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E Maffei,
S Seitun,
A Palumbo,
C Martini,
E Emiliano,
A Cuttone,
A Aldrovandi,
R Malagò,
L La Grutta,
M Midiri,
C Tedeschi,
R De Rosa,
O Catalano, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD).
A total of 722 patients (480 men; 62.7±10.9 years) who were referred for further cardiac evaluation underwent CACS and contrast-enhanced CTCA to evaluate the presence and severity of CAD. Of these, 511 (71%) patients were without previous history of CAD. Patients were stratified according to the Morise clinical score (low, intermediate, high), to CACS (0-10, 11-100, 101-400, 401-1,000, >1,000) and to CTCA (absence of CAD, nonsignificant CAD, obstructive CAD). Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation.
Significant CAD (>50% luminal narrowing) was detected in 260 (36%) patients; nonsignificant CAD (<50% luminal narrowing) in 250 (35%) and absence of CAD in 212 (29%). During a mean follow-up of 20±4 months, 116 events (21 hard) occurred. In patients with normal coronary arteries on CTCA, the major event rate was 0% vs. 1.7% in patients with nonsignificant CAD and 7.3% in patients with significant CAD (p<0.0001). Three hard events (14%) occurred in patients with CACS≤100 and two (9.5%) in patients with intermediate Morise score; one revascularisation was observed in a patient with low Morise score. At multivariate analysis, diabetes, obstructive CAD and CACS >1,000 were significant predictors of events (p<0.05).
An excellent prognosis was noted in patients with a normal CTCA (0% event rate). CACS ≤100 and low-intermediate Morise score did not exclude the possibility of events at follow-up.
La radiologia medica 09/2011; 116(8):1188-202. · 1.44 Impact Factor
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N Mollet,
E Maffei,
C Martini, A Weustink,
C van Mieghem,
T Baks,
E McFadden,
P de Feyter,
O Catalano,
S Seitun,
G Krestin,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris.
Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS).
Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05).
MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
La radiologia medica 09/2011; 116(8):1174-87. · 1.44 Impact Factor
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E Maffei,
C Martini,
C Tedeschi,
P Spagnolo,
A Zuccarelli,
T Arcadi,
A Guaricci,
S Seitun, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in a male and female population.
A total of 1,372 patients (882 men, 490 women; mean age 59.3 ± 11.9 years) in sinus rhythm imaged with CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR+ and LR-) of CTCA were assessed against CAG for the male and female populations.
The prevalence of obstructive disease was 53% (men 58%; women 43%). CAG demonstrated the absence of significant coronary artery disease (CAD) in 47% (men 42%; women 56%), single-vessel disease in 25% (men 36%; women 22%) and multivessel disease in 29% (men 32%; women 23%) of patients. In the per-patient analysis, sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of CTCA were 99% (men 98%; women 100%), 92% (men 92%; women 92%), 94% (men 95%; women 90%) and 99% (men 98%; women 100%), respectively. The per-patient likelihood ratios (LR) in the total population (LR+=12.4 and LR-=0.011), the male (LR+=12.9 and LR-=0.016) and female (LR =11.9 and LR-=0) populations were very good. We observed no significant differences in diagnostic accuracy between male and female populations.
CTCA is a reliable diagnostic modality with high sensitivity and NPV in the female population.
La radiologia medica 06/2011; 117(1):6-18. · 1.44 Impact Factor
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E Maffei,
C Martini,
C Tedeschi,
P Spagnolo,
A Zuccarelli,
T Arcadi,
A Guaricci,
S Seitun, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study evaluated the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) at different coronary calcium score (CACS) values with conventional coronary angiography (CAG) as the reference standard.
A total of 1,500 patients (928 men, mean age 58.2±12.5 years) in sinus rhythm who underwent CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR) of CTCA were evaluated against CAG for the total population and in different CACS classes (0; 1-10; 11-100; 101-400; 401-1,000; >1,000).
The prevalence of obstructive disease was 51% (23.5% single vessel; 27.5% multivessel; progressive increase from 17.9% to 94% through the CACS classes). In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 99%, 92%, 94% and 99%, respectively. Per-patient analysis showed a worse PPV of CTCA (76-77%) in classes with low CACS (1-10/11-100). Per-patient LR were higher in classes with extreme CACS values (0 = LR+ 18.3 and LR- = 0.0; c1,000 = LR+ 17.0 and LR- = 0.0) with values always >7 for LR+ and <0.033 for LR- for all CACS classes.
