[show abstract][hide abstract] ABSTRACT: In 2009, the add-on codes for spectral Doppler and color flow Doppler echocardiography were bundled into the code for primary transthoracic echocardiography. The relative value units for the new single code were substantially lower than the previous sum for the 3 codes. The purpose of this study was to see how this affected the distribution of outpatient echocardiographic studies between cardiology offices and hospital outpatient departments (HOPDs).
The 2005 to 2011 Medicare databases were used. All echocardiography Current Procedural Terminology codes were selected. Specialty codes identified those done by cardiologists (who do most echocardiographic studies). Place-of-service codes identified those done in offices and HOPDs. Procedure volumes and utilization rates per 1,000 were determined each year before and after bundling occurred in 2009.
Cardiologists' office echocardiography utilization rate rose from 219.5 per 1,000 in 2005 to 257.1 in 2008 (+17%), then dropped to 100.0 in 2009 (-61%) because of bundling. Their HOPD echocardiography rate rose from 72.2 in 2005 to 76.5 in 2008 (+6%), then dropped to 35.0 in 2009 (-54%). From 2009 to 2011, cardiologists' office echocardiography rate dropped again from 100.0 to 88.8 (-11%), while their HOPD rate increased from 35.0 to 46.1 (+32%).
Echocardiography code bundling produced the expected sharp drop in outpatient claims from cardiologists in 2009. But after bundling, office echocardiography rates continued to drop, while HOPD rates increased. It seems that in this instance, code bundling led to the closure of many cardiology offices and a resultant shift of echocardiography from that lower cost setting to the higher cost HOPD setting.
Journal of the American College of Radiology: JACR 12/2013;
[show abstract][hide abstract] ABSTRACT: The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.
Informed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated. Coronary computed tomography angiography findings were rated on a 6-level plaque burden scale and classified for significant CAD (stenosis ≥50%). Adverse cardiovascular outcomes were recorded at 30 days.
Among 250 patients evaluated by cCTA, 143 (57%) had no CAD, 64 (26%) demonstrated minimal plaque (<30% stenosis), 26 (10%) demonstrated mild plaque (<50% stenosis), 9 (4%) demonstrated moderate single vessel disease (50%-70% stenosis), 2 (1%) demonstrated moderate multivessel disease, and 6 (2%) demonstrated severe disease (>70% stenosis). Six patients developed adverse cardiovascular outcomes. Among traditional cardiac risk factors, only age (older) and sex (male) were significant independent predictors of CAD. Correlation with CAD was poor for the TIMI (r = 0.12) and GRACE (r = 0.09-0.23) scores. The TIMI and GRACE scores were not useful to predict adverse outcomes. Coronary computed tomography angiography identified severe CAD in all subjects with adverse outcomes.
Among ED patients who present with chest pain judged to be at low to intermediate risk for acute coronary syndrome, traditional risk factors are not useful to stratify risk for CAD and adverse outcomes. Coronary computed tomography angiography is an excellent predictor of CAD and outcome.
The American journal of emergency medicine 09/2013; · 1.54 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose
The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride.
Materials and Methods
In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant.
Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7–2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (Az 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (Az 0.74) and contrast enhanced ultrasound (Az 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, Az 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97).
Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.
The Journal of Urology. 11/2012; 188(5):1739–1745.
[show abstract][hide abstract] ABSTRACT: Studies suggest that electrocardiographically gated coronary computed tomographic angiography provides a clear definition of the left ventricular outflow tract (LVOT), and normal LVOT morphology may not be round, as assumed when the continuity equation is applied during echocardiography. The aims of this study were to demonstrate the morphology of the LVOT on coronary computed tomographic angiography and to establish normal values for LVOT measurements.
Two independent readers retrospectively measured anterior-posterior (AP) and transverse diameters of the LVOT and performed LVOT planimetry on coronary computed tomographic angiographic studies of 106 consecutive patients with normal aortic valves.
