J W Nance

Publications of J W Nance

• Coronary computed tomography--present status and future directions.

  Authors: P Apfaltrer, U J Schoepf, R Vliegenthart, G W Rowe, J R Spears, C Fink, J W Nance

  International journal of clinical practice. Supplement. 10/2011;

  The use of coronary computed tomography angiography (cCTA) is growing rapidly, in large part because of fast-paced technical innovations that have increased diagnostic accuracy while providing newThe use of coronary computed tomography angiography (cCTA) is growing rapidly, in large part because of fast-paced technical innovations that have increased diagnostic accuracy while providing new opportunities for radiation dose reduction. cCTA using recent generation CT scanners has been repeatedly shown to have excellent negative predictive value for ruling out significant coronary stenosis in comparison with invasive coronary angiography (ICA) and is now accepted for this use in selected populations. Current work is increasingly focused on evaluating and optimising radiation dose reduction techniques, the cost-effectiveness of cCTA implementation, and the impact of cCTA on patient management and outcomes. In addition, the potential value of emerging applications, such as atherosclerotic plaque characterisation and myocardial perfusion and viability assessment, are undergoing intense investigation.

• Pulmonary embolism: ct signs and cardiac biomarkers for predicting right ventricular dysfunction.

  Authors: T Henzler, S Roeger, M Meyer, U J Schoepf, J W Nance, D Haghi, W E Kaminski, M Neumaier, S O Schoenberg, C Fink

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 09/2011;

  To prospectively evaluate the accuracy of quantitative cardiac CT parameters and two cardiac biomarkers (NT-pro-Brain Natriuretic Peptide (NT-pro-BNP); troponin I), alone and in combination, forTo prospectively evaluate the accuracy of quantitative cardiac CT parameters and two cardiac biomarkers (NT-pro-Brain Natriuretic Peptide (NT-pro-BNP); troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (PE).557 consecutive patients with suspected PE underwent pulmonary CTA. Patients with PE also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. 3 different CT measurements were obtained (RV/LVaxial, RV/LV4-CH), and RV/LVvolume). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography.Patients with RVD (n=77) showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LVaxial 1.68±0.84 vs. 1.00±0.21; RV/LV4ch 1.52±0.45 vs. 1.01±0.21; RV/LVvolume 1.97±0.53 vs. 1.07±0.52; serum NT-pro-BNP 6372±2319 vs. 1032±1559 ng·L(-1); troponin I 0.18±0.41 vs. 0.06±0.18). The area under the curve for the detection of RVD of RV/LVaxial, RV/LV4Ch, RV/LVvolume, NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LVvolume increased the AUC to 0.95 (RV/LVvolume with NT-pro-BNP) and 0.93 (RV/LVvolume with troponin I).RV/LVvolume is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LVvolume with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.

• Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT?

  Authors: G Schmid-Bindert, Thomas Henzler, T Q Chu, M Meyer, J W Nance, U J Schoepf, D J Dinter, P Apfaltrer, R Krissak, C Manegold, S O Schoenberg, C Fink

  European radiology. 08/2011; 22(1):93-103.

  To investigate the correlation between maximum standardized uptake value (SUV(max)) of (18)FDG PET-CT and iodine-related attenuation (IRA) of dual energy CT (DECT) of primary tumours and (18)FDGTo investigate the correlation between maximum standardized uptake value (SUV(max)) of (18)FDG PET-CT and iodine-related attenuation (IRA) of dual energy CT (DECT) of primary tumours and (18)FDG PET-CT positive thoracic lymph nodes (LN) in patients with lung cancer. 37 patients with lung cancer (27 NSCLC, 10 SCLC, 86 (18)FDG PET-CT positive thoracic LN) who underwent both (18)FDG PET-CT and DECT were analyzed. The mean study interval between (18)FDG PET-CT and DECT was ≤21 days in 17 patients. The mean and maximum IRA of DECT as well as of virtual unenhanced and virtual 120 kV images of DECT was analyzed and correlated to the SUV(max) of (18)FDG PET-CT in all tumours and (18)FDG PET-CT positive thoracic lymph nodes. Further subgroup analysis was performed for histological subtypes in all groups. A moderate correlation was found between SUV(max) and maximum IRA in all tumours (n = 37;r = 0.507;p = 0.025) whereas only weak or no correlation were found between SUV(max) and all other DECT measurements. A strong correlation was found in patients with study intervals ≤21 days (n = 17; r = 0.768;p = 0.017). Analysis of histological subtypes of lung cancer showed a strong correlation between SUV(max) and maximum IRA in the analysis of all patients with NSCLC (r = 0.785;p = 0.001) and in patients with NSCLC and study intervals ≤21 days (r = 0.876;p = 0.024). Thoracic LN showed moderate correlation between SUV(max) and maximum IRA in patients with study intervals ≤21 days (r = 0.654; p = 0.010) whereas a weak correlation was found between SUV(max) and maximum IRA in patients with study intervals >21 days (r = 0.299; p = 0.035). DECT could serve as a valuable functional imaging test for patients with NSCLC as the IRA of DECT correlates with SUV(max) of (18)FDG PET-CT.

