Deep learning–based image reconstruction significantly improved the reproducibility of coronary artery calcium scoring compared with filtered back projection and iterative reconstruction. In 120 patients scored independently by two blinded readers, deep learning reconstruction demonstrated the highest inter- and intra-reader agreement, minimized reader-dependent bias, and yielded the greatest reader confidence. These advantages were consistent across patient characteristics and resulted in incre…
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Implementation of Coronary Plaque Quantification from Cardiac CT into Clinical Practice– Proceeding with Caution
Imaging to risk-stratify patients with coronary artery disease (CAD) has shifted from the detection of myocardial ischemia and/or obstructive stenosis toward detecting and differentiating coronary plaque, which represents an earlier disease state.(1) Non-obstructive plaques usually do not cause anginal symptoms or myocardial ischemia, but do elevate the risk for future coronary events. Indeed, non-obstructive CAD at baseline accounted for most events in the PROMISE trial and ORFAN study.(2, 3) I…
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Post-TAVR evaluation using photon-counting detector CT with only 10 mL of contrast media: A case report
Ultra–low-contrast photon-counting detector computed tomography (PCD-CT) enabled comprehensive post–transcatheter aortic valve replacement (TAVR) assessment in a patient with atrial fibrillation. An 87-year-old woman with severe aortic stenosis underwent TAVR. Although contrast-enhanced CT is essential for detecting post-procedural complications,1 cumulative contrast burden may increase the risk of kidney injury, particularly when procedures are performed within a short time period.
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Diagnostic performance of on-site, CT-derived fractional flow reserve in predicting invasive fractional flow reserve and absolute myocardial blood flow
CT-derived fractional flow reserve (FFR) improves the diagnostic accuracy of coronary CT angiography (CCTA) but typically requires off-site processing. We evaluated the agreement and diagnostic accuracy of a fast (∼8-min), on-site CT-FFR algorithm against invasive FFR and its correlation with myocardial blood flow.
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Re: When imaging phase shapes physiology: A commentary on CFD fidelity in multiphase CCTA
Mechanical stimuli, mediated by the activation of Piezo ion channels, drive many physiological processes including cardiovascular functions and disease progression.1 Significant efforts have therefore been devoted to quantifying mechanical loads within the cardiovascular system. Determining wall shear stress (WSS) and vessel structural stress (VSS), along with derived parameters such as the oscillatory shear index (OSI), relative residence time (RRT) and stress gradient, requires detailed knowle…
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Prognostic value of aortic valve calcium score on contrast cardiac computed tomography in patients undergoing transcatheter aortic valve replacement
Aortic valve calcification (AVCa) is characterized by progressive thickening, scarring, and degeneration of the aortic valve, which promotes calcium deposition and is ultimately associated with aortic stenosis (AS).1 In clinical practice, AVCa is generally quantified using the modified Agatston score technique on non-contrast computed tomography (CT), with thresholds of >2000 for men and >1200 for women for severe AS with prognostic implications 1–3. However, contrast-enhanced CT is now ro…
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Coronary calcification mimicking dissection on CT angiography: A diagnostic pitfall
A 60-year-old woman with a past medical history of hyperlipidemia and elevated diastolic blood pressure, presented with a two-month history of worsening intermittent palpitations, chest tightness, and diaphoresis. Electrocardiography revealed non-specific ST-T changes in the anterior leads; high-sensitivity troponin was normal. Based on intermediate pre-test probability per 2021 AHA/ACC Chest Pain Guidelines,1 coronary CT angiography (CTA) was performed for suspected coronary artery disease.
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Importance of coronary artery lumen size in the relationship between coronary artery plaque and vessel-specific ischemia: A post hoc analysis of CREDENCE and PACIFIC-1
While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV).
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Normal-resolution vs. super-resolution deep learning reconstruction for diagnosis of functionally significant coronary stenosis using cardiac CT
Super-resolution deep learning reconstruction (SR-DLR) has been developed to reduce image noise and enhance spatial resolution beyond that of normal-resolution deep learning reconstruction (NR-DLR).
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Doubly obstructed mixed total anomalous pulmonary venous connection with a unique “vascular vise”
An 11-month-old cyanotic infant presented to pediatric cardiology outpatient clinic with respiratory distress and oxygen saturation of 70 % on room air. Chest radiograph revealed dextrocardia and with a tortuous tubular opacity (Fig. 1A) seen in left lower lung field. Subsequently transthoracic echocardiography was performed which revealed dextrocardia with complete atrioventricular septal defect and total anomalous pulmonary venous connection (TAPVC).