Guideline for Appropriate Use of Cardiac CT in Heart Disease
01 Feb 2014-Journal of the Korean Society of Radiology (The Korean Society of Radiology)-Vol. 70, Iss: 2, pp 93-109
TL;DR: This work intends to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases in Korea.
Abstract: This work is supported by a Grant from National Strategic Coordiating Center for Clinical Research, Republic of Korea (A102065). Heart disease is one of the leading causes of deaths in Korea, along with malignant neoplasms and cerebrovascular diseases. The proper diagnosis and management for patients with suspected heart diseases should be warranted for the public health care. Advances in CT technology have allowed detailed images of the heart to be obtained, which enable evaluations not only of the coronary arteries but also of other cardiac structures. Currently, the latest multi-detector CT machines are widespread around Korea. The appropriate use of cardiac CT may lead to improvements of the physicians’ medical performances and to reduce medical costs which eventually contribute to promotions of public health. However, until now, there has been no guidelines regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases.
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01 Jan 2011
TL;DR: In this paper, a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke was evaluated.
Abstract: Background and Purpose—A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. Methods—We studied 83 consecutive patients with stroke (56 men and 27 women; mean age, 62.6 years) who had high risk factors for thrombus formation and had undergone both dual-source CT and transesophageal echocardiography within a 3-day period. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Results—Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined...
94 citations
TL;DR: The methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency is summarized.
Abstract: This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.
29 citations
Cites background from "Guideline for Appropriate Use of Ca..."
...In Korea, the need for radiological guidelines led to the development of ‘the CT Examination and Repeat CT Examination Guideline’ by collaboration of Health Insurance Review & Assessment Service and Korean Society of Radiology (KSR) (9), ‘the Guideline for Diagnosis and Management of Hepatocellular Carcinoma’ by Korean Liver Cancer Study Group (10), ‘the Guideline for Ultrasonographic Diagnosis and Image-Based Management of Thyroid Nodules’ by Korean Society of Thyroid Radiology (11), ‘Korean Guideline for Interventional Recanalization of Lower Extremity Arteries’ by collaboration of multi-disciplinary societies including Korean Society of Interventional Radiology (12), and ‘the Guidelines for Appropriate Use of Cardiac CT in Heart Disease’ by the KSR, Korean Society of Cardiology, and National Strategic Coordinating Center of Clinical Research (13, 14)....
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TL;DR: The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.
Abstract: Objective To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. Materials and methods We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. Results For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. Conclusion The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.
13 citations
Cites background from "Guideline for Appropriate Use of Ca..."
...CCTA is not usually recommended in patients with coronary stents because of the high nondiagnostic rates (29, 30)....
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TL;DR: It is found that Wide Coverage Volume Axial Mode is an useful method through improving video quality and reducing exposure doses to patients than using High Pitch Mode from ASiR-V, which is low-dose technology.
Abstract: We are trying to evaluate usefulness of Wide Coverage Volume Axial Mode by comparing and analyzing for exposure doses to patients and video quality extracted from two materials. First material is a computer tomography scanning of paediatric cardiac made by using High Pitch Mode, which is designed for diagnosing Congenital cardiac diseases. Second material is computer tomography scanning of paediatric cardiac made by using Wide Coverage Volume Axial Mode. When we did computer tomography scanning of paediatric cardiac, we used High Pitch Mode and Wide Coverage Volume Axial Mode to 50 patients of each, overall 100 patients. Also, we compared exposure doses to patients using videos got from each protocol. Then we compared video quality by calculating SNR and CNR by setting ROI of each. Not only exposure doses to patients were reduced by 13.07 %, but also SNR and CNR were improved when testing used Wide Coverage Volume Axial Mode rather than using High Pitch Mode. Wide Coverage Volume Axial Mode reduced testing time by using high-speed scanner. Furthermore, we can find out that Wide Coverage Volume Axial Mode is an useful method through improving video quality and reducing exposure doses to patients than using High Pitch Mode from ASiR-V, which is low-dose technology.
1 citations
TL;DR: This dissertation aims to provide a history of modern neurosurgery in South Korea with a focus on the role of prolapse and prolapse preoperatively and during the post-operative period.
Abstract: Dongbeom Song, MD, Young Dae Kim, MD, Keun-Sik Hong, MD, Byung-Woo Yoon, MD, Byung-Chul Lee, MD, Joung-Ho Rha, MD, Sun-Uck Kwon, MD, Hee-Joon Bae, MD, Kyung-Ho Yu, MD, Jong-Moo Park, MD, Kwang-Yeol Park, MD, Sang-Bae Ko, MD, Chang Wan Oh, MD, Jeong Eun Kim, MD, Ji Hoe Heo, MD Department of Neurology, Yonsei University College of Medicine, Seoul, Korea Department of Neurology, Inje University College of Medicine, Goyang, Korea Department of Neurology, Seoul National University College of Medicine, Seoul, Korea Department of Neurology, Hallym University College of Medicine, Anyang, Korea Department of Neurology, Inha University College of Medicine, Incheon, Korea Department of Neurology, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Eulji University College of Medicine Seoul, Korea Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
1 citations
Additional excerpts
...으로 한 무증상관상동맥질환 선별검사의 유용성에 대해 기술하고 있는 진료지침으로, 미국의 ACCF Appropriate Use Criteria Task Force에서 각종 관상동맥질환 선별검사들의 적응증에 대해 정리하 여 소개하고 있으며,(36-38) 국내에서는 대한영상의학과에서 대한심장 학회와 함께 작성한 심장질환에서 심장CT의 사용에 관한 권고안 이 있다.(39) 2006년에 발표된 심장CT검사에 관한 ACCF Appropriate Use Criteria Task Force 임상진료지침에서는 무증상 고위험군(FRS ≥ 20%)에서 심장CT검사의 유용성은 아직 명확하지 않은 것으로 기 술하였다....
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...하지만, 2010년에 발표된 국내 임상진료지침에서는 무증상 고위험군의 심장CT검사를 근거수준은 낮지만(근거수준, C) 적절한 것으로(권고등급, A) 권고하고 있다.(39) 이들 두 임상진...
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References
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University of California, Irvine1, Saint Francis University2, Wake Forest University3, National Institutes of Health4, University of Minnesota5, Northwestern University6, Columbia University7, Johns Hopkins University8, Carney Hospital9, University of Vermont10, University of California, Los Angeles11, University of Washington12
TL;DR: The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States.
Abstract: BACKGROUND In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups. METHODS We collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years. RESULTS There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors. CONCLUSIONS The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected.
2,547 citations
TL;DR: WRITING COMMITTEE MEMBERS Lee A. Fleisher, MD, FACC, FAHA, Chair; Joshua A. Beckman,MD, F ACC¶; Kenneth A. Kasper, MD; Judy R. Kersten,MD; Barbara Riegel, DNSc, RN,FAHA.
1,393 citations
TL;DR: This large observational data series shows that CAC provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.
1,270 citations
TL;DR: It is concluded that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.
Abstract: Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events Methods We searched online databases (eg, PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients In this cohort, 146 of 25,903 patients without CAC (056%) had a cardiovascular event during a mean follow-up period of 51 months In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 180% of patients without CAC had a cardiovascular event Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group
602 citations
TL;DR: In this article, the authors analyzed multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortal regurgitation following transcatheter aortric valve replacement (TAVR).
371 citations