• Tako-tsubo cardiomyopathy: findings on cardiac CT and coronary catheterisation.

  Authors: J W Nance, U J Schoepf, L Ramos-Duran

  Heart (British Cardiac Society). 03/2010; 96(5):406-7.

• Tako-tsubo cardiomyopathy: findings on cardiac CT and coronary catheterisation

  Authors: J. W. Nance, U. J. Schoepf, L. Ramos-Duran

  Heart. 96(5):406-7.

• CT imaging of acute pulmonary embolism

  Authors: T. Henzler, J. M. Barraza, J. W. Nance, P. Costello, R. Krissak, C. Fink, U. J. Schoepf

  J Cardiovasc Comput Tomogr. 5(1):3-11.

  CT pulmonary angiography (CTPA) has become the de facto clinical "gold standard" for the diagnosis of acute pulmonary embolism (PE) and has replaced catheter pulmonary angiography andCT pulmonary angiography (CTPA) has become the de facto clinical "gold standard" for the diagnosis of acute pulmonary embolism (PE) and has replaced catheter pulmonary angiography and ventilation-perfusion scintigraphy as the first-line imaging method. The factors underlying this algorithmic change are rooted in the high-sensitivity and specificity, cost-effectiveness, and 24-hour availability of CTPA. In addition, CTPA is superior to other imaging methods in its ability to diagnose and exclude, in a single examination, a variety of diseases that mimic the symptoms of PE. This article reviews the current role of CTPA in the diagnosis of acute PE as well as more recent developments, such as the use of CT parameters of right ventricular dysfunction for patient prognostication and the assessment of lung perfusion with CT.

• Coronary computed tomography--present status and future directions

  Authors: P. Apfaltrer, U. J. Schoepf, R. Vliegenthart, G. W. Rowe, J. R. Spears, C. Fink, J. W. Nance

  Int J Clin Pract Suppl.

  The use of coronary computed tomography angiography (cCTA) is growing rapidly, in large part because of fast-paced technical innovations that have increased diagnostic accuracy while providing newThe use of coronary computed tomography angiography (cCTA) is growing rapidly, in large part because of fast-paced technical innovations that have increased diagnostic accuracy while providing new opportunities for radiation dose reduction. cCTA using recent generation CT scanners has been repeatedly shown to have excellent negative predictive value for ruling out significant coronary stenosis in comparison with invasive coronary angiography (ICA) and is now accepted for this use in selected populations. Current work is increasingly focused on evaluating and optimising radiation dose reduction techniques, the cost-effectiveness of cCTA implementation, and the impact of cCTA on patient management and outcomes. In addition, the potential value of emerging applications, such as atherosclerotic plaque characterisation and myocardial perfusion and viability assessment, are undergoing intense investigation.

• Tako-tsubo cardiomyopathy: findings on cardiac CT and coronary catheterisation

  Authors: J. W. Nance, U. J. Schoepf, L. Ramos-Duran

  Heart. 96(5):406-7.

• Apicoaortic Conduits, an innovative solution to difficult aortic stenosis: the MUSC Experience

  Authors: J. W. Nance, J. M. Kratz, J. S. Ikonomidis, J. M. Toole, J. M. Barraza, W. G. McMaster, U. J. Schoepf

  J S C Med Assoc. 107(4):160-3.

• Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

  Authors: T. Henzler, S. Roeger, M. Meyer, U. J. Schoepf, J. W. Nance, D. Haghi, W. E. Kaminski, M. Neumaier, S. O. Schoenberg, C. Fink

  Eur Respir J. 39(4):919-26.

  The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptideThe aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)(axial), RV/LV(4-CH) and RV/LV(volume)). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LV(axial) 1.68+/-0.84 versus 1.00+/-0.21; RV/LV(4-CH) 1.52+/-0.45 versus 1.01+/-0.21; RV/LV(volume) 1.97+/-0.53 versus 1.07+/-0.52; serum NT-pro-BNP 6,372+/-2,319 versus 1,032+/-1,559 ng.L(-1); troponin I 0.18+/-0.41 versus 0.06+/-0.18 g.L(-1)). The area under the curve for the detection of RVD of RV/LV(axial), RV/LV(4-CH), RV/LV(volume), NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LV(volume) increased the AUC to 0.95 (RV/LV(volume) with NT-pro-BNP) and 0.93 (RV/LV(volume) with troponin I). RV/LV(volume) is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LV(volume) with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.

• Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications

  Authors: D. K. Kang, U. J. Schoepf, G. Bastarrika, J. W. Nance, J. A. Abro, B. Ruzsics

  Semin Ultrasound CT MR. 31(4):276-91.

  The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological,The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological, functional versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is growing evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this technology for the comprehensive diagnosis of ischemic heart disease. We examine recent scientific findings in the context of current pivotal transitions in cardiovascular disease management and demonstrate the potential of cardiac DECT for the integrative assessment of patients with known or suspected CAD within a single CT-based protocol.

• High-temporal resolution dual-energy computed tomography of the heart using a novel hybrid image reconstruction algorithm: initial experience

  Authors: J. W. Nance, G. Bastarrika, D. K. Kang, B. Ruzsics, S. Vogt, B. Schmidt, R. Raupach, T. G. Flohr, U. J. Schoepf

  J Comput Assist Tomogr. 35(1):119-25.

  OBJECTIVES: Dual-energy computed tomography (DECT) has been proposed for the comprehensive assessment of coronary artery stenosis and myocardial perfusion yet traditionally required reducing theOBJECTIVES: Dual-energy computed tomography (DECT) has been proposed for the comprehensive assessment of coronary artery stenosis and myocardial perfusion yet traditionally required reducing the temporal resolution of cardiac studies. We evaluated a reconstruction algorithm that preserves high temporal resolution at cardiac DECT. METHODS: Twelve consecutive patients (3 women; mean [SD] age, 64 [10] years) with an abnormal single photon emission CT result underwent invasive coronary angiography and cardiac DECT. Dual-energy CT studies were reconstructed using the standard algorithm with 165-millisecond temporal resolution and a hybrid algorithm providing 83-millisecond temporal resolution. These studies were rated for coronary image quality and motion artifacts and compared with invasive coronary angiographic studies. RESULTS: One hundred sixty-eight coronary artery segments (82%) were evaluated. The standard 165-millisecond reconstruction provided 95% diagnostic segments compared with 100% using the 83-millisecond hybrid reconstruction. Image quality was rated significantly (P < 0.05) better with hybrid reconstruction and had 91.4% sensitivity, 94.7% specificity, 82.1% positive predictive value, and 97.7% negative predictive value for detecting significant stenosis versus 85.7%, 93.2%, 76.9%, and 96.1% with standard reconstruction, respectively. CONCLUSIONS: Hybrid image reconstruction mitigates the former limitations in temporal resolution of cardiac DECT.

• Radiation dose at coronary CT angiography: second-generation dual-source CT versus single-source 64-MDCT and first-generation dual-source CT

  Authors: C. Fink, R. Krissak, T. Henzler, U. Lechel, G. Brix, R. A. Takx, J. W. Nance, J. A. Abro, S. O. Schoenberg, U. J. Schoepf

  AJR Am J Roentgenol. 196(5):W550-7.

