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INTRODUCTION We evaluate the ability of 2D non-contrast-enhanced echocardiography (CE-echo), 2DCE-echo, 3D-echo, 3D non-CE-echo, and 3DCE-echo to evaluate allograft function and dimensions in orthotropic heart transplantation (OHT). Cardiac resonance (CMR) was used as reference. METHODS Twenty six consecutive OHT-recipients were prospectively recruited. Bland-Altman, Spearman rank, and concordance-correlation coefficients (CCC) were determined. RESULTS Good CCCs were found between the four modalities and CMR for ejection fraction (r ≥ 0.72/P

Objective To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methods We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). Results We included 295 patients followed up for a median of 28 (19–36) months. A total of 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). Conclusions Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability.

Purpose of review This review article discusses the evolution of extracellular volume (ECV) quantification using both cardiovascular magnetic resonance (CMR) and computed tomography (CT). Recent findings Visualizing diffuse myocardial fibrosis is challenging and until recently, was restricted to the domain of the pathologist. CMR and CT both use extravascular, extracellular contrast agents, permitting ECV measurement. The evidence base around ECV quantification by CMR is growing rapidly and just starting in CT. In conditions with high ECV (amyloid, oedema and fibrosis), this technique is already being used clinically and as a surrogate endpoint. Non-invasive diffuse fibrosis quantification is also generating new biological insights into key cardiac diseases. Summary CMR and CT can estimate ECV and in turn diffuse myocardial fibrosis, obviating the need for invasive endomyocardial biopsy. CT is an attractive alternative to CMR particularly in those individuals with contraindications to the latter. Further studies are needed, particularly in CT.

Rationale Pulmonary artery enlargement (PAE) is associated with exacerbations in Chronic Obstructive Pulmonary Disease (COPD) and with survival in moderate to severe patients. The potential role of PAE in survival prediction has not been compared with other clinical and physiological prognostic markers. Methods In 188 patients with COPD, PA diameter was measured on a chest CT and the following clinical and physiological parameters registered: age, gender, smoking status, pack-years history, dyspnea, lung function, exercise capacity, Body Mass Index, BODE index and history of exacerbations in year prior to enrolment. Proportional Cox regression analysis determined the best predictor of all cause survival. Results During 83 months (±42), 43 patients died. Age, pack-years history, smoking status, BMI, FEV1%, six minute walking distance, Modified Medical Research Council dyspnea scale, BODE index, exacerbation rate prior to enrollment, PA diameter and PAE (diameter≥30mm) were associated with survival. In the multivariable analysis, age (HR: 1.08; 95%CI: 1.03–1.12, p

Purpose To extract radiologic features from small pulmonary nodules (SPNs) that did not meet the original criteria for a positive screening test and identify features associated with lung cancer risk by using data and images from the National Lung Screening Trial (NLST). Materials and Methods Radiologic features in SPNs in baseline low-dose computed tomography (CT) screening studies that did not meet NLST criteria to be considered a positive screening examination were extracted. SPNs were identified for 73 incident case patients who were given a diagnosis of lung cancer at either the first or second follow-up screening study and for 157 control subjects who had undergone three consecutive negative screening studies. Multivariable logistic regression was used to assess the association between radiologic features and lung cancer risk. All statistical tests were two sided. Results Nine features were significantly different between case patients and control subjects. Backward elimination followed by bootstrap resampling identified a reduced model of highly informative radiologic features with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval [CI]: 0.88, 0.96), a specificity of 92.38% (95% CI: 52.22%, 84.91%), and a sensitivity of 76.55% (95% CI: 87.50%, 95.35%) that included total emphysema score (odds ratio [OR] = 1.71; 95% CI: 1.39, 2.01), attachment to vessel (OR = 2.41; 95% CI: 0.99, 5.81), nodule location (OR = 3.25; 95% CI: 1.09, 8.55), border definition (OR = 7.56; 95% CI: 1.89, 30.8), and concavity (OR = 2.58; 95% CI: 0.89, 5.64). Conclusion A set of clinically relevant radiologic features were identified that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants with SPNs.

Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ≥30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity.To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion.Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema.Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%.LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.

Resumen Introduccion y objetivos La experiencia europea en relacion con el cribado de cancer de pulmon con tomografia de baja dosis de radiacion (TBDR) es amplia. Sin embargo, la evidencia sobre la experiencia en Espana es limitada. Nuestro objetivo es presentar los resultados del programa de cribado de cancer de pulmon mas largo de Espana. Metodos El Programa Internacional de Deteccion Precoz de Cancer de Pulmon con TBDR de Pamplona (P-IELCAP) viene reclutando individuos de manera activa desde el ano 2000 siguiendo el protocolo IELCAP. Se incluyen individuos ≥ 40 anos de edad, fumadores o ex fumadores (consumo acumulado ≥ 10 paquetes-ano). Los resultados se comparan con los de otros estudios europeos. Resultados Un total de 2.989 participantes fueron reclutados hasta marzo de 2014 (73% varones), realizando una mediana de 2 (IQR 1-3) rondas de cribado por individuo. Se detectaron 60 canceres de pulmon en 53 participantes (73% en estadio i ). Adenocarcinoma fue el tipo histologico mas frecuente. La proporcion de prevalencia e incidencia de cancer de pulmon fue del 1,0 y del 1,4%, respectivamente, con una tasa de deteccion anual de 0,41. La tasa de supervivencia a 10 anos de los pacientes con cancer de pulmon fue del 70%. La enfermedad pulmonar obstructiva cronica y el enfisema son importantes factores de riesgo para desarrollar cancer de pulmon. Conclusiones La experiencia del programa de cribado de cancer de pulmon mas largo de Espana es comparable con lo descrito en el resto de Europa y confirma la viabilidad y la eficacia del cribado mediante TBDR.

