Journal of cardiovascular computed tomography Impact Factor & Information

Publisher: Elsevier

Journal description

Current impact factor: 4.51

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 4.506
2012 Impact Factor 2.552

Additional details

5-year impact 0.00
Cited half-life 0.00
Immediacy index 0.00
Eigenfactor 0.00
Article influence 0.00
ISSN 1876-861X

Publisher details


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Publications in this journal

  • Journal of cardiovascular computed tomography 05/2015; 9(4). DOI:10.1016/j.jcct.2015.05.010
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    ABSTRACT: Epicardial adipose tissue (EAT) is a metabolically active fat depot. Studies have investigated the effect of EAT thickness on outcomes of radiofrequency catheter ablation of atrial fibrillation (AF). However, data on the relationship between EAT thickness and outcome of cryoballoon-based pulmonary vein isolation (PVI) are lacking. In this study, we investigate the association between EAT thickness and AF recurrence after cryoballoon-based PVI. Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s) were scheduled for cryoballoon-based PVI for AF per the recent recommendations. Periatrial, periventricular, and total EAT thickness measurements were obtained from preprocedural multidetector CT scans. A total of 249 patients (55.6 ± 10.7 years; 48.2% male; 18.5% persistent AF) were involved in the study. Patients were followed-up for 29 months (8-48 months). When blanking period was considered, freedom from AF after the ablation procedure was 75.9% at a median follow-up of 29 months. Total periatrial EAT thickness (18.1 ± 6.2 vs 14.7 ± 4.7 mm; P < .001) was greater in patients with late AF recurrence when compared to those without. On the other hand, periventricular or total EAT thickness measurements did not differ between both groups (P > .05). Multivariate Cox proportional hazard regression analysis showed that periatrial EAT thickness (hazard ratio, 1.086; P = .001) and left atrial volume index (hazard ratio, 1.144; P < .001) were independent predictors for late AF recurrence. Quantification of EAT thickness from preprocedural multidetector CT scans may serve as a beneficial parameter for prediction of AF recurrence after cryoballoon-based PVI. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 04/2015; DOI:10.1016/j.jcct.2015.03.011
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    ABSTRACT: Aortoenteric fistula is a rare clinical entity. Early clinical and imaging diagnosis and prompt surgical intervention are crucial for patient survival. We present a case of aortoenteric fistula with direct contrast extravasation from the abdominal aorta into an ileal loop during Multi-Detector Computed Tomography scan. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 04/2015; DOI:10.1016/j.jcct.2015.03.009
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    ABSTRACT: Multidetector CT (MDCT) is performed to evaluate patients before transcatheter aortic valve implantation (TAVI). MDCT can uncover relevant nonvascular incidental findings. The use of venous phase imaging (VPI) in MDCT before TAVI has not been evaluated. To evaluate the incidence of nonvascular findings in MDCT before TAVI with effect on the TAVI procedure and the value of VPI in this setting. Sixty-four-slice MDCT angiography with VPI (100 mL contrast agent with 370-mg iopromide per mL) in 76 patients was retrospectively evaluated by 2 readers. Nonvascular findings were separately assessed on arterial and venous phase images and categorized in consensus as nonsignificant (no effect on TAVI), intermediate (further workup or surveillance necessary, no effect on TAVI), or significant (effect on TAVI). Radiation dose was recorded as dose-length product (DLP) and effective dose was calculated. A total of 169 findings were detected, of which 155 (91.7%) were nonsignificant, 13 (7.7%) were intermediate, and 1 (0.6%) was significant. TAVI was canceled in 1 patient (1.3%) because of suspected pancreatic cancer. No significant finding was seen on VPI only. Mean total DLP was 1137.9 mGy·cm (16.07 mSv) and the proportional mean DLP of VPI was 403 mGy·cm (6.85 mSv). The incidence of nonvascular significant findings in MDCT before TAVI is low and VPI in our series did not add value. However, it may be considered in selected patients. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 04/2015; DOI:10.1016/j.jcct.2015.03.007