  OBJECTIVE: The purpose of this study was to assess the radiation doses of different coronary CTA (CTA) protocols: second-generation dual-source 128-MDCT, first-generation dual-source 64-MDCT, andOBJECTIVE: The purpose of this study was to assess the radiation doses of different coronary CTA (CTA) protocols: second-generation dual-source 128-MDCT, first-generation dual-source 64-MDCT, and single-source 64-MDCT. MATERIALS AND METHODS: Thermoluminescent dosimetry was used to determine scanner-specific dose coefficients for standard coronary CTA of an anthropomorphic phantom. These coefficients were used to estimate the effective doses (EDs) of retrospectively gated, prospectively triggered, and prospectively triggered high pitch coronary CTA performed at 100 and 120 kV. The coronary CTA protocols used in imaging of 43 patients undergoing dual-source 128-MDCT were analyzed for ED, image quality, and signal-to-noise ratio. RESULTS: Regardless of coronary CTA protocol and CT system, imaging at 100 kV lowered the ED 40-50%. In retrospectively gated 120-kV coronary CTA, the ED ranged from 5.7 to 10.7 mSv and was approximately 50% lower with single-source 64-MDCT than with either DSCT protocol. In prospectively triggered 120-kV coronary CTA, the ED ranged from 3.8 to 4.0 mSv. The lowest ED of all protocols (1.3 mSv) was observed in prospectively triggered high-pitch 100-kV coronary CTA performed with dual-source 128-MDCT. Patient measurements showed similar dose reductions for prospective triggering and low voltage settings without an influence on signal-to-noise ratio or image quality. CONCLUSION: A combination of prospective triggering with low voltage settings is an effective measure for reducing the ED of coronary CTA to values of 2-4 mSv independent of scanner system. Further dose reduction to nearly 1 mSv can be achieved with high-pitch prospectively triggered coronary CTA.

• Quantification of left and right ventricular function and myocardial mass: Comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI

  Authors: R. A. Takx, A. Moscariello, U. J. Schoepf, J. M. Barraza, J. W. Nance, G. Bastarrika, M. Das, M. Meyer, J. E. Wildberger, S. O. Schoenberg, C. Fink, T. Henzler

  Eur J Radiol. 81(4):e598-604.

  OBJECTIVE: To prospectively evaluate the accuracy of left and right ventricular function and myocardial mass measurements based on a dual-step, low radiation dose protocol with prospectivelyOBJECTIVE: To prospectively evaluate the accuracy of left and right ventricular function and myocardial mass measurements based on a dual-step, low radiation dose protocol with prospectively ECG-triggered 2nd generation dual-source CT (DSCT), using cardiac MRI (cMRI) as the reference standard. MATERIALS AND METHODS: Twenty patients underwent 1.5T cMRI and prospectively ECG-triggered dual-step pulsing cardiac DSCT. This image acquisition mode performs low-radiation (20% tube current) imaging over the majority of the cardiac cycle and applies full radiation only during a single adjustable phase. Full-radiation-phase images were used to assess cardiac morphology, while low-radiation-phase images were used to measure left and right ventricular function and mass. Quantitative CT measurements based on contiguous multiphase short-axis reconstructions from the axial CT data were compared with short-axis SSFP cardiac cine MRI. Contours were manually traced around the ventricular borders for calculation of left and right ventricular end-diastolic volume, end-systolic volume, stroke volume, ejection fraction and myocardial mass for both modalities. Statistical methods included independent t-tests, the Mann-Whitney U test, Pearson correlation statistics, and Bland-Altman analysis. RESULTS: All CT measurements of left and right ventricular function and mass correlated well with those from cMRI: for left/right end-diastolic volume r=0.885/0.801, left/right end-systolic volume r=0.947/0.879, left/right stroke volume r=0.620/0.697, left/right ejection fraction r=0.869/0.751, and left/right myocardial mass r=0.959/0.702. Mean radiation dose was 6.2+/-1.8mSv. CONCLUSIONS: Prospectively ECG-triggered, dual-step pulsing cardiac DSCT accurately quantifies left and right ventricular function and myocardial mass in comparison with cMRI with substantially lower radiation exposure than reported for traditional retrospective ECG-gating.