Background: There is increasing interest in performing left atrial appendage (LAA) occlusion at the time of atrial fibrillation (AF) ablation procedures. However, to date there has been no description of the acute changes to the LAA immediately following pulmonary vein (PV) isolation and additional left atrium (LA) substrate modification. This study assessed changes in the size and tissue characteristics of the LAA ostium in patients undergoing PV isolation. Methods: This series included 8 patients who underwent cardiovascular magnetic resonance evaluation of the LA with delayed enhancement magnetic resonance imaging and contrast enhanced 3-D magnetic resonance angiography pre-, within 48 h of, and 3 months post ablation. Two independent cardiac radiologists evaluated the ostial LAA diameters and area at each time point in addition to the presence of gadolinium enhancement. Results: Compared to pre-ablation values, the respective median differences in oblique diameters and LAA area were +1.8 mm, +1.7 mm, and +0.6 cm2 immediately post ablation (all NS) and −2.7 mm, −2.3 mm, and −0.5 cm2 at 3 months (all NS). No delayed enhancement was detected in the LAA post ablation. Conclusion: No significant change to LAA diameter, area, or tissue characteristics was noted after PV isolation. While these findings suggest the safety and feasibility of concomitant PV isolation and LAA device occlusion, the variability in the degree and direction of change of the LAA measurements highlights the need for further study.

Introduction and objectives European experience regarding lung cancer screening using low-dose chest CT (LDCT) is available. However, there is limited data on the Spanish experience in this matter. Our aim is to present the results from the longest ongoing screening program in Spain. Methodology The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) is actively screening participants for lung cancer using LDCT since the year 2000 following the IELCAP protocol, including spirometric assessments. Men and women, ≥40 years of age, current or former smokers with a tobacco history of ≥10 pack-years are included. Results are compared to those from other European trials. Results A total of 2989 participants were screened until March 2014 (73% male). A median of 2 (IQR 1–3) annual screening rounds were performed. Sixty lung cancers were detected in 53 participants (73% in Stage I). Adenocarcinoma was the most frequent. The lung cancer prevalence and incidence proportion was 1.0% and 1.4%, respectively, with an annual detection rate of 0.41. The estimated 10-year survival rate among individuals with lung cancer was 70%. Chronic obstructive pulmonary disease and emphysema are important lung cancer predictors. Conclusions The experience in Spain's longest lung cancer screening program is comparable to what has been described in the rest of Europe, and confirms the feasibility and efficacy of lung cancer screening using LDCT.

The relationship between osteoprotegerin (OPG) a glycoprotein related to bone metabolism and the metabolic syndrome (MS) has not been established.The aim of this study is to evaluate OPG concentration in patients with MS and its association with subclinical atherosclerosis and coronary arterial calcification (CAC).The study included 238 asymptomatic patients. MS was diagnosed according to the NCEP/ATPIII guidelines. OPG was measured by ELISA. All subjects underwent ultrasonography of the common carotid arteries to measure intima-media thickness (IMT) and evaluate the presence of atheroma plaques. In a subgroup (n=39) CAC was quantified by ECG-triggered cardiac computed tomography. Adipose tissue was excised from 25 patients and OPG expression by RT-PCR and immunohistochemistry was studied.Patients with the MS (n=60) had higher OPG than patients without (n=178) (p0.05). OPG correlated with IMT (r=0.2, p=0.005) and patients with atheroma plaques had higher OPG (p=0.008) and also those with coronary artery calcification (p0.05). OPG expression was confirmed in adipose tissue (n=12) and the expression was significantly higher in patients with MS than in those without (p=0.003).This study shows that OPG may potentially be a biomarker for cardiovascular risk/damage in the MS and identifies adipose tissue as a potential source of OPG.

Background Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Methods CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. Results During a median follow up of 65 months (ICR: 36–100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19–1.46, p

The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

Resumen El dolor toracico agudo es una causa frecuente de consulta en los servicios de urgencias. Puede estar ocasionado por una amplia variedad de enfermedades, algunas potencialmente letales, por lo que tienen que diagnosticarse rapidamente. El auge de la tomografia computarizada para estudiar a pacientes con dolor toracico agudo es notable. Sin embargo, se trata de una exploracion no exenta de limitaciones. La resonancia magnetica cardiovascular es una tecnica potencialmente util en este grupo de pacientes, aunque la disponibilidad y la duracion de las exploraciones restringen su uso a determinadas indicaciones. En este trabajo se ilustran los hallazgos de la resonancia magnetica en pacientes con dolor toracico agudo y se describen los protocolos de adquisicion. Ademas, se resaltan los datos semiologicos mas caracteristicos de las causas isquemicas y no isquemicas que pueden provocar estos sintomas.

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.

Resumen La comorbilidad cardiaca es uno de los factores pronosticos mas importantes en las enfermedades pulmonares, particularmente en la enfermedad pulmonar obstructiva cronica (EPOC). Entre las distintas tecnicas de imagen disponibles para estudiar dicha manifestacion sistemica concomitante a la EPOC se incluyen el cateterismo cardiaco, la ecocardiografia transtoracica y la resonancia magnetica. La tomografia computarizada multidetector (TCMD) ha supuesto un progreso significativo en este campo, al permitir obtener estudios simultaneos de la anatomia cardiopulmonar que van mas alla del analisis anatomico-morfologico e incluyen una aproximacion funcional a dicha afectacion. En este trabajo se repasan aspectos practicos necesarios para valorar la comorbilidad cardiaca en pacientes con EPOC, tanto desde el punto de vista de la hipertension pulmonar, como del analisis de la disfuncion ventricular y de la enfermedad coronaria.

The clinical characteristics of patients with emphysema but without airway limitations remain unknown. The goal of this study was to compare the clinical features of current and former smokers without airflow limitation who have radiologic emphysema on chest CT scans vs a control group of current and ex-smokers without emphysema.Subjects enrolled had anthropometric characteristics recorded, provided a medical history, and underwent low-dose chest CT scanning. The following parameters were also evaluated: pulmonary function tests including diffusion capacity for carbon monoxide (Dlco), the modified Medical Research Council dyspnea score, COPD assessment test (CAT), and 6-min walk test (6MWT). A comparison was conducted between those with and without CT-confirmed emphysema.Of the 203 subjects, 154 had emphysema, and 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema according to low-dose chest CT scanning had an abnormal Dlco value (80%) (46% vs 19%; P = .02), a decrease in percentage of oxygen saturation 4% during the 6MWT (8.5% vs 0; P = .04), and an altered quality of life (CAT score ≥ 10) (32% vs 14%; P = .01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score ≥ 1 in the "chest tightness" (P = .05) and "limitation when doing activities at home" (P .01) items compared with those with no emphysema. They also experienced significantly more exacerbations in the previous year (0.19 vs 0.04; P = .02).A significant proportion of smokers with emphysema according to low-dose chest CT scanning but without airway limitation had alterations in their quality of life, number of exacerbations, Dlco values, and oxygen saturation during the 6MWT test.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) has been associated with osteoporosis. Little is known about the potential role of radiological emphysema on the presence of osteoporosis. Objective: Our objective was to determine the putative role of emphysema in the presence of osteoporosis in active and former smokers. Methods: Data from 120 active and former smokers, followed at a Pulmonary Service from 2013 to 2015 were prospectively registered: age, sex, body mass index (BMI), pack-years history, smoking status, spirometric diagnosis of COPD and the presence of emphysema (chest computed tomography- documented). Bone densitometry (BD) was performed on all patients, and classified according to WHO criteria as healthy, osteopenia or osteoporotic. Results: The characteristics of patients with and without osteoporosis are described in Table 1. Patients with osteoporosis were mainly women, with lower BMI, and higher percentage of them with radiological emphysema. Adjusted analyses showed that only the presence of emphysema (odds ratio [OR]: 4.49; 95% confidence interval [CI]:1.81-11.15, p