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    ABSTRACT: Coronary CT angiography (CCTA) has been proven accurate and is incorporated in clinical recommendations for coronary artery disease (CAD) diagnosis workup, but cost-effectiveness data, especially in comparison to other methods such as myocardial single photon emission CT (SPECT) are insufficient. To compare the cost-effectiveness of CCTA and myocardial SPECT in a real-world setting. We performed a retrospective cohort study on consecutive patients with suspected CAD and a pretest probability between 10% and 90%. Test accuracy was compared by correcting referral bias to coronary angiography depending on noninvasive test results based on the Bayes' theorem and also by incorporating 1-year follow-up results. Cost-effectiveness was analyzed using test accuracy and quality-adjusted life year (QALY). The model using diagnostic accuracy used the number of patients accurately diagnosed among 1000 persons as the effect and contained only expenses for diagnostic testing as the cost. In the model using QALY, a decision tree was developed, and the time horizon was 1 year. CCTA was performed in 635 patients and SPECT in 997 patients. An accurate diagnosis per 1000 patients was achieved in 725 patients by CCTA vs 661 patients by SPECT. In the model using diagnostic accuracy, CCTA was more effective and less expensive than SPECT ($725.38 for CCTA vs $661.46 for SPECT). In the model using QALY, CCTA was generally more effective in terms of life quality (0.00221 QALY) and cost ($513) than SPECT. However, cost utility varied among subgroups, with SPECT outperforming CCTA in patients with a pretest probability of 30% to 60% (0.01890 QALY; $113). These results suggest that CCTA may be more cost-effective than myocardial SPECT. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 03/2015; DOI:10.1016/j.jcct.2015.02.008
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    ABSTRACT: Concerns have been raised about radiation dose of coronary CT angiography. Although high-pitch acquisition technique yields high potential for radiation dose savings, it is more vulnerable to artifacts, which impair diagnostic image quality. The purpose of this study was to compare 2 scan strategies for coronary CT angiography: a high-pitch helical scan first or a conventional scan first strategy. In this prospective, multicenter trial, we randomized 303 consecutive patients with a low and stable heart rate to either of the aforementioned mentioned strategies. Intravenous β-blockers were administered to achieve target heart rates. All scans were performed on a second-generation dual-source CT scanner. In case of nondiagnostic image quality, coronary CT angiography was allowed to be repeated. The primary end point was to demonstrate noninferior image quality in the high-pitch group. Image quality was assessed on a 4-point scale (1: nondiagnostic, 4: excellent). Secondary end point was total radiation dose. In the high-pitch helical first group, repeat scanning was necessary in 21 patients compared with 14 patients in the conventional first scan group (P = .25). Image quality in the high-pitch group was noninferior compared to the conventional scan group (3.81 ± 0.35 vs 3.83 ± 0.37; P for noninferiority <.0001). The total effective radiation dose estimate was 58% lower in the high-pitch group (2.0 ± 2.4 vs 4.7 ± 4.8 mSv; P < .0001). In patients with a low and stable heart rate diagnostic image quality can be maintained with a high-pitch helical scan first strategy while 58% of radiation dose can be saved. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 03/2015; 9(4). DOI:10.1016/j.jcct.2015.03.001
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    ABSTRACT: Both low tube voltage and sinogram-affirmed iterative reconstruction (IR) techniques hold promise to decrease radiation dose at coronary CT angiography (CCTA). The increased iodine contrast at low tube voltage allows for minimizing iodine load. To assess the effect of reduced x-ray tube voltage, low iodine concentration contrast medium and IR on image quality and radiation dose at CCTA. Two hundred thirty-one consecutive patients with suspected coronary artery disease were enrolled in this prospective, multicenter trial and randomized to 1 of 2 dual-source CCTA protocols: 120-kVp with 370 mgI/mL iopromide or iopamidol (n = 116; 44 women; 55.3 ± 9.8 years) or 100 kVp with 270 mgI/mL iodixanol (n = 115; 48 women; 54.2 ± 10.4 years). Reconstruction was performed with filtered back projection and IR. Attenuation, image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured and image quality scored. Size-specific dose estimates and effective doses were calculated. There were no significant differences in mean arterial attenuation (406.6 ± 76.7 vs 409.7 ± 65.2 Hounsfield units; P = .739), image noise (18.7 ± 3.8 vs 17.9 ± 3.4 Hounsfield units; P = .138), signal-to-noise ratio (22.5 ± 5.4 vs 23.7 ± 6.1; P = .126), contrast-to-noise ratio (17.5 ± 5.5 vs 18.3 ± 6.1; P = .286), or image quality scores (4.1 ± 0.9 vs 4.0 ± 0.9; P > .05) between 120-kVp filtered back projection-reconstructed and 100-kVp IR-reconstructed series. Mean iodine dose was 26.5% lower (18.3 ± 0.5 vs 24.9 ± 0.9 g; P < .0001), mean size-specific dose estimate was 35.1% lower (17.9 ± 6.6 vs 27.5 ± 8.2 mGy; P < .0001), and effective dose was 34.9% lower (2.3 ± 1.0 vs 3.5 ± 1.1 mSv; P < .0001) with the 100 kVp compared with the 120-kVp protocol, respectively. Using low x-ray tube voltage and IR allows for decreasing the iodine load and effective radiation dose at CCTA while maintaining image quality. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 01/2015; 9(3). DOI:10.1016/j.jcct.2015.01.010
