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Left atrial appendage occlusion (LAAO) is rapidly growing as valid stroke prevention therapy in atrial fibrillation. Cardiac imaging plays an instrumental role in preprocedural planning, procedural execution, and postprocedural follow-up. Recently, cardiac computed tomography (CCT) has made significant advancements, resulting in increasing use both preprocedurally and in outpatient follow-up. It provides a noninvasive, high-resolution alternative to the current standard, transesophageal echocardiography, and may display advantages in both the detection and characterization of device-specific complications, such as peridevice leak and device-related thrombosis. The implementation of CCT in the follow-up after LAAO has identified new findings such as hypoattenuated thickening on the atrial device surface and left atrial appendage contrast patency, which are not readily assessable on transesophageal echocardiography. Currently, there is a lack of standardization for acquisition and interpretation of images and consensus on definitions of essential findings on CCT in the postprocedural phase. This paper intends to provide a practical and standardized approach to both acquisition and interpretation of CCT after LAAO based on a comprehensive review of the literature and expert consensus among European and North American interventional and imaging specialists., Competing Interests: Funding Support and Author Disclosures Dr Korsholm has received speaker honorarium from Abbott and Boston Scientific. Dr Saw has received unrestricted research grant support from AstraZeneca, Abbott, Boston Scientific, and Servier; has received speaker honorarium from AstraZeneca, Abbott, Boston Scientific, and Sunovion; and is a consultant/proctor for Boston Scientific, AstraZeneca, and Abbott. Dr Wang has received research grant support from Boston Scientific; and is a consultant for Edwards Lifesciences, Boston Scientific, and Materialise. Dr Berti is a proctor for Abbott and Edwards Lifesciences. Dr Galea has received speaker honorarium from Boston Scientific. Dr De Backer is a consultant for Abbott. Dr Räber has received research grants to the institution from Abbott Vascular, Biotronik, Boston Scientific, Heartflow, Sanofi, Regeneron, Medis Medical Imaging Systems, and Bangerter-Rhyner Stiftung; and has received speaker or consultation fees from Abbott Vascular, Amgen, AstraZeneca, Canon, Novo Nordisk, Medtronic, Occlutech, and Sanofi outside the submitted work. Dr Alkhouli is on the Advisory Board for Abbott and Boston Scientific. Dr Nielsen-Kudsk is a consultant for Boston Scientific; and is a consultant/proctor for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the detection of erosion, sclerosis and ankylosis using 1 mm 3D T1-weighted spoiled gradient echo (T1w-GRE) MRI and 1 mm MRI-based synthetic CT (sCT), compared with conventional 4 mm T1w-TSE., Materials and Methods: Prospective, cross-sectional study. Semi-coronal 4 mm T1w-TSE and axial T1w-GRE with 1.6 mm slice thickness and 0.8 mm spacing between overlapping slices were performed. The T1w-GRE images were processed into sCT images using a commercial deep learning algorithm, BoneMRI. Both were reconstructed into 1 mm semi-coronal images. T1w-TSE, T1w-GRE and sCT images were assessed independently by 3 expert and 4 non-expert readers for erosion, sclerosis and ankylosis. Cohen's kappa for inter-reader agreement, exact McNemar test for lesion frequencies and Wilcoxon signed-rank test for confidence in lesion detection were used., Results: Nineteen patients with axial spondyloarthritis were evaluated. T1w-GRE increased inter-reader agreement for detecting erosion (kappa 0.42 vs 0.21 in non-experts), increased detection of erosion (57 vs 43 of 152 joint quadrants) and sclerosis (26 vs 17 of 152 joint quadrants) among experts, and increased reader confidence for scoring erosion and sclerosis. sCT increased inter-reader agreement for detecting sclerosis (kappa 0.69 vs 0.37 in experts) and ankylosis (0.71 vs 0.52 in non-experts), increased detection of sclerosis (34 vs 17 of 152 joint quadrants) and ankylosis (20 vs 13 of 76 joint halves) among experts, and increased reader confidence for scoring erosion, sclerosis and ankylosis., Conclusion: T1w-GRE and sCT increase sensitivity and reader confidence for the detection of erosion, sclerosis and ankylosis, compared with T1w-TSE., Clinical Relevance Statement: These methods improve the detection of sacroiliac joint structural lesions and might be a useful addition to SIJ MRI protocols both in routine clinical care and as structural outcome measures in clinical trials., (© 2024. The Author(s).)

