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Background Breast implant-related health problems are a subject of fierce debate. Reliable population-based estimates of implant prevalence rates are not available, however, due to a lack of historical registries and incomplete sales data, precluding absolute risk assessments. Objectives This study aimed to describe the methodology of a novel procedure to determine Dutch breast implant prevalence based on the evaluation of routine chest radiographs. Methods The validity of the new method was first examined in a separate study. Eight reviewers examined a series of 180 chest radiographs with (n = 60) or without (n = 120) a breast implant confirmed by a computed tomography or magnetic resonance imaging scan. After a consensus meeting with best-performing expert reviewers, we reviewed 3000 chest radiographs of women aged 20 to 70 years in 2 large regional hospitals in the Netherlands in 2015. To calculate the national breast implant prevalence, regional prevalence variations were corrected utilizing the National Breast Cancer Screening Program. Results Eight reviewers scored with a median sensitivity of 71.7% (range, 41.7%-85.0%) and a median specificity of 94.6% (range, 73.4%-97.5%). After a consensus meeting and a reevaluation by best-performing expert reviewers, sensitivity was 79.9% and specificity was 99.2%. The estimated national prevalence of breast implants among women between 20 and 70 years was 3.0%, ranging from 1.7% at 21 to 30 years to 3.9% between 51 and 60 years. Conclusions The novel method in this study was validated with a high sensitivity and specificity, resulting in accurate prevalence estimates and providing the opportunity to conduct absolute risk assessment studies on the health consequences of breast implants. Level of Evidence: 2

Objective Obesity has been associated with microstructural brain tissue damage. Different fat compartments demonstrate different metabolic and endocrine behaviors. The aim was to investigate the individual associations between abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and microstructural integrity in the brain. Methods This study comprised 243 subjects aged 65.4 ± 6.7 years. The associations between abdominal VAT and SAT, assessed by CT, and magnetization transfer imaging markers of brain microstructure for gray and white matter were analyzed and adjusted for confounding factors. Results VAT was associated with normalized magnetization transfer ratio (MTR) peak height in gray (β −0.216) and white matter (β −0.240) (both P 0.05). Stepwise linear regression analysis showed that only VAT was associated with normalized MTR peak height in gray and white matter (both P

Background Right ventricular (RV) function is predictive of outcome in patients with acute pulmonary embolism (PE). We assessed the possible incremental value of ventricular function with ECG-synchronized cardiac CT scanning over pulmonary CT scan angiography (CTA) for predicting short-term outcome in patients with suspected acute PE. Methods The local ethics committee approved the study, and informed consent was obtained. In addition to standard CTA, 430 consecutive patients (193 men, 237 women; age, 55 ± 17 years) with suspected acute PE underwent ECG-synchronized CT scanning to assess ventricular function. RV/left ventricular (LV) function ratio and pulmonary obstruction index were obtained from non-ECG-synchronized CTA. Ventricular function was used to predict adverse events ( Results In 113 patients with PE, RV and LV ejection fraction (EF) and RV/LV diameter and volume ratios were associated with adverse outcome (P Conclusions RVEF was the best predictor for clinical outcome in patients with acute PE. However, incremental value of RVEF over axial RV/LV ratio was not found.

Objectives To evaluate the diagnostic performance of 320-slice computed tomography coronary angiography (CTA) in the evaluation of patients with prior coronary artery bypass grafting (CABG). Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach. Methods CTA studies were performed using CT equipment with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 0.35 s. All grafts, recipient and nongrafted vessels were deemed interpretable or uninterpretable. The presence of significant (≥50%) stenosis and occlusion were determined on vessel and patient basis. Results were compared to ICA using quantitative coronary angiography. Results A total of 40 patients (28 men, 76 ± 15 years), with 89 grafts, were included in the study. On a graft analysis, the sensitivity, specificity, positive and negative predictive values in the evaluation of significant stenosis were 96%, 92%, 83% and 98% respectively. The diagnostic accuracy for the assessment of recipient and nongrafted vessels was 89% and 80%, respectively. The diagnostic accuracy for the assessment of graft, recipient and nongrafted vessel occlusion was 96%, 92% and 100%, respectively. Conclusions 320-slice CTA allows accurate non-invasive assessment of significant graft, recipient vessel and nongrafted vessel stenosis in patients with prior CABG.

