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35 results on '"Muscogiuri G."'

1. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE–ICM International Registry

Author

Pontone, G, Guaricci, A, Fusini, L, Baggiano, A, Guglielmo, M, Muscogiuri, G, Volpe, A, Abete, R, Aquaro, G, Barison, A, Bogaert, J, Camastra, G, Carigi, S, Carrabba, N, Casavecchia, G, Censi, S, Cicala, G, De Cecco, C, De Lazzari, M, Di Giovine, G, Di Roma, M, Dobrovie, M, Focardi, M, Gaibazzi, N, Gismondi, A, Gravina, M, Lanzillo, C, Lombardi, M, Lorenzoni, V, Lozano-Torres, J, Martini, C, Marzo, F, Masi, A, Memeo, R, Moro, C, Nese, A, Palumbo, A, Pavon, A, Pedrotti, P, Marra, M, Pica, S, Pradella, S, Presicci, C, Rabbat, M, Raineri, C, Rodriguez-Palomares, J, Sbarbati, S, Schoepf, U, Squeri, A, Sverzellati, N, Symons, R, Tat, E, Timpani, M, Todiere, G, Valentini, A, Varga-Szemes, A, Masci, P, Schwitter, J, Pontone G., Guaricci A. I., Fusini L., Baggiano A., Guglielmo M., Muscogiuri G., Volpe A., Abete R., Aquaro G., Barison A., Bogaert J., Camastra G., Carigi S., Carrabba N., Casavecchia G., Censi S., Cicala G., De Cecco C. N., De Lazzari M., Di Giovine G., Di Roma M., Dobrovie M., Focardi M., Gaibazzi N., Gismondi A., Gravina M., Lanzillo C., Lombardi M., Lorenzoni V., Lozano-Torres J., Martini C., Marzo F., Masi A., Memeo R., Moro C., Nese A., Palumbo A., Pavon A. G., Pedrotti P., Marra M. P., Pica S., Pradella S., Presicci C., Rabbat M. G., Raineri C., Rodriguez-Palomares J. F., Sbarbati S., Schoepf U. J., Squeri A., Sverzellati N., Symons R., Tat E., Timpani M., Todiere G., Valentini A., Varga-Szemes A., Masci P. -G., Schwitter J., Pontone, G, Guaricci, A, Fusini, L, Baggiano, A, Guglielmo, M, Muscogiuri, G, Volpe, A, Abete, R, Aquaro, G, Barison, A, Bogaert, J, Camastra, G, Carigi, S, Carrabba, N, Casavecchia, G, Censi, S, Cicala, G, De Cecco, C, De Lazzari, M, Di Giovine, G, Di Roma, M, Dobrovie, M, Focardi, M, Gaibazzi, N, Gismondi, A, Gravina, M, Lanzillo, C, Lombardi, M, Lorenzoni, V, Lozano-Torres, J, Martini, C, Marzo, F, Masi, A, Memeo, R, Moro, C, Nese, A, Palumbo, A, Pavon, A, Pedrotti, P, Marra, M, Pica, S, Pradella, S, Presicci, C, Rabbat, M, Raineri, C, Rodriguez-Palomares, J, Sbarbati, S, Schoepf, U, Squeri, A, Sverzellati, N, Symons, R, Tat, E, Timpani, M, Todiere, G, Valentini, A, Varga-Szemes, A, Masci, P, Schwitter, J, Pontone G., Guaricci A. I., Fusini L., Baggiano A., Guglielmo M., Muscogiuri G., Volpe A., Abete R., Aquaro G., Barison A., Bogaert J., Camastra G., Carigi S., Carrabba N., Casavecchia G., Censi S., Cicala G., De Cecco C. N., De Lazzari M., Di Giovine G., Di Roma M., Dobrovie M., Focardi M., Gaibazzi N., Gismondi A., Gravina M., Lanzillo C., Lombardi M., Lorenzoni V., Lozano-Torres J., Martini C., Marzo F., Masi A., Memeo R., Moro C., Nese A., Palumbo A., Pavon A. G., Pedrotti P., Marra M. P., Pica S., Pradella S., Presicci C., Rabbat M. G., Raineri C., Rodriguez-Palomares J. F., Sbarbati S., Schoepf U. J., Squeri A., Sverzellati N., Symons R., Tat E., Timpani M., Todiere G., Valentini A., Varga-Szemes A., Masci P. -G., and Schwitter J.

Abstract

Background: Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. Objectives: The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. Methods: A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. Results: During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). Conclusions: The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.

Published
2023

2. Preoperative Ozaki technique measures on tridimensional engineered root

Author

Pirola, S, Mastroiacovo, G, Mostardini, G, Bonomi, A, Guglielmo, M, Muscogiuri, G, Baggiano, A, Montisci, A, Pontone, G, Polvani, G, Pirola S, Mastroiacovo G, Mostardini G, Bonomi A, Guglielmo M, Muscogiuri G, Baggiano A, Montisci A, Pontone G, Polvani G., Pirola, S, Mastroiacovo, G, Mostardini, G, Bonomi, A, Guglielmo, M, Muscogiuri, G, Baggiano, A, Montisci, A, Pontone, G, Polvani, G, Pirola S, Mastroiacovo G, Mostardini G, Bonomi A, Guglielmo M, Muscogiuri G, Baggiano A, Montisci A, Pontone G, and Polvani G.