Background: Left atrial appendage occlusion (LAAO) is performed increasingly, but long-term follow-up imaging data are lacking., Aims: The aim of this study was to evaluate the safety and durability of the Amplatzer Amulet device >4 years after LAAO., Methods: This was a prospective observational cohort study including 52 patients implanted with the Amplatzer Amulet device at Aarhus University Hospital, Denmark. A >4-year follow-up cardiac computed tomography (CT) scan after LAAO was performed and compared with the results from the 2-month and 12-month scans. The primary outcome was left atrial appendage (LAA) sealing based on distal LAA contrast patency and peridevice leakage (PDL), stratified into complete occlusion (grade 0 [G0]) and grade 1-3 leakage (G1-3), respectively. Secondary outcomes were low- and high-grade hypoattenuated thickening (HAT), device-related thrombosis (DRT) and device durability., Results: The median (interquartile range [IQR]) follow-up time from LAAO to the latest CT scan was 5.8 years (4.5; 6.3). At 2-month (n=52), 12-month (n=27) and >4-year CT follow-ups (n=52), rates of both complete occlusion (33%, 37%, 35%) and G2 leaks (52%, 52%, 48%) remained stable. Rates of G1 leaks varied (14%, 4%, 6%) and G3 leaks rose (2%, 7%, 12%) from earliest to latest follow-up. The median left atrial (LA) volume increased from 127 mL (96; 176) to 144 mL (108; 182) and 147 mL (107; 193). No DRT was found. The structural device integrity was preserved., Conclusions: This study indicates a stable LAA sealing status throughout the follow-up period, emphasising the importance of the procedural result in avoiding PDL. Few patients displayed PDL progression, which might partly be related to LA remodelling with increasing volume. The long-term device durability appears excellent. Larger studies are warranted to confirm these findings.

Background: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing., Methods: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1-3) along with the underlying mechanism., Results: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), - 0.39 mm (± 2.43), and - 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment., Conclusion: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter., (© 2023. The Author(s).)

Objective: To investigate the ability of MRI-based synthetic CT (sCT), low-dose CT (ldCT) and radiography to detect spinal new bone formation (NBF) in patients with axial spondyloarthritis (axSpA)., Methods: Radiography of lumbar and cervical spine, ldCT and sCT of the entire spine were performed in 17 patients with axSpA. sCT was reconstructed using the BoneMRI application (V.1.6, MRIGuidance BV, Utrecht, NL), a quantitative three-dimensional MRI-technique based on a dual-echo gradient sequence and a machine learning processing pipeline that can generate CT-like MR images. Images were anonymised and scored by four readers blinded to other imaging/clinical information, applying the Canada-Denmark NBF assessment system., Results: Mean scores of NBF lesions for the four readers were 188/209/37 for ldCT/sCT/radiography. Most NBF findings were at anterior vertebral corners with means 163 on ldCT, 166 on sCT and 35 on radiography. With ldCT of the entire spine as reference standard, the sensitivity to detect NBF was 0.67/0.13 for sCT/radiography; both with specificities >0.95. For levels that were assessable on radiography (C2-T1 and T12-S1), the sensitivity was 0.61/0.48 for sCT/radiography, specificities >0.90. For facet joints, the sensitivity was 0.46/0.03 for sCT/radiography, specificities >0.94. The mean inter-reader agreements (kappa) for all locations were 0.68/0.58/0.56 for ldCT/sCT/radiography, best for anterior corners., Conclusion: With ldCT as reference standard, MRI-based sCT of the spine showed very high specificity and a sensitivity much higher than radiography, despite limited reader training. sCT could become highly valuable for detecting/monitoring structural spine damage in axSpA, not the least in clinical trials., Competing Interests: Competing interests: STW has received grants from the Danish Rheumatism Association ('Gigtforeningen') and the PARTNER Psoriatic Arthritis Network Fellowship program. AEFH has received grants from Novartis. NV has received grants from Novartis and speaker and/or consultancy fees from MSD. JMM has no competing interests. BMKV has no competing interests. SS has no competing interests. SJP has received grants and contracts from Innovation Fund Denmark and Nordic Bioscience A/S, consulting fees, speaking fees and/or research support from AbbVie, Novartis, MSD, Pfizer and UCB. MØ has received research grants from Abbvie, BMS, Merck, Novartis and UCB, and speaker and/or consultancy fees from Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, MEDAC, Merck, Novartis, Pfizer, Sandoz and UCB., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)

