Abstract Background The clinical work-up of patients presenting with chest pain is a diagnostic challenge. We investigated the diagnostic performance of global (GLS) and territorial (TLS) ...longitudinal strain to predict coronary artery disease (CAD) in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but apparent normal global and regional systolic function. Methods 150 consecutive suspected NSTE-ACS patients were initially screened for inclusion ; 58 patients with normal LVEF (≥ 55%) and WMSI (= 1) were prospectively enrolled. Speckle-tracking echocardiography was performed on admission and all the patients underwent coronary angiography. CAD was defined as the presence of stenosis of > 50%. Results CAD was present in 33 patients (57%). LVEF was 60.7 ± 4.6% in group 1 (CAD) and 61.1 ± 5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (− 16.7 ± 3.4%) as compared to group 2 (− 22.4 ± 2.9%, p < 0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC = 0.92 0.84–1.00, p = 0.0001). TLS was able to discriminate between coronary stenosis in the LAD, LCX or RCA. Conclusions Longitudinal 2D strain has a good diagnostic value and can efficiently localize the culprit lesion in patients presenting with NSTE-ACS but apparent normal global and regional systolic function.
Acute myocarditis (AM) often involves the left ventricular (LV) subepicardium that might be displayed by cardiac magnetic resonance even late after the acute phase. In the absence of global or ...regional LV dysfunction, conventional transthoracic echocardiography (TTE) does not accurately identify tissue sequelae of AM. We sought to evaluate the diagnostic value of two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography to identify patients with a history of AM with preserved LV ejection fraction (LVEF).
Fifty patients (group 1: age, 31.4 ± 10.5 years; 76% males) with a history of cardiac magnetic resonance-confirmed diagnosis of AM (according to the Lake Louise criteria) were retrospectively identified and then (21.7 ± 23.4 months later) evaluated by complete echocardiography including 2D and 3D speckle-tracking analysis, as well as 50 age- and gender-matched healthy controls (group 2: age, 31.2 ± 9.5 years: 76% males). Patients with a history of severe clinical presentation of AM (sudden death, ventricular arrhythmia, heart failure, alteration of LVEF) were excluded.
At diagnosis, peak troponin and C-reactive protein were 11.97 (interquartile range, 4.52-25.92) μg/L and 32.3 (interquartile range, 14.85-70.45) mg/L, respectively. Mean delay between acute phase and follow-up study TTE was 21.7 ± 23.4 months. LVEF was not statistically different between groups (62.1% vs 63.5%, P = .099). Two-dimensional global longitudinal strain (GLS) was lower in magnitude in group 1 (-17.8% vs -22.1%, P < .0001) as were 2D layer-specific subepicardial GLS (-15.4% vs -19.7%, P < .0001) and subendocardial GLS (-20.71% vs -25.08%, P < .0001). Three-dimensional global longitudinal, circumferential, area, and radial strains were lower in magnitude in group 1 (-11.80% vs -14.98%, P < .0001; -12.57% vs -15.12%, P < .0001; -22.28% vs -25.87%, P < .0001; 31.47% vs 38.06%, P < .0001, respectively). Receiver operating characteristic curve analysis showed that subepicardial GLS displayed a better diagnostic performance to detect sequelae of AM as compared with GLS (area under the curve = 0.97 vs 0.93, P = .045).
In patients with a history of AM, a subtle LV dysfunction can be detected by 2D and 3D speckle-tracking echocardiography, even though LVEF is conserved, adding incremental information over conventional TTE.
Super-resolution deep-learning-based reconstruction: SR-DLR is a newly developed and clinically available deep-learning-based image reconstruction method that can improve the spatial resolution of CT ...images. The image quality of the output from non-linear image reconstructions, such as DLR, is known to vary depending on the structure of the object being scanned, and a simple phantom cannot explicitly evaluate the clinical performance of SR-DLR. This study aims to accurately investigate the quality of the images reconstructed by SR-DLR by utilizing a structured phantom that simulates the human anatomy in coronary CT angiography.
The structural phantom had ribs and vertebrae made of plaster, a left ventricle filled with dilute contrast medium, a coronary artery with simulated stenosis, and an implanted stent graft. By scanning the structured phantom, we evaluated noise and spatial resolution on the images reconstructed with SR-DLR and conventional reconstructions.
The spatial resolution of SR-DLR was higher than conventional reconstructions; the 10 % modulation transfer function of hybrid IR (HIR), DLR, and SR-DLR were 0.792-, 0.976-, and 1.379 cycle/mm, respectively. At the same time, image noise was lowest (HIR: 21.1-, DLR: 19.0-, and SR-DLR: 13.1 HU). SR-DLR could accurately assess coronary artery stenosis and the lumen of the implanted stent graft.
SR-DLR can obtain CT images with high spatial resolution and lower noise without special CT equipments, and will help diagnose coronary artery disease in CCTA and other CT examinations that require high spatial resolution.
Purpose
To determine the impact of the COVID-19 on the CT activities in French radiological centers during the epidemic peak.