Abstract

Background: The aortic valve neocuspidalization (AVNeo) is an innovative surgical technique aiming at the reconstruction of the aortic valve using autologous pericardium. One of the main criticisms to AVNeo is the longer duration of the aortic clamping time (ACT) as compared to standard aortic valve replacement due to the sizing of the valve neocusps. Methods: We retrospectively enrolled 30 consecutives patients underwent AVNeo. For each patient we developed a 3D aortic root model (ARM) based on CT-scan datasets. We retrospectively compared the leaflets measurements performed during surgery with those obtained on the corresponding ARMs. Results: In 100% of cases no difference between the in vitro and in vivo measurements exceeded the acceptable error limit of 2 ​mm. The correlation of each single in vitro versus in vivo measurements demonstrates a strong coincidence between the two different methods of sizing (r ​> ​0,9, p ​< ​.0001). By analyzing the data considering the annulus perimeter and not the single cusp size, the perfect coincidence was to be found in 89.9% with a slight acceptable discrepancy (2 ​mm on total) in the remaining 10.1%. Conclusions: 3D-ARMs, printed from CT-scan, represent a reproducible process to obtain overlapping cusp sizes compared to those measured in-vivo, possibly reducing the ACT.

Published
2022

3. State of the art paper: Cardiovascular CT for planning ventricular tachycardia ablation procedures

Author

Conte, E, Mushtaq, S, Carbucicchio, C, Piperno, G, Catto, V, Mancini, M, Formenti, A, Annoni, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Belmonte, M, Cattani, F, Pontone, G, Jereczek-Fossa, B, Orecchia, R, Tondo, C, Andreini, D, Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, Andreini D., Conte, E, Mushtaq, S, Carbucicchio, C, Piperno, G, Catto, V, Mancini, M, Formenti, A, Annoni, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Belmonte, M, Cattani, F, Pontone, G, Jereczek-Fossa, B, Orecchia, R, Tondo, C, Andreini, D, Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, and Andreini D.

Abstract

In the last 20 years coronary computed tomography angiography (CCTA) gained a pivotal role in the evaluation of patients with suspected coronary artery disease (CAD) as finally recognized by the ESC guidelines on stable CAD. Technological advances have progressively improved the temporal resolution of CT scanners, contemporary reducing acquisition time, radiation dose and contrast volume needed for the whole heart volume acquisition, further expanding the role of cardiac CT beyond coronary anatomy evaluation. Aim of the present review is to discuss use and benefit of cardiac CT for the planning and preparation of VT ablation.

Published
2021

4. Role of computed tomography in COVID-19

Author

Pontone, G, Scafuri, S, Mancini, M, Agalbato, C, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Gennari, A, Guaricci, A, Rabbat, M, Pompilio, G, Pepi, M, Rossi, A, Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Gennari AG, Guaricci AI, Rabbat MR, Pompilio G, Pepi M, Rossi A, Pontone, G, Scafuri, S, Mancini, M, Agalbato, C, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Gennari, A, Guaricci, A, Rabbat, M, Pompilio, G, Pepi, M, Rossi, A, Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Gennari AG, Guaricci AI, Rabbat MR, Pompilio G, Pepi M, and Rossi A

Abstract

Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.

Published
2021

5. Current evidence on the diagnostic and prognostic role of native T1 mapping in heart diseases

Author

Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, Pontone G., Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, and Pontone G.

Abstract

Tissue characterization represents a prerogative of cardiac magnetic resonance. Beside late gadolinium enhancement, native T1 mapping (nT1m) reveals tissue composition. It could represent a useful tool for example when contrast medium can't be administrated. The present review summarises current evidence about nT1m in main heart diseases.

Published
2021

6. Interpretability of Coronary CT Angiography Performed With a Novel Whole-Heart Coverage High-Definition CT Scanner in 300 Consecutive Patients With Coronary Artery Bypass Grafts

Author

Mushtaq, S, Conte, E, Pontone, G, Pompilio, G, Guglielmo, M, Annoni, A, Baggiano, A, Formenti, A, Mancini, M, Muscogiuri, G, Nicoli, F, Giannitto, C, Magatelli, M, Tanzilli, A, Consiglio, E, Fiorentini, C, Bartorelli, A, Pirillo, S, Pepi, M, Andreini, D, Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, Andreini D, Mushtaq, S, Conte, E, Pontone, G, Pompilio, G, Guglielmo, M, Annoni, A, Baggiano, A, Formenti, A, Mancini, M, Muscogiuri, G, Nicoli, F, Giannitto, C, Magatelli, M, Tanzilli, A, Consiglio, E, Fiorentini, C, Bartorelli, A, Pirillo, S, Pepi, M, Andreini, D, Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, and Andreini D

Abstract

Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries. Methods and results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv. Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even

Published
2020

7. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion

Author

Mushtaq, S, Conte, E, Pontone, G, Baggiano, A, Annoni, A, Formenti, A, Mancini, M, Guglielmo, M, Muscogiuri, G, Tanzilli, A, Nicoli, F, Bartorelli, A, Pepi, M, Andreini, D, Mushtaq S., Conte E., Pontone G., Baggiano A., Annoni A., Formenti A., Mancini M. E., Guglielmo M., Muscogiuri G., Tanzilli A., Nicoli F., Bartorelli A. L., Pepi M., Andreini D., Mushtaq, S, Conte, E, Pontone, G, Baggiano, A, Annoni, A, Formenti, A, Mancini, M, Guglielmo, M, Muscogiuri, G, Tanzilli, A, Nicoli, F, Bartorelli, A, Pepi, M, Andreini, D, Mushtaq S., Conte E., Pontone G., Baggiano A., Annoni A., Formenti A., Mancini M. E., Guglielmo M., Muscogiuri G., Tanzilli A., Nicoli F., Bartorelli A. L., Pepi M., and Andreini D.

