CT Virtual Intravascular Endoscopy in the Visualization of Coronary Plaques: A Pictorial Essay

Sun, Zhonghua; Xu, Lei

doi:10.2174/1573405612666160530145327

Cited by 3 publications

(5 citation statements)

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“…VIE generated from CCTA data provides unique intraluminal views that allow qualitative assessment of the arterial lumen. Several other studies have used VIE to evaluate the aorta [ 19 , 20 , 21 , 22 , 23 , 24 ], but only three studies have used VIE to assess coronary arteries [ 25 , 26 , 27 ]. Only one study has evaluated the diagnostic value of VIE in assessing coronary stenosis, via an investigation of 61 patients with calcified coronary plaques, and showed a significant improvement in specificity and positive predictive value when compared with CCTA [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…CT volume data converted from original DICOM (digital imaging and communications in medicine) images were transferred to a separate workstation equipped with the software Analyze V 11.0 (AnalyzeDirect, Inc., Overland Park, KS, USA) for image post-processing and generation of 3D VIE images. Post-processing of CT data was performed with a CT number thresholding technique [ 27 , 28 ]. Generation of VIE images of coronary plaques and coronary lumen depends on the selection of an appropriate CT threshold, which was determined by measuring the CT attenuation in the ascending aorta according to previous reports [ 23 , 24 , 25 ], as illustrated in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

“…Virtual intravascular endoscopy (VIE), a CCTA-generated 3D visualization tool, is another approach that provides unique intraluminal views of the blood vessels, including endovascular stents or stent grafts [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], thus having potential to overcome the limitations of CCTA. To our knowledge, there are very few reports investigating the application of virtual intravascular endoscopy (VIE) in assessing coronary arteries [ 25 , 26 , 27 , 28 ]. Only one study has compared the diagnostic performance of VIE with that of CCTA, via an investigation of 61 patients with calcified coronary plaques [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Only one study has compared the diagnostic performance of VIE with that of CCTA, via an investigation of 61 patients with calcified coronary plaques [ 26 ]. Another article has described using VIE to assess coronary arteries with stents, but the case number is limited to only 13 patients [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Tsay

Sun

et al. 2022

Diagnostics

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Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Tsay

Sun

et al. 2022

Diagnostics

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“…3D virtual intravascular endoscopy (VIE) views were also generated using a commercially available software Analyze 12.0 (AnalyzeDirect, Inc., Lexana, KS, USA) in the images reconstructed with soft kernel Bv36 algorithm to provide intraluminal views of the coronary stents in relation to the coronary wall for determining the position of stent placement, stent patency and configuration. Details of producing VIE images have been well described in our previous studies (32)(33)(34)(35).…”

Section: D and 3d Image Visualization And Assessmentmentioning

confidence: 99%

Personalized 3D printed coronary models in coronary stenting

Sun

Jansen

2019

Quant. Imaging Med. Surg.

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Background: 3D printing has shown great promise in cardiovascular disease, with reports mainly focusing on pre-surgical planning and medical education. Research on utilization of 3D printed models in simulating coronary stenting has not been reported. In this study, we presented our experience of placing coronary stents into personalized 3D printed coronary models with the aim of determining stent lumen visibility with images reconstructed with different postprocessing views and algorithms.Methods: A total of six coronary stents with diameter ranging from 2.5 to 4.0 mm were placed into 3 patient-specific 3D printed coronary models for simulation of coronary stenting. The 3D printed models were placed in a plastic container and scanned on a 192-slice third generation dual-source CT scanner with images reconstructed with soft (Bv36) and sharp (Bv59) kernel algorithms. Thick and thin slab maximumintensity projection (MIP) images were also generated from the original CT data for comparison of stent lumen visibility. Stent lumen diameter was measured on 2D axial and MIP images, while stent diameter was measured on 3D volume rendering images. 3D virtual intravascular endoscopy (VIE) images were generated to provide intraluminal views of the coronary wall and stent appearances.Results: All of these stents were successfully placed into the right and left coronary arteries but 2 of them did not obtain wall apposition along the complete length. The stent lumen visibility ranged from 54 to 97%, depending on the stent location in the coronary arteries. The mean stent lumen diameters measured on 2D axial, thin and thick slab MIP images were found to be significantly smaller than the actual size (P<0.01). Thick slab MIP images resulted in measured stent lumen diameters smaller than those from thin slab MIP images, with significant differences noticed in most of the measurements (4 out of 6 stents) (P<0.05), and no significant differences in the remaining 2 stents (P=0.19-0.38). In contrast, 3D volume rendering images allowed for more accurate measurements with measured stent diameters close to the actual dimensions in most of these coronary stents, except for the stent placed at the right coronary artery in one of the models due to insufficient expansion of the stent. Images reconstructed with sharp kernel Bv59 significantly improved stent lumen visibility when compared to the smooth Bv36 kernel (P=0.01). 3D VIE was successfully generated in all of the datasets with clear visualization of intraluminal views of the stents in relation to the coronary wall.Conclusions: This preliminary report shows the feasibility of using 3D printed coronary artery models in coronary stenting for investigation of optimal coronary CT angiography protocols. Future studies should focus on placement of more stents with a range of stent diameters in the quest to reduce the need for invasive angiography for surveillance.

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Cardiovascular computed tomography in cardiovascular disease: An overview of its applications from diagnosis to prediction

SUN

2024

Journal of Geriatric Cardiology

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Cardiovascular computed tomography angiography (CTA) is a widely used imaging modality in the diagnosis of cardiovascular disease. Advancements in CT imaging technology have further advanced its applications from high diagnostic value to minimising radiation exposure to patients. In addition to the standard application of assessing vascular lumen changes, CTA-derived applications including 3D printed personalised models, 3D visualisations such as virtual endoscopy, virtual reality, augmented reality and mixed reality, as well as CT-derived hemodynamic flow analysis and fractional flow reserve (FFRCT) greatly enhance the diagnostic performance of CTA in cardiovascular disease. The widespread application of artificial intelligence in medicine also significantly contributes to the clinical value of CTA in cardiovascular disease. Clinical value of CTA has extended from the initial diagnosis to identification of vulnerable lesions, and prediction of disease extent, hence improving patient care and management. In this review article, as an active researcher in cardiovascular imaging for more than 20 years, I will provide an overview of cardiovascular CTA in cardiovascular disease. It is expected that this review will provide readers with an update of CTA applications, from the initial lumen assessment to recent developments utilising latest novel imaging and visualisation technologies. It will serve as a useful resource for researchers and clinicians to judiciously use the cardiovascular CT in clinical practice.

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CT Virtual Intravascular Endoscopy in the Visualization of Coronary Plaques: A Pictorial Essay

Cited by 3 publications

References 32 publications

Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Personalized 3D printed coronary models in coronary stenting

Cardiovascular computed tomography in cardiovascular disease: An overview of its applications from diagnosis to prediction

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