scholarly journals Feasibility of a Single Contrast Bolus High-Pitch Pulmonary CT Angiography Protocol Followed by Low-Dose Retrospectively ECG-Gated Cardiac CT in Patients with Suspected Pulmonary Embolism

2018 ◽  
Vol 190 (06) ◽  
pp. 542-550 ◽  
Author(s):  
Julia Schäfer ◽  
Holger Haubenreisser ◽  
Mathias Meyer ◽  
Joachim Grüttner ◽  
Thomas Walter ◽  
...  
Keyword(s):  
Low Dose ◽  
Cardiac Ct ◽  
Main Pulmonary Artery ◽  
Suspected Pulmonary Embolism ◽  
High Pitch ◽  
Descending Aorta ◽  
The Mean ◽  
Contrast Bolus ◽  
Attenuation Values ◽  
Rv Function

Introduction To prospectively evaluate the feasibility of single contrast bolus high-pitch CT pulmonary angiography (CTPA) subsequently followed by low-dose retrospectively ECG-gated cardiac CT (4D-cCT) in patients with suspected pulmonary embolism (PE) to accurately evaluate right ventricular (RV) function. Materials and Methods 62 patients (33 female, age 65.1 ± 17.5 years) underwent high-pitch CTPA examination with 80cc of iodinated contrast material. 5 s after the end of the high-pitch CTPA study, a low-dose retrospectively ECG-gated cardiac CT examination was automatically started. The volume CT dose index (CTDI vol) and dose length product (DLP) were recorded in all patients and the effective dose was calculated. For the assessment of image quality, attenuation was measured as Hounsfield units (HUs) within various regions of interest (ROIs). These ROIs were used to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was assessed using a five-point Likert scale. On 4D-cCT, the ejection fraction of both ventricles (RVEF, LVEF) as well as the ratio of RVEF and LVEF (RVEF/LVEF) was assessed. The statistical difference of all parameters between the PE and non-PE group was calculated. Results The mean effective radiation dose was 4.22 ± 2.05 mSv. Attenuation measurements on CTPA showed the highest attenuation values in the main pulmonary artery (442.01 ± 187.64). On 4D-cCT attenuation values were highest in the descending aorta (560.59 ± 208.81). The CNR and SNR values on CTPA were highest within the main pulmonary artery (CNR = 12.43 ± 4.57; SNR = 15.14 ± 4.90). On 4D-cCT images, the highest SNR and CNR could be measured in the descending aorta (CNR = 10.26 ± 5.57; SNR = 10.86 ± 5.17). The mean LVEF was 60.73 %± 14.65 %, and the mean RVEF was 44.90 %± 9.54 %. The mean RVEF/LVEF was 0.79 ± 0.29. There was no significant difference between the PE and non-PE group for either of the parameters. Conclusion The investigated combined CTPA and 4D-cCT protocol is feasible using a single contrast bolus and allows the evaluation of RV function in patients with suspected PE. Further studies have to evaluate the additional value of this protocol regarding risk stratification in patients with PE. Key Points:  Citation Format

scholarly journals Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A K M Darwish ◽  
M M Farouk ◽  
H Hafez ◽  
A Adel
Keyword(s):  
Image Quality ◽  
Pulmonary Artery ◽  
Coronary Arteries ◽  
Main Pulmonary Artery ◽  
Iodine Concentration ◽  
Ascending Aorta ◽  
P Value ◽  
Group A ◽  
The Mean ◽  
Attenuation Values

Abstract Background Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs. Objective To compare image quality and attenuation values of multidetector CT coronary angiography (MDCT) between iopromide 300 and iopromide 370 and to evaluate whether the higher iodine contrast material has better image quality or not. Material and Methods Patients were prospectively enrolled and were randomized into two groups (group A, 30 patients received iopromide 300, iodine flux 1.2g I/s; group B, 30 patients received iomeprol 370, iodine flux 1.48g I/s). CT attenuation values were measured in the proximal end coronary arteries,ascending aorta and main pulmonary artery. The image quality of 15 coronary artery segments was graded by cardiologist in consensus with the use of a four-point scale (1 excellent enhancement to 4 poor enhancement). Non-parametric statistical approaches were used to compare the two groups. Results No statistically significant differences were found between the mean attenuation values (302 HU for iopromide 300 and 326 HU for iopromide 370, P = 0.175) in the coronary arteries in the two groups. The mean attenuation value of the proximal ascending aorta (AA)and main pulmonary artery (MPA) was found to be 345+/-63 HU and 241+/- 89 in group A respectively, whereas the mean attenuation value in proximal ascending aorta and main pulmonary artery in group B was found to be 348+/-74 and 238+/- 50 respectively. No significant difference was found between iopromide 300 and iopromide 370 in terms of contrast enhancement at the level of great arteries, P value AA = 0.826 and P value for MPA = 0.884. 92.9% of coronary arterial segments got score (range 1–2) in group A whereas 93.6 of coronary arterial segments got score (range 1-2) in group with no statistically significant difference P value = 0.755. Conclusion With the current CT technology iopromide 300 is not inferior to iopromide 370 in terms of coronary artery attenuation values and image quality. Iopromide 300 provides similar enhancement of coronary arteries and excellent image quality as compared with iopromide 370 using identical amount of total iodine with fewer cost and less estimated adverse effects owing to low iodine concentration of iopromide 300.