Abstract

Large multicenter studies and meta-analysis have documented the diagnostic accuracy and the prognostic implications of stress echocardiography, cardiac magnetic resonance and, mainly, nuclear stress tests. However, none of them provides a comprehensive anatomical and functional evaluation within the same study as stress CT perfusion. Myocardial CT perfusion is the only non-invasive modality that allows to quantifying coronary stenosis and determining its functional relevance, constituting a potential “one-stop-shop” method for the diagnosis and global management of patients with known or suspected coronary artery disease. In comparison with the dynamic modality, that requires increased radiation, precise acquisition protocols and dedicated post-processing softwares, static CT perfusion was associated with less radiation exposure, non-inferior diagnostic accuracy, easier interpretation of images and is nowadays more widely available.

Published
2020

9. Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study

Author

Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M, Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, and Pepi M

Abstract

Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and compara

Published
2019

10. Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Author

Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., Pepi M., Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., and Pepi M.

Abstract

Objectives: The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients. Background: Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan. Methods: A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR. Results: The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8 ± 1.4 mSv and 2.5 ± 1.1 mSv. Conclusions: The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.

Published
2019

11. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With ST-Segment Elevation Myocardial Infarction

Author

Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C., Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, and Banfi C.

Abstract

Objectives: This study aimed to evaluate the correlation between different haptoglobin (Hp)phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR)in consecutive patients after ST-segment elevation myocardial infarction (STEMI). Background: Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE)technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH)in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). Methods: A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men)were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. Results: CMR showed an area at risk (AAR)involving 26.6 ± 19.1% of left ventricular (LV)mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%)and 12 (8%)patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR)(OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008])and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). Conclusions: Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.

Published
2019

12. Left atrial appendage closure guided by 3D computed tomography printing technology: A case control study

Author

Conti, M, Marconi, S, Muscogiuri, G, Guglielmo, M, Baggiano, A, Italiano, G, Mancini, M, Auricchio, F, Andreini, D, Rabbat, M, Guaricci, A, Fassini, G, Gasperetti, A, Costa, F, Tondo, C, Maltagliati, A, Pepi, M, Pontone, G, Conti M, Marconi S, Muscogiuri G, Guglielmo M, Baggiano A, Italiano G, Mancini ME, Auricchio F, Andreini D, Rabbat MG, Guaricci AI, Fassini G, Gasperetti A, Costa F, Tondo C, Maltagliati A, Pepi M, Pontone G, Conti, M, Marconi, S, Muscogiuri, G, Guglielmo, M, Baggiano, A, Italiano, G, Mancini, M, Auricchio, F, Andreini, D, Rabbat, M, Guaricci, A, Fassini, G, Gasperetti, A, Costa, F, Tondo, C, Maltagliati, A, Pepi, M, Pontone, G, Conti M, Marconi S, Muscogiuri G, Guglielmo M, Baggiano A, Italiano G, Mancini ME, Auricchio F, Andreini D, Rabbat MG, Guaricci AI, Fassini G, Gasperetti A, Costa F, Tondo C, Maltagliati A, Pepi M, and Pontone G

Abstract

Background: We sought to evaluate the additional value of left atrial appendage (LAA) 3D printing derived from computed tomography (CCT) in determining the size for LAA occlusion (LAAO) devices as compared to standard measurement by using occurrence of LAA leak as endpoint. Methods: We evaluated 6 patients with LAA leak (cases) and 14 matched patients without LAA leak (controls) after LAAO. For each group, a patient-specific 3D printed model of LAA was manufactured using CT pre-operative images. The size recommended by the 3D printed model was compared with the size of the implanted device. Results: Compared to the 3D printed model, 55% of the devices were underestimated, the two sizing approaches agreed in 35% of the patients, while the 3D printed model overestimated the size in 10% of patients. The prevalence of LAA leak was significantly higher in the subset of patients with underestimation of prosthesis implanted with the standard approach as compared to the other patients (p = 0.019). Conclusion: 3D printing of the LAA may provide additional value to standard practice for LAAO device prosthesis sizing with the potential impact to reduce LAA leak.

Published
2019

13. Pediatric Cardiac MR Imaging:: Practical Preoperative Assessment

Author

Muscogiuri, G, Surany, P, Eid, M, Varga-Szemes, A, Griffith, L, Pontone, G, Schoepf, U, De Cecco, C, Muscogiuri G, Surany P, Eid M, Varga-Szemes A, Griffith L, Pontone G, Schoepf UJ, De Cecco CN, Muscogiuri, G, Surany, P, Eid, M, Varga-Szemes, A, Griffith, L, Pontone, G, Schoepf, U, De Cecco, C, Muscogiuri G, Surany P, Eid M, Varga-Szemes A, Griffith L, Pontone G, Schoepf UJ, and De Cecco CN

Abstract

Prevalence of patients with congenital heart disease (CHD) is rapidly increasing due to continuous advancements in diagnostic techniques and medical or surgical treatment approaches. Along with cardiac computed tomography angiography, cardiac magnetic resonance (CMR) serves as a fundamental imaging modality for pre-surgical planning in patients with CHD, as CMR allows for the evaluation of cardiac and great vessel anatomy, biventricular function, flow dynamics, and tissue characterization. This information is essential for risk-assessment and optimal timing of surgical interventions. This article discusses the current role of pediatric cardiac MR imaging as a practical preoperative assessment tool in the pediatric population.

