Objectives This study sought to determine the accuracy of plaque pattern assessment by coronary computed tomography angiography (CCTA) to differentiate between early and advanced atherosclerotic ...lesions as defined by histology. Background A ringlike attenuation pattern of coronary atherosclerotic plaques termed as napkin-ring sign (NRS) was described in CCTA of patients who had acute coronary syndrome. Methods All procedures were performed in accordance with local and federal regulations and the Declaration of Helsinki. Approval of the local ethics committees was obtained. We investigated 21 coronary arteries of 7 donor hearts. Overall, 611 histological sections were obtained and coregistered with CCTA images. The CCTA cross sections were read in random order for conventional plaque categories (noncalcified NCP, mixed MP, calcified CP) and plaque patterns (homogenous, heterogeneous with no napkin-ring sign non-NRS, and heterogeneous with NRS). Results No plaque was detected in 134 (21.9%), NCP in 254 (41.6%), MP in 191 (31.3%), and CP in 32 (5.2%) CCTA cross sections. The NCP and MP were further classified into homogenous plaques (n = 207, 46.5%), non-NRS plaques (n = 200, 44.9%), and NRS plaques (n = 38, 8.6%). The specificities of NCP and MP to identify advanced lesions were moderate (57.9%, 95% confidence interval CI: 50.1% to 65.6%, and 72.1%, 95% CI: 64.7% to 79.4%, respectively), which were similar to the homogenous and heterogeneous plaques (62.6%, 95% CI: 54.8% to 70.3%, and 67.3%, 95% CI: 58.6% to 76.1%, respectively). In contrast, the specificity of the NRS to identify advanced lesions was excellent (98.9%, 95% CI: 97.6% to 100%). The diagnostic performance of the pattern-based scheme to identify advanced lesions was significantly better than that of the conventional plaque scheme (area under the curve: 0.761 vs. 0.678, respectively; p = 0.001). Conclusions The assessment of the plaque pattern improves diagnostic accuracy of CCTA to identify advanced atherosclerotic lesions. The CCTA finding of NRS has a high specificity and high positive predictive value for the presence of advanced lesions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives
The objective was to prospectively investigate the diagnostic accuracy of high-pitch (HP) dual-source computed tomography coronary angiography (CTCA) compared with catheter coronary ...angiography (CCA) for the diagnosis of significant coronary stenoses.
Methods
Thirty-five patients (seven women; mean age 62 ± 8 years) underwent both CTCA and CCA. CTCA was performed with a second-generation dual-source CT system permitting data acquisition at an HP of 3.4. Patients with heart rates >60 bpm were excluded from study enrolment. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a four-point scale (1: excellent to 4: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). CCA served as the standard of reference. Radiation dose values were calculated using the dose-length product.
Results
Diagnostic image quality was found in 99% of all segments (455/459). Non-diagnostic image quality occurred in a single patient with a sudden increase in heart rate immediately before and during CTCA. Taking segments with non-evaluative image quality as positive for disease, the sensitivity, specificity and positive and negative predictive values were 94, 96, 80 and 99% per segment and 100, 91, 88 and 100% per patient. The effective radiation dose was on average 0.9 ± 0.1 mSv.
Conclusion
In patients with heart rates ≤60 bpm, CTCA using the HP mode of the dual-source CT system is associated with high diagnostic accuracy for the assessment of coronary artery stenoses at sub-milliSievert doses.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
The aim of this study was to derive reference values of 18F-fluoro-ethyl-L-tyrosine positron emission tomography (18F-FET-PET) uptake in normal brain and head structures to allow for differentiation ...from tumor tissue.
We examined the datasets of 70 patients (median age 53 years, range 15-79), whose dynamic 18F-FET-PET was acquired between January 2016 and October 2017. Maximum standardized uptake value (SUVmax), target-to-background standardized uptake value ratio (TBR), and time activity curve (TAC) of the 18F-FET-PET were assessed in tumor tissue and in eight normal anatomic structures and compared using the t-test and Mann-Whitney U-test. Correlation analyses were performed using Pearson or Spearman coefficients, and comparisons between several variables with Pearson's chi-squared tests and Kruskal-Wallis tests as well as the Benjamini-Hochberg correction.
All analyzed structures showed an 18F-FET uptake higher than background (threshold: TBR > 1.5). The venous sinuses and cranial muscles exhibited a TBR of 2.03±0.46 (confidence interval (CI) 1.92-2.14), higher than the uptake of caudate nucleus, pineal gland, putamen, and thalamus (TBR 1.42±0.17, CI 1.38-1.47). SUVmax, TBR, and TAC showed no difference in the analyzed structures between subjects with high-grade gliomas and subjects with low-grade gliomas, except the SUVmax of the pineal gland (t-tests of the pineal gland: SUVmax: p = 0.022; TBR: p = 0.411). No significant differences were found for gender and age.
Normal brain tissue demonstrates increased 18F-FET uptake compared to background tissue. Two distinct clusters have been identified, comprising venous structures and gray matter with a reference uptake of up to SUVmax of 2.99 and 2.33, respectively.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose of this study was to compare the diagnostic accuracy of whole-body unenhanced PET/MR with that of PET/CT in determining the stage of non-small cell lung cancer.