Telomeres are DNA–protein structures that protect chromosome ends from degradation and shorten progressively with each cell division [1]. Telomere length measured in peripheral leukocytes has been used to determine an individual's “biological age”, and previous reports have demonstrated that patients with chronic obstructive pulmonary disease (COPD) and/or emphysema have shorter peripheral leukocyte telomere length [2–5]. The presence of COPD and emphysema are independent risk factors for the ultimate development of lung cancer [6, 7]. Leukocyte telomere length should be included among the independent risk factors associated with lung cancer J.P. de-Torres, G. Bastarrika, J.J. Zulueta, P. Sanchez-Salcedo, B.R. Celli (conception and design, analysis and interpretation, and drafting the manuscript for important intellectual content); A.B. Alcaide, J. Berto, A. Campo, M. del Mar Ocon, C. Monente, R. Pio, M.J. Pajares, L. Montuenga (analysis and interpretation).

Different "hybrid" techniques that combine open debranching of the supra-aortic vessels with endografting of the aortic arch have emerged as alternatives to the open arch repair in high-risk patients. This study aims to review the early and mid-term results of single-stage hybrid arch repair with ascending aorta stent graft deployment for aortic arch aneurysms and dissections.Between June 2006 and May 2015, five consecutive patients, with an age range of 54-78 years, with complex aortic arch diseases, were treated with a hybrid approach in which the endograft had a proximal landing zone in the ascending aorta. Indications included: acute and chronic type A aortic dissections and three arch aneurysms associated with distal aortic pathology. Length of postoperative clinical and imaging follow-up ranged from 10 to 121 months and was completed in all patients.Technical success of the endografting was achieved in all cases. There was one in-hospital mortality secondary to pulmonary embolism, one case of retrograde type A aortic dissection (RTAD) detected before discharge and one case of late type Ib endoleak that required an endografting procedure. No postoperative stroke or transient or permanent spinal cord ischemia occurred.Hybrid arch repair with endograft landing in zone 0 may decrease mortality and morbidity in high-risk patients. doi: 10.1111/jocs.12735 (J Card Surg 2016;31:341-347).

An incidental saccular left anterior descending (LAD) coronary artery aneurysm was detected in a 72-year-old patient undergoing non-gated chest CT evaluation for the development of a seroma postmastectomy for invasive lobular carcinoma. The LAD aneurysm (arrowhead) was confirmed on gated CT imaging with three-dimensional reconstructions (figure 1A, B) and detected on sagittal oblique reformats (figure 1C). Figure 1 Left anterior descending (LAD) aneurysm (yellow arrowhead) depicted on gated CT imaging three-dimensional reconstructions (A and B) and a sagittal …

The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions.We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model.295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28).Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.

To evaluate the feasibility of using virtual noncontrast material-enhanced (VNC) computed tomographic (CT) series derived from dual-energy CT imaging studies for coronary artery calcium quantification.This HIPAA-compliant study was institutional review board approved; all patients provided written informed consent. Thirty-six patients prospectively underwent noncontrast-enhanced CT calcium scoring followed by coronary CT angiography performed in dual-energy mode. By using different reconstruction algorithms, three VNC series were generated and evaluated for noise and efficiency of virtual iodine removal. Two readers independently quantified calcium on VNC images and true noncontrast-enhanced conventional calcium scoring series. A leave-one-out cross validation was used to assess the accuracy of calcium score prediction from VNC series by means of linear regression.CT value histograms of the VNC series closely resembled the profile in the true noncontrast-enhanced series. There was excellent correlation between calcium volumes on the VNC series and true noncontrast-enhanced series on a per-patient (r = 0.94, P.001, n = 36) and per-vessel (r = 0.94, 0.91, and 0.92 for the three coronary arteries, all P.001, n = 36 each) level. The ability of a linear regression model to predict actual calcium scores from calcium volumes on VNC series was excellent (r = 0.82). Multiethnic Study of Atherosclerosis rankings that were derived from the predicted calcium scores also showed excellent agreement (intraclass correlation coefficient = 0.909).Coronary artery calcium identification and quantification based on dual-energy coronary CT angiographic studies may obviate the need for dedicated CT calcium scoring studies.

Aim To determine the image quality and diagnostic performance of an optimized pulmonary computed tomography angiography (CTA) protocol in terms of radiation and contrast volume saving. Materials and methods Seventy consecutive patients weighting ≤80 kg with clinical suspicion of pulmonary embolism (PE) were prospectively enrolled. Two pulmonary CTA protocols (group A: n = 35, 80 kV/60 ml; group B: n = 35, 100 kV/80 ml) were compared. The presence of PE, image quality parameters [contrast attenuation, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR)] and effective radiation dose (mSv) were assessed. Results PE was found in 11 patients (five of group A, six of group B). The total mean attenuation of the pulmonary arteries was significantly higher in group A (362.4 ± 100.2 HU) than in group B (262.4 ± 134.3 HU), whereas the CNR and SNR did not differ statistically (14.8 ± 7.4 and 16.3 ± 7.5 for group A and 12.5 ± 8.6 and 13.8 ± 9.1 for group B, respectively). The estimated effective radiation dose was significantly lower in group A (1.1 ± 0.7 mSv) than in group B (2.7 ± 1.2 mSv). Conclusion In individuals weighting ≤80 kg, the evaluated pulmonary CTA protocol allows similar image quality to be achieved as compared with the conventional pulmonary CTA protocol while reducing radiation exposure by 60% and contrast media volume by 25%.

