Coronary computed tomography angiography in acute chest pain: A sustainable model with remote support

Galea, Nicola; Bellù, Roberto; Catapano, Federica; Marchitelli, Livia; Cannavale, Giuseppe; Sedati, Pietro; Colmo, Cristian; Zamana, Alberto; Arboit, Marco; Raspanti, Xenia; Roncacci, Alessandro; Catalano, Carlo; Francone, Marco

doi:10.1016/j.ejrad.2022.110277

Cited by 2 publications

(4 citation statements)

References 33 publications

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“…We prospectively included 103 consecutive patients who underwent CCTA from November 2021 to January 2022, for suspected or known CAD, older than 18 years, with no contraindications to iodine agent administration. Fourteen patients were excluded, 6…”

Section: Study Populationmentioning

confidence: 99%

“…3,4 According to the European Society of Cardiovascular Radiology (ESCR) MR/CT Registry (www.mrct-registry.org) from 2010 to present over 185,000 CCTA were performed all over Europe, numbers set to grow further from the new massive deployment in the acute setting. 5,6 The increasing number of examination requests raised concerns about dose exposure, and subsequently led to the development of dose-reduction strategies that have been coupled with highly efficient iterative reconstruction (IR) algorithms that allowed to significantly reduce individual radiation dose keeping image quality adequate [7][8][9] according to the as low as reasonably achievable principle. 10 Iterative reconstruction algorithms have shown good results in preserving image quality in low-dose radiation CCTA even in a debated population such as pediatric patients, 11 because of the increased radiosensitivity due to the longer time available to develop stochastic effects, which constantly fuels an ongoing search for methods to further reduce radiation dose.…”

mentioning

confidence: 99%

“…Coronary computed tomography angiography (CCTA) has become an essential tool to safely rule out coronary artery disease (CAD) with high negative predictive value 1,2 with increasingly wider application in clinical practice 3,4 . According to the European Society of Cardiovascular Radiology (ESCR) MR/CT Registry (www.mrct-registry.org) from 2010 to present over 185,000 CCTA were performed all over Europe, numbers set to grow further from the new massive deployment in the acute setting 5,6 . The increasing number of examination requests raised concerns about dose exposure, and subsequently led to the development of dose-reduction strategies that have been coupled with highly efficient iterative reconstruction (IR) algorithms that allowed to significantly reduce individual radiation dose keeping image quality adequate 7–9 according to the as low as reasonably achievable principle 10 .…”

mentioning

confidence: 99%

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Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application

Catapano,

Lisi,

Savini

et al. 2023

J Comput Assist Tomogr

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Objective The increasing number of coronary computed tomography angiography (CCTA) requests raised concerns about dose exposure. New dose reduction strategies based on artificial intelligence have been proposed to overcome limitations of iterative reconstruction (IR) algorithms. Our prospective study sought to explore the added value of deep-learning image reconstruction (DLIR) in comparison with a hybrid IR algorithm (adaptive statistical iterative reconstruction-veo [ASiR-V]) in CCTA, even in clinical challenging scenarios, as obesity, heavily calcified vessels and coronary stents. Methods We prospectively included 103 consecutive patients who underwent CCTA. Data sets were reconstructed with ASiR-V and DLIR. For each reconstruction signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was calculated, and qualitative assessment was made with a four-point Likert scale by two independent and blinded radiologists with different expertise. Results Both SNR and CNR were significantly higher in DLIR (SNR-DLIR median value [interquartile range] of 13.89 [11.06–16.35] and SNR-ASiR-V 25.42 [22.46–32.22], P < 0.001; CNR-DLIR 16.84 [9.83–27.08] vs CNR-ASiR-V 10.09 [5.69–13.5], P < 0.001). Median qualitative score was 4 for DLIR images versus 3 for ASiR-V (P < 0.001), with a good interreader reliability [intraclass correlation coefficient(2,1)e intraclass correlation coefficient(3,1) 0.60 for DLIR and 0.62 and 0.73 for ASiR-V]. In the obese and in the “calcifications and stents” groups, DLIR showed significantly higher values of SNR (24.23 vs 11.11, P < 0.001 and 24.55 vs 14.09, P < 0.001, respectively) and CNR (16.08 vs 8.04, P = 0.008 and 17.31 vs 10.14, P = 0.003) and image quality. Conclusions Deep-learning image reconstruction in CCTA allows better SNR, CNR, and qualitative assessment than ASiR-V, with an added value in the most challenging clinical scenarios.

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Section: Study Populationmentioning

confidence: 99%

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confidence: 99%

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Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application

Catapano,

Lisi,

Savini

et al. 2023

J Comput Assist Tomogr

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“…In the last decades, cardiac computed tomography angiography (CCTA) has gained a preeminent role in the evaluation of symptomatic patients with suspected CAD, thanks to its high diagnostic accuracy and high negative predictive value. According to recent guidelines, CCTA can be considered the exam of choice to rule out obstructive CAD in patients with chronic cardiac symptoms and low clinical pre-test likelihood of disease [ 4 – 6 ], and in patients with acute chest pain with low-to-intermediate pre-test probability [ 7 , 8 ]. However, the pure anatomical assessment of coronary arteries obtained with CCTA, does not provide functional information on lesion-specific ischemia.…”

Section: Introductionmentioning

confidence: 99%

Imaging biomarkers in cardiac CT: moving beyond simple coronary anatomical assessment

Cundari,

Marchitelli,

Pambianchi

et al. 2024

Radiol med

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Cardiac computed tomography angiography (CCTA) is considered the standard non-invasive tool to rule-out obstructive coronary artery disease (CAD). Moreover, several imaging biomarkers have been developed on cardiac-CT imaging to assess global CAD severity and atherosclerotic burden, including coronary calcium scoring, the segment involvement score, segment stenosis score and the Leaman-score. Myocardial perfusion imaging enables the diagnosis of myocardial ischemia and microvascular damage, and the CT-based fractional flow reserve quantification allows to evaluate non-invasively hemodynamic impact of the coronary stenosis. The texture and density of the epicardial and perivascular adipose tissue, the hypodense plaque burden, the radiomic phenotyping of coronary plaques or the fat radiomic profile are novel CT imaging features emerging as biomarkers of inflammation and plaque instability, which may implement the risk stratification strategies. The ability to perform myocardial tissue characterization by extracellular volume fraction and radiomic features appears promising in predicting arrhythmogenic risk and cardiovascular events. New imaging biomarkers are expanding the potential of cardiac CT for phenotyping the individual profile of CAD involvement and opening new frontiers for the practice of more personalized medicine.

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Coronary computed tomography angiography in acute chest pain: A sustainable model with remote support

Cited by 2 publications

References 33 publications

Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application

Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application

Imaging biomarkers in cardiac CT: moving beyond simple coronary anatomical assessment

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