The Role of Coronary Ct Angiography in Suspected
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Cardiac CT - Quantitative Evaluation of Coronary Calcification
Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Imaging of the Heart Effective Date: January 1, 2018 Proprietary Date of Origin: 03/30/2005 Last revised: 11/14/2017 Last reviewed: 11/14/2017 8600 W Bryn Mawr Avenue South Tower - Suite 800 Chicago, IL 60631 P. 773.864.4600 Copyright © 2018. AIM Specialty Health. All Rights Reserved www.aimspecialtyhealth.com Table of Contents Description and Application of the Guidelines ........................................................................3 Administrative Guidelines ........................................................................................................4 Ordering of Multiple Studies ...................................................................................................................................4 Pre-test Requirements ...........................................................................................................................................5 Cardiac Imaging ........................................................................................................................6 Myocardial Perfusion Imaging ................................................................................................................................6 Cardiac Blood Pool Imaging .................................................................................................................................12 Infarct Imaging .....................................................................................................................................................15 -
Nuclear Cardiology
1 XA9847621 Chapter 24 NUCLEAR CARDIOLOGY A. Cuardn Introduction. The assessment of cardiovascular performance with radionuclides dates back to 1927, when Blumgart and Weiss conducted the first clinical studies using a natural bismuth radioisotope 214Bi, in that time known as "Radium C". They injected a solution of this radionuclide into the vein of one arm and detected with a cloud chamber the appearance of its highly penetrating gamma rays in the contralateral arm. Their aim was to study the "velocity of the blood". In these pioneering studies, the mean normal arm-to-arm circulation time proved to be 18 sec., but it was found to be prolonged in patients with heart disease. Subsequently, they were able to calculate the pulmonary circulation time and the pulmonary blood volume by using a forerunner of the Geiger counter with platinum needle electrodes over the right atrium and the left elbow, and to study the effects on them of various heart and lung lesions, thyroid disorders, anaemia, polycythaemia, and drugs. Such classical studies, while appearing crude by today's technology, illustrate that minds and methods were fully prepared to exploit the eventual appearance of the artificial radioisotopes of elements of a more physiological character than bismuth, and laid the foundation for the established techniques of present day nuclear medicine. Although these studies on cardiovascular physiology were the first ever performed in humans with the aid of the radiotracer principle, the cardiologist had to wait for the accumulation of decades of research and development in the fields of radiochemistry, radiopharmacy and instrumentation before being able to capitalize this new approach for the non-invasive investigation of cardiac functions. -
Assessment of the Coronary Artery in High-Pitch, Dual-Source CT
CARDIAC IMAGING Iran J Radiol. 2017 July; 14(3):e22024. doi: 10.5812/iranjradiol.22024. Published online 2017 July 1. Research Article Assessment of the Coronary Artery in High-Pitch, Dual-Source CT Aortography Without ECG Synchronization Hyeong Gi Choi,1 Mi Jung Park,1,* Ho Cheol Choi,1 Hye Young Choi,1 Hwa Seon Shin,1 Jae Boem Na,1 Jae Min Cho,1 and Dae Seob Choi1 1Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Chilam-Dong, Jinju City, Gyeongnam-Do, Republic of Korea *Corresponding author: Mi Jung Park, MD, Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, 90, Chilam-Dong, Jinju, Gyeongnam-Do, Republic of Korea. Tel: +82-557508814, Fax: +82-557581568, E-mail: [email protected] Received 2016 December 22; Revised 2017 March 17; Accepted 2017 April 01. Abstract Background: The high pitch, dual source computed tomography (CT) provides motion-free aortic imaging. Objectives: To evaluate the image quality of coronary artery using dual-source CT aortography without electrocardiogram (ECG) synchronization. Patients and Methods: One hundred fifty patients (87 men; mean age; 63.7 ± 13.0 years, mean heart rate; 64.7 ± 6.6 beats/min) with suspected or known aortic disease underwent non-ECG gated, high-pitch, dual-source CT aortography. No beta blocker or ni- troglycerin was administered for the patients. The image quality of each coronary artery segment and its ostium was graded on a three-point scale (excellent, moderate, and non-diagnostic image quality). Results: Most patients (88.7%) showed diagnostic image quality in the ostia of the left main and right coronary artery. -