Purpose To compare the accuracy of cardiac dual-source CT (DSCT) reconstructions obtained at 5% and 10% of the cardiac cycle and MRI for quantifying global left ventricular (LV) function and mass in heart transplant recipients. Material and methods We prospectively included 23 heart transplant recipients (21 males, mean age 60 ± 11.7 years) who underwent cardiac DSCT and MRI examinations. We compared LV parameters on cardiac DSCT reconstructions obtained at 5% (0–95%) and 10% (0–90%) intervals of the cardiac cycle and on double-oblique short-axis MR images. We determined ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and myocardial mass using commercially available semiautomated segmentation analysis software for DSCT datasets and conventional manual contour tracing for MR studies. Results Using different reconstruction intervals to quantify LV parameters at DSCT resulted in non-significant differences ( P > .05). Compared to MRI, DSCT slightly overestimated LV-EDV, ESV, and mass when both 5% (11.5 ± 25.1 mL, 6.8 ± 10.9 mL, and 28.3 ± 21.6 g, respectively) and 10% (mean difference 15.3 ± 26.3 mL, 7.4 ± 11.5 mL, and 29.3 ± 18.7 g, respectively) reconstruction intervals were used. DSCT and MRI estimates of EF and SV were not significantly different. Conclusion In heart transplant recipients, DSCT allows reliable quantification of LV function and mass compared with MRI, even using 10% interval reconstructions.

Objective To prospectively evaluate the accuracy of left and right ventricular function and myocardial mass measurements based on a dual-step, low radiation dose protocol with prospectively ECG-triggered 2nd generation dual-source CT (DSCT), using cardiac MRI (cMRI) as the reference standard. Materials and methods Twenty patients underwent 1.5 T cMRI and prospectively ECG-triggered dual-step pulsing cardiac DSCT. This image acquisition mode performs low-radiation (20% tube current) imaging over the majority of the cardiac cycle and applies full radiation only during a single adjustable phase. Full-radiation-phase images were used to assess cardiac morphology, while low-radiation-phase images were used to measure left and right ventricular function and mass. Quantitative CT measurements based on contiguous multiphase short-axis reconstructions from the axial CT data were compared with short-axis SSFP cardiac cine MRI. Contours were manually traced around the ventricular borders for calculation of left and right ventricular end-diastolic volume, end-systolic volume, stroke volume, ejection fraction and myocardial mass for both modalities. Statistical methods included independent t-tests, the Mann–Whitney U test, Pearson correlation statistics, and Bland–Altman analysis. Results All CT measurements of left and right ventricular function and mass correlated well with those from cMRI: for left/right end-diastolic volume r = 0.885/0.801, left/right end-systolic volume r = 0.947/0.879, left/right stroke volume r = 0.620/0.697, left/right ejection fraction r = 0.869/0.751, and left/right myocardial mass r = 0.959/0.702. Mean radiation dose was 6.2 ± 1.8 mSv. Conclusions Prospectively ECG-triggered, dual-step pulsing cardiac DSCT accurately quantifies left and right ventricular function and myocardial mass in comparison with cMRI with substantially lower radiation exposure than reported for traditional retrospective ECG-gating.

OBJECTIVE. This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature.CONCLUSION. Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.

Chest pain is a challenging clinical problem in the emergency department. Despite advances in clinical diagnosis, many patients with atypical chest pain are needlessly hospitalized and others are mistakenly discharged. Faced with the specific clinical situation in which a patient has chest pain, an initially normal or inconclusive electrocardiogram, and normal cardiac biomarkers, multislice CT has proven useful for ruling out the conditions that involve the greatest morbidity and mortality and for establishing the cause of pain. This article reviews the current usefulness of multislice CT in the diagnostic workup of patients presenting at the emergency department with chest pain. We review the technique, define the most appropriate population, describe the acquisition protocols, and discuss the advantages and disadvantages of each study protocol.

Objectives: The purpose of this study was to compare the prognostic role of various computed tomography (CT) signs of right ventricular (RV) dysfunction, including 3-dimensional ventricular volume ...

To use coronary computed tomographic (CT) angiography to compare the prevalence, extent, and composition of coronary atherosclerotic lesions in African American and white patients with acute chest pain.The institutional review board waived the requirement for informed consent for this retrospective, HIPAA-compliant matched-cohort study. The authors analyzed the CT angiographic data of 301 patients (150 consecutive African American patients; 151 white control patients; mean age, 55 years ± 11 [standard deviation]; 33% male) with acute chest pain. Each coronary artery segment was evaluated for presence of atherosclerotic plaque, plaque composition (calcified, noncalcified, or mixed), and stenosis. In addition, the noncalcified plaque volume was quantified by using a threshold-based automated algorithm. The presence and extent of atherosclerotic plaque were compared between the groups by using univariate and multivariate regression analyses.While there was no significant difference between the African American and white patients with respect to presence of any plaque (118 [79%] of 150 vs 112 [74%] of 151 patients, respectively; P = .36) or presence of stenosis (26 [17%] vs 37 [24%] patients, respectively; P = .13), the African American patients had a significantly higher prevalence (96 [64%] vs 62 [41%] patients, respectively; P.001) and volume (median volume, 2.2 vs 1.4 mL, respectively; P.001) of noncalcified plaque, independent of diabetes and other cardiovascular risk factors (odds ratio, 2.45; 95% confidence interval: 1.52, 4.04). In contrast, the African American patients had a lower prevalence of calcified plaque (39 [26%] vs 68 [45%] white patients, P = .001).Study results suggest that atherosclerotic plaque burden and composition, as measured by using coronary CT angiography, differ between African American and white patients, with relatively more noncalcified disease in African Americans and more calcified disease in white individuals. Further research is warranted to determine whether CT plaque characterization can improve cardiac risk prediction in African Americans.