Excellent interobserver agreement was observed for all measurements (r = 0.78-0.94). The LVOT was ovoid, with a larger transverse diameter than AP diameter during diastole and systole (P < .001). However, the ratio of AP diameter to transverse diameter was closer to 1.0 during systole (P < .001). Mean indexed LVOT area was minimally larger in systole than in diastole (P = .01-.04) and was larger in men than in women during diastole (P ≤ .001) and systole (P ≤ .01). Mean LVOT area indexed to body surface area was 2.3 ± 0.5 cm(2)/m(2) in women and 2.6 ± 0.7 cm(2)/m(2) in men. LVOT area demonstrated significant correlation with aortic root diameter.
The normal LVOT is ovoid in shape. LVOT is more circular during systole, but the AP diameter remains smaller than the transverse diameter throughout the cardiac cycle. The oval shape of the LVOT has important implications when LVOT area is calculated from LVOT diameters. Normal LVOT area values established in this study should facilitate diagnosis of the fixed component of LVOT obstruction.
[show abstract][hide abstract] ABSTRACT: Traditional grayscale ultrasonography has poor discrimination between benign and malignant areas within the prostate. Current biopsy techniques commonly miss prostate cancer when present within the gland, with the majority of prostate biopsies negative for cancer. Enhanced ultrasound (US) modalities may improve the visualization of the prostate and better detect foci of prostate cancer. These enhanced US modalities include intravenous contrast enhancement, to better visualize areas with increased blood flow within the prostate, which may be indicative of latent prostate cancer. We reviewed the current literature for contrast-enhanced transrectal prostate ultrasonography.
Numerous American and international studies demonstrate improved prostate cancer detection when contrast-enhanced US biopsy techniques are used. Enhanced US modalities include the use of harmonic imaging and flash replenishment techniques, as well as quantitative measurement of blood flow within the prostate. Vascular areas visualized with these techniques targeted for prostate biopsy yield improved prostate cancer detection rates. US contrast microbubbles linked to antibodies or small molecules may also allow targeted visualization and delivery of agents to the prostate.
Enhanced US modalities with intravenous contrast enhancement dramatically improve vascular imaging and resolution within the prostate. Targeted biopsies have higher yield for prostate cancer detection, and may prove useful for the initial evaluation of patients with elevated serum prostate-specific antigen levels, as well as for patients with persistently elevated prostate-specific antigen after negative prostate biopsy.
Current opinion in urology 05/2012; 22(4):303-9. · 2.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objectives. To evaluate prostate cancer (PCa) detection rates of real-time elastography (RTE) in dependence of tumor size, tumor volume, localization and histological type. Materials and Methods. Thirdy-nine patients with biopsy proven PCa underwent RTE before radical prostatectomy (RPE) to assess prostate tissue elasticity, and hard lesions were considered suspicious for PCa. After RPE, the prostates were prepared as whole-mount step sections and were compared with imaging findings for analyzing PCa detection rates. Results. RTE detected 6/62 cancer lesions with a maximum diameter of 0-5 mm (9.7%), 10/37 with a maximum diameter of 6-10 mm (27%), 24/34 with a maximum diameter of 11-20 20 mm (70.6%), 14/14 with a maximum diameter of >20 mm (100%) and 40/48 with a volume ≥0.2 cm(3) (83.3%). Regarding cancer lesions with a volume ≥ 0.2 cm³ there was a significant difference in PCa detection rates between Gleason scores with predominant Gleason pattern 3 compared to those with predominant Gleason pattern 4 or 5 (75% versus 100%; P = 0.028). Conclusions. RTE is able to detect PCa of significant tumor volume and of predominant Gleason pattern 4 or 5 with high confidence, but is of limited value in the detection of small cancer lesions.
The Scientific World Journal 01/2012; 2012:193213. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate enhanced transrectal ultrasound (E-TRUS) techniques including real-time sonoelastography (RTE) and contrast-enhanced transrectal ultrasound (CE-TRUS) for prostate cancer (PCa) detection in men with elevated prostate-specific antigen (PSA) serum levels.
A total of 133 men with elevated PSA serum levels (≥1.25 ng/mL) showed PCa suspicious lesions on E-TRUS. RTE was done to assess tissue elasticity, and hard areas of the peripheral zone were considered suspicious for malignancy. CE-TRUS was done with cadence contrast pulse sequencing (CPS) technique to assess tumor neoangiogenesis, which were defined as areas with increased and rapid contrast enhancement in the peripheral zone and were considered suspicious for malignancy. All patients underwent an E-TRUS-targeted biopsy of the prostate into the suspected lesions. PCa detection rates for E-TRUS were analyzed.