Prevalence of Coronary Artery Disease Evaluated by Coronary CT Angiography in Women with Mammographically Detected Breast Arterial Calcifications
RESEARCH ARTICLE Prevalence of Coronary Artery Disease Evaluated by Coronary CT Angiography in Women with Mammographically Detected Breast Arterial Calcifications Leila Mostafavi1*, Wanda Marfori2, Cesar Arellano1, Alessia Tognolini1, William Speier3, Ali Adibi1, Stefan G. Ruehm1 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America, 2 Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States of America, 3 Medical Imaging Informatics, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States of America * [email protected] Abstract To assess the correlation between breast arterial calcifications (BAC) on digital mammogra- OPEN ACCESS phy and the extent of coronary artery disease (CAD) diagnosed with dual source coronary Citation: Mostafavi L, Marfori W, Arellano C, computed tomography angiography (CTA) in a population of women both symptomatic and Tognolini A, Speier W, Adibi A, et al. (2015) asymptomatic for coronary artery disease. 100 consecutive women (aged 34 – 86 years) Prevalence of Coronary Artery Disease Evaluated by who underwent both coronary CTA and digital mammography were included in the study. Coronary CT Angiography in Women with Mammographically Detected Breast Arterial Health records were reviewed to determine the presence of cardiovascular risk factors such Calcifications. PLoS ONE 10(4): e0122289. as hypertension, hyperlipidemia, diabetes mellitus, and smoking. Digital mammograms doi:10.1371/journal.pone.0122289 were reviewed for the presence and degree of BAC, graded in terms of severity and extent. Academic Editor: Barry I Hudson, University of Coronary CTAs were reviewed for CAD, graded based on the extent of calcified and non- Miami, UNITED STATES calcified plaque, and the degree of major vessel stenosis. -
ACR Manual on Contrast Media
ACR Manual On Contrast Media 2021 ACR Committee on Drugs and Contrast Media Preface 2 ACR Manual on Contrast Media 2021 ACR Committee on Drugs and Contrast Media © Copyright 2021 American College of Radiology ISBN: 978-1-55903-012-0 TABLE OF CONTENTS Topic Page 1. Preface 1 2. Version History 2 3. Introduction 4 4. Patient Selection and Preparation Strategies Before Contrast 5 Medium Administration 5. Fasting Prior to Intravascular Contrast Media Administration 14 6. Safe Injection of Contrast Media 15 7. Extravasation of Contrast Media 18 8. Allergic-Like And Physiologic Reactions to Intravascular 22 Iodinated Contrast Media 9. Contrast Media Warming 29 10. Contrast-Associated Acute Kidney Injury and Contrast 33 Induced Acute Kidney Injury in Adults 11. Metformin 45 12. Contrast Media in Children 48 13. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 14. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents 15. Adverse Reactions To Gadolinium-Based Contrast Media 79 16. Nephrogenic Systemic Fibrosis (NSF) 83 17. Ultrasound Contrast Media 92 18. Treatment of Contrast Reactions 95 19. Administration of Contrast Media to Pregnant or Potentially 97 Pregnant Patients 20. Administration of Contrast Media to Women Who are Breast- 101 Feeding Table 1 – Categories Of Acute Reactions 103 Table 2 – Treatment Of Acute Reactions To Contrast Media In 105 Children Table 3 – Management Of Acute Reactions To Contrast Media In 114 Adults Table 4 – Equipment For Contrast Reaction Kits In Radiology 122 Appendix A – Contrast Media Specifications 124 PREFACE This edition of the ACR Manual on Contrast Media replaces all earlier editions. -
Contrast Echocardiography