Objective: Cardiacallograft vasculopathy and late graft failure are the main limiting factors of long-termsuccess of heart transplantation, and little is known about graft function in the long-term survivors. The aim of this study was to assess the ventricular function and the allograft vasculopathy in long-term survivors (>15 years) with the cardiac magnetic resonance imaging (MRI) and dual-source computed tomography (DSCT) coronary angiogram. Methods: In our database, 34 cardiac recipients have more than 15 years of follow-up and were evaluated for this study; 22 (65%) of them were enrolled. Mean age at transplant was 46 13.5 years, mean donor age was 28.5 10.1 years, and mean graft ischemictimewas189 58 min.Meanfollow-upwas18.5 2.4years(range15—22).AllpatientsunderwentcardiacMRIandDSCT.Results:Mean leftventricular(LV) volumesindexedtothebodysurfacearea(BSA)werewithinnormalrange:theend-diastolicvolume/BSAwas61 16 ml m 2 , end-systolic volume/BSA was 22 15 ml m 2 , stroke volume/BSA was 38 6m l m 2 , LV mass/BSA: 72 18 g m 2 , and mean ejection fraction (EF)was0.59 0.08.Twopatients(9%)showedaglobalcardiachypokinesiaandtwootherpatients(9%)showedakinesiaofonesegment.AtDSCT, 41% of patients had a strictly normal coronary angiogram, 41% had wall thickening and 18% presented a least one >60% stenosis. Conclusions: CardiacMRI and DSCTcoronaryangiogramrevealeda normalgraftfunctionandmorphologyafter morethan 15yearsof transplantation. However, a certain number of patients have significant cardiac allograft vasculopathy and another consistent group has initial disease. These patients deserve further follow-up and tailoring of the immunosuppressive regimen. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

To assess feasibility, image quality, and radiation dose of prospectively ECG-triggered coronary CT angiography (CTA) in orthotopic heart transplant (OHT) recipients.47 consecutive OHT recipients (40 men, mean age 62.1 ± 10.9 years, mean heart rate 86.3 ± 14.4 bpm) underwent dual-source CTA to rule out coronary allograft vasculopathy in a prospectively ECG-triggered mode with data acquisition during 35% to 45% of the cardiac cycle. Two independent observers blindly assessed image quality on a per-segment and per-vessel basis using a four-point scale (1-excellent, 4-not evaluable). Scores 1-3 were considered acceptable for diagnosis. Multivariate analysis was performed to evaluate differences between image quality scores obtained at different reconstruction intervals. Effective radiation doses were calculated.671 coronary segments were evaluated. Interobserver agreement on the image quality was κ=0.75. Diagnostic image quality was observed in 93.9%, 95.5% and 93.3% of the segments at 35%, 40% and 45% reconstruction intervals. Mean image quality score was 1.5 ± 0.7 for the entire coronary tree, 1.4 ± 0.7 for the RCA, 1.6 ± 0.8 for the LCA and 1.6 ± 0.7 for the Cx at the best reconstruction interval. Estimated mean radiation dose was 4.5 ± 1.2 mSv.Systolic prospectively ECG-triggered CTA allows diagnostic image quality coronary angiograms in OHT recipients at low radiation doses.

To evaluate the effect of a computer-aided detection (CAD) algorithm on the performance of novice readers for detection of pulmonary embolism (PE) at CT pulmonary angiography (CTPA).We included CTPA examinations of 79 patients (50 female, 52 ± 18 years). Studies were evaluated by two independent inexperienced readers who marked all vessels containing PE. After 3 months all studies were reevaluated by the same two readers, this time aided by CAD prototype. A consensus read by three expert radiologists served as the reference standard. Statistical analysis used χ(2) and McNemar testing.Expert consensus revealed 119 PEs in 32 studies. For PE detection, the sensitivity of CAD alone was 78%. Inexperienced readers' initial interpretations had an average per-PE sensitivity of 50%, which improved to 71% (p0.001) with CAD as a second reader. False positives increased from 0.18 to 0.25 per study (p = 0.03). Per-study, the readers initially detected 27/32 positive studies (84%); with CAD this number increased to 29.5 studies (92%; p = 0.125).Our results suggest that CAD significantly improves the sensitivity of PE detection for inexperienced readers with a small but appreciable increase in the rate of false positives.

OBJECTIVES Dual-energy computed tomography (DECT) has been proposed for the comprehensive assessment of coronary artery stenosis and myocardial perfusion yet traditionally required reducing the temporal resolution of cardiac studies. We evaluated a reconstruction algorithm that preserves high temporal resolution at cardiac DECT. METHODS Twelve consecutive patients (3 women; mean [SD] age, 64 [10] years) with an abnormal single photon emission CT result underwent invasive coronary angiography and cardiac DECT. Dual-energy CT studies were reconstructed using the standard algorithm with 165-millisecond temporal resolution and a hybrid algorithm providing 83-millisecond temporal resolution. These studies were rated for coronary image quality and motion artifacts and compared with invasive coronary angiographic studies. RESULTS One hundred sixty-eight coronary artery segments (82%) were evaluated. The standard 165-millisecond reconstruction provided 95% diagnostic segments compared with 100% using the 83-millisecond hybrid reconstruction. Image quality was rated significantly (P < 0.05) better with hybrid reconstruction and had 91.4% sensitivity, 94.7% specificity, 82.1% positive predictive value, and 97.7% negative predictive value for detecting significant stenosis versus 85.7%, 93.2%, 76.9%, and 96.1% with standard reconstruction, respectively. CONCLUSIONS Hybrid image reconstruction mitigates the former limitations in temporal resolution of cardiac DECT.

Background Electromagnetic navigation bronchoscopy (ENB) has been developed as a novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules. Despite successful navigation in 90% of patients, ENB diagnostic yield does not generally exceed 70%. We sought to determine whether the presence of a bronchus sign on CT imaging conditions diagnostic yield of ENB and might account for the discrepancy between successful navigation and diagnostic yield. Methods We conducted a prospective, single-center study of ENB in 51 consecutive patients with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique in patients with a high surgical risk, suspected metastatic disease, or advanced-stage disease, or in those who demanded a preoperative diagnosis prior to undergoing curative resection. We studied patient and technical variables that might condition diagnostic yield, including size, cause, location, distance to the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the presence of a bronchus sign on CT imaging; registration point divergence; and the minimum distance from the tip of the locatable guide to the nodule measured during the procedure. Results The diagnostic yield of ENB was 67% (34/51). The sensitivity and specificity of ENB for malignancy in this study were 71% and 100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign. Univariate analysis identified the bronchus sign ( P = .005) and nodule size ( P = .04) as statistically significant variables conditioning yield, but on multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95% CI, 1.8-31.7). No procedure-related complications were observed. Conclusions ENB diagnostic yield is highly dependent on the presence of a bronchus sign on CT imaging.

