Aim
The aim of this cone‐beam computed tomography (CBCT)‐based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst‐like periapical ...lesions (LCPL) and to identify the predictive factors affecting healing.
Methodology
Fifty‐four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi‐visit RCT. Patients were clinically and radiographically examined at 6, 12 months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre‐ and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0‐beta‐20181028‐win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%.
Results
A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%–93%). No pre‐ or intra‐operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, β = −51.5; 95% CI: −86.9 to −16, p = .006) and apical extent of obturation (long versus flush, β = −27.2; 95% CI: −53.8 to −0.6, p = .04) were negatively associated with reduction in lesion volume (%).
Conclusion
Large cyst‐like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.
Evaluation of coronary artery disease (CAD) using coronary computed tomography angiography (CCTA) has seen a paradigm shift in the last decade. Evidence increasingly supports the clinical utility of ...CCTA across various stages of CAD, from the detection of early subclinical disease to the assessment of acute chest pain. Additionally, CCTA can be used to noninvasively quantify plaque burden and identify high-risk plaque, aiding in diagnosis, prognosis, and treatment. This is especially important in the evaluation of CAD in immune-driven conditions with increased cardiovascular disease prevalence. Emerging applications of CCTA based on hemodynamic indices and plaque characterization may provide personalized risk assessment, affect disease detection, and further guide therapy. This review provides an update on the evidence, clinical applications, and emerging technologies surrounding CCTA as highlighted at the 2019 National Heart, Lung and Blood Institute CCTA Summit.
Transcatheter aortic valve replacement (TAVR) has become more common than surgical aortic valve replacement since 2016, with over 200,000 procedures globally each year. As patients increasingly ...outlive their TAVR devices, managing these cases is a growing concern. Treatment options include surgical removal of the old TAVR device (transcatheter aortic valve TAV explant) or implantation of a new transcatheter aortic valve (redo TAV). Redo TAV is complex because of the unique designs of TAV devices; compatibility issues; and the need for individualized planning based on factors such as implant depth, shape, and coronary artery relationships. This review serves as a comprehensive guide for redo TAV, detailing the design characteristics of TAV devices, device compatibility, standardized terminology, and a structured approach for computed tomography analysis. It aims to facilitate decision making, risk identification, and achieving optimal outcomes in redo TAV procedures.
Display omitted
•Because TAVR has now expanded to patients with longer life expectancies, increasing numbers of patients will present with structural valve deterioration of TAV prostheses. It is important to understand the risks and suitability of patients for repeat implantation of another TAV (redo TAV or TAV-in-TAV).•Unlike valve-in-valve for failed surgical aortic valve replacement because of the complexity of TAV designs, a systematic CT analysis for each combination is necessary to determine suitability with respect to coronary risk, sizing, and injury to the surrounding structures.•Bench testing, prospective clinical studies, and validation of CT algorithms with simulation software will play a critical role in appropriate case selection and improving outcomes.
Prior studies with single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) have shown a survival benefit with early revascularization in patients with >10% to 12.5% ...ischemic myocardium. The relationship among positron emission tomography (PET)–derived extent of ischemia, early revascularization, and survival is unknown.
The purpose of this study was to evaluate the association among percent ischemia on PET MPI, revascularization, and survival.
A total of 16,029 unique consecutive patients who were undergoing Rubidium-82 rest-stress PET MPI from 2010 to 2016 were included. Patients with known cardiomyopathy and nondiagnostic perfusion results were excluded. Percent ischemic myocardium was estimated from a 17-segment model. Propensity scoring was used to account for nonrandomized referral to early revascularization (90 days of PET). A Cox model was developed, adjusting for propensity scores for early revascularization and percent ischemia, and an interaction between ischemia and early revascularization was tested.