CTCA is a reliable diagnostic modality, with high sensitivity and NPV regardless of CACS.
La radiologia medica 03/2011; 116(7):1000-13. · 1.44 Impact Factor
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E Maffei,
C Martini,
S De Crescenzo,
T Arcadi,
A Clemente,
E Capuano,
A Rossi,
R Malagò,
N Mollet, A Weustink,
C Tedeschi,
L La Grutta,
S Seitun,
A Igoren Guaricci,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: In 10 years, computed tomography coronary angiography (CTCA) has shifted from an investigational tool to clinical reality. Even though CT technologies are very advanced and widely available, a large body of evidence supporting the clinical role of CTCA is missing. The reason is that the speed of technological development has outpaced the ability of the scientific community to demonstrate the clinical utility of the technique. In addition, with each new CT generation, there is a further broadening of actual and potential applications. In this review we examine the state of the art on CTCA. In particular, we focus on issues concerning technological development, radiation dose, implementation, training and organisation.
La radiologia medica 12/2010; 115(8):1179-207. · 1.44 Impact Factor
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E Maffei,
S Seitun,
C Martini,
A Aldrovandi,
T Arcadi,
A Clemente,
G Messalli,
R Malagò, A Weustink,
N Mollet,
K Nieman,
D Ardissino,
P de Feyter,
G Krestin,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: The authors investigated the prognostic value of computed tomography coronary angiography (CTCA) for major adverse cardiac events (MACE) in patients with suspected or known coronary artery disease (CAD), with particular focus on left main (LM) disease and obstructive vs. nonobstructive disease.
A total of 727 consecutive patients (485 men, age 62 ± 11 years) with suspected (514; 70.1%) or known (213; 29.9%) CAD underwent CTCA. Patients were followed up for the occurrence of MACE (i.e. cardiac death, nonfatal myocardial infarction, unstable angina, percutaneous/surgical revascularisation).
A total of 117 MACE [five cardiac deaths, 11 acute myocardial infarctions (AMI), five unstable angina, 86 percutaneous coronary interventions, ten coronary artery bypass grafts] occurred during a mean follow-up of 20 months. Severity and extension of CAD was associated with a progressively worse prognosis. The event rate was 0% among patients with normal coronary arteries at CTCA. The presence of LM disease was not associated with a worse prognosis either in patients with no history of CAD or in those with a history of CAD. At multivariate analysis, presence of obstructive CAD and diabetes were the only independent predictors of MACE.
Evaluation of atherosclerotic burden by CTCA provides an independent prognostic value for prediction of MACE. Patients with normal CTCA findings have an excellent prognosis at follow-up.
La radiologia medica 10/2010; 116(1):15-31. · 1.44 Impact Factor
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E Maffei,
G Messalli,
A Palumbo,
C Martini,
S Seitun,
A Aldrovandi,
A Cuttone,
E Emiliano,
R Malagò, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study compared cardiac computed tomography (CT) and two-dimensional transthoracic echocardiography (ECC) for assessing left ventricular ejection fraction (LVEF) using real-world data from a large patient population.
We studied 450 patients (284 males; mean age 64±12 years; range 12-88) who underwent CT and ECC due to suspected coronary artery disease. For CT, we used multiphase short-axis reconstructions and evaluated them with a dedicated software tool that uses Simpson's rule to compute LV volumes. For ECC, computation was based on the biplane Simpson's method. Results in terms of EF were compared with the paired Student's t test, Pearson's correlation coefficient (r), and Bland-Altman analysis.
EF was 52%±15% for CT and 55%±13% for ECC. Statistically significant differences, albeit with good correlation, were observed between the measurements (r=0.71; p<0.05). ECC showed a slight tendency to overestimate EF. When the population was divided into subgroups according to EF, this was underestimated by ECC in the subgroup with EF >50% and overestimated in those with EF 35%-50% and <35%, with consistently significant differences between ECC and CT (p<0.05) and progressively lower levels of agreement.
In the real-world assessment of EF, ECC provides significantly different data from CT, with a bias that increases proportionally to LV systolic dysfunction.