PCa detection rate of E-TRUS-targeted biopsy was 59.4% (79/133) using a median of 5 cores per patient and a median of 3 cores per lesion. RTE showed a per patient detection rate of 56.5% (70/124) and CE-TRUS of 74.2% (69/93). The subgroup analysis demonstrated the highest detection rates in prostate volumes <40 mL (72.2%) and in men older than 70 years (87%).
The combined use of CE-TRUS and RTE is feasible and allows for targeted biopsy and may improve PCa detection.
World Journal of Urology 12/2011; 30(3):341-6. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Left atrial volume (LAV) measurement by conventional two-dimensional (2D) transthoracic echocardiography (TTE) may be limited by the geometric model, by suboptimal definition of left atrial endocardium, or by chamber foreshortening. Three-dimensional (3D) TTE is posited to eliminate chamber foreshortening, and LAV measurement by 3D TTE should be more reflective of true LAV. The aim of this study was to compare conventional 2D TTE and newer 3D TTE for measurements of LAV to multidetector computed tomographic (MDCT) measurements using automated chamber reconstruction (ACR).
Twenty-two subjects consented to undergo 2D TTE and 3D TTE immediately prior to or following coronary computed tomographic angiography. LAV was calculated from 2D TTE using the area-length method (ALM) and from 3D TTE with the ALM as well as with a 3D model. Electrocardiographically gated coronary computed tomographic angiography was performed in helical mode. LAV was measured using the ALM as well as ACR.
LAV was significantly smaller by 2D TTE (80 ± 21 mL) and 3D-TTE (90 ± 24 mL with the ALM, 61 ± 16 mL with the 3D model) compared to MDCT ACR (120 ± 30 mL) (P < .01). Correlation between MDCT ALM and MDCT ACR was excellent (mean Δ = -1.4 ± 14 mL, r = 0.91). Correlation with MDCT ACR was no better for 3D TTE (r = 0.80) than for 2D TTE (r = 0.80).
LAV is underestimated by both 2D TTE and 3D TTE relative to coronary computed tomographic angiography. Excellent agreement between the ALM and ACR with MDCT imaging suggests that the geometric model plays a negligible role in the underestimation of LAV. Underestimation of LAV by echocardiography is likely related to suboptimal definition of left atrial contour.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to compare the value of real-time sonoelastography with T2-weighted endorectal magnetic resonance imaging (MRI) for prostate cancer detection.
Thirty-three patients with an elevated prostate-specific antigen level were investigated with real-time sonoelastography and T2-weighted endorectal MRI for prostate cancer diagnosis before systematic prostate biopsy. Real-time sonoelastography was performed to assess prostate tissue elasticity, and hard areas were considered suspicious for prostate cancer. Low-signal intensity nodules on T2-weighted endorectal MRI were considered suspicious for prostate cancer. Imaging findings were assigned to 6 areas of the peripheral zone (sextants), and their cancer detection rates were compared.
Overall, prostate cancer was detected in 13 of 33 patients (39.4%). Both real-time sonoelastography and T2-weighted endorectal MRI detected 11 cancer-positive patients (84.6%). Real-time sonoelastography showed 27 suspicious lesions in 198 sextants, and 15 (55.6%) were cancer positive. T2-weighted endorectal MRI showed 31 suspicious lesions in 198 sextants, and 13 (40.6%) were cancer positive. These findings resulted in sensitivity rates and negative predictive values per patient of 84.6% and 86.7%, respectively, for sonoelastography and 84.6% and 83.3% for MRI. The per-sextant analysis showed sensitivity rates and negative predictive values of 57.7% and 93.6% for sonoelastography and 50.0% and 92.2% for MRI.
Real-time sonoelastography showed comparable results as T2-weighted endorectal MRI for prostate cancer detection.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/2011; 30(5):643-9. · 1.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this article is to study recent utilization trends in coronary CT angiography (CTA) and compare them with radionuclide myocardial perfusion imaging (MPI), a competing procedure.