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    ABSTRACT: Fractional flow reserve (FFR) is the gold standard for determining lesion-specific ischemia. Computed FFRCT derived from coronary CT angiography (coronary CTA) correlates well with invasive FFR and accurately differentiates between ischemia-producing and nonischemic lesions. The diagnostic performance of FFRCT when applied in a clinically relevant way to all vessels ≥ 2 mm in diameter stratified by sex and age has not been previously examined. Two hundred fifty-two patients and 407 vessels underwent coronary CTA, FFRCT, invasive coronary angiography, and invasive FFR. FFRCT and FFR ≤0.80 were considered ischemic, whereas CT stenosis ≥50% was considered obstructive. The diagnostic performance of FFRCT was assessed following a prespecified clinical use rule which included all vessels ≥2 mm in diameter, not just those assessed by invasive FFR measurements. Stenoses <30% were assigned an FFR of 0.90, and stenoses >90% were assigned an FFR of 0.50. Diagnostic performance of FFRCT was stratified by vessel diameter, sex, and age. By FFR, ischemia was identified in 129 of 252 patients (51%) and in 151 of 407 vessels (31%). Mean age (±standard deviation) was 62.9 ± 9 years, and women were older (65.5 vs 61.9 years; P = .003). Per-patient diagnostic accuracy (83% vs 72%; P < .005) and specificity (54% vs 82%, P < .001) improved significantly after application of the clinical use tool. These were significantly improved over standard coronary CTA values before application of the clinical use rule. Discriminatory power of FFRCT also increased compared with baseline (area under the receiver operating characteristics curve [AUC]: 0.93 vs 0.81, P < .001). Diagnostic performance improved in both sexes with no significant differences between the sexes (AUC: 0.93 vs 0.90, P = .43). There were no differences in the discrimination of FFRCT after application of the clinical use rule when stratified by age ≥65 or <65 years (AUC: 0.95 vs 0.90, P = .10). The diagnostic accuracy and discriminatory power of FFRCT improve significantly after the application of a clinical use rule which includes all clinically relevant vessels >2 mm in diameter. FFRCT has similar diagnostic accuracy and discriminatory power for ischemia detection in men and women irrespective of age using a cut point of 65 years. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 01/2015; 9(2). DOI:10.1016/j.jcct.2015.01.008
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    ABSTRACT: We present a case that demonstrates myocardial fibrosis detected on a cardiac computed tomography study performed for the evaluation of chest pain in a patient with hypertrophic cardiomyopathy. We describe the correlation between echocardiographic strain imaging, quantitative positron emission tomography, and computed tomographic evidence of fibrosis and its implications in hypertrophic cardiomyopathy.
    Journal of cardiovascular computed tomography 03/2014; 8(2):166-9. DOI:10.1016/j.jcct.2013.12.019
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    ABSTRACT: The evaluation of native coronary arteries (NCAs) as well as coronary artery bypass graft (CABG) patency after surgery is essential. However, NCAs are often blurred in the craniocaudal scan direction because of long scan time with 64-slice CT. The purpose of the study was to determine the effect of scan direction on image quality and radiation exposure in assessment of NCAs and CABGs. Retrospective analysis of 191 consecutive individuals undergoing coronary CT angiography to evaluate CABG patency using 64-slice dual source CT. A retrospectively ECG gated spiral acquisition protocol with ECG based tube current modulation and automatic adjustment of tube current to a reference of 320 mAs ("CareDose 4D") was used. Tube current was 120 kVp. Scan direction was either cranio-caudal (CRC, n = 98) or caudo-cranial (CRC, n = 93) and the scan volume covered the entire course of all bypass grafts. Independent investigators determined quantitative image quality of the coronary arteries by evaluating contrast-to-noise ratio (CNR), radiation exposure by comparing the effective dose, and qualitative image quality through a 5 point rating scale. Quantitative image quality was not significantly different for the two groups except for the CNR of the right coronary artery which was significantly higher in patients with caudio-cranial scan direction (P = .0007). The qualitative image quality of the CaC group also was better for both NCAs and CABGs (P = .002 for NCAs and <.001 for CABGs), mostly because of the lower frequency of respiration artifacts on coronary arteries of the CaC group (P = .005). As an effect of automatic tube current adjustment, radiation dose was lower in patients with caudo-cranial scan direction (6.8 mSv vs. 9.6 mSv, p < 0.0001). In patients with coronary bypass grafts imaged by 64-slice dual source CT with spiral acquisition and automated tube current adjustment, a caudo-cranial scan direction results in improved image quality and reduced radiation exposure.