La radiologia medica 03/2010; 115(7):1015-27. · 1.44 Impact Factor
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C Martini,
E Maffei,
A Palumbo, A Weustink,
T Baks,
A Moelker,
D Dunker,
A Cuttone,
E Emiliano,
N Mollet,
G Krestin,
P De Feyter,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study evaluated the impact of tube current (mAs) in delayed-enhancement computed tomography (CT) imaging for assessing acute reperfused myocardial infarction in a porcine model.
In five domestic pigs (mean weight 24 kg), the circumflex coronary artery was balloon-occluded for 2 h and then reperfused. After 5 days, CT imaging was performed following administration of iodinated contrast material. A 64-slice CT system was used to perform first-pass coronary angiography with a tube current of 15 mAs/kg [Arterial Phase (ART)] followed by two delayed-enhancement (DE) scans 15 min after contrast material administration, with a tube current of 15 mAs/kg and 37.5 mAs/kg, respectively (DE(1) and DE(2)). The mean heart rate decreased to 51±9 beats/min after administration of zatebradine (10 mg/kg IV). The data set was reconstructed during the end-diastolic phase of the cardiac cycle. Areas with DE, no reflow and remote myocardium [remote left ventricular (LV)] were calculated. CT values expressed in Hounsfield units (HU) were measured using five regions of interest (ROI): DE, no reflow, remote LV, LV cavity (LV lumen) and in air, respectively. Differences, correlations, image quality [signal-to-noise ratio (SNR)] and contrast resolution [contrast-to-noise ratio (CNR)] were calculated.
Significant differences were found between attenuation of areas of DE, no reflow and remote LV (p<0.001) within the different scans. There was a fair correlation between DE and no-reflow attenuation (r=0.6; p<0.001). In DE(1) vs. DE(2), areas of DE and no reflow were not significantly different (p>0.05). The SNR and CNR were not significantly different in DE(1) vs. DE(2) (p>0.05).
Tube current does not significantly affect infarction area, image quality or contrast resolution of DE imaging with CT.
La radiologia medica 03/2010; 115(7):1003-14. · 1.44 Impact Factor
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A Palumbo,
E Maffei,
C Martini,
G Messalli,
S Seitun,
R Malagò,
A Aldrovandi,
E Emiliano,
A Cuttone, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: The authors sought to compare magnetic resonance imaging (MRI) and computed tomography (CT) for assessing left ventricular (LV) function parameters in a large patient population.
The study was conducted on 181 patients who underwent cardiac MRI and cardiac CT for various indications. For MRI, we used two-dimensional cine balanced steady-state free precession (b-SSFP) sequences, and for CT we used multiphase short-axis reconstructions. Volume data sets were evaluated with dedicated software. Results were compared with a paired, two-tailed Student's t test, Pearson's correlation (r), and Bland-Altman analysis.
A high level of concordance was observed between cardiac MRI and CT. Ejection fraction (EF) was 53+/-14% for MRI vs. 53%+/-15% for CT. There was good correlation for EF (r=0.71; p>0.05) and end-systolic volume (r=0.74; p>0.05). End-diastolic volume (74+/-23 ml at MRI vs. 71+/-19 ml at CT; r=0.58; p<0.05) and myocardial mass (63+/-20 g at MRI and 56+/-18 g at CT; r=0.89; p<0.01) showed statistically significant differences, although the discrepancy had no clinical impact.
MRI and CT show a good level of agreement in assessing LV function parameters, and both can be used interchangeably in clinical practice.
La radiologia medica 02/2010; 115(5):702-13. · 1.44 Impact Factor
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C Martini,
A Palumbo,
E Maffei,
A Rossi,
M Rengo,
R Malagò,
M Dijkshoorn, A Weustink,
N Mollet,
G Krestin,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study was undertaken to estimate surplus radiation dose in retrospectively electrocardiography (ECG)-gated dual-source computed tomography coronary angiography (DSCT-CA) due to the slope-up and slope-down of the tube current using prospectively ECG-triggered tube modulation.
We used an anthropomorphic phantom with an ECG-gated retrospective protocol and a DSCT scanner (Definition, Siemens). We used four tube current modulation algorithms: narrow pulsing window, with tube current reduction to 20% (A) and 4% (B) of peak current; and wide pulsing window, with tube current reduction to 20% (C) and 4% (D). Each algorithm was applied at five heart rates (HR=45, 60, 75, 90 and 120 bpm) with adaptive pitch values (0.2-0.5). Data sets were reconstructed in 5% increments from 0-95% of the R-R interval. Noise was measured at each R-R step in order to identify low noise (100% dose), medium noise (slope-up/down) and high noise (4/20% dose). Width of the transition window (slope-up/slope-down from 4/20% to 100% dose) was calculated. The surplus dose due to slope-up/slope-down was calculated.