The nationwide Medicare Part B databases were used to determine utilization rates per 100,000 beneficiaries. Rates for coronary CTA were studied from 2006 (the first year Current Procedural Terminology codes were available for this procedure) through 2008. Rates for MPI were studied from 1998 through 2008. Medicare specialty codes were used to identify examinations done by radiologists and cardiologists.
The coronary CTA total utilization rate per 100,000 rose from 99 in 2006 to 210 in 2007 (112%) but then decreased to 193 in 2008 (-8%). The rate for MPI increased from 4748 in 1998 to a peak of 8753 in 2006 (84%), then declined to 8467 in 2008. Cardiologists performed the majority of both coronary CTA and MPI. In 2008, MPI was performed 44 times as often as coronary CTA.
Given that coronary CTA is a new procedure that has aroused much interest and has been shown to have very favorable results, the drop in its utilization rate in 2008 was surprising. A review of the literature indicates that there are shortcomings to the clinical diagnosis of coronary artery disease (which often includes the use of MPI), that coronary CTA can be used to stratify risk, and that it can expedite the workup of patients with acute chest pain in emergency departments. The evidence from the literature review suggests that both invasive coronary angiography and MPI may be overutilized, whereas coronary CTA is probably underutilized.
American Journal of Roentgenology 04/2011; 196(4):862-7. · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and adult sudden death. As it predominantly presents in the first year of life, diagnosis in living adults is extremely rare. Current management is based on limited case series or extrapolated from pediatric cases. Modern advances in noninvasive cardiac imaging have substantially increased the number of diagnoses, uncovering a large adult population that has not been reviewed.
The availability of newer diagnostic modalities correlates with an increasing incidence in an older cohort, and true association between sudden death and ALCAPA may be lower, especially among older patients.
A comprehensive literature search was performed for all case reports of ALCAPA on MEDLINE and PubMed using the keywords ALCAPA, Bland-White-Garland, and coronary anomaly; and augmented by references from published case reports from 1908 to 2008. All adult cases, defined by age 18 years and older, were reviewed for this article.
One hundred fifty-one adult cases of ALCAPA are described, in addition to the case of an asymptomatic 53-year-old woman. The average reported age was 41 years old with the oldest being 83. Sixty-six percent of the patients presented with symptoms of angina, dyspnea, palpitations, or fatigue; 17% presented with ventricular arrhythmia, syncope, or sudden death; and 14% were asymptomatic. Twelve percent were diagnosed at autopsy. The majority had some form of surgical correction during their clinical course.
ALCAPA is a rare and life-threatening condition in adults. The availability of newer, less invasive diagnostic modalities has resulted in more frequent identification of this condition in an older cohort.
[show abstract][hide abstract] ABSTRACT: To evaluate the accuracy of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS) in patients with a bifid median nerve on the basis of cross-sectional area (CSA) measurements of the median nerve at the level of the carpal tunnel (CSAc), with additional measurements obtained more proximally (CSAp) at the level of the pronator quadratus muscle.
This HIPAA-compliant study was approved by the local institutional review board; informed oral and written consent were obtained. Fifty-three wrists in 49 consecutive patients with a bifid median nerve and CTS symptoms and 28 wrists in 27 healthy volunteers with a bifid median nerve were examined by using US. Two independent US examiners who were blinded to prior test results measured median nerve CSA at two levels, CSAc and CSAp. The difference between CSAc and CSAp (ΔCSA) was calculated for each wrist. Receiver operating characteristic (ROC) analysis was performed.
The study population included 17 men and 32 women (mean age, 55.1 years; age range, 24-78 years). The control population included 13 men and 14 women (mean age, 52.6 years; age range, 24-86 years). Mean CSAc was approximately 5 mm(2) greater in patients with CTS than in healthy volunteers (P < .0001), while mean ΔCSA was 5.8-5.9 mm(2) greater in patients with CTS (P < .0001). A CSAc threshold of 12 mm(2) provided sensitivity and specificity of 84.9% and 46.5%, respectively, while a ΔCSA threshold of 4 mm(2) provided sensitivity and specificity of 92.5% and 94.6%, respectively. ROC analysis demonstrated a significant advantage of ΔCSA (area under ROC curve [A(z)] = 0.95-0.96) compared with CSAc (A(z) = 0.84-0.85) for the diagnosis of CTS (P < .003).
