between SEI (median, 2.99) and VMI (both energies: median, 2.87; P = .04). Overall subjective image quality was rated significantly higher for SEI (median, 4 [IQR, 4-4) as compared with 40 and 50 keV (both energies: median, 4 [IQR, 3-4]; P < .001). Conclusion SEI demonstrated higher image quality and comparable diagnostic accuracy as compared with 50-keV VMI for endoleak detection at CTA after EVAR. Keywords: Aneurysms, CT, CT Angiography, Vascular, Aorta, Technology Assessment, Multidetector CT, Abdominal Aortic Aneurysms, Endoleaks, Perigraft Leak Supplemental material is available for this article. © RSNA, 2024.

目的 比较单能量和多能量图像在血管内主动脉修复术(EVAR)后 CT 血管造影(CTA)中用于内漏检测的图像质量、诊断性能和清晰度。材料与方法 在这项单中心前瞻性随机对照试验中,2020 年 8 月至 2022 年 5 月期间接受 EVAR 后 CTA 的患者被分配到使用低千伏单能图像(SEI;80 千伏,A 组)或多能 CT(80/Sn150 千伏,B 组)40 和 50 千伏的低千伏虚拟单能图像(VMI)进行成像。扫描方案剂量匹配(容积 CT 剂量指数:平均值 4.5 mGy ± 1.8 [SD] vs 4.7 mGy ± 1.3,P = .41)。测量对比度与噪声比(CNR)。两位放射科专家确定了是否存在内漏的参考标准。由两名不同的盲人放射科医生对内膜漏的检测和明显程度以及主观图像质量进行评估。计算读片者之间的一致性。采用非参数统计检验。结果 共有 125 名参与者(平均年龄 76 岁 ± 8 岁;103 名男性)被分配到 A 组(64 人)和 B 组(61 人)。与 SEI(平均值为 22.2)相比,40-keV VMI(平均值为 19.1;P = .048)和 50-keV VMI(平均值为 16.8;P < .001)的 CNR 明显较低。共有 45 个内漏(A:23 个;B:22 个)。与 40-keV VMI(77.3%,22 人中有 17 人)相比,SEI(82.6%,23 人中有 19 人;P = .88)和 50-keV VMI(81.8%,22 人中有 18 人;P = .90)的内漏检测灵敏度更高。各组的特异性相当(SEI:92.7%,41 组中的 38 组;两种 VMI 能量:92.3%,38 组中的 35 组;P = .99),读片者之间的一致性为 1。SEI(中位数,2.99)和 VMI(两种能量:中位数,2.87;P = .04)的内漏明显度相当。与 40 和 50 keV(两种能量:中位数均为 4 [IQR,3-4];P < .001)相比,SEI 的整体主观图像质量评分明显更高(中位数为 4 [IQR,4-4])。结论 SEI 与 50-keV VMI 相比,在 EVAR 后的 CTA 内漏检测中显示出更高的图像质量和相当的诊断准确性。关键词动脉瘤、CT、CT 血管造影、血管、主动脉、技术评估、多载体 CT、腹主动脉瘤、内漏、移植物周围漏 本文有补充材料。© RSNA, 2024.
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引用次数: 0
Performance of Image-navigated and Diaphragm-navigated 3D Late Gadolinium-enhanced Cardiac MRI for the Assessment of Atrial Fibrosis. 用于评估心房纤维化的图像导航和膈肌导航三维晚期钆增强心脏磁共振成像的性能。
IF 7 Pub Date : 2024-04-01 DOI: 10.1148/ryct.230172
L. Hopman, JA Solís-Lemus, Mark B M Hofman, P. Bhagirath, Sonia Borodzicz-Jazdzyk, Nikki van Pouderoijen, Axel J Krafft, Michaela Schmidt, C.P. Allaart, Steven Niederer, Marco J W Götte
Purpose To perform a qualitative and quantitative evaluation of the novel image-navigated (iNAV) 3D late gadolinium enhancement (LGE) cardiac MRI imaging strategy in comparison with the conventional diaphragm-navigated (dNAV) 3D LGE cardiac MRI strategy for the assessment of left atrial fibrosis in atrial fibrillation (AF). Materials and Methods In this prospective study conducted between April and September 2022, 26 consecutive participants with AF (mean age, 61 ± 11 years; 19 male) underwent both iNAV and dNAV 3D LGE cardiac MRI, with equivalent spatial resolution and timing in the cardiac cycle. Participants were randomized in the acquisition order of iNAV and dNAV. Both, iNAV-LGE and dNAV-LGE images were analyzed qualitatively using a 5-point Likert scale and quantitatively (percentage of atrial fibrosis using image intensity ratio threshold 1.2), including testing for overlap in atrial fibrosis areas by calculating Dice score. Results Acquisition time of iNAV was significantly lower compared with dNAV (4.9 ± 1.1 minutes versus 12 ± 4 minutes, P < .001, respectively). There was no evidence of a difference in image quality for all prespecified criteria between iNAV and dNAV, although dNAV was the preferred image strategy in two-thirds of cases (17/26, 65%). Quantitative assessment demonstrated that mean fibrosis scores were lower for iNAV compared with dNAV (12 ± 8% versus 20 ± 12%, P < .001). Spatial correspondence between the atrial fibrosis maps was modest (Dice similarity coefficient, 0.43 ± 0.15). Conclusion iNAV-LGE acquisition in individuals with AF was more than twice as fast as dNAV acquisition but resulted in a lower atrial fibrosis score. The differences between these two strategies might impact clinical interpretation. ©RSNA, 2024.
目的 对新型图像导航(iNAV)三维晚期钆增强(LGE)心脏 MRI 成像策略与传统膈肌导航(dNAV)三维 LGE 心脏 MRI 策略进行定性和定量评估,以评估心房颤动(AF)患者左心房纤维化的情况。材料和方法 在这项于 2022 年 4 月至 9 月进行的前瞻性研究中,26 名连续的房颤患者(平均年龄为 61 ± 11 岁;19 名男性)同时接受了 iNAV 和 dNAV 三维 LGE 心脏 MRI,其空间分辨率和心动周期的时间相当。参试者按 iNAV 和 dNAV 的采集顺序随机分组。iNAV-LGE 和 dNAV-LGE 图像均采用 5 分李克特量表进行定性和定量分析(使用图像强度比阈值 1.2 分析心房纤维化的百分比),包括通过计算 Dice 评分检测心房纤维化区域的重叠情况。结果 iNAV 的采集时间明显低于 dNAV(分别为 4.9 ± 1.1 分钟和 12 ± 4 分钟,P < .001)。尽管三分之二的病例(17/26,65%)首选 dNAV,但没有证据表明 iNAV 和 dNAV 在所有预设标准下的图像质量存在差异。定量评估显示,iNAV 的平均纤维化评分低于 dNAV(12 ± 8% 对 20 ± 12%,P < .001)。心房纤维化图之间的空间对应性一般(Dice 相似性系数,0.43 ± 0.15)。结论 对房颤患者进行 iNAV-LGE 采集的速度是 dNAV 采集速度的两倍多,但获得的心房纤维化评分较低。这两种策略之间的差异可能会影响临床解释。©RSNA,2024。
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引用次数: 0
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Radiology. Cardiothoracic imaging
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