Published
2019

14. Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived

Author

Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Soldi, M, Del Torto, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Olivares, P, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Baggiano A., Andreini D., Guaricci A. I., Guglielmo M., Muscogiuri G., Fusini L., Soldi M., Del Torto A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Olivares P., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Montorsi P., Rabbat M. G., Bartorelli A. L., Pepi M., Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Soldi, M, Del Torto, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Olivares, P, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Baggiano A., Andreini D., Guaricci A. I., Guglielmo M., Muscogiuri G., Fusini L., Soldi M., Del Torto A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Olivares P., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Montorsi P., Rabbat M. G., Bartorelli A. L., and Pepi M.

Abstract

Objectives: The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFRCT) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). Background: Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure. Methods: Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP, or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. Results: The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respe

Published
2019

15. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With ST-Segment Elevation Myocardial Infarction

Author

Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C., Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, and Banfi, C

Subjects
myocardial infarction, microvascular obstruction, cardiac magnetic resonance, haptoglobin
Abstract

Objectives: This study aimed to evaluate the correlation between different haptoglobin (Hp)phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR)in consecutive patients after ST-segment elevation myocardial infarction (STEMI). Background: Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE)technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH)in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). Methods: A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men)were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. Results: CMR showed an area at risk (AAR)involving 26.6 ± 19.1% of left ventricular (LV)mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%)and 12 (8%)patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR)(OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008])and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). Conclusions: Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.

Published
2019

16. Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study

Author

Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M, Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, and Pepi, M

Subjects
accuracy, computed tomography, fractional flow reserve, coronary artery disease, perfusion
Abstract

Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.

Published
2019

17. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Author

Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M., Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M.

Abstract

Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP an

Published
2018

18. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

Author

Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, De Martini S, Mancini, ME, Bartorelli, AL, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, De Martini S, Mancini, ME, and Bartorelli, AL

Abstract

Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagn

Published
2020

19. Repaired Congenital Heart Disease in Older Children and Adults: Up-to-Date Practical Assessment and Characteristic Imaging Findings

Author

Gadiyaram, V, Monti, C, Sahu, A, Filev, P, Muscogiuri, G, Secchi, F, Sardanelli, F, Stillman, A, De Cecco, C, Gadiyaram, VK, Monti, CB, Filev, PD, Stillman, AE, De Cecco, CN, Gadiyaram, V, Monti, C, Sahu, A, Filev, P, Muscogiuri, G, Secchi, F, Sardanelli, F, Stillman, A, De Cecco, C, Gadiyaram, VK, Monti, CB, Filev, PD, Stillman, AE, and De Cecco, CN

Abstract

Because of a recent increase in survival rates and life expectancy of patients with congenital heart disease (CHD), radiologists are facing new challenges when imaging the peculiar anatomy of individuals with repaired CHD. Cardiac computed tomography and magnetic resonance are paramount noninvasive imaging tools that are useful in assessing patients with repaired CHD, and both techniques are increasingly performed in centers where CHD is not the main specialization. This review provides general radiologists with insight into the main issues of imaging patients with repaired CHD, and the most common findings and complications of each individual pathology and its repair.

Published
2020

20. Submillisievert CT angiography for carotid arteries using wide array CT scanner and latest iterative reconstruction algorithm in comparison with previous generations technologies: Feasibility and diagnostic accuracy

Author

Daniele Annoni, A, Montorsi, P, Andreini, D, Muscogiuri, G, Formenti, A, Mushtaq, S, Trabattoni, P, Dainese, L, Pepi, M, Andrea Daniele Annoni, Piero Montorsi, Daniele Andreini, Giuseppe Muscogiuri, Alberto Formenti, Saima Mushtaq, Piero Trabattoni, Luca Dainese, Mauro Pepi, Daniele Annoni, A, Montorsi, P, Andreini, D, Muscogiuri, G, Formenti, A, Mushtaq, S, Trabattoni, P, Dainese, L, Pepi, M, Andrea Daniele Annoni, Piero Montorsi, Daniele Andreini, Giuseppe Muscogiuri, Alberto Formenti, Saima Mushtaq, Piero Trabattoni, Luca Dainese, and Mauro Pepi