To define the potential, limitations and synergies of micro-CT and other non-radiological techniques for the quantification of emphysema and related processes in mice, by performing a complete characterization of the elastase-induced emphysema model.Ninety A/J mice (45 treated and 45 controls) were studied at different time points using breath-hold gated micro-CT, functional test parameters, RT-PCR for RNA cytokine expression, Luminex technology for cytokine plasma concentration and histomorphometry.Both histomorphometry and micro-CT imaging reflect rapid initial emphysema progression followed by steady-state development at decreasing rates. Cytokine measurements reveal an acute inflammatory response within the first 24 h that disappears after the first week. Limited systemic effect was observed based on plasma cytokine concentration. Lung compliance decreases during the acute inflammation phase and increases afterwards.Histomorphometry is the most sensitive technique since it detects airspace enlargement before the other methods (1 h after treatment). Micro-CT correlates well with histology (r2 = 0.63) proving appropriate for longitudinal studies. Functional test parameters do not necessarily correlate with the extent of emphysema, as they can be influenced by acute inflammation. Finally, cytokine measurements correlate with the presence of inflammation in histology but not with emphysema.

Technological advances in multidetector computed tomography (MDCT) like second-generation dual source scanners have made it possible to evaluate myocardial perfusion as well as the anatomy of the coronary arteries in patients with suspected coronary disease; until recently, this application was confined to other imaging modalities. In this brief communication, we report a cardiac CT imaging protocol that combines CT coronary angiography with the analysis of ventricular function, perfusion, and myocardial viability in a single examination, thereby enabling a comprehensive assessment of coronary disease.

Objectives To evaluate the feasibility of using automatic quantitative analysis of breath hold gated micro-CT images to detect and monitor disease in a mouse model of chronic pulmonary inflammation, and to compare image-based measurements with pulmonary function tests and histomorphometry. Material and methods Forty-nine A/J mice were used, divided into control and inflammation groups. Chronic inflammation was induced by silica aspiration. Fourteen animals were imaged at baseline, and 4, 14, and 34 weeks after silica aspiration, using micro-CT synchronized with ventilator-induced breath holds. Lung input impedance was measured as well using forced oscillation techniques. Five additional animals from each group were killed after micro-CT for comparison with histomorphometry. Results At all time points, micro-CT measurements show statistically significant differences between the two groups, while first differences in functional test parameters appear at 14 weeks. Micro-CT measurements correlate well with histomorphometry and discriminate diseased and healthy groups better than functional tests. Conclusion Longitudinal studies using breath hold gated micro-CT are feasible on the silica-induced model of chronic pulmonary inflammation, and automatic measurements from micro-CT images correlate well with histomorphometry, being more sensitive than functional tests to detect lung damage in this model.

Rationale and Objectives The aim of this study was to compare the reproducibility of bidimensional and volumetric quantification of epicardial adipose tissue (EAT) on cardiac computed tomography (CT) and evaluate their relationship with the extent of coronary artery disease (CAD). Materials and Methods Forty-five individuals underwent cardiac dual-source CT and conventional coronary angiography for suspicion of CAD. Nonenhanced images acquired to assess calcium score were used to quantify EAT. Coronary stenosis grading was performed on conventional coronary angiograms using Gensini scores. Two independent observers manually measured right ventricular EAT thickness at three different levels and in two different planes (four chamber and short axis) to obtain mean values. Additionally, EAT volume was automatically determined using a commercially available software tool. Results Conventional coronary angiography demonstrated nonstenotic coronary arteries in 22 subjects and significant coronary artery stenosis in 23. Significant correlations were observed between volumetric estimation of EAT and body mass index, coronary artery calcification, and Gensini score. On automatic volumetry, patients with significant coronary artery stenosis had significantly greater EAT volumes (154.58 ± 58.91 mL) than those without significant CAD (120.94 ± 81.85 mL) ( P = .016). The manual bidimensional approach based on thickness measurements failed to show a significant difference between the two groups. Reproducibility and interobserver agreement for EAT quantification were higher when the automatic volumetric method was used (concordance-correlation coefficient, 0.96) compared to manual measurements (concordance-correlation coefficients, 0.37 for four-chamber EAT, 0.53 for short-axis EAT, and 0.58 for average EAT). Conclusions For the quantification of EAT on cardiac CT, automated volumetry is more reproducible and correlates better with the extent of CAD than manual bidimensional measurements.

Skin burns below ground pads during monopolar RF ablation are increasingly prevalent, thereby hindering the development of higher power RF generators capable of creating larger tumor ablation zones in combination with multiple or new applicators. Our goal was to evaluate reduction in skin temperatures via additional ground pads in an in vivo porcine model. Three ground pads placed on the animal's abdomen were activated either simultaneously or sequentially, where activation timing was adjusted to equilibrate skin temperature below each pad. Thirteen RF ablations (n = 4 simultaneous at 300 W, n = 5 sequential at 300 W, and n = 4 sequential at 375 W) were performed for 12 min via two internally cooled cluster electrodes placed in the gluteus maximus of domestic swine. Temperature rise at each pad and burn degree as determined via histology were compared. Ablation zone size was determined via T2-weighted MRI. Maximum temperature rise was significantly higher with simultaneous activation than with either of the sequential activation group (21.4 degrees C versus 8.1 degrees C or 9.6 degrees C, p0.01). Ablation zone diameters during simultaneous (300 W) and sequential activations (300 and 375 W) were and 6.9 +/- 0.3, 5.6 +/- 0.3, and 7.5 +/- 0.6 cm, respectively. Sequential activation of multiple ground pads results in significantly lower skin temperatures and less severe burns, as measured by histological examination.