Background: Device-related thrombosis (DRT) following left atrial appendage occlusion is a rare but feared complication. The diagnostic value of cardiac compute tomography (CT) for detection of DRT is unknown. This study sought to evaluate the clinical value of cardiac CT for detection of DRT using transesophageal echocardiography (TEE) as the reference standard and to provide insights into the causes, natural history, and risk of DRT., Methods: We reviewed 301 consecutive patients undergoing left atrial appendage occlusion at Aarhus University Hospital, Denmark, between 2010 and 2017. Of these, 248 patients had cardiac CT and TEE imaging available at 8-week follow-up; 139 had complete 12-month imaging. A blinded investigator analyzed all images. On TEE, an echo-dense mass attached to the device was defined as DRT. Cardiac CT was analyzed for presence of hypoattenuated thickening (HAT) on the device, which was subclassified as low grade or high grade. High-grade HAT was considered as definite DRT., Results: At 8 weeks, TEE detected 5 (2%) cases with DRT; and cardiac CT 6 (2.4%) cases with high-grade HAT. At 12 months, both TEE and cardiac CT detected 2 (1.4%) cases with DRT or high-grade HAT, respectively. Cardiac CT demonstrated low-grade HAT in 9 (3.6%) cases at 8 weeks; and 13 cases (9.4%) at 12-months. High-grade HAT/DRT was associated with thromboembolism in 2 cases, whereas low-grade HAT was not related to embolic events. Low-grade HAT resolved spontaneously over time., Conclusions: Cardiac CT seems equally good as TEE for detection of DRT. In addition, cardiac CT demonstrates cases with low-grade HAT, not visualized by TEE. The clinical significance hereof requires further investigation.

Transcatheter left atrial appendage occlusion is increasingly used for stroke prevention in atrial fibrillation. The technique has proven effective and safe in randomized trials and multiple observational studies. The procedure is challenging due to the complex anatomy of the left atrial appendage; accurate cardiac imaging is essential for procedural guidance. Transesophageal echocardiography is the gold standard, but cardiac computed tomography (CT) has gained increasing interest within recent years. Cardiac CT offers high-resolution imaging allowing for preprocedural anatomic evaluation and device sizing, but may also be useful for exclusion of left atrial appendage thrombus, and follow-up assessment of residual peri-device leaks., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Paravalvular leakage (PVL) occurs in 6%-15% of cases after surgical heart valve replacement. A percutaneous approach is increasingly used to close PVLs as an alternative to repeat surgery. Computed tomography (CT) can be used for simulation of fluoroscopic cardiac anatomy. This technique allows preprocedural definition of optimal C-arm angulations and PVL localization in reference to fluoroscopic views. It is very helpful for guidewire crossing of the PVL and positioning of the closure device. We report a case with the first use of dedicated software for fluoroscopic simulation (FluoroCT) in transcatheter mitral PVL closure.