Surplus dose was 19% (A), 34% (B), 14% (C) and 21% (D). The transition window lasted 10%+10% (slope-up + down) for HR <75 bpm and all HR in C (except for 120 bpm; 25%+15%), 15%+15% for HR >90 bpm (A). For C and D, instead, the slope-up increased with progressively higher HR (10%-25% of the R-R interval, except for 90 bpm, 10%), whereas the slope-down remained constant at 5% (except for 120 bpm; 10%).
The adaptive ECG-pulsing windows produced an increment of the surplus dose with increasing HR. The transition window was a constant source of surplus radiation dose in the range of 14%-34%.
La radiologia medica 02/2010; 115(1):36-50. · 1.44 Impact Factor
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E Maffei,
A Palumbo,
C Martini,
W Meijboom,
C Tedeschi,
P Spagnolo,
A Zuccarelli, A Weustink,
T Torri,
N Mollet,
S Seitun,
G P Krestin,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CT-CA) for the detection of significant coronary artery stenosis (> or =50% lumen reduction) compared with conventional coronary angiography (CCA) in a registry and to review major multicentre trials.
A total of 1,372 patients (882 men, 490 women; mean age 59.3+/-11.9 years) in sinus rhythm were studied with CT-CA (64-slice technology) and CCA. The diagnostic accuracy of CT-CA was evaluated against quantitative CCA as a reference standard for coronary artery stenosis. Positive and negative likelihood ratios and inter- and intraobserver agreement were calculated.
The prevalence of disease was 53%. CCA demonstrated the absence of significant coronary artery disease in 46.6% (639/1372), single-vessel disease in 24.7% (337/1372) and multivessel disease in 28.9% (396/1372) of patients. In per-patient analysis sensitivity, specificity and positive and negative predictive value of CT-CA were 99% [confidence interval (CI) 97-99], 92% (CI 89-94), 94% (CI 91-95) and 99% (CI 97-99), respectively. Per-patient and per-segment likelihood ratios (LR+=12.4 and LR-=0.011; LR+=18.3 and LR-=0.064, respectively), were good. Inter- and intraobserver variability was 0.78 and 0.85, respectively.
CT-CA is a reliable diagnostic modality both in terms of sensitivity and negative predictive value. Differences in trial results are also due to the different parameters used for patient inclusion.
La radiologia medica 12/2009; 115(3):368-84. · 1.44 Impact Factor
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C Martini,
E Maffei,
A Palumbo, A Weustink,
T Baks,
A Moelker,
D Dunker,
E Emiliano,
A Cuttone,
N Mollet,
G Krestin,
P De Feyter,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: Our purpose in this study was to compare the impact of contrast material volume in delayed-enhancement computer tomography (CT) imaging for assessing acute reperfused myocardial infarction.
In five domestic pigs (20-30 kg), the circumflex coronary artery (CX) was balloon-occluded for 2 h followed by reperfusion. After 5 days, CT imaging was performed after intravenous administration of iodinated contrast material (Iomeprol 400 mgI/ml; Bracco, Italy). A 64-slice multidetector CT (MDCT) (Sensation 64, Siemens) scanner was used for imaging, with standard angiography characteristics. Three scans were performed: first, coronary angiography at first pass with 1.25 gI/kg of contrast material (ART); and remaining delayed-enhancement (DE(1)-DE(2)) 15 min after administration of 1.25 (DE(1)) and 15 min after additional administration of 2.50 gI/kg (=total 3.75 gI/kg - DE(2)). Mean heart rate decreased to 51+/-9 bpm after intravenous administration of Zatebradine (10 mg/kg). Data sets were reconstructed during the end-diastolic phase of the cardiac cycle. Areas of infarction-enhanced (DE), no-reflow (no-reflow) and remote myocardial [remote left ventricle (LV)] were manually contoured. CT attenuation values (Hounsfield units) were measured using five regions of interest: DE, no-reflow, remote LV, left ventricular cavity (lumen LV) and in air. Differences, correlations, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.
