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1. Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Author

Wu, P., Tsay, P.K., Sun, Zhonghua, Peng, S.J., Lee, C.Y., Hsu, M.Y., Ko, Y.S., Hsieh, I.C., Wen, M.S., Wan, Y.L., Wu, P., Tsay, P.K., Sun, Zhonghua, Peng, S.J., Lee, C.Y., Hsu, M.Y., Ko, Y.S., Hsieh, I.C., Wen, M.S., and Wan, Y.L.

Abstract

Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries

Published
2022

2. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: Meta-analysis of individual patient data

Author

Haase, R. (Robert), Schlattmann, P. (Peter), Gueret, P. (Pascal), Andreini, D. (Daniele), Pontone, G. (Gianluca), Alkadhi, H. (Hatem), Hausleiter, J. (Jörg), Garcia, M. (Mario), Leschka, S. (Sebastian), Meijboom, W.B. (Willem Bob), Zimmermann, E. (Elke), Gerber, B. (Bernhard), Schoepf, U.J. (Joseph), Shabestari, A.A. (Abbas A), Nørgaard, B. (Bjarne), Meijs, M.F.L. (Matthijs), Sato, A. (Akira), Altern Ovrehus, K. (Kristian), Diederichsen, A.C.P. (Axel C P), Jenkins, S.M.M. (Shona), Knuuti, J. (Juhani), Hamdan, A. (Ashraf), Halvorsen, B.A. (Bjørn Arild), Mendoza-Rodriguez, V. (Vladimir), Rochitte, C. (Carlos), Rixe, J. (Johannes), Wan, Y.L. (Yung Liang), Langer, C. (Christoph), Bettencourt, N. (Nuno), Martuscelli, E. (Eugenio), Ghostine, S. (Said), Buechel, R.R. (Ronny Ralf), Nikolaou, K. (Konstantin), Mickley, H. (Hans), Yang, L. (Lin), Zhang, Z. (Zhaqoi), Chen, M.Y. (Marcus Y), Halon, D.A. (David), Rief, M. (Matthias), Sun, K. (Kai), Hirt-Moch, B. (Beatrice), Niinuma, H. (Hiroyuki), Marcus, R.P. (Roy P), Muraglia, S. (Simone), Jakamy, R. (Reda), Chow, B.J.W. (Benjamin), Kaufmann, P.A. (Philipp), Tardif, J.-C. (Jean-Claude), Nomura, C.H. (Cesar), Kofoed, K.F. (Klaus F), Laissy, J.-P. (Jean-Pierre), Arbab-Zadeh, A. (Armin), Kitagawa, K. (Kakuya), Laham, R. (Roger), Jinzaki, M. (Masahiro), Hoe, J. (John), Rybicki, F.J. (Frank J), Scholte, A. (Arthur), Paul, N. (Narinder), Tan, S.Y. (Swee Y), Yoshioka, K. (Kunihiro), Röhle, R. (Robert), Schuetz, G.M. (Georg), Schueler, S. (Sabine), Coenen, M.H. (Maria H), Wieske, V. (Viktoria), Achenbach, S. (Stephan), Budoff, M.J. (Matthew), Laule, M. (Michael), Newby, D.E. (David E.), Dewey, T.M. (Todd M.), Haase, R. (Robert), Schlattmann, P. (Peter), Gueret, P. (Pascal), Andreini, D. (Daniele), Pontone, G. (Gianluca), Alkadhi, H. (Hatem), Hausleiter, J. (Jörg), Garcia, M. (Mario), Leschka, S. (Sebastian), Meijboom, W.B. (Willem Bob), Zimmermann, E. (Elke), Gerber, B. (Bernhard), Schoepf, U.J. (Joseph), Shabestari, A.A. (Abbas A), Nørgaard, B. (Bjarne), Meijs, M.F.L. (Matthijs), Sato, A. (Akira), Altern Ovrehus, K. (Kristian), Diederichsen, A.C.P. (Axel C P), Jenkins, S.M.M. (Shona), Knuuti, J. (Juhani), Hamdan, A. (Ashraf), Halvorsen, B.A. (Bjørn Arild), Mendoza-Rodriguez, V. (Vladimir), Rochitte, C. (Carlos), Rixe, J. (Johannes), Wan, Y.L. (Yung Liang), Langer, C. (Christoph), Bettencourt, N. (Nuno), Martuscelli, E. (Eugenio), Ghostine, S. (Said), Buechel, R.R. (Ronny Ralf), Nikolaou, K. (Konstantin), Mickley, H. (Hans), Yang, L. (Lin), Zhang, Z. (Zhaqoi), Chen, M.Y. (Marcus Y), Halon, D.A. (David), Rief, M. (Matthias), Sun, K. (Kai), Hirt-Moch, B. (Beatrice), Niinuma, H. (Hiroyuki), Marcus, R.P. (Roy P), Muraglia, S. (Simone), Jakamy, R. (Reda), Chow, B.J.W. (Benjamin), Kaufmann, P.A. (Philipp), Tardif, J.-C. (Jean-Claude), Nomura, C.H. (Cesar), Kofoed, K.F. (Klaus F), Laissy, J.-P. (Jean-Pierre), Arbab-Zadeh, A. (Armin), Kitagawa, K. (Kakuya), Laham, R. (Roger), Jinzaki, M. (Masahiro), Hoe, J. (John), Rybicki, F.J. (Frank J), Scholte, A. (Arthur), Paul, N. (Narinder), Tan, S.Y. (Swee Y), Yoshioka, K. (Kunihiro), Röhle, R. (Robert), Schuetz, G.M. (Georg), Schueler, S. (Sabine), Coenen, M.H. (Maria H), Wieske, V. (Viktoria), Achenbach, S. (Stephan), Budoff, M.J. (Matthew), Laule, M. (Michael), Newby, D.E. (David E.), and Dewey, T.M. (Todd M.)