Abstract

Objectives: To assess evaluability and diagnostic accuracy of a low dose CT angiography (CTA) protocol for carotid arteries using latest Iterative Reconstruction (IR) algorithm in comparison with standard 100 kVp protocol using previous generation CT and IR. Materials and methods: 105 patients, referred for CTA of the carotid arteries were prospectively enrolled in our study and underwent CTA with 80 kVp and latest IR algorithm (group 1). Data were retrospectively compared with 100 consecutive patients with similar examination indications that had previously undergone CTA of carotid arteries with a standard 100 kVp protocol and a first generation IR algorithm (group 2). Image quality was evaluated with a 4-point Likert-scale. For each exam CT number, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) at level of common carotid artery (CCA), internal carotid artery (ICA) and at level of Circle of Willis and Effective Dose (ED) were evaluated. 62 Group 1 patients underwent a clinically indicated DSA and results were compared with CTA. Results: No exams reported as not diagnostic. The overall mean CT number value of all arterial segments was above 450 HU in both groups. Significant lower noise, and higher SNR and CNR values were found in group 1 in comparison with group 2 despite the use of 80 kVp. In 62-group 1 patients studied by DSA, CTA showed in a segment-based analysis a sensitivity, negative predictive value and accuracy of 100%, 100% and 99% respectively. Mean ED in group 1 was 0.54 ± 0.1 mSv with a dose reduction up to 86%. Conclusions: CTA for carotid arteries using latest IR algorithm allows to perform exams with submillisievert radiation exposure maintaining good image quality, overall evaluability and diagnostic accuracy.

Published
2019

21. Multimodality imaging of left atrium in patients with atrial brillation

Author

Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Maria Mancini, E, Gripari, P, Igoren Guaricci, A, Rabbat, M, Pepi, M, Pontone, G, Marco Guglielmo, Andrea Baggiano, Giuseppe Muscogiuri, Laura Fusini, Daniele Andreini, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Maria Mancini, Paola Gripari, Andrea Igoren Guaricci, Mark G. Rabbat, Mauro Pepi, Gianluca Pontone, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Maria Mancini, E, Gripari, P, Igoren Guaricci, A, Rabbat, M, Pepi, M, Pontone, G, Marco Guglielmo, Andrea Baggiano, Giuseppe Muscogiuri, Laura Fusini, Daniele Andreini, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Maria Mancini, Paola Gripari, Andrea Igoren Guaricci, Mark G. Rabbat, Mauro Pepi, and Gianluca Pontone

Abstract

Atrial fibrillation (AF) is the most common arrhythmia worldwide associated with significant morbidity and mortality and represents a significant health care burden. Goals of AF treatment include prevention of cardioembolic stroke using anticoagulation and device therapy and restoration of sinus rhythm using antiarrhythmic drugs or catheter ablation techniques. A comprehensive assessment of cardiac chamber size and function is often started with echocardiography as a first line diagnostic imaging strategy. Recently, innovations in advanced imaging using cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) provide a detailed characterization of atrial anatomy and have been shown to accurately exclude thrombus and guide left atrial appendage (LAA) closure or catheter ablation (CA) of atrial fibrillation. Compared to echocardiography, CCT offers an uncompromised spatial resolution and a fast dataset acquisition, with the disadvantages of the need of iodine contrast agent and radiation exposure. CMR, conversely, can rely on very high temporal resolution, the unique feature of tissue characterization and the absence of radiation exposure. However, the main drawbacks of this diagnostic tool are long scan times and low availability. This review will illustrate the vital role of multimodality cardiac imaging in the accurate identification of left atrial, pulmonary vein and LAA size and function, discuss advanced imaging techniques to rule out thrombus and highlight novel CMR and CCT techniques to guide catheter ablation of AF and LAA occlusion.

Published
2019

27. Reconstruction of the superior vena cava by biologic conduit: Assessment of long-term patency by magnetic resonance imaging

Author

D'Andrilli, A, De Cecco, C, Maurizi, G, Muscogiuri, G, Baldini, R, David, V, Venuta, F, Rendina, E, D'Andrilli A., De Cecco C. N., Maurizi G., Muscogiuri G., Baldini R., David V., Venuta F., Rendina E. A., D'Andrilli, A, De Cecco, C, Maurizi, G, Muscogiuri, G, Baldini, R, David, V, Venuta, F, Rendina, E, D'Andrilli A., De Cecco C. N., Maurizi G., Muscogiuri G., Baldini R., David V., Venuta F., and Rendina E. A.

Abstract

Background: To assess the long-term patency of the biologic prosthetic conduit used for reconstruction of the superior vena cava (SVC) by magnetic resonance imaging (MRI). Methods: Patients undergoing oncologic resection and reconstruction of the SVC by a bovine pericardial prosthesis (January 2003 to April 2010) have been studied after 1 year (if surviving) by MRI for the assessment of the conduit long-term patency. Results were compared with those of a control group of patients with normal SVC. Blood flow and area of lumen section at 3 different levels (proximal, middle, distal) were analyzed. Results: Sixteen consecutive patients surviving after 1 year from surgery out of 17 (9 lung cancer, 8 mediastinal malignancy) undergoing SVC reconstruction were included. One patient died postoperatively and was not included. Sixteen patients with similar demographic characteristics were studied in the control group. Mean blood flow was 18.4 ± 3.5 mL/sec (range 14.3 to 25.7) in patients with reconstructed SVC and 20.8 ± 4.1 mL/sec (range 15.3 to 27.7) in the control group. Mean area of the conduit lumen section was 2.2 ± 0.6 cm2 (range 1.6 to 3.6) at proximal level, 2.9 ± 1.3 cm2 at middle level (range 1.3 to 5.7), and 2.1 ± 0.9 cm2 (range 0.5 to 4) at distal level in the reconstructed group, and 2.6 ± 0.7 cm2 (range 1.8 to 4.2), 2.7 ± 0.7 cm 2 (range 1.9 to 4.3), and 2.4 ± 0.3 cm2 (range 1.8 to 3.1), respectively, at proximal, middle, and distal levels in the control group. Differences between the 2 groups were not significant (p > 0.05). Conclusions: The MRI assessment in terms of blood flow and area of lumen section at 3 different levels confirms that bovine pericardial conduit used for SVC replacement shows an optimal patency over the long term. © 2013 by The Society of Thoracic Surgeons.