4MEDICAL REVIEW Contrast Echocardiography Mark A. Friedman Echocardiography Laboratory Barnes-Jewish Hospital Washington University School of Medicine St. Louis, MO 53110 ABSTRACT CONTRAST AGENTS Ultrasound contrast agents are widely used in clinical The ability to opacify vascular structures on echocardio- practice for left ventricle opacification in sub-optimal grams by injecting agitated saline solution has been well echocardiograms. Recently, significant research has recognized for more than thirty years (Gramiak and Shah, focused on the use of contrast echocardiography as a 1968). Early contrast agents were produced by manually non-invasive means to evaluate myocardial perfusion. agitating solutions such as saline, yielding bubbles that Advances in contrast agents as well as ultrasound tech- provided brief ultrasound contrast by scattering the nology have enabled investigations into myocardial con- incoming ultrasound energy before dissolving rapidly in trast echocardiography as a possible alternative to blood. These hand-agitated intravenous solutions have nuclear imaging studies. This review will focus on the been shown to be safe and are still used clinically to pro- development and current uses of contrast echocardiog- vide brief contrast during echocardiograms for evaluating raphy, as well as future indications, including myocardial cardiac shunts and patent foramen ovale (Bommer et al., perfusion and risk stratification following myocardial 1984). Hand-agitated intravenous solutions, however, infarction. cannot be used to evaluate left-sided cardiac chambers because the bubbles have neither a small enough size nor the stability to cross the pulmonary vasculature. (Table 1) INTRODUCTION Echocardiography has become a standard tool in the TABLE 1 PROPERTIES OF AN IDEAL ECHOCARDIOGRAPHIC CONTRAST AGENT evaluation and diagnosis of a wide range of cardiac con- ditions. -
2012-Nia-Clinical-Guidelines-Avmed
2012 NIA Standard Clincal Guidelines AvMed Guidelines for Clinical Review Determination Preamble NIA is committed to the philosophy of supporting safe and effective treatment for patients. The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging. These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient‘s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice will be used when applying the guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based on unique aspects of the patient‘s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient. Guideline Development Process These medical necessity criteria were developed by NIA for the purpose of making clinical review determinations for requests for diagnostic tests. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, and cardiology. They were developed following a literature search pertaining to established clinical guidelines and accepted diagnostic imaging practices. All inquiries should be directed to: National Imaging Associates, Inc. 6950 Columbia Gateway Drive Columbia, MD 21046 Attn: NIA Associate Chief Medical Officer 2011 National -
Cardiac PET and PET/CT Imaging
Cardiac PET and PET/CT Imaging M. F. Di Carli and M. J. Lipton, eds. New York, NY: Springer, 2007, 466 pages, $149 Cardiac PET and PET/CT Imaging is a comprehensive, therapy. Chapters 17, 18, and 21 are a must-read for clini- informative, up-to-date, state-of-the-art textbook on newer cal PET, whereas chapters 23 through 26 are informative cardiac imaging technologies and also provides valuable and useful regarding ongoing research and will help one insight into the future of cardiac imaging. The book has 6 keep up with future developments in this evolving field. parts; the first 5 parts or sections are subdivided into several Part 6 comprises multiple case presentations with good chapters that cover a wide spectrum of presently available illustrations and good explanations of image findings, and newer cardiac imaging modalities and future research goals. many are supported with additional relevant correlations or The first 3 parts progress in a systematic and orderly manner, follow-up findings. There are 18 diverse illustrative cases, starting with the basics of PET instrumentation, the princi- including normal study findings, misregistration and atten- ples of PET, PET tracers and radiopharmaceuticals, CT uation correction artifacts, incidental findings, abnormal cardiac anatomy, iodinated contrast agents, radiation safety, high-risk PET/CT scans, myocardial viability, integrated patient preparation, stress protocols, PET and PET/CT pro- myocardial perfusion with assessment of coronary artery tocols, myocardial PET interpretation, and PET quantifica- calcium score, left ventricular function assessment, and CT tion for assessing preclinical coronary artery disease. The coronary angiography. The writing is clear and understand- relative merits of coronary CT angiography and MRI along able; even difficult topics such as physics, radiochemistry, with integrated assessment of myocardial perfusion using and biochemistry are well presented and are understandable coronary angiography and PET/CT for diagnosing and man- with concentrated reading. -