We found significant differences between the attenuation of DE, no-reflow and remote LV (p<0.001). DE and no-reflow size were assessed accurately with DEMDCT. In particular, SNR and CNR showed higher values in DE(2) (approximately 6.0 and 3.5, respectively; r(2)=0.90) vs. DE(1) (approximately 4.0 and 2.2, respectively; r(2)=0.85).
The increase of contrast material volume determines a significant improvement in myocardial infarction image quality with DE-MDCT.
La radiologia medica 12/2009; 115(1):22-35. · 1.44 Impact Factor
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E Maffei,
A Palumbo,
C Martini,
A Cuttone,
F Ugo,
E Emiliano,
A Menozzi,
L Vignali,
V Brambilla,
P Coruzzi, A Weustink,
N Mollet,
D Ardissino,
C Reverberi,
G Crisi,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to evaluate the diagnostic accuracy of stress electrocardiogram (ECG) and computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis (> or =50%) in the real world using conventional CA as the reference standard.
A total of 236 consecutive patients (159 men, 77 women; mean age 62.8+/-10.2 years) at moderate risk and with suspected coronary artery disease (CAD) were enrolled in the study and underwent stress ECG, CTCA and CA. The CTCA scan was performed after i.v. administration of a 100-ml bolus of iodinated contrast material. The stress ECG and CTCA reports were used to evaluate diagnostic accuracy compared with CA in the detection of significant stenosis > or =50%.
We excluded 16 patients from the analysis because of the nondiagnostic quality of stress ECG and/or CTCA. The prevalence of disease demonstrated at CA was 62% (n=220), 51% in the population with comparable stress ECG and CTCA (n=147) and 84% in the population with equivocal stress ECG (n=73). Stress ECG was classified as equivocal in 73 cases (33.2%), positive in 69 (31.4%) and negative in 78 (35.5%). In the per-patient analysis, the diagnostic accuracy of stress ECG was sensitivity 47%, specificity 53%, positive predictive value (PPV) 51% and negative predictive value (NPV) 49%. On stress ECG, 40 (27.2%) patients were misclassified as negative, and 34 (23.1%) patients with nonsignificant stenosis were overestimated as positive. The diagnostic accuracy of CTCA was sensitivity 96%, specificity 65%, PPV 74% and NPV 94%. CTCA incorrectly classified three (2%) as negative and 25 (17%) as positive. The difference in diagnostic accuracy between stress ECG and CTCA was significant (p<0.01).
CTCA in the real world has significantly higher diagnostic accuracy compared with stress ECG and could be used as a first-line study in patients at moderate risk.
La radiologia medica 11/2009; 115(3):354-67. · 1.44 Impact Factor
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C Martini,
A Palumbo,
E Maffei,
A Rossi,
M Rengo,
R Malagò,
M Dijkshoorn, A Weustink,
N Mollet,
G Krestin,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: The authors sought to compare different algorithms for dose reduction in retrospectively echocardiographically (ECG)-gated dual-source computed tomography (CT) coronary angiography (DSCT-CA) in a phantom model.
Weighted CT dose index (CTDI) was measured by using an anthropomorphic phantom in spiral cardiac mode (retrospective ECG gating) at five pitch values adapted with two heart-rate-adaptive ECG pulsing windows using four algorithms: narrow pulsing window, with tube current reduction to 20% (A) and 4% (B) of peak current outside the pulsing window; wide pulsing window, with tube current reduction to 20% (C) and 4% (D). Each algorithm was applied at different heart rates (45, 60, 75, 90, 120 bpm).
Mean CTDI volume (CTDIvol) was 36.9+/-9.7 mGy, 23.9+/-5.6 mGy, 49.7+/-16.2 mGy and 38.5+/-12.3 mGy for A, B, C and D, respectively. Consistent dose reduction was observed with protocols applying the 4% tube current reduction (B and D). Using the conversion coefficient for the chest, the mean effective dose was the highest for C (9.6 mSv) and the lowest for B (4.6 mSv). Heart-ratedependent pitch values (pitch=0.2, 0.26, 0.34, 0.43, 0.5) and the use of heart-rate-adaptive ECG pulsing windows provided a significant decrease in the CTDIvol with progressively higher heart rates (45, 60, 75, 90, 120 bpm), despite using wider pulsing windows.
Radiation exposure with DSCT-CA using a narrow pulsing window significantly decreases when compared with a wider pulsing window. When using a protocol with reduced tube current to 4%, the radiation dose is significantly lower.