Published
2013

28. State of the art paper: Cardiovascular CT for planning ventricular tachycardia ablation procedures

Author

Maria Elisabetta Mancini, Barbara Alicja Jereczek-Fossa, Roberto Orecchia, Marco Guglielmo, Federica Cattani, Daniele Andreini, Alberto Formenti, Gaia Piperno, Corrado Carbucicchio, Gianluca Pontone, Marta Belmonte, Valentina Catto, Andrea Baggiano, Giuseppe Muscogiuri, Andrea Annoni, Edoardo Conte, Saima Mushtaq, Claudio Tondo, Conte, E, Mushtaq, S, Carbucicchio, C, Piperno, G, Catto, V, Mancini, M, Formenti, A, Annoni, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Belmonte, M, Cattani, F, Pontone, G, Jereczek-Fossa, B, Orecchia, R, Tondo, C, and Andreini, D

Subjects
medicine.medical_specialty, Computed Tomography Angiography, CAD, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Ventricular tachycardia, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Ventricular tachycardia ablation, Predictive Value of Tests, Stable cad, Cardiac CT, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Heart volume, Radiofrequency transcatheter ablation, business.industry, Coronary anatomy, medicine.disease, Tachycardia, Ventricular, Acquisition time, Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Abstract

In the last 20 years coronary computed tomography angiography (CCTA) gained a pivotal role in the evaluation of patients with suspected coronary artery disease (CAD) as finally recognized by the ESC guidelines on stable CAD. Technological advances have progressively improved the temporal resolution of CT scanners, contemporary reducing acquisition time, radiation dose and contrast volume needed for the whole heart volume acquisition, further expanding the role of cardiac CT beyond coronary anatomy evaluation. Aim of the present review is to discuss use and benefit of cardiac CT for the planning and preparation of VT ablation.

Published
2021

29. Anomalous origin of the left circumflex artery from the right coronary sinus with retro-aortic course: A potential malign variant

Author

Marco Guglielmo, Alberico Del Torto, Giuseppe Muscogiuri, Andrea Baggiano, Gianluca Pontone, Del Torto, A, Baggiano, A, Guglielmo, M, Muscogiuri, G, and Pontone, G

Subjects
Male, medicine.medical_specialty, Computed Tomography Angiography, Left circumflex artery, Predictive Value of Test, Cardiac-Gated Imaging Technique, Coronary Angiography, Cardiac-Gated Imaging Techniques, Electrocardiography, Text mining, medicine, Radiology, Nuclear Medicine and imaging, Coronary sinus, Computed tomography angiography, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Anomalous Left Coronary Artery, Middle Aged, Magnetic Resonance Imaging, Predictive value of tests, Coronary Sinu, Radiology, Cardiology and Cardiovascular Medicine, business, Human
Published
2020

30. Repaired Congenital Heart Disease in Older Children and Adults: Up-to-Date Practical Assessment and Characteristic Imaging Findings

Author

Varuna K, Gadiyaram, Caterina B, Monti, Anurag, Sahu, Peter D, Filev, Giuseppe, Muscogiuri, Francesco, Secchi, Francesco, Sardanelli, Arthur E, Stillman, Carlo N, De Cecco, Gadiyaram, V, Monti, C, Sahu, A, Filev, P, Muscogiuri, G, Secchi, F, Sardanelli, F, Stillman, A, and De Cecco, C

Subjects
Adult, Heart Defects, Congenital, Aortic coarctation, Heart defect, Multidetector computed tomography, Young Adult, Congenital, Magnetic resonance imaging, Transposition of great vessel, Adolescent, Tetralogy of Fallot, Humans, Tomography, X-Ray Computed
Abstract

Because of a recent increase in survival rates and life expectancy of patients with congenital heart disease (CHD), radiologists are facing new challenges when imaging the peculiar anatomy of individuals with repaired CHD. Cardiac computed tomography and magnetic resonance are paramount noninvasive imaging tools that are useful in assessing patients with repaired CHD, and both techniques are increasingly performed in centers where CHD is not the main specialization. This review provides general radiologists with insight into the main issues of imaging patients with repaired CHD, and the most common findings and complications of each individual pathology and its repair.