Variation in Outcomes Among 24/7 Percutaneous Coronary Intervention Centres For
Title: Variation in Outcomes Among 24/7 Percutaneous Coronary Intervention Centres for Patients Resuscitated from Out-of-Hospital Cardiac Arrest. Authors: Bryn E. Mumma, MD, MAS1; Machelle D. Wilson, PhD2; María F. García-Pintos, MD1; Pablo J. Erramouspe, MD1 Daniel J. Tancredi, PhD3 Author Affiliations: Departments of 1Emergency Medicine, 2Public Health Sciences, and 3Pediatrics, University of California Davis, Sacramento, CA. Address for Correspondence: Bryn E. Mumma, MD, MAS 4150 V Street, PSSB #2100 Sacramento, CA 95817 Fax: 916-734-7950 Email: [email protected] Phone: 916-734-5010 Running Title: Variation in OHCA Outcomes Source of support: The project described was supported by the National Heart, Lung, and Blood Institute (NHLBI) through grant #5K08HL130546. Word count abstract: 250 Word count paper: 2,409 Number of figures and tables: 5 Conflict of Interest declaration: The authors have no conflicts of interest to disclose. All authors have reviewed and approved the final manuscript. ABSTRACT Background: Patients treated at 24/7 percutaneous coronary intervention (PCI) centres following out-of-hospital cardiac arrest (OHCA) have better outcomes than those treated at non-24/7 PCI centres. However, variation in outcomes between 24/7 PCI centres is not well studied. Objectives: To evaluate variation in outcomes among 24/7 PCI centres and to assess stability of 24/7 PCI centre performance. Methods: Adult patients in the California Office of Statewide Health Planning and Development Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest admitted to a 24/7 PCI centre from 2011 to 2015 were included. Primary outcome was good neurologic recovery at hospital discharge. -
Real-Time Magnetic Resonance Imaging-Guided Coronary Catheterization in Swine
Real-Time Magnetic Resonance Imaging-Guided Coronary Catheterization in Swine R. A. Omary1, J. D. Green1, B. Schirf1, Y. Li1, J. Carr1, J. P. Finn1, D. Li1 1Northwestern University, Chicago, IL, United States Synopsis: In 11 swine, we performed real-time MRI-guided left coronary artery catheterization from a percutaneous femoral artery approach. A 0.30-inch diameter active guidewire was coaxially inserted within 6 or 7-French Judkins left coronary catheters. The catheter was filled with 4% contrast agent and tracked using an inversion-recovery-prepared spoiled gradient echo sequence at 7 frames/s. The guidewire was tracked using steady-state precession imaging at 9 frames/s. Selective MR coronary angiography with injections of dilute contrast agent was used to verify catheter positioning. Left coronary artery catheterization under MRI guidance was successful in 11/11 pigs (100%). Introduction: Catheter-based coronary MR angiography is feasible using dilute contrast agent injections (1). The coronary catheterization for these injections has been performed under x-ray (1) or MRI (2) guidance, using surgical carotid artery access. The surgical carotid approach is less technically demanding than the percutaneous femoral artery approach because of the more direct and shorter route to the coronary ostium. An active internal guidewire used in conjunction with a contrast agent-filled catheter is one technique (3) to improve signal detection of endovascular devices, which in turn can be used to improve the spatial and temporal resolution of endovascular device tracking. Using this technique, we tested the hypothesis that MRI can guide coronary artery catheterization in swine via a percutaneous femoral artery approach. -
Corrected Coronary Opacification Decrease from Coronary Computed
ORIGINAL ARTICLE Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography Dominik C. Benz, MD,a Christoph Gra¨ni, MD,a Paola Ferro, MD,a Luis Neumeier,a Michael Messerli, MD,a Mathias Possner, MD,a Olivier F. Clerc, MD,a Catherine Gebhard, MD,a Oliver Gaemperli, MD,a Aju P. Pazhenkottil, MD,a Philipp A. Kaufmann, MD,a and Ronny R. Buechel, MDa a Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland Received Mar 25, 2017; accepted Jun 7, 2017 doi:10.1007/s12350-017-0980-2 Background. To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI). Methods and Results. This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively. Conclusions. CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. -
American College of Radiology – Practice Parameter for Cardiac CT
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 45)* ACR–NASCI–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF CARDIAC COMPUTED TOMOGRAPHY (CT) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.