• Radiation dose at coronary CT angiography: second-generation dual-source CT versus single-source 64-MDCT and first-generation dual-source CT

  Authors: C. Fink, R. Krissak, T. Henzler, U. Lechel, G. Brix, R. A. Takx, J. W. Nance, J. A. Abro, S. O. Schoenberg, U. J. Schoepf

  AJR Am J Roentgenol. 196(5):W550-7.

  OBJECTIVE: The purpose of this study was to assess the radiation doses of different coronary CTA (CTA) protocols: second-generation dual-source 128-MDCT, first-generation dual-source 64-MDCT, andOBJECTIVE: The purpose of this study was to assess the radiation doses of different coronary CTA (CTA) protocols: second-generation dual-source 128-MDCT, first-generation dual-source 64-MDCT, and single-source 64-MDCT. MATERIALS AND METHODS: Thermoluminescent dosimetry was used to determine scanner-specific dose coefficients for standard coronary CTA of an anthropomorphic phantom. These coefficients were used to estimate the effective doses (EDs) of retrospectively gated, prospectively triggered, and prospectively triggered high pitch coronary CTA performed at 100 and 120 kV. The coronary CTA protocols used in imaging of 43 patients undergoing dual-source 128-MDCT were analyzed for ED, image quality, and signal-to-noise ratio. RESULTS: Regardless of coronary CTA protocol and CT system, imaging at 100 kV lowered the ED 40-50%. In retrospectively gated 120-kV coronary CTA, the ED ranged from 5.7 to 10.7 mSv and was approximately 50% lower with single-source 64-MDCT than with either DSCT protocol. In prospectively triggered 120-kV coronary CTA, the ED ranged from 3.8 to 4.0 mSv. The lowest ED of all protocols (1.3 mSv) was observed in prospectively triggered high-pitch 100-kV coronary CTA performed with dual-source 128-MDCT. Patient measurements showed similar dose reductions for prospective triggering and low voltage settings without an influence on signal-to-noise ratio or image quality. CONCLUSION: A combination of prospective triggering with low voltage settings is an effective measure for reducing the ED of coronary CTA to values of 2-4 mSv independent of scanner system. Further dose reduction to nearly 1 mSv can be achieved with high-pitch prospectively triggered coronary CTA.

• Quantification of left and right ventricular function and myocardial mass: Comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI

  Authors: R. A. Takx, A. Moscariello, U. J. Schoepf, J. M. Barraza, J. W. Nance, G. Bastarrika, M. Das, M. Meyer, J. E. Wildberger, S. O. Schoenberg, C. Fink, T. Henzler

  Eur J Radiol. 81(4):e598-604.

  OBJECTIVE: To prospectively evaluate the accuracy of left and right ventricular function and myocardial mass measurements based on a dual-step, low radiation dose protocol with prospectivelyOBJECTIVE: To prospectively evaluate the accuracy of left and right ventricular function and myocardial mass measurements based on a dual-step, low radiation dose protocol with prospectively ECG-triggered 2nd generation dual-source CT (DSCT), using cardiac MRI (cMRI) as the reference standard. MATERIALS AND METHODS: Twenty patients underwent 1.5T cMRI and prospectively ECG-triggered dual-step pulsing cardiac DSCT. This image acquisition mode performs low-radiation (20% tube current) imaging over the majority of the cardiac cycle and applies full radiation only during a single adjustable phase. Full-radiation-phase images were used to assess cardiac morphology, while low-radiation-phase images were used to measure left and right ventricular function and mass. Quantitative CT measurements based on contiguous multiphase short-axis reconstructions from the axial CT data were compared with short-axis SSFP cardiac cine MRI. Contours were manually traced around the ventricular borders for calculation of left and right ventricular end-diastolic volume, end-systolic volume, stroke volume, ejection fraction and myocardial mass for both modalities. Statistical methods included independent t-tests, the Mann-Whitney U test, Pearson correlation statistics, and Bland-Altman analysis. RESULTS: All CT measurements of left and right ventricular function and mass correlated well with those from cMRI: for left/right end-diastolic volume r=0.885/0.801, left/right end-systolic volume r=0.947/0.879, left/right stroke volume r=0.620/0.697, left/right ejection fraction r=0.869/0.751, and left/right myocardial mass r=0.959/0.702. Mean radiation dose was 6.2+/-1.8mSv. CONCLUSIONS: Prospectively ECG-triggered, dual-step pulsing cardiac DSCT accurately quantifies left and right ventricular function and myocardial mass in comparison with cMRI with substantially lower radiation exposure than reported for traditional retrospective ECG-gating.