Published
2020

31. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

Author

Luca Di Odoardo, Maria Elisabetta Mancini, Piero Montorsi, Daniela Trabattoni, Andrea Annoni, Jeroen Sonck, Giuseppe Muscogiuri, Giuseppe Calligaris, Marco Guglielmo, Daniele Andreini, Antonio L. Bartorelli, Andrea Baggiano, Elisa Consiglio, Alberto Formenti, Mauro Pepi, Stefano De Martini, Edoardo Conte, Paolo Ravagnani, Saima Mushtaq, Cesare Fiorentini, Gianluca Pontone, Federico Lombardi, Franco Fabbiocchi, Giovanni Teruzzi, Paolo Olivares, Marco Magatelli, Andrea D'Errico, Carlos Collet, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, Clinical sciences, Graduate School, and ACS - Heart failure & arrhythmias

Subjects
Male, Adenosine, Computed Tomography Angiography, Vasodilator Agents, viruses, medicine.medical_treatment, invasive coronary angiography, Perfusion scanning, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, 030218 nuclear medicine & medical imaging, Coronary artery disease, coronary stent, 0302 clinical medicine, Restenosis, heterocyclic compounds, Prospective Studies, musculoskeletal, neural, and ocular physiology, Myocardial Perfusion Imaging, Middle Aged, static CT perfusion, Fractional Flow Reserve, Myocardial, Treatment Outcome, Disease Progression, Female, Stents, Radiology, Cardiology and Cardiovascular Medicine, Perfusion, medicine.drug, medicine.medical_specialty, coronary CT angiography, Article, Coronary Restenosis, 03 medical and health sciences, Percutaneous Coronary Intervention, Predictive Value of Tests, coronary stents, Multidetector Computed Tomography, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, business.industry, Stent, Gold standard (test), medicine.disease, Iodixanol, enzymes and coenzymes (carbohydrates), business
Abstract

Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.

Published
2020

32. Pediatric Cardiac MR Imaging:: Practical Preoperative Assessment

Author

Giuseppe, Muscogiuri, Pal, Suranyi, Marwen, Eid, Akos, Varga-Szemes, Lewis, Griffith, Gianluca, Pontone, Uwe Joseph, Schoepf, Carlo N, De Cecco, Muscogiuri, G, Surany, P, Eid, M, Varga-Szemes, A, Griffith, L, Pontone, G, Schoepf, U, and De Cecco, C

Subjects
Heart Defects, Congenital, Male, Adolescent, Cardiac magnetic resonance, Infant, Heart, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Magnetic Resonance Imaging, Cardiac shunts, Congenital heart disease, Pre-surgical planning, Child, Preschool, Cardiac shunt, Preoperative Care, Humans, Female, Child
Abstract

Prevalence of patients with congenital heart disease (CHD) is rapidly increasing due to continuous advancements in diagnostic techniques and medical or surgical treatment approaches. Along with cardiac computed tomography angiography, cardiac magnetic resonance (CMR) serves as a fundamental imaging modality for pre-surgical planning in patients with CHD, as CMR allows for the evaluation of cardiac and great vessel anatomy, biventricular function, flow dynamics, and tissue characterization. This information is essential for risk-assessment and optimal timing of surgical interventions. This article discusses the current role of pediatric cardiac MR imaging as a practical preoperative assessment tool in the pediatric population.

Published
2019

33. Submillisievert CT angiography for carotid arteries using wide array CT scanner and latest iterative reconstruction algorithm in comparison with previous generations technologies: Feasibility and diagnostic accuracy

Author

Luca Dainese, Gianluca Pontone, Piero Montorsi, Piero Trabattoni, Giuseppe Muscogiuri, Maria Elisabetta Mancini, Saima Mushtaq, Mauro Pepi, Andrea Annoni, Alberto Formenti, Daniele Andreini, Daniele Annoni, A, Montorsi, P, Andreini, D, Muscogiuri, G, Formenti, A, Mushtaq, S, Trabattoni, P, Dainese, L, and Pepi, M

Subjects
Male, Tomography Scanners, X-Ray Computed, Databases, Factual, Image quality, Dose reduction, Iterative reconstruction, 030204 cardiovascular system & hematology, Radiation Dosage, Severity of Illness Index, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, medicine.artery, Multidetector Computed Tomography, medicine, Image noise, Humans, Radiology, Nuclear Medicine and imaging, Carotid Stenosis, cardiovascular diseases, Common carotid artery, Computed tomography angiography, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Reproducibility of Results, Carotid arterie, Equipment Design, Middle Aged, Radiation Exposure, Iterative reconstruction algorithm, Carotid Arteries, Atherosclerosi, Angiography, Feasibility Studies, Radiographic Image Interpretation, Computer-Assisted, Female, Internal carotid artery, Cardiology and Cardiovascular Medicine, business, Algorithm, Algorithms, Circle of Willis
Abstract

Objectives To assess evaluability and diagnostic accuracy of a low dose CT angiography (CTA) protocol for carotid arteries using latest Iterative Reconstruction (IR) algorithm in comparison with standard 100 kVp protocol using previous generation CT and IR. Materials and methods 105 patients, referred for CTA of the carotid arteries were prospectively enrolled in our study and underwent CTA with 80 kVp and latest IR algorithm (group 1). Data were retrospectively compared with 100 consecutive patients with similar examination indications that had previously undergone CTA of carotid arteries with a standard 100 kVp protocol and a first generation IR algorithm (group 2). Image quality was evaluated with a 4-point Likert-scale. For each exam CT number, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) at level of common carotid artery (CCA), internal carotid artery (ICA) and at level of Circle of Willis and Effective Dose (ED) were evaluated. 62 Group 1 patients underwent a clinically indicated DSA and results were compared with CTA. Results No exams reported as not diagnostic. The overall mean CT number value of all arterial segments was above 450 HU in both groups. Significant lower noise, and higher SNR and CNR values were found in group 1 in comparison with group 2 despite the use of 80 kVp. In 62-group 1 patients studied by DSA, CTA showed in a segment-based analysis a sensitivity, negative predictive value and accuracy of 100%, 100% and 99% respectively. Mean ED in group 1 was 0.54 ± 0.1 mSv with a dose reduction up to 86%. Conclusions CTA for carotid arteries using latest IR algorithm allows to perform exams with submillisievert radiation exposure maintaining good image quality, overall evaluability and diagnostic accuracy.