Median follow-up was 3.7 years. Overall, 1,277 (8%) patients underwent early revascularization and 2,493 (15.6%) died (738 cardiac). Nearly 37% of patients (n = 5,902) had ischemia, with 13.5% (n = 2,160) having ≥10%. In propensity-adjusted analyses, there was a significant interaction between ischemia and early revascularization (p < 0.001 for all-cause and cardiac death), such that patients with greater ischemia had improved survival with early revascularization, with a potential ischemia threshold at 5% (upper limit 95% confidence interval at 10%). There was no differential association between ischemia and early revascularization on death based on history of known coronary artery disease (interaction p = 0.72).
In a contemporary cohort of patients undergoing PET MPI, patients with greater ischemia had a survival benefit from early revascularization. On exploratory analyses, this threshold was lower than that previously reported for SPECT. These findings require future validation in prospective cohorts or trials.
Display omitted
Abstract
Aims
Symptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a ...machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS), to predict the presence of obstructive CAD on coronary computed tomography angiography (CCTA).
Methods and results
The study screened 35 281 participants enrolled in the CONFIRM registry, who underwent ≥64 detector row CCTA evaluation because of either suspected or previously established CAD. A boosted ensemble algorithm (XGBoost) was used, with data split into a training set (80%) on which 10-fold cross-validation was done and a test set (20%). Performance was assessed of the (1) ML model (using 25 clinical and demographic features), (2) ML + CACS, (3) CAD consortium clinical score, (4) CAD consortium clinical score + CACS, and (5) updated Diamond-Forrester (UDF) score. The study population comprised of 13 054 patients, of whom 2380 (18.2%) had obstructive CAD (≥50% stenosis). Machine learning with CACS produced the best performance area under the curve (AUC) of 0.881 compared with ML alone (AUC of 0.773), CAD consortium clinical score (AUC of 0.734), and with CACS (AUC of 0.866) and UDF (AUC of 0.682), P < 0.05 for all comparisons. CACS, age, and gender were the highest ranking features.
Conclusion
A ML model incorporating clinical features in addition to CACS can accurately estimate the pretest likelihood of obstructive CAD on CCTA. In clinical practice, the utilization of such an approach could improve risk stratification and help guide downstream management.
The field of medical image reconstruction has seen roughly four types of methods. The first type tended to be analytical methods, such as filtered backprojection (FBP) for X-ray computed tomography ...(CT) and the inverse Fourier transform for magnetic resonance imaging (MRI), based on simple mathematical models for the imaging systems. These methods are typically fast, but have suboptimal properties such as poor resolution-noise tradeoff for CT. A second type is iterative reconstruction methods based on more complete models for the imaging system physics and, where appropriate, models for the sensor statistics. These iterative methods improved image quality by reducing noise and artifacts. The U.S. Food and Drug Administration (FDA)-approved methods among these have been based on relatively simple regularization models. A third type of methods has been designed to accommodate modified data acquisition methods, such as reduced sampling in MRI and CT to reduce scan time or radiation dose. These methods typically involve mathematical image models involving assumptions such as sparsity or low rank. A fourth type of methods replaces mathematically designed models of signals and systems with data-driven or adaptive models inspired by the field of machine learning. This article focuses on the two most recent trends in medical image reconstruction: methods based on sparsity or low-rank models and data-driven methods based on machine learning techniques.
Objectives
To compare the average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate between hemoptysis patients with multidetector computed tomography ...(MDCT) angiography
prior to
bronchial artery embolization (BAE) and those without preprocedural MDCT angiography
Methods
This retrospective study was approved by the institutional review board with waiver of patient informed consent. From September 2012 to March 2017, 157 consecutive hemoptysis patients had been undergoing BAE. Among them, 106 patients received preprocedural MDCT angiography (MDCT group), while 51 patients did not receive preprocedural MDCT angiography (control group). The average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate were compared between the two groups.