Materials and methods
A cross-sectional prospective CT scan survey was ...conducted between March 16 and April 12, 2020, in accordance with the local IRB. Seven hundred nine radiology centers were invited to participate in a weekly online survey. Numbers of CT examinations related to COVID-19 including at least chest (CT
covid
) and whole chest CT scan activities (CT
chest
) were recorded each week. A sub-analysis on French departments was performed during the 4 weeks of the study. The impact of the number of RT-PCRs (reverse transcriptase polymerase chain reactions) on the CT workflow was tested using two-sample
t
test and Pearson’s test.
Results
Five hundred seventy-seven structures finally registered (78%) with mean response numbers of 336 ± 18.9 (323; 351). Mean CT
chest
activity per radiologic structure ranged from 75.8 ± 133 (0–1444) on week 12 to 99.3 ± 138.6 (0–1147) on week 13. Mean ratio of CT
covid
on CT
chest
varied from 0.36 to 0.59 on week 12 and week 14 respectively. There was a significant relationship between the number of RT-PCR performed and the number of CT
covid
(
r
= 0.73,
p
= 3.10
−16
) but no link with the number of positive RT-PCR results.
Conclusion
In case of local high density COVID-19, CT workflow is strongly modified and redirected to the management of these specific patients.
Key Points
• Over the 4-week survey period, 117,686 chest CT (CT
total
) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CT
covid
).
• Across the country, the ratio CT
covid
/CT
total
varied from 0.36 to 0.59 and depended significantly on the local epidemic density (p = 0.003).
• In clinical practice, in a context of growing epidemic, in France, chest CT was used as a surrogate to RT-PCR for patient triage.
Aims
To prospectively evaluate the performance of a last generation magnetic resonance imaging (MRI) device with tractography to identify the normal female urethral sphincters in terms of morphology ...and quantification on a large cohort of continent women.
Methods
We have recorded the data of 75 continent women who underwent a diffusion tensor imaging (DTI) sequence with fiber tractography during a pelvic MR examination. Three groups of age were analyzed in terms of color fiber tracking quality and quantitative parameters (fractional anisotropy FA and mean diffusibility MD). Statistical analysis was done for the qualitative assessment using weighted kappa statistics of Cohen and for the quantitative parameters using a non‐parametric Kruskal–Wallis test.
Results
For all cases, fiber‐tracking resulted in a satisfactory representation of the complexity of the orientation of the fibers. The interobserver concordance of qualitative data was substantial, calculated at 0.78 (confidence interval: 0.71–0.85). For FA, there was no statistically significant difference with the age between the three urethral segments (p > 0.05). However, we registered a significant difference inside each group between the different segments (p < 0.05), corresponding to different orientation of fibers. For MD, we have found a statistically significant difference both between levels inside each group and according the age, meaning a variation of the water mobility for each type of musculature and with age (p < 0.05).
Conclusion
DTI with fiber tractography performed on a recent MR unit is a robust method for the three‐dimensional visualization of the details and connections of the urethral female sphincters. Quantitative variations with age need to be considered.
Abstract Background At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and ...electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED. Methods This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED. Results Of the 280 patients included, 141 didn’t have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% 95%CI: 98.2 – 100. Sensitivity and specificity were 98.4% 95%CI: 83.8 – 100 and 53% 95%CI: 47 – 58.9, respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group. Conclusions A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone.
This is the first study to show a stepwise increase in venous thrombotic events according to COVID-19 coagulopathy (COVID-19-associated hemostatic abnormalities CAHA) staging and lung injuries ...assessed by chest computed tomography. Excess mortality and/or transfer to intensive care unit according to CAHA staging.
To evaluate the diagnostic performance of Ultra-Low-Dose Chest CT (ULD CT) for the detection of any asbestos-related lesions (primary endpoint) and specific asbestos-related abnormalities, i.e. ...non-calcified and calcified pleural plaques, diffuse pleural thickening, asbestosis and significant lung nodules (secondary endpoints).
55 male patients (55.7±8.1 years old) with occupational asbestos exposure for at least 15 years and where CT screening was indicated were prospectively included. They all underwent a standard unenhanced chest CT (120kV, automated tube current modulation), considered as the reference, and an ULD CT (135kV, 10mA), both with iterative reconstruction. Two chest radiologists independently and blindly read the examinations, following a detailed protocol. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and error rate of ULD CT were calculated using the exact method of Pearson with a confidence interval of 95%.
Radiation dose was 17.9±1.2mGy.cm (0.25mSv) for the ULD-CT versus 288.8 ±151mGy.cm (4mSv); p <2.2e-16. Prevalence of abnormalities was 20%. The ULD CT's diagnostic performance in joint reading was high for the primary endpoint (sensitivity = 90.9%, specificity = 100%, positive predictive value = 100%, negative predictive value = 97.8%), high for lung nodules, diffuse pleural thickening and calcified pleural plaques (sensitivity, specificity, PPV and NPV = 100%) and fair for asbestosis (sensitivity = 75%, specificity = 100%, PPV = 00%, NPV = 98.1%). Intra-reader accuracy between the ULD CT and the reference CT for the primary endpoint was 98% for the senior and 100% for the junior radiologist. Inter-reader agreement for the primary endpoint was almost perfect (Cohen's Kappa of 0.81).
ULD CT in the screening of asbestos exposure related diseases has 90.9% sensitivity and 100% specificity, and could therefore be proposed as a first line examination.
PDF
