Antonio Moscariello

Publications of Antonio Moscariello

• CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability.

  Authors: Rozemarijn Vliegenthart, Thomas Henzler, Antonio Moscariello, Balazs Ruzsics, Gorka Bastarrika, Matthijs Oudkerk, U Joseph Schoepf

  AJR. American journal of roentgenology. 03/2012; 198(3):531-47.

  OBJECTIVE: This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION: Rapid advances in CTOBJECTIVE: This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION: Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.

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

  Authors: Richard A P Takx, Antonio Moscariello, U Joseph Schoepf, J Michael Barraza, John W Nance, Gorka Bastarrika, Marco Das, Mathias Meyer, Joachim E Wildberger, Stefan O Schoenberg, Christian Fink, Thomas Henzler

  European journal of radiology. 08/2011;

  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.

• Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection.

  Authors: Antonio Moscariello, Richard A P Takx, U Joseph Schoepf, Matthias Renker, Peter L Zwerner, Terrence X O'Brien, Thomas Allmendinger, Sebastian Vogt, Bernhard Schmidt, Giancarlo Savino, Christian Fink, Lorenzo Bonomo, Thomas Henzler

  European radiology. 05/2011; 21(10):2130-8.

  To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) andTo compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings. Sixty five consecutive patients (48 men; 59.3 ± 7.7 years) prospectively underwent cCTA and coronary catheter angiography (CCA). Full radiation dose data, using all projections, were reconstructed with FBP. To simulate image acquisition at half the radiation dose, 50% of the projections were discarded from the raw data. The resulting half-dose data were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Full-dose FBP and half-dose iterative reconstructions were compared with regard to image noise and image quality, and their respective accuracy for stenosis detection was compared against CCA. Compared with full-dose FBP, half-dose iterative reconstructions showed significantly (p = 0.001 - p = 0.025) lower image noise and slightly higher image quality. Iterative reconstruction improved the accuracy of stenosis detection compared with FBP (per-patient: accuracy 96.9% vs. 93.8%, sensitivity 100% vs. 100%, specificity 94.6% vs. 89.2%, NPV 100% vs. 100%, PPV 93.3% vs. 87.5%). Iterative reconstruction significantly reduces image noise without loss of diagnostic information and holds the potential for substantial radiation dose reduction from cCTA.

• Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease.

  Authors: Mathias Meyer, John W Nance, U Joseph Schoepf, Antonio Moscariello, Markus Weininger, Garrett W Rowe, Balazs Ruzsics, Doo Kyoung Kang, Salvatore A Chiaramida, Stefan O Schoenberg, Christian Fink, Thomas Henzler

  European journal of radiology. 01/2011;

  PURPOSE: We compared cost-effectiveness and potential lifetime benefits of using dual-energy computed tomography (DECT) for myocardial perfusion assessment instead of single photon emission computedPURPOSE: We compared cost-effectiveness and potential lifetime benefits of using dual-energy computed tomography (DECT) for myocardial perfusion assessment instead of single photon emission computed tomography (SPECT) for the workup of coronary artery disease (CAD). MATERIALS AND METHODS: A decision and simulation model was developed to estimate cost and health effects of using DECT myocardial perfusion imaging instead of SPECT for identifying patients in need of invasive imaging and possible revascularization. The model was based on the performance indices of stress/rest DECT compared with stress/rest SPECT for detecting myocardial perfusion deficits in 50 patients (mean age 61±10 years) with CAD. Stress/rest perfusion and delayed enhancement cardiac MRI served as reference standard. For DECT a reimbursement of US$1700 was assumed but costs of cardiac MRI were not included in the model. All other actual healthcare costs in these patients were derived from MUSC's hospital billing system. RESULTS: Compared with cardiac MRI, DECT (versus SPECT) had 90% (85%) sensitivity and 71% (58%) specificity for identifying patients with obstructive CAD. Compared with the no imaging and no treatment strategy, routine SPECT gained 13.49 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$3557 (in 2010) per QALY. In comparison, DECT ICER was lower (US$3.191 per QALY, p=0.0002) and an additional 0.64 QALYs was obtained (total of 14.13 QALYs) if compared with the SPECT strategy as well as the no imaging and no treatment strategy. CONCLUSION: Using DECT as the first-line imaging test for myocardial perfusion for the workup of patients with CAD has the potential to provide gains in QALYs, while lowering costs if compared to routine myocardial perfusion SPECT.