Published
2019

34. Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived

Author

Giovanni Teruzzi, Piero Montorsi, Daniele Andreini, Cristina Ferrari, Margherita Soldi, Stefano De Martini, Mark G. Rabbat, Andrea Igoren Guaricci, Edoardo Conte, Giuseppe Calligaris, Paolo Ravagnani, Saima Mushtaq, Mauro Pepi, Gianluca Pontone, Andrea Baggiano, Marco Guglielmo, Daniela Trabattoni, Laura Fusini, Alberico Del Torto, Franco Fabbiocchi, Giuseppe Muscogiuri, Stefano Galli, Luca Grancini, Antonio L. Bartorelli, Paolo Olivares, Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Soldi, M, Del Torto, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Olivares, P, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Montorsi, P, Rabbat, M, Bartorelli, A, and Pepi, M

Subjects
Male, Scanner, Tomography Scanners, X-Ray Computed, Computed tomography perfusion, Computed Tomography Angiography, Computed tomography, Fractional flow reserve, Coronary Angiography, Radiation Dosage, Severity of Illness Index, Coronary artery disease, dynamic stress computed tomography, Predictive Value of Tests, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, Dynamic stress, medicine.diagnostic_test, accuracy, business.industry, Coronary Stenosis, Myocardial Perfusion Imaging, Coronary computed tomography angiography, Reproducibility of Results, computed tomography, Middle Aged, Radiation Exposure, medicine.disease, Coronary Vessels, Fractional Flow Reserve, Myocardial, Invasive coronary angiography, Female, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, coronary artery disease
Abstract

Objectives: The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFRCT) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). Background: Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure. Methods: Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP, or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. Results: The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respectively. Conclusions: The addition of dynamic stress CTP on top of cCTA and FFRCT provides additional diagnostic accuracy with acceptable radiation exposure.

Published
2019

35. Accuracy of noncontrast quiescent-interval single-shot lower extremity MR angiography versus CT angiography for diagnosis of peripheral artery disease: comparison with digital subtraction angiography

Author

Akos, Varga-Szemes, Wichmann, Julian L., Joseph Schoepf, U., Pal, Suranyi, De Cecco, Carlo N., Muscogiuri, Giuseppe, Caruso, Damiano, Yamada, Ricardo T., Litwin, Sheldon E., Christian, Tesche, Duguay, Taylor M., Shivraman, Giri, Rozemarijn, Vliegenthart, Todoran, Thomas M., Varga-Szemes, A, Wichmann, J, Joseph Schoepf, U, Suranyi, P, De Cecco, C, Muscogiuri, G, Caruso, D, Yamada, R, Litwin, S, Tesche, C, Duguay, T, Giri, S, Vliegenthart, R, and Todoran, T

Subjects
cardiovascular magnetic resonance, noncontrast magnetic resonance angiography, quiescent interval single shot
Abstract

Objectives This study sought to evaluate the image quality and diagnostic accuracy of noncontrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) versus iodine-contrast computed tomography angiography (CTA) in patients with peripheral artery disease (PAD), with invasive digital subtraction angiography (DSA) as the reference standard. Background QISS is a recently introduced noncontrast MRA technique. Although the diagnostic accuracy of QISS is reportedly similar to that of contrast-enhanced MRA, its performance compared with contrast-enhanced CTA, the most frequently used noninvasive modality for evaluation of PAD, is unknown. Methods Thirty patients (66 ± 7 years of age) with PAD underwent lower extremity CTA with third-generation dual-source dual-energy CT and 1.5-T MRA using a prototype noncontrast QISS sequence. DSA was performed within 50 days. The abdominal aorta and lower extremity run-off were imaged. Eighteen arterial segments were analyzed. Subjective image quality (3-point Likert scale) and stenosis (5-point grading) were evaluated by 2 observers and compared using the Mann–Whitney U and chi-square tests, respectively. Sensitivity and specificity of MRA and CTA for >50% stenosis detection were compared using the McNemar-test. Results Of 540 segments, 15 (2.8%) and 42 (7.8%) inconclusive segments were excluded from MRA and CTA analysis, respectively (p = 0.0006). The DSA results were available for 410 of the remaining segments. Overall subjective image quality was rated similarly with QISS-MRA (2.52 [95% confidence interval: 2.46 to 2.57]) and CTA (2.49 [95% confidence interval: 2.43 to 2.55]; p = 0.5062). The sensitivity and specificity of MRA for >50% stenosis were 84.9% and 97.2%, respectively, similar to those of CTA (87.3% and 95.4%, respectively). Interobserver agreement for stenosis detection was excellent for MRA (κ > 0.81) and CTA (κ > 0.81). Conclusions Noncontrast QISS-MRA provides high diagnostic accuracy compared with DSA, while being less prone to image artifacts than CTA. QISS better visualizes heavily calcified segments with impaired flow. QISS-MRA obviates the need for contrast administration in PAD patients.

Published
2017

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