The use of a ΔCSA parameter improves the diagnostic accuracy of US for the presence of CTS in patients with a bifid median nerve.
[show abstract][hide abstract] ABSTRACT: To compare computer-generated interpretation of coronary computed tomography angiography (cCTA) by commercially available COR Analyzer software with expert human interpretation.
This retrospective Health Insurance Portability and Accountability Act‑compliant study was approved by the institutional review board. Among 225 consecutive cCTA examinations, 207 were of adequate quality for automated evaluation. COR Analyzer interpretation was compared to human expert interpretation for detection of stenosis defined as ≥50% vessel diameter reduction in the left main, left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), or a branch vessel (diagonal, ramus, obtuse marginal, or posterior descending artery).
Among 207 cases evaluated by COR Analyzer, human expert interpretation identified 48 patients with stenosis. COR Analyzer identified 44/48 patients (sensitivity 92%) with a specificity of 70%, a negative predictive value of 97% and a positive predictive value of 48%. COR Analyzer agreed with the expert interpretation in 75% of patients. With respect to individual segments, COR Analyzer detected 9/10 left main lesions, 33/34 LAD lesions, 14/15 LCX lesions, 27/31 RCA lesions, and 8/11 branch lesions. False-positive interpretations were localized to the left main (n = 16), LAD (n = 26), LCX (n = 21), RCA (n = 21), and branch vessels (n = 23), and were related predominantly to calcified vessels, blurred vessels, misidentification of vessels and myocardial bridges.
Automated computer interpretation of cCTA with COR Analyzer provides high negative predictive value for the diagnosis of coronary disease in major coronary arteries as well as first-order arterial branches. False-positive automated interpretations are related to anatomic and image quality considerations.
[show abstract][hide abstract] ABSTRACT: The study aimed to examine time and imaging costs of 2 different imaging strategies for low-risk emergency department (ED) observation patients with acute chest pain or symptoms suggestive of acute coronary syndrome. We compared a "triple rule-out" (TRO) 64-section multidetector computed tomography protocol with nuclear stress testing.
This was a prospective observational cohort study of consecutive ED patients who were enrolled in our chest pain observation protocol during a 16-month period. Our standard observation protocol included a minimum of 2 sets of cardiac enzymes at least 6 hours apart followed by a nuclear stress test. Once a week, observation patients were offered a TRO (to evaluate for coronary artery disease, thoracic dissection, and pulmonary embolus) multidetector computed tomography with the option of further stress testing for those patients found to have evidence of coronary artery disease.
We analyzed 832 consecutive observation patients including 214 patients who underwent the TRO protocol. Mean total length of stay was 16.1 hours for TRO patients, 16.3 hours for TRO plus other imaging test, 22.6 hours for nuclear stress testing, 23.3 hours for nuclear stress testing plus other imaging tests, and 23.7 hours for nuclear stress testing plus TRO (P < .0001 for TRO and TRO + other test compared to stress test ± other test). Mean imaging times were 3.6, 4.4, 5.9, 7.5, and 6.6 hours, respectively (P < .05 for TRO and TRO + other test compared to stress test ± other test). Mean imaging costs were $1307 for TRO patients vs $945 for nuclear stress testing.
Triple rule-out reduced total length of stay and imaging time but incurred higher imaging costs. A per-hospital analysis would be needed to determine if patient time savings justify the higher imaging costs.
The American journal of emergency medicine 02/2011; 29(2):187-95. · 1.54 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare the efficiency of contrast-enhanced colour Doppler ultrasound (CECD-US) targeted biopsy versus systematic biopsy (SB) for PCa detection in 1,776 men.
Retrospective, single-centre, diagnostic accuracy study from 2002 until 2006 in 1,776 male volunteers with a serum total PSA of 1.25 ng/ml or greater. In each patient five CECD-US targeted biopsies were performed in hypervascular areas in the peripheral zone during intravenous injection of a second-generation microbubble US contrast agent. Subsequently, another examiner performed ten SBs. The PCa detection rates for the two techniques were compared.