• Apicoaortic Conduits, an innovative solution to difficult aortic stenosis: the MUSC Experience

  Authors: J. W. Nance, J. M. Kratz, J. S. Ikonomidis, J. M. Toole, J. M. Barraza, W. G. McMaster, U. J. Schoepf

  J S C Med Assoc. 107(4):160-3.

• High-temporal resolution dual-energy computed tomography of the heart using a novel hybrid image reconstruction algorithm: initial experience

  Authors: J. W. Nance, G. Bastarrika, D. K. Kang, B. Ruzsics, S. Vogt, B. Schmidt, R. Raupach, T. G. Flohr, U. J. Schoepf

  J Comput Assist Tomogr. 35(1):119-25.

  OBJECTIVES: Dual-energy computed tomography (DECT) has been proposed for the comprehensive assessment of coronary artery stenosis and myocardial perfusion yet traditionally required reducing theOBJECTIVES: Dual-energy computed tomography (DECT) has been proposed for the comprehensive assessment of coronary artery stenosis and myocardial perfusion yet traditionally required reducing the temporal resolution of cardiac studies. We evaluated a reconstruction algorithm that preserves high temporal resolution at cardiac DECT. METHODS: Twelve consecutive patients (3 women; mean [SD] age, 64 [10] years) with an abnormal single photon emission CT result underwent invasive coronary angiography and cardiac DECT. Dual-energy CT studies were reconstructed using the standard algorithm with 165-millisecond temporal resolution and a hybrid algorithm providing 83-millisecond temporal resolution. These studies were rated for coronary image quality and motion artifacts and compared with invasive coronary angiographic studies. RESULTS: One hundred sixty-eight coronary artery segments (82%) were evaluated. The standard 165-millisecond reconstruction provided 95% diagnostic segments compared with 100% using the 83-millisecond hybrid reconstruction. Image quality was rated significantly (P < 0.05) better with hybrid reconstruction and had 91.4% sensitivity, 94.7% specificity, 82.1% positive predictive value, and 97.7% negative predictive value for detecting significant stenosis versus 85.7%, 93.2%, 76.9%, and 96.1% with standard reconstruction, respectively. CONCLUSIONS: Hybrid image reconstruction mitigates the former limitations in temporal resolution of cardiac DECT.

• Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications

  Authors: D. K. Kang, U. J. Schoepf, G. Bastarrika, J. W. Nance, J. A. Abro, B. Ruzsics

  Semin Ultrasound CT MR. 31(4):276-91.

  The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological,The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological, functional versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is growing evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this technology for the comprehensive diagnosis of ischemic heart disease. We examine recent scientific findings in the context of current pivotal transitions in cardiovascular disease management and demonstrate the potential of cardiac DECT for the integrative assessment of patients with known or suspected CAD within a single CT-based protocol.

• Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

  Authors: T. Henzler, S. Roeger, M. Meyer, U. J. Schoepf, J. W. Nance, D. Haghi, W. E. Kaminski, M. Neumaier, S. O. Schoenberg, C. Fink

  Eur Respir J. 39(4):919-26.

  The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptideThe aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)(axial), RV/LV(4-CH) and RV/LV(volume)). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LV(axial) 1.68+/-0.84 versus 1.00+/-0.21; RV/LV(4-CH) 1.52+/-0.45 versus 1.01+/-0.21; RV/LV(volume) 1.97+/-0.53 versus 1.07+/-0.52; serum NT-pro-BNP 6,372+/-2,319 versus 1,032+/-1,559 ng.L(-1); troponin I 0.18+/-0.41 versus 0.06+/-0.18 g.L(-1)). The area under the curve for the detection of RVD of RV/LV(axial), RV/LV(4-CH), RV/LV(volume), NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LV(volume) increased the AUC to 0.95 (RV/LV(volume) with NT-pro-BNP) and 0.93 (RV/LV(volume) with troponin I). RV/LV(volume) is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LV(volume) with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.