    Journal of cardiovascular computed tomography 03/2014; 8(2):124-30. DOI:10.1016/j.jcct.2013.12.011
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    ABSTRACT: We evaluated the accuracy of commonly used thresholds for vessel area evaluation on coronary CT angiography (CTA) and assessed ability of CTA to image the adventitial border. We evaluated 137 paired (coronary CTA and intravascular ultrasound [IVUS]) coronary artery cross-sections in 30 patients. CTA analysis included measurements of external vessel border area defined at Hounsfield unit (HU) thresholds of 0 (presumed adventitia), 50, and 70 (presumed external elastic membrane [EEM]). IVUS analysis included measurements of lumen, EEM, and outer border of the highly echogenic area adjacent to EEM (presumed adventitia area). High correlation was found between CTA and IVUS measurements for EEM areas (R(2) = 0.65, P < .001 and R(2) = 0.60, P < .001 for CTA thresholds of 50 and 70 HU, respectively). CTA and IVUS measurements of adventitia areas were significantly correlated (R(2) = 0.74; P < .001), with no significant difference between the 2 methods (20.2 ± 6.4 mm(2) vs 19.8 ± 6.4 mm(2), respectively; P = .278). Cross-sectional coronary lumen radiodensity on CTA images and plaque burden measured on IVUS significantly affected the accuracy of CTA in assessment of the EEM area but not the presumed adventitial area. We have demonstrated that use of a 50-HU threshold for vessel area determination by CTA led to its significant overestimation, whereas 70-HU threshold was close to that of EEM on IVUS. CTA may accurately delineate the coronary adventitial border by using a 0-HU threshold.
    Journal of cardiovascular computed tomography 03/2014; 8(2):141-8. DOI:10.1016/j.jcct.2013.12.014
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    ABSTRACT: Most current iterative reconstruction algorithms for CT imaging are a mixture of iterative reconstruction and filtered back projection. The value of "fully" iterative reconstruction in coronary CT angiography remains poorly understood. We aimed to assess the value of the knowledge-based iterative model reconstruction (IMR) algorithm on the qualitative and quantitative image quality at 256-slice cardiac CT. We enrolled 21 patients (mean age: 69 ± 11 years) who underwent retrospectively ECG gated coronary CT anhgiography at 100 kVp tube voltage. Images were reconstructed with the filtered back projection (FBP), hybrid iterative reconstruction (IR), and IMR algorithms. CT attenuation and the contrast-to-noise ratio (CNR) of the coronary arteries were calculated. With the use of a 4-point scale, 2 reviewers visually evaluated the coronary arteries and cardiac structures. The mean CT attenuation of the proximal coronary arteries was 369.3 ± 73.6 HU, 363.9 ± 75.3 HU, and 363.3 ± 74.5 HU, respectively, for FBP, hybrid IR, and IMR and was not significantly different. The image noise of the proximal coronary arteries was significantly lower with IMR (11.3 ± 2.8 HU) than FBP (51.9 ± 12.9 HU) and hybrid IR (23.2 ± 5.2 HU). The mean CNR of the proximal coronary arteries was 9.4 ± 2.4, 20.2 ± 4.7, and 41.8 ± 9.5 with FBP, hybrid IR and IMR, respectively; it was significantly higher with IMR. The best subjective image quality for coronary vessels was obtained with IMR (proximal vessels: FBP, 2.6 ± 0.5; hybrid IR, 3.4 ± 0.5; IMR, 3.8 ± 0.4; distal vessels: FBP, 2.3 ± 0.5; hybrid IR. 3.1 ± 0.5; IMR, 3.7 ± 0.5). IMR also yielded the best visualization for cardiac systems, that is myocardium and heart valves. The novel knowledge-based IMR algorithm yields significantly improved CNR and better subjective image quality of coronary vessels and cardiac systems with reliable CT number measurements for cardiac CT imaging.
    Journal of cardiovascular computed tomography 03/2014; 8(2):115-23. DOI:10.1016/j.jcct.2013.12.010
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    ABSTRACT: A 71-year-old woman underwent diagnostic workup for progressive shortness of breath. Transthoracic echocardiography showed a dilated main pulmonary artery (MPA) and an anomalous configuration of the pulmonary valve. CT revealed a bicuspid pulmonary valve (BPV) and confirmed MPA dilation. Further congenital abnormalities were excluded. An isolated finding of BPV is rather rare. To our knowledge we present the first 4-dimensional CT images of a BPV. As in this case, 4-dimensional cine cardiac CT may be helpful to reveal the underlying cause of MPA dilation.
    Journal of cardiovascular computed tomography 03/2014; 8(2):170-1. DOI:10.1016/j.jcct.2013.12.018