La radiologia medica 09/2009; 114(7):1037-52. · 1.44 Impact Factor
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G Messalli,
A Palumbo,
E Maffei,
C Martini,
S Seitun,
A Aldrovandi,
M Imbriaco,
M Salvatore, A Weustink,
N Mollet,
F Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: This study compared two quantitative semiautomated software packages for volumetric analysis of the left ventricle (LV) by magnetic resonance (MR) imaging using two-dimensional (2D) cine balanced steady-state free precession (b-SSFP) sequences.
We included 46 consecutive patients who underwent cardiac MR imaging for various indications. Two-dimensional cine b-SSFP sequences were used to assess the LV. Data sets were evaluated with two dedicated software packages: ViewForum, version 4.2, and Argus, version Va60C. Results were compared with Student's t test for paired samples, Pearson's r correlation coefficient and R2 coefficient of determination; ejection fraction differences were assessed with Bland-Altman analysis. The time required for analysis was also recorded.
We observed very high levels of concordance and reproducibility. High correlation was observed for ejection fraction (p>0.05; r=0.9; R (2)=0.82). The time required for analysis was 7.6+/-2.78 min vs. 7.52+/-2.4 min (p>0.05; r=0.85; R (2)=0.73). Intraobserver and interobserver variability did not show significant differences.
LV volume evaluation is an integral part of cardiac MR imaging. In our experience, there is no significant difference between the commonly used software packages in either quantitative output or time required for analysis.
La radiologia medica 06/2009; 114(5):718-27. · 1.44 Impact Factor
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F Cademartiri,
L La Grutta,
R Malagò,
F Alberghina,
A Palumbo,
M Belgrano,
E Maffei,
A Aldrovandi,
F Pugliese,
G Runza, A Weustink,
W Bob Meeijboom,
N R Mollet,
M Midiri
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to correlate left main (LM) coronary artery dimensions with the presence of atherosclerosis by multidetector-row computed tomography (MDCT) coronary angiography (CA) and to assess coronary atherosclerotic plaques with a semiquantitative method.
Sixty-two consecutive patients (41 men, mean age 60+/-11) with suspected coronary artery disease underwent 64-MDCT coronary angiography. LM dimensions (length, ostial and bifurcation diameters), quantitative [location, Hounsfield unit (HU) attenuation] and qualitative (composition, shape) analysis of plaques within the LM were performed. All patients underwent conventional CA.
Thirty patients (mean age 55+/-10) without plaques in the LM presented the following average dimensions: length 10.6+/-6.1 mm, ostial diameter 5.5+/-0.7 mm, bifurcation diameter 4.9+/-0.9 mm. LM plaques (n=36) were detected in 32 patients (mean age 64+/-10) with the following LM average dimensions: length 11.3+/-4.0 mm, ostial diameter 6.0+/-1.2 mm and bifurcation diameter 6.0+/-1.2 mm. Plaques were calcified (40%, mean attenuation 742+/-191 HU), mixed (43%, mean attenuation 387+/-94 HU) or noncalcified (17%, mean attenuation 56+/-14 HU) and were frequently eccentric (77%). Age was significantly different in the two groups (p<0.05). LM diameters of patients with plaques were improved (p<0.05). A moderate correlation was found between the LM bifurcation diameter and the corresponding plaque area (r=0.56). Significant conventional CA lesions of the LM were present in just three patients (5%).
Increased LM diameters are associated with the presence of atherosclerosis. MDCT CA indicates relevant features of LM atherosclerotic burden, as rupture and subsequent thrombosis of vulnerable plaques may develop from lesions characterised as nonsignificant at conventional CA.
La radiologia medica 05/2009; 114(3):358-69. · 1.44 Impact Factor
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F Cademartiri,
L La Grutta,
A Palumbo,
E Maffei,
C Martini,
S Seitun,
F Coppolino,
M Belgrano,
R Malagò,
A Aldrovandi,
N Mollet, A Weustink,
M Cova,
M Midiri
[show abstract]
[hide abstract]
ABSTRACT: This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain.
MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8+/-7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test.
The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) for the stress test and 10.0 (95% CI: 1.8-78.4) and 0.0 (95% CI: 0.0-infinity) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD.
Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.
La radiologia medica 04/2009; 114(4):513-23. · 1.44 Impact Factor
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ABSTRACT: Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool.
Clinical Cardiology 10/2007; 30(9):437-42. · 2.15 Impact Factor