Abstract

Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were ob

Published
2019
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4. Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions

Author

Wan, Y.L., Cheung, Y.C., Lui, K.W., Tseng, J.H., and Lee, T.Y.

Abstract

The purpose of this study was to analyse the sonographic findings of focal splenic lesions with an attempt to differentiate benign lesions from malignancies. The sonographic findings of 53 cases of verified focal splenic lesions, excluding post-traumatic haematomas and phleboliths, were retrospectively analysed. Of the 53 cases, 30 cases (57%) were benign and 23 cases (43%) were malignant. The malignancies included lymphoma (n=13), metastases (n=10); while the benign lesions included cysts (n=17), infarcts (n=3), and abscesses (n=5), and one case each of haemangioma, hamartoma, spontaneous rupture, tuberculosis, and lymphangioma. Significant differences were noted between the benign and malignant groups with respect to the presence of solitary lesions (p<0.0001), anechoic mass (p<0.0001), lesions with highly echogenic foci due to gas or calcification (p = 0.0303), hyperechoic/mixed echoic lesions (p<0.0001), presence of extrasplenic abdominal masses (p<0.0001), and nodules with the target sign (p<0.0001). Solitary lesions, anechoic mass, and lesions with highly echogenic foci due to gas or calcification each had a positive predictive value of 85%, 100%, and 100%, respectively, for the lesions to be benign. The multifocal/diffuse lesions, presence of extrasplenic abdominal masses, hyperechoic/mixed echoic lesions, and nodules with the target sign each had a positive predictive value of 70%, 100%, 70%, and 100%, respectively, for the lesions to be malignant. In summary, focal lesions with anechoic pattern or echogenic foci due to gas or calcification are suggestive signs of benign process. The sonographic observations of multifocal or diffuse solid lesions, especially those associated with target sign or extrasplenic abdominal masses are suggestive of malignancy.

Published
2000

5. Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization

Author

Hung, C.F., Tseng, J.H., Lui, K.W., Wan, Y.L., Tsai, C.C., Shem, C.H., and Wu, C.S.

Abstract

SummaryWe describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.

Published
1999

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