Objectives: To investigate the pattern and development of bone erosion and proliferation in patients with psoriatic arthritis (PsA) during treatment with adalimumab, using high-resolution computed tomography (CT) and conventional radiography., Method: Forty-one biologic-naïve PsA patients were initiated with adalimumab 40 mg subcutaneously every other week. CT and radiography of the 2nd-5th metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints were conducted at baseline (n = 41) and after 24 weeks (n = 32). Changes in bone erosion and proliferation are described and the imaging modalities compared., Results: Ninety percent of bone erosions detected by CT were located in the metacarpal heads, and most frequently in the 2nd-3rd MCP joints. Radial (37%) and ulnar (31%) surfaces were more frequently eroded than dorsal (10%) and palmar (22%) sites. Using CT, bone proliferations were located primarily on the sides of the distal part of the DIP joints (43% of all proliferations), but also proximally in DIP (17%) and MCP joints (27%). For bone erosions and proliferations, respectively, radiography showed a low sensitivity (17% and 26%), but a high specificity (98% and 95%) and accuracy (93% and 87%), with CT as the gold standard reference. Neither CT nor radiography revealed statistically significant changes in bone erosion or proliferation scores between baseline and follow-up., Conclusions: Patterns of bone erosion and proliferation in PsA hands were revealed in more detail by CT than by radiography. No overall progression or repair could be detected during adalimumab treatment with either of the methods.

Purpose: Detection of coronary artery calcification (CAC) has been proposed for population screening. It remains unknown whether such a strategy would result in unnecessary concern among participants. Therefore, we set out to assess whether CAC screening affects the psychological well-being of screening participants., Materials and Methods: A random sample of 1825 middle-aged subjects (men and women, 50 or 60 y old) were invited for health screening. The European HeartScore was calculated, and a CAC score was measured using a cardiac computed tomography scanner. Therapeutic interventions as a result of the observations were at the discretion of the individual general practitioner. Before screening and at 6-month follow-up a depression test (Major Depression Inventory) was conducted, and the use of psychoactive medication was recorded., Results: A total of 1257 (69%) subjects agreed to participate. Because of known cardiovascular disease or diabetes mellitus, 88 persons were excluded. Of the remaining 1169, 47% were men, and one half were 50 years old. At 6-month follow-up, significant reductions were observed in the Major Depression Inventory score from 5.3 to 3.9 (P<0.0001) and in the prescription rates of psychoactive medication from 7.1% (83 of 1169) to 6.2% (72 of 1169) (P=0.003). The results were independent of sex, age, HeartScore, CAC Score, and changes in other medication., Conclusions: A population screening program including CAC score appears to have no detrimental impact on mental distress and does not increase the use of psychoactive medication.

Introduction: Coronary CT angiography (CTA) is a promising method used for diagnostic evaluation of patients suspected of coronary artery disease (CAD). CTA is increasingly used as an alternative to conventional coronary angiography. Information on the diagnostic and therapeutic consequences of using CTA in the diagnostic work-up of patients suspected of CAD is sparse., Material and Methods: Out-clinic patients (n = 215) with chest pain and an intermediate pre-test probability of CAD were referred to diagnostic evaluation by CTA., Results: CTA was not performed in 5% (11/215) due to extensive coronary calcification or arrhythmia, was non-conclusive in 7% (15/215) and was diagnostic in 88% (189/215) of the patients. CTA excluded CAD in 46% (99/215) of the patients. No further diagnostic or hospital follow-up after CTA was necessary in 73% (156/215) of the patients. CTA identified non-significant CAD in 27% (57/215) and significant CAD (>or= 50% stenosis) in 15% (33/215) of the patients. The proportion of patients with CAD in relevant antithrombotic and lipid-lowering medication increased following CTA. Further diagnostic evaluation with coronary angiography following CTA was indicated in 18% (39/215) of the patients due to obstructive CAD (n = 21), non-diagnostic examination (n = 7), or the presence of extensive coronary calcification or arrhythmia (n = 11)., Conclusion: CTA ruled-out CAD in 46% of the patients. No further diagnostic testing or hospital follow-up after CTA was necessary in 73% of the patients. CTA seems valuable in excluding CAD, and may prevent unnecessary invasive angiography in patients without CAD.

The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography, represent true erosive changes. We included 17 RA patients with at least one, previously detected, radiographically invisible MCP joint MRI erosion, and four healthy control individuals. They all underwent CT, MRI, US and radiography of the 2nd to 5th MCP joints of one hand on the same day. Each imaging modality was evaluated for the presence of bone erosions in each MCP joint quadrant. In total, 336 quadrants were examined. The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). The present study strongly indicates that bone erosions, detected with MRI and US in RA patients, represent a loss of calcified tissue with cortical destruction, and therefore can be considered true bone erosions.