To compare left atrial performance with dual-source CT (DSCT) with respect to magnetic resonance imaging (MRI) in orthotopic heart transplant recipients.Twenty-nine consecutive heart transplant recipients (27 male; mean age 64.1 +/- 13 years; mean time from transplantation 122.8 +/- 69.7 months) referred for exclusion of cardiac allograft vasculopathy underwent cardiac DSCT and MRI. Standard biatrial technique was employed in 13 subjects whereas 16 were transplanted after the bicaval technique. Axial 5-mm slice-thickness DSCT datasets reconstructed in 5% steps of the cardiac cycle and axial 5-mm SSFP-MRI images were analyzed. Two blinded readers manually traced left atrial contours in random order to estimate end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). Parameters were compared with a paired sample Student t test. Concordance correlation coefficient (CCC) was calculated to determine measurement agreement between techniques and observers.Left atrial volumes were significantly higher with cardiac DSCT (EDV: 170.9 +/- 78.1 mL; ESV: 139.5 +/- 76.6 mL) than with MRI (EDV: 158.2 +/- 72.5 mL; ESV: 124.2 +/- 68.2 mL), whereas left atrial EF was lower with DSCT (EF: 20.8% +/- 7.5% vs. 23.6% +/- 7.7%) (P0.05). Measurement agreement between DSCT and MRI was excellent for all parameters (CCCor =0.82). Individuals operated with the biatrial anastomosis technique presented significantly higher left atrial volumes and lower EF compared with subjects with bicaval anastomosis. Interobserver agreement was excellent for all parameters (CCCor =0.80).Even if DSCT slightly overestimates left atrial volumes with respect to MRI, results remain clinically valid. Bicaval surgical technique offers improved left atrial performance compared with standard biatrial anastomosis. DSCT may be used as a reliable tool to estimate left atrial parameters in orthotopic heart transplant recipients.

Resumen Objetivo Evaluar la posibilidad de cuantificar la calcificacion coronaria en las tomografias computarizadas (TC) de baja dosis de radiacion (TCBD) toracicas realizadas en un programa de deteccion precoz de cancer de pulmon con respecto al protocolo cardiaco especifico realizado con sincronizacion electrocardiografica (ECG) retrospectiva. Material y metodos Tras obtener el consentimiento informado se analizaron las exploraciones de 48 fumadores asintomaticos consecutivos (44 varones, 4 mujeres; edad media 59,7 anos) incluidos en un programa de deteccion precoz de cancer de pulmon a los que se realizo TCBD toracica y un estudio cardiaco especificamente dirigido a cuantificar la calcificacion coronaria con sincronizacion ECG retrospectiva en un equipo TC multicorte (Volume Zoom, Siemens). La exploracion TC de baja dosis de radiacion se reconstruyo para reproducir los parametros del estudio cardiaco. Los valores de calcio coronario se compararon con el test de Wilcoxon. Se calculo el coeficiente de correlacion de concordancia (CCC) para determinar la concordancia entre ambos metodos. Resultados Los valores del calcio coronario oscilaron entre 0 y 1.908,4 (mediana: 89,6; amplitud intercuartil [AIC]: 3,2; 227,4) en TCBD y entre 0 y 1.486,6 (mediana: 81,3; AIC: 2,5; 316,4) en los estudios cardiacos. No se observaron diferencias estadisticamente significativas en la estimacion total de calcio coronario (p=0,28). La concordancia entre ambas tecnicas fue buena (CCC≥0,81). Conclusion Los estudios de TC de baja dosis de radiacion realizados en programas de deteccion precoz de cancer de pulmon permiten cuantificar la calcificacion coronaria con la misma exactitud que el protocolo cardiaco especifico realizado con sincronizacion ECG retrospectiva.

Objective To evaluate the feasibility of quantifying coronary artery calcification in low-radiation dose chest CT (LDCT) studies performed in an early lung cancer detection program by comparing the results of this technique with those of dedicated retrospectively ECG-gated cardiac CT. Material and methods After obtaining informed consent, we evaluated the CT studies of 48 consecutive asymptomatic smokers (44 male, 4 female; mean age 59.7 years) included in an early lung cancer detection trial who underwent multislice LDCT (Volume Zoom, Siemens) of the chest and a retrospectively ECG-gated cardiac CT specifically dedicated to quantifying coronary artery calcification. LDCT examinations were reconstructed to reproduce cardiac CT parameters. Coronary calcium values were compared using the Wilcoxon signed-rank test. The concordance correlation coefficient (CCC) was calculated to determine the agreement between the two methods. Results Coronary calcium values ranged from 0 to 1,908.4 (median: 89.6; IQR: 3.2; 227.4) in LDCT exams and from 0 to 1,486.6 (median: 81.3; IQR: 2.5; 316.4) in cardiac CT studies. No statistically significant difference was observed in the estimation of total coronary calcium score (p = 0.28). The concordance between the two techniques was excellent (CCC ≥ 0.81). Conclusion The LDCT study performed in lung cancer early detection trials enables coronary artery calcification to be quantified with the same accuracy as the dedicated retrospectively ECG-gated cardiac CT examination.

Pulmonary embolism is a frequent condition for which multidetector computed tomography (MDCT) plays an important role in its detection. Occasionally, on MDCT studies, dense linear branching opacities may be found within the pulmonary vessels. They represent dense emboli within the pulmonary arteries (DEPA). These may occur in oncologic patients that undergo specific treatments or interventional procedures, such as cement embolus from vertebroplasty, catheter or coil migration after embolization procedures, radioactive seed embolus in patients treated with local brachytherapy for prostate, lung, or liver cancer, and also in chronic pulmonary embolism. Usually DEPA does not have any clinical significance but may be fatal when massive or when in patients with impaired cardiopulmonary function. Being familiar with their radiologic appearance and knowing about the good clinical outcome of these patients will avoid unnecessary imaging testing. In this article, we describe some examples of DEPA. Based on the MDCT imaging findings, these emboli have very few or no side effects on the underlying lung parenchyma. We would like to stress the need for using bone window values for identifying these emboli. We provide examples of dense linear nonvascular images (pulmonary calcification secondary to tuberculosis (TBC) or radiotherapy, calcified mucous plugs, lung sutures, etc) that may mimic DEPA.

Resumen Objetivo Valorar la utilidad de la tomografia computarizada de doble fuente (TCDF) como tecnica diagnostica en pacientes hospitalizados con dolor toracico atipico de etiologia incierta. Material y metodos Se incluyeron 41 sujetos consecutivos hospitalizados en nuestro centro (25 varones, 16 mujeres; edad media 55,6±17,39 anos) con dolor toracico atipico sin causa clinicamente reconocible en los que se indico un estudio de TC para filiar su etiologia. Los estudios se realizaron en un equipo TCDF con sincronizacion ECG retrospectiva tras administrar 120 ml de contraste iodado a 4 ml/s utilizando la tecnica de bolus tracking. Los estudios fueron analizados por 2 observadores de forma consensuada. Resultados Las exploraciones fueron diagnosticas en todos los pacientes. Se hallaron 5 casos de tromboembolismo pulmonar y 2 de patologia aortica (1 ulcera aortica y 1 aneurisma sacular). Se objetivaron anomalias en las arterias coronarias en 15 sujetos, 2 de los cuales presentaron estenosis >50%. Como hallazgos extracardiovasculares se diagnosticaron 11 casos de neumonia, 1 sarcoidosis y 1 carcinoma no microcitico de pulmon. Ademas, se observo derrame pleural en 4 sujetos y derrame pericardico en otros 4. El resultado fue negativo en un 22% de los sujetos. La evolucion fue favorable en todos los pacientes y ninguno volvio a acudir por persistencia del dolor o episodio de dolor toracico de nueva aparicion durante el periodo de seguimiento. Conclusion La TCDF es una tecnica util para filiar la etiologia y descartar las causas potencialmente mas graves de dolor toracico en pacientes hospitalizados.