With the introduction of 64-multidetector row CT, coronary CT angiography has become a clinical tool, owing to improved image quality and reduced breath-hold time, and contrast and radiation dose. Nowadays, cardiac CT is widely used in clinical practice for various indications and patient groups. In this article, recent technical developments are presented. Current clinical applications of cardiac CT are reviewed (e.g., calcium score, evaluation of coronary arteries, coronary artery bypass grafts and stents, triple rule-out protocols, cardiac function, valve imaging and imaging congenital heart disease). For these topics, status, future directions and recommendations are specifically addressed. Future perspectives of cardiac CT are also discussed.

The purpose of this article is to evaluate to what extent Agatston scores may be derived from CT coronary angiography (CTA) examinations, compared with traditional unenhanced CT calcium scores.Fifty patients with a CT calcium score-Agatston score of zero and 50 patients with a CT calcium score-Agatston score of 1 or greater whose CT calcium scores had been calculated and who had undergone CTA using volumetric 320-MDCT were included. Agatston scores were obtained at 3.0-mm slices for CT calcium score and CTA. Method agreement, interobserver agreement, and diagnostic performance of CTA for detecting coronary calcium were evaluated.Of 50 patients with a positive CT calcium score-Agatston score, coronary artery calcium was detected with CTA in 43 patients by observer 1 (mean CTA score, 102 ± 202; mean CT calcium score, 254 ± 501) and in 46 patients by observer 2 (mean CTA score, 94 ± 147; mean CT calcium score, 272 ± 531). Of the 50 patients with a CT calcium score-Agatston score of zero, 49 (98%, observer 1) and 50 (100%, observer 2) had a zero score with CTA as well. An intraclass correlation of 0.78 and 0.62 was found between CT calcium score and CTA (p0.01), whereas higher Agatston scores were underestimated with CTA. For observer 1, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of coronary calcium with CTA were 86%, 98%, 98%, 88%, and 92%, respectively, and the corresponding values for observer 2 were 92%, 100%, 100%, 93%, and 96%, respectively. Interobserver agreement was 0.996 for CT calcium score and 0.93 for CTA.Coronary artery calcium can be detected on CTA images with high accuracy. The Agatston calcium score derived from CTA images shows good correlation with unenhanced CT calcium score and is highly reproducible. However, higher Agatston scores are systematically underestimated when derived from CTA images.

The purpose of this study was to assess the performance of 0.5 versus 3.0 mm slice reconstructions in depicting coronary calcium with special attention to patients having zero calcium scores at 3.0 mm reconstructions by using computed tomography (CT). Imaging was performed by volumetric 320-detector row CT. Scans of 100 patients with a negative and 100 patients with a positive Agatston score at 3.0 mm reconstructions were consecutively selected. Non-overlapping volume sets with 3.0 and 0.5 mm slice thickness were reconstructed from the same raw data and Agatston and volume scores were obtained. The Wilcoxon signed ranks test was used to determine statistical differences between 3.0 and 0.5 mm calcium scores. Agatston and volume scores obtained at 0.5 mm were significantly higher than at 3.0 mm reconstructions (mean Agatston score: 266 +/- A 495 vs. 231 +/- A 461. Mean volume score: 223 +/- A 399 vs. 206 +/- A 385, both P < 0.01). In 21% of patients with zero 3.0 mm Agatston scores, a positive Agatston and/or volume score was found at 0.5 mm reconstructions. With volumetric 320-detector row CT, prospective ECG-triggered calcium scoring at 0.5 mm compared to 3.0 mm reconstructions leads to an increase in Agatston and volume scores and small amounts of coronary calcium are earlier depicted. This may be of special interest in patients with zero calcium scores with traditional 3.0 mm measures, where 0.5 mm reconstructions may help in superior depicting or ruling out coronary artery disease.

Obesity has been associated with microstructural brain tissue damage. Different fat compartments demonstrate different metabolic and endocrine behaviors. The aim was to investigate the individual associations between abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and microstructural integrity in the brain.This study comprised 243 subjects aged 65.4 ± 6.7 years. The associations between abdominal VAT and SAT, assessed by CT, and magnetization transfer imaging markers of brain microstructure for gray and white matter were analyzed and adjusted for confounding factors.VAT was associated with normalized MTR peak height in gray (β -0.216) and white matter (β -0.240) (both P 0.01) after adjustment for confounding factors. After adjustment for sex, age, and descent, SAT was associated with normalized MTR peak height in gray and white matter, but not after additional correction for BMI, hypertension, current smoking, statin use, and type 2 diabetes (respectively, β -0.055 and β 0.035, both P 0.05). Stepwise linear regression analysis showed that only VAT was associated with normalized MTR peak height in gray and white matter (both P 0.001).Our data indicate that increased abdominal VAT rather than SAT is associated with microstructural brain tissue damage in elderly individuals.