Results
The average number of culprit ectopic bronchial arteries and that of non-bronchial systemic arteries originating from the subclavian and internal mammary arteries per patient in the MDCT group were both significantly higher than those in the control group (0.15 ± 0.51 vs 0.04 ± 0.20,
p
= 0.022, and 0.17 ± 0.56 vs 0.08 ± 0.39,
p
= 0.040, respectively). The clinical success rate of BAE with preprocedural MDCT angiography tended to be higher than that without MDCT angiography (97.2 vs 88.2%,
p
= 0.057). Importantly, patients in the MDCT group had a significantly higher hemoptysis-free early survival rate compared to those in the control group (96.1 vs 86.7%,
p
= 0.031).
Conclusions
Preprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries during BAE, and can improve the hemoptysis-free early survival rate, which could be recommended as a regular examination prior to BAE in patients with hemoptysis.
Key Points
• Preprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and NBSAs originating from subclavian and internal mammary arteries during BAE.
• Conducting MDCT angiography prior to BAE can improve hemoptysis-free early survival rate in hemoptysis patients.
OBJECTIVESThe aim of this study was to perform an objective and subjective image analysis of traditional and advanced noise-optimized virtual monoenergetic imaging (VMI) algorithms and standard ...linearly blended images in third-generation dual-source dual-energy computed tomography angiography (DE-CTA) of the thorax and abdomen.
MATERIALS AND METHODSThoracoabdominal DE-CTA examinations of 55 patients (36 male; mean age, 64.2 ± 12.7 years) were included in this retrospective institutional review board–approved study. Dual-energy computed tomography angiography data were reconstructed using standard linearly blended M_0.6 (merging 60% low kiloelectron volt 90 kV with 40% high kiloelectron volt 150 kV spectrum), traditional (VMI), and advanced VMI (VMI+) algorithms. Monoenergetic series were calculated ranging from 40 to 120 keV with 10 keV increments. Attenuation and standard deviation of 8 arteries and various anatomical landmarks of the thorax and abdomen were measured to calculate contrast-to-noise ratio values. Two radiologists subjectively assessed image quality, contrast conditions, noise, and visualization of small arterial branches using 5-point Likert scales.
RESULTSVascular attenuation of VMI and VMI+ series showed a gradual increase from high to low kiloelectron volt levels without significant differences between both algorithms (P < 0.894). VMI+ 40-keV series showed the highest contrast-to-noise ratio for both thoracic and abdominal DE-CTA (P < 0.001), albeit revealing higher noise than M_0.6 images (objectively and subjectively, P < 0.001) and were rated best for visualization of small arterial branches in the subjective analysis (P < 0.109). Substantially increased noise was found for VMI 40 and 50 keV series compared with all other reconstructions (objectively and subjectively, P < 0.001). VMI+ images at 100 keV+ were rated best regarding image noise (P < 0.843), whereas VMI+ reconstructions at 70 keV were found to have superior subjective image quality (P < 0.031) compared with other series except for 60 and 80 keV VMI+ series (P < 0.587). Contrast conditions at 50 keV VMI+ were rated superior compared with 60 to 100 keV VMI and VMI+ reconstructions (P < 0.012).
CONCLUSIONSGeneral image quality of DE-CTA examinations can be substantially improved using the VMI+ algorithm with observer preference of 70 keV, while 40 to 50 keV series provide superior contrast and improved visualization of small arterial branches compared with traditional VMI and standard linearly blended series.
The technical execution of root canal treatment procedures demands a thorough understanding and knowledge of root and canal anatomy. Over the decades, and with the aid of various research methods ...such as staining and clearing, 2D radiographic imaging, sectioning procedures, cone beam computed tomography and micro‐computed tomography, many laboratory and clinical studies have been undertaken to understand the root and canal anatomy of the human dentition. This has resulted in a tremendous increase in the body of knowledge with a wide range of qualitative and quantitative presentations of the root and canal anatomy. This review aims to provide a critical analysis for the laboratory and clinical research methods in root and canal anatomy studies. In addition, it aims to identify existing gaps and present insights for directions of future research and ways for translation to clinical endodontics.
PDF