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    ABSTRACT: Despite the improvement of cardiac CT, right heart visualization remains challenging. We herein describe a new method, called the time-adjusted gradual replacement injection protocol. The aim of this study was to compare this protocol with the split-bolus injection protocol. Fifty-two patients who had undergone dual-source cardiac CT were retrospectively recruited. Twenty-six patients were injected by using the split-bolus injection protocol, and 26 patients were injected by using the time-adjusted gradual replacement injection protocol. For this method, we injected contrast medium for 10 seconds at a flow rate of 0.07 × body weight mL/s, then gradually replaced the contrast material with saline until 2 seconds before finishing the scans. The CT attenuation was measured in 4 chambers, the aorta, and the coronary arteries. The visualization of the anatomic structures and the occurrence and severity of streak artifacts were scored for the cardiac structures in the heart. For the analyses, either Welch t-test or Student t-test was performed. In the right heart, the CT values and visualization scores were significantly higher in the time-adjusted replacement injection group than in the split-bolus injection group, whereas the artifact scores were comparable between the 2 groups. The CT values, visualization scores, and artifact scores of the left heart were not significantly different between the 2 groups. In this study, the time-adjusted gradual replacement injection protocol provided excellent attenuation for visualization of the right heart. This method may help to accurately evaluate the right cardiac anatomy and thereby identify any potential diseases.
    Journal of cardiovascular computed tomography 03/2014; 8(2):158-65. DOI:10.1016/j.jcct.2013.12.016
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    ABSTRACT: Background Treatment decisions for ascending aortic aneurysms are guided by measurements from CT angiograms. Objective To evaluate the reproducibility of these measurements using manual techniques and advanced imaging software. Methods Two radiologists measured maximal ascending aorta diameter on CT angiograms in 30 subjects at four separate reading sessions—two with manual techniques and two using semiautomated software analysis. Inter- and intraobserver variability was assessed using Bland-Altman plots and Spearman’s correlation coefficients. Results Interobserver variability was smaller for the software-assisted method. Limits of agreement for manual method were [-4.2 mm, 9.2 mm]; as compared to [-4.0 mm, 4.6 mm] for software-assisted; coefficients of repeatability were 6.8 mm and 4.3 mm. Intraobserver variability was inconsistent between readers. There was strong correlation between observers using both methods (R2 = 0.8078-0.9881, p<0.05 for all). Conclusion The use of an advanced imaging software for ascending aortic aneurysm measurement reduces interobserver variability.
    Journal of cardiovascular computed tomography 03/2014; DOI:10.1016/j.jcct.2013.12.009
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    ABSTRACT: At least two-thirds of cases of acute coronary syndrome are caused by disruption of an atherosclerotic plaque. The natural history of individual plaques is unknown and needs to be established. The Plaque Registration and Evaluation Detected In Computed Tomography (PREDICT) registry is a prospective, multicenter, longitudinal, observational registry. This registry was designed to examine the relationships among coronary CT angiography (CTA) findings and clinical findings, mortality, and morbidity. The relationships among progression of coronary atherosclerosis, including changes in plaque characteristics on coronary CTA, and serum lipid levels and modification of coronary risk factors will also be evaluated. From October 2009 to December 2012, 3015 patients who underwent coronary CTA in 29 centers in Japan were enrolled. These patients were followed for 2 years. The primary end points were considered as all-cause mortality and major cardiac events, including cardiac death, nonfatal myocardial infarction, and unstable angina that required hospitalization. The secondary end points were heart failure that required administration of diuretics, target vessel revascularization, cerebral infarction, peripheral arterial disease, and invasive coronary angiography. Blood pressure, serum lipid, and C-reactive protein levels and all cardiovascular events were recorded at 1 and 2 years. If the initial coronary CTA showed any stenosis or plaques, follow-up coronary CTA was scheduled at 2 years to determine changes in coronary lesions, including changes in plaque characteristics. Analysis of the PREDICT registry data will clarify the relationships between coronary CTA findings and cardiovascular mortality and morbidity in a collaborative multicenter fashion. This trial is registered at as NCT 00991835.
    Journal of cardiovascular computed tomography 03/2014; 8(2):90-6. DOI:10.1016/j.jcct.2013.12.004