Of 1,776 patients, cancer was detected in 559 patients (31%), including 476 of the 1,776 patients (27%) with CECD-US and 410 (23%) with SB (p < 0.001). The detection rate for CECD-US targeted biopsy cores (10.8% or 961 of 8,880 cores) was significantly better than for SB cores (5.1% or 910 of 17,760 cores, p < 0.001). Among patients with a positive biopsy for PCa, cancer was detected by CECD-US alone in 149 patients (27%) and by SB alone in 83 (15%) (p < 0.001).
This study represents the largest clinical trial to date, demonstrating a significant benefit of CECD-US targeted biopsy relative to SB.
European Radiology 12/2010; 20(12):2791-6. · 3.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Standard grayscale transrectal ultrasound has a poor sensitivity for detection of prostate cancer. Saturation biopsy schemes have improved prostate cancer detection rates over standard template biopsy schemes, but carry additional morbidity and cost. Enhanced ultrasound modalities (EUM), including color and power Doppler, contrast-enhancement, harmonic and flash replenishment imaging, and elastography have demonstrated improved prostate cancer detection. EUM targeting areas with increased or abnormal vascularity or firmness for biopsy offer improved prostate cancer detection. EUM, detect prostate cancer more efficiently than standard ultrasound guided biopsies. These emerging technologies may potentially augment standard prostate biopsy in clinical practice.
[show abstract][hide abstract] ABSTRACT: ECG-gated multislice CT provides a cost-effective, non-invasive technology for evaluation of the coronary arteries, as well as for additional clinical applications, which require morphological assessment of the heart and adjacent structures with simultaneous evaluation of the coronary circulation.The excellent negative predictive value of a normal coronary CTA (cCTA) examination excludes the presence of significant coronary disease in the symptomatic patient. Triple rule-out studies provide evaluation of the aorta and pulmonary arteries without loss of image quality in the coronary circulation. The ability to visualize surrounding vascular structures along with the coronary arteries is essential in the evaluation of coronary anomalies.Cardiac CTA is useful in non-coronary applications, including evaluation of the thoracic aorta, cardiac valves and other aspects of cardiac morphology that may require surgical or percutaneous repair. Although radiation exposure is a limitation of cCTA relative to echocardiography and MRI, recent technological advances allow coronary imaging with effective doses as low as 1 mSv.Recent advances in evaluation of coronary plaque morphology as well as myocardial perfusion will allow a more complete noninvasive cardiac assessment in the future and may provide a highly effective method of cardiac risk stratification to facilitate preventive cardiac care.
[show abstract][hide abstract] ABSTRACT: We assessed the prostate cancer detection rate of real-time elastography targeted biopsy in men with total prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less.
Real-time elastography using an EUB 8500 Hitachi ultrasound system (Hitachi Medical, Tokyo, Japan) was done in 94 men with a mean age of 57.4 years (range 35 to 77) with increased prostate specific antigen between 1.25 ng/ml or greater and 4.00 ng/ml or less (mean 3.20, range 1.30 to 4.00) and a free-to-total prostate specific antigen ratio of less than 18%. Real-time elastography was done to evaluate peripheral zone tissue elasticity and hard areas were defined as suspicious. Targeted biopsies with a maximum of 5 cores were done in suspicious areas, followed by 10-core systematic biopsy. We analyzed the cancer detection rate of real-time elastography and systematic biopsy.
Cancer was found in 27 of 94 patients (28.7%). Real-time elastography detected cancer in 20 patients (21.3%) and systematic biopsy detected it in 18 (19.1%). Positive cancer cores were found in real-time elastography targeted cores in 38 of 158 cases (24%) and in systematic cores in 38 of 752 (5.1%) (chi-square test p <0.0001). The cancer detection rate per core was 4.7-fold greater for targeted than for systematic biopsy.
Real-time elastography targeted biopsy allows prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4 ng/ml or less with a decreased number of cores compared with that of systematic biopsy.
The Journal of urology 09/2010; 184(3):913-7. · 4.02 Impact Factor