The clinical applications of computed tomography coronary angiography (CTCA) are constantly evolving. Initially employed to quantify coronary artery calcification, multidetector CT also makes it possible to evaluate the anatomy and anatomical variations of coronary circulation, rule out coronary disease, and follow up surgical and percutaneous revascularization procedures. Moreover, CTCA may potentially be useful to quantify ventricular function, characterize non-calcified atherosclerotic plaques, and analyze myocardial perfusion and viability, providing anatomical, morphological, and functional information in patients with suspected ischemic heart disease.

Multidetector-row computed tomography (MDCT) plays an essential role in oncologic imaging as the modality of mapping out the treatment strategy at staging, assessing response to the treatment, and following up patient outcome after the treatment. Even without electrocardiogram gating, MDCT provides accurate information about the heart. In the group of oncologic patients, different tumoral and non-tumoral-related heart disorders can be found, for example, metastatic cardiac involvement (approximately 10% of patients with lung or breast cancer will develop metastases to the heart), paraneoplastic cardiac disorders, non-tumor-related heart disorders, and chemotherapy- and radiotherapy-related cardiac side effects. MDCT plays a role in the detection of these entities. We show the non-electrocardiogram-gated MDCT findings of oncology-related cardiac disorders to encourage radiologists to recognize and report cardiac findings in oncologic patients. Appropriate knowledge of tumoral and non-tumoral-related MDCT features allows a complete evaluation of oncologic patients with ancillary cardiac findings. An adequate knowledge of the patient's medical history, previous treatments, and concomitant illnesses is essential to interpret heart findings in oncologic patients who undergo MDCT.

OBJECTIVE. The purpose of this article is to describe the current role of ECG-synchronized CT in the evaluation of patients with acute chest pain (triple rule-out) in the emergency department. We discuss clinical contexts of the chest pain algorithm, technical improvements that have enabled CT to attain its current role for this application, scan protocols and radiation considerations, the evidence base regarding diagnostic and prognostic performance, and initial data on the cost-effectiveness of this promising emerging test.CONCLUSION. Currently available evidence suggests that CT-based approaches with modern scan technology are safe, accurate, and potentially cost-saving, although large-scale clinical trials are needed to ascertain the precise role of CT in the evaluation of acute chest pain.

Resumen Objetivo evaluar prospectivamente la relacion entre frecuencia cardiaca y calidad de imagen, y determinar el intervalo de reconstruccion optimo para las arterias coronarias en estudios de tomografia computarizada de doble fuente (TCDF). Material y metodos se analizaron 28 sujetos consecutivos en que se realizo coronariografia mediante TCDF (Somatom Definition, Siemens). Las imagenes se reconstruyeron a lo largo del ciclo cardiaco en intervalos del 5% R-R. Dos observadores independientes evaluaron la calidad diagnostica de las imagenes para las arterias coronarias (izquierda, circunfleja y derecha) (1=no evaluable; 4=calidad excelente). Resultados la frecuencia cardiaca media de los pacientes fue 73,1±14,8 lpm (rango, 49–107 lpm). En el mejor intervalo de reconstruccion se obtuvo excelente calidad de imagen (4 puntos) en el 98,8% (83/84) de las arterias coronarias. La concordancia interobservador para la puntuacion de calidad de imagen y seleccion del intervalo de reconstruccion optimo fue muy buena (κ=0,77 y κ=0,86). La puntuacion media de calidad para todo el arbol coronario fue 2,84±0,31. No se observo correlacion entre la frecuencia cardiaca media y la calidad de la imagen de las arterias coronarias (r=0,108). No hubo diferencias estadisticamente significativas al comparar la calidad de imagen obtenida en las reconstrucciones sistolicas y diastolicas en cada paciente. Conclusiones la TCDF permite obtener coronariografias de excelente calidad diagnostica independientemente de la frecuencia cardiaca. Las reconstrucciones se pueden realizar tanto en sistole como en diastole sin que hayan diferencias estadisticamente significativas en la calidad, incluso con frecuencias cardiacas elevadas.

To evaluate the accuracy and effect on interreader reproducibility of automated versus manual volumetric quantification of noncalcified coronary artery plaque burden at coronary computed tomography angiography.Thirty-seven patients underwent 64-slice coronary computed tomography angiography. Two experienced observers in consensus evaluated each study and identified 40 noncalcified coronary artery plaques. Also in consensus, they performed manual, 3-dimensional planimetric measurements on each plaque as the reference standard. The same 2 observers then performed volumetric measurements on each plaque using a threshold-based automated volumetry automated plaque analysis algorithm. Two different, less experienced observers also performed both, manual and automated measurements of each plaque, first independently and then in consensus. Spearman rank correlation was used to determine association between variables.Automated volumetry was successfully performed on each plaque. There was excellent (R=0.920) correlation between the expert manual measurements (average plaque burden=33.58 mm(3)+/-18.16) and automated plaque volumetry (35.64 mm(3)+/-16.42). For the less experienced observers, there was better correlation with expert manual measurements using automated plaque volumetry (R=0.885) than with manual measurements (R=0.854). Interreader correlation for volume measurements by the 2 less experienced observers without and with use of the automated plaque analysis algorithm significantly (P0.001) increased from R=0.781 to R=0.919.Compared with expert manual measurements, automated plaque volumetry enables accurate quantification of noncalcified plaque burden. Reproducibility of plaque measurements between different observers is improved. Use of such automated plaque analysis algorithms should facilitate fast, objective and reproducible assessment of noncalcified plaque burden for risk stratification and therapeutic monitoring.