Offspring of long-lived parents have a low prevalence of cardiovascular disease in middle age. The purposes of this study were to investigate calcium scores in offspring as compared to controls and to determine the influence of cardiovascular risk factors. CT coronary artery calcium score was measured in offspring of long-lived families (n = 244, 125 males) and their partners (n = 223, 96 males) who served as controls. Calcium scores were analyzed separately for sexes. Subjects were grouped by very low calcium score ≤10 and scores above 10. Nonparametric Mann-Whitney test, chi-squared tests, and logistic regression analyses were performed to determine the association between calcium scores, familial longevity, and cardiovascular risk factors. More offspring of long-lived parents had lower calcium scores than controls. In men, 34 % of offspring had score ≤10 versus 21 % of controls (odds ratio (OR) and 95 % confidence interval (CI) 2.0, 1.08–3.7, p = 0.028). In women, 70 % of offspring had score ≤10 versus 54 % of controls (OR 1.9, 95 % CI 1.13–3.4, p = 0.019). Differences remained significant after correction for age (men, p = 0.043 and women, p = 0.003) and further correction for major risk factors in women, indicating genetic influence for lower calcium scores. In men, the association was found to be influenced by cardiovascular risk factors. Men and women with a familial propensity to become long-lived have lower coronary artery calcium scores than controls. Low scores may indicate a younger biologic arterial age associated with a low risk for incident cardiovascular disease.

To evaluate the effect of radiation dose reduction on image quality and diagnostic accuracy of coronary computed tomography (CT) angiography. Coronary CT angiography studies of 40 patients with (n = 20) and without (n = 20) significant (≥50 %) stenosis were included (26 male, 14 female, 57 ± 11 years). In addition to the original clinical reconstruction (100 % dose), simulated images were created that correspond to 50, 25 and 12.5 % of the original dose. Image quality and diagnostic performance in identifying significant stenosis were determined. Receiver-operator-characteristics analysis was used to assess diagnostic accuracy at different dose levels. The identification of patients with significant stenosis decreased consistently at doses of 50, 25 and 12.5 of the regular clinical acquisition (100 %). The effect was relatively weak at 50 % dose, and was strong at dose levels of 25 and 12.5 %. At lower doses a steady increase was observed for false negative findings. The number of coronary artery segments that were rated as diagnostic decreased gradually with dose, this was most prominent for smaller segments. The area-under-the-curve (AUC) was 0.90 (p = 0.4) at 50 % dose; accuracy decreased significantly with 25 % (AUC 0.70) and 12.5 % dose (AUC 0.60) (p < 0.0001), with underestimation of patients having significant stenosis. The clinical acquisition protocol for evaluation of coronary artery stenosis with CT angiography represents a good balance between image quality and patient dose. A potential for a modest (

Right ventricular (RV) function is predictive of outcome in patients with acute pulmonary embolism (PE). We assessed the possible incremental value of ventricular function with ECG-synchronized cardiac CT scanning over pulmonary CT scan angiography (CTA) for predicting short-term outcome in patients with suspected acute PE.The local ethics committee approved the study, and informed consent was obtained. In addition to standard CTA, 430 consecutive patients (193 men, 237 women; age, 55 ± 17 years) with suspected acute PE underwent ECG-synchronized CT scanning to assess ventricular function. RV/left ventricular (LV) function ratio and pulmonary obstruction index were obtained from non-ECG-synchronized CTA. Ventricular function was used to predict adverse events (6 weeks). Receiver operating characteristic analysis was performed to determine differences between ECG-synchronized CT scan and CTA in predicting outcome.In 113 patients with PE, RV and LV ejection fraction (EF) and RV/LV diameter and volume ratios were associated with adverse outcome (P.05), whereas vascular obstruction index was not. RVEF had the largest area under the receiver operating characteristic curve (0.75; 95% CI, 0.62-0.88) for predicting adverse outcome but had no significant incremental value over the RV/LV function ratio (0.72; 95% CI, 0.57-0.86; P = .25). All parameters revealed high negative predictive values (94%-98%) but low positive predictive values (13%-18%). For disease-specific outcome, areas under the curve were 0.80 (95% CI, 0.69-0.91) for RVEF vs 0.68 (95% CI, 0.48-0.88) for axial RV/LV ratio; the difference was not significant (P = .07). RVEF and RV/LV ratio proved better predictors for outcome than pulmonary obstruction index (both P.001).RVEF was the best predictor for clinical outcome in patients with acute PE. However, incremental value of RVEF over axial RV/LV ratio was not found.