This study was approved by ...the institutional review board and by national government authorities. Forty-two consecutive patients referred for the initial staging of non-small cell lung cancer underwent whole-body imaging with a sequential trimodality PET/CT/MR system. PET/MR and PET/CT datasets were evaluated separately, and a TNM stage was assigned on the basis of the image analysis. Nodal stations in the chest were identified according to the mapping system of the American Thoracic Society. The standard of reference was histopathology for the tumor stage in 20 subjects, for the nodal stage in 22 patients, and for extrathoracic metastases in 5 subjects. All other lesions were confirmed by at least 1 different imaging method. A Wilcoxon signed-ranks test was used for comparing PET/MR with PET/CT.
PET/MR did not provide additional information compared with PET/CT. The diagnostic accuracy of both imaging modalities was equal (T staging, P = 0.177; N staging, P = 0.114; M staging, P = 0.465), however, with advantages for PET/CT by trend. In the subgroup with histopathologic confirmation of T and N stages, the situation was similar (T staging, P = 0.705; N staging, P = 0.334).
This study indicates that PET/MR using a fast MR protocol does not improve the diagnostic accuracy of the staging of non-small cell lung cancer.
Objectives This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography ...myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). Background Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. Methods In 541 patients (59% male, age 59 ± 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. Results In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT ≥50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score SSS: ≥4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT ≥50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS ≥4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005). Conclusions MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose
18
F-FDG PET/CT (PET/CT) is a useful tool for the diagnosis of aortic graft infection (AGI), but has rarely been used to influence therapeutic decisions during follow-up. We aimed to study ...the role of PET/CT in the long-term monitoring of patients.
Methods
Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) were included if they had microbiologically proven AGI. We quantified the metabolic activity in PET/CT by using maximum standardized uptake value (SUV
max
) and further classified it as being focal or diffuse. Multivariable linear regression models were fit using generalized estimating equations to investigate factors associated with SUV
max
over time.
Results
Sixty-eight participants with AGI contributed to 266 PET/CTs including 36 examinations performed after stop of antimicrobial therapy. Higher C-reactive protein (CRP) (adjusted coefficient per log
10
mg/L 0.05 95% C.I. 0.02–0.08) was associated with higher SUV
max
. CRP, metabolic and clinical findings informed the decision to either start (medians of SUV
max
7.1 and CRP 31.5 mg/L; 100% focal uptake), escalate (SUV
max
9.5; CRP 31.5; 100% focal uptake), continue (SUV
max
6.0; CRP 9.95 mg/L; 90% focal uptake), or stop (SUV
max
4.3; CRP 3.5 mg/L; 61% focal uptake) antibiotic treatment. Of note, decisions to escalate or continue antibiotic treatment were taken despite normal CR
P
values in 12.5 and 35.7% of PET/CTs, respectively.
Conclusions
Consecutive PET/CTs could influence the clinical decision-making in patients with AGI in the near future. More studies on the use of PET/CT in case of aortic graft infection may offer the potential for individualized treatment approaches.
CLINICALTRIALS.GOV IDENTIFIER
NCT01821664.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
The purpose of this study was to prospectively evaluate the average heart rate and heart rate variability required for diagnostic imaging of the coronary arteries with high-pitch dual-source CT ...angiography of the thoracic and thoracoabdominal aorta.
One hundred consecutively registered patients (82 men, 18 women; mean age, 68 +/- 13 years) underwent clinically indicated CT angiography of the thoracic (n = 33) and thoracoabdominal (n = 67) aorta with a dual-source 128-MDCT scanner in ECG-synchronized high-pitch (pitch, 3.2) data acquisition mode. No beta-blockers were administered. The image quality of the coronary arteries was graded on a 3-point scale by two independent blinded readers. The average heart rate and heart rate variability before data acquisition were noted. Effective radiation doses were calculated.
Interobserver agreement on grade of image quality for the 1,414 coronary segments evaluated by both observers was good (kappa = 0.68). Diagnostic image quality was found for 1,375 of the 1,414 segments (97.2%) in 83 of 100 patients (83%). In 17% of the patients, image quality was nondiagnostic for at least one coronary artery segment. Average heart rate and heart rate variability (each p < 0.05) were significantly higher in patients with at least one nondiagnostic coronary segment compared with those without. All patients with an average heart rate less than 63 beats/min and heart rate variability less than 1.2 beats/min had diagnostic image quality in all coronary segments. Effective radiation doses were 2.3 +/- 0.3 mSv for thoracic and 4.4 +/- 0.5 mSv for thoracoabdominal CT angiography. The average scan times were 0.88 +/- 0.06 second for thoracic and 1.67 +/- 0.15 seconds for thoracoabdominal CT angiography.
For patients with an average heart rate less than 63 beats/min and heart rate variability less than 1.2 beats/min, dual-source CT angiography of the thoracoabdominal aorta at a high pitch of 3.2 delivers diagnostic depiction of the coronary arteries at a low radiation dose.
Objective
To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).
Methods
PMCT of 55 cases in which heroin and/or methadone had ...been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy.
Results
The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (
p
< 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis.
Conclusions
Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death.
Key Points
•
Frequent findings in cases of fatal opioid intoxication were investigated
.
•
Lung oedema
,
brain oedema and full urinary bladder represent a highly specific constellation
.
•
This combination of findings in post
-
mortem CT should raise suspicion of intoxication
.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
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