Total anomalous pulmonary venous connection in a neonate characterised by low-dose, high-pitch cardiac CT

2014 ◽  
Vol 25 (6) ◽  
pp. 1197-1199 ◽  
Author(s):  
Swati Deshmukh ◽  
W. Reid Thompson ◽  
Stefan L. Zimmerman
Keyword(s):  
Radiation Dose ◽  
Low Dose ◽  
Cardiac Ct ◽  
Background Radiation ◽  
High Pitch ◽  
Novel Technique ◽  
Reduction Strategies ◽  
Dual Source ◽  
Effective Doses ◽  
Anomalous Pulmonary Venous Connection

AbstractWe describe the use of low-dose dual-source cardiac for the evaluation of a neonate with suspected total anomalous pulmonary venous connection. This novel technique obviates the need for sedation or breathholding. Radiation dose-reduction strategies result in sub-mSv-estimated effective doses, substantially lower than annual background radiation dose. Low-dose, high-pitch cardiac CT should be considered as an alternative to MRI or diagnostic cardiac catheterisation in neonates with complex CHD, requiring definitive anatomic evaluation.

Sex-specific distributions and determinants of thoracic aortic diameters in the elderly

Heart ◽  
2019 ◽  
Vol 106 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Lidia R Bons ◽  
Oscar L Rueda-Ochoa ◽  
Khalid El Ghoul ◽  
Sofie Rohde ◽  
Ricardo PJ Budde ◽  
...  
Keyword(s):  
Cardiac Ct ◽  
The Elderly ◽  
Population Based ◽  
Aortic Diameter ◽  
Rotterdam Study ◽  
Descending Aorta ◽  
Specific Distribution ◽  
The Mean ◽  
Male Sex ◽  
Ascending Aortic Diameter

ObjectiveTo provide population-based distributions of thoracic aortic diameters in men and women aged 55 years or older and to identify determinants of thoracic aortic diameters.MethodsFrom 2003 to 2006, 2505 participants (1208 men, mean age 69.1±6.8 years) from the prospective population-based Rotterdam Study underwent non-enhanced cardiac CT. The diameter of the ascending (AA) and descending aorta (DA) was measured at the level of the pulmonary bifurcation.ResultsThe mean diameter of the ascending and descending aorta was substantially larger in men (38±4 mm and 30±2 mm) than in women (35±3 mm and 27±2 mm). An ascending aortic diameter of larger than 40 mm was found in 228 (18.9%) men and 76 (5.9%) women and a descending aortic diameter larger than 40 mm was found in two men and no women. Male sex was found to be independently associated with larger DA diameter (standardised β 0.24, 95% CI 0.19 to 0.30), while a statistically non-significant trend was found for the AA diameter (standardised β 0.06, 95% CI 0.00 to 0.12). Age, height, weight and traditional cardiovascular risk factors were also associated with larger AA and/or DA diameters. Diabetes was associated with smaller AA and DA diameters. We found no evidence for effect modification by sex.ConclusionsIn persons aged 55 years or older, an ascending aortic diameter of 40 mm or larger was found in 18.9% of men and 5.9% of women. Given the importance of sex, sex-specific distribution values may prove useful in clinical practice, even when correcting for body surface area or height.

scholarly journals Assessment of thoracic aorta in different cardiac phases in patients with non-aorta diseases using cardiac CT

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xue Zheng ◽  
Yu-jiao Deng ◽  
Fu-Gang Han ◽  
Jin-Rong Zhou ◽  
Li Luo ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Mixed Model ◽  
Cardiac Ct ◽  
Linear Mixed Model ◽  
Main Pulmonary Artery ◽  
Aortic Disease ◽  
Aortic Diameter ◽  
Maximum Diameter ◽  
Cardiac Phase ◽  
Descending Aorta

AbstractThe aim was to evaluate the thoracic aorta in different cardiac phases to obtain the correct cardiac phase for measuring the maximum diameter required to predict aortic disease. Cardiac CT was performed on 97 patients for suspected coronary artery disease. The average diameter of ascending (AAD) and descending aorta (DAD) in the plane of pulmonary bifurcation, in the plane of the sinus junction (AAD [STJ] and DAD [STJ]), descending aorta in the plane of the diaphragm (DAD [Dia]), the diameter of the main pulmonary artery (MPAD), distance from the sternum to the spine (S-SD), and distance from the sternum to the ascending aorta (S-AAD) were assessed at 20 different time points in the cardiac cycle. Differences in aortic diameter in different cardiac phases and the correlation between aortic diameter and traditional risk factors were analyzed by the general linear mixed model. The diameter of the thoracic aorta reached the minimum at the phase of 95–0%, and reached the maximum at 30–35%. The maximum values of AAD, AAD (STJ), DAD, DAD (STJ), and DAD (Dia) were 32.51 ± 3.35 mm, 28.86 ± 3.01 mm, 23.46 ± 2.88 mm, 21.85 ± 2.58 mm, and 21.09 ± 2.66 mm, respectively. The maximum values of MPAD/AAD and DAD/AAD (STJ) were 0.8140 ± 0.1029, 0.7623 ± 0.0799, respectively. The diameter of the thoracic aorta varies with the cardiac phase. Analyzing the changes in aortic diameter, which can be done using cardiac CT, could provide a more accurate clinical measurement for predicting aortic disease.

Hormone Replacement Therapy and Voice

2019 ◽  
Vol 4 (4) ◽  
pp. 607-614
Author(s):  
Jean Abitbol
Keyword(s):  
Replacement Therapy ◽  
Symptom Severity ◽  
Low Dose ◽  
Hormone Replacement ◽  
Clinical Signs ◽  
Female Voice ◽  
Fat Cells ◽  
High Pitch ◽  
Endocrine Effects ◽  
The Voice

The purpose of this article is to update the management of the treatment of the female voice at perimenopause and menopause. Voice and hormones—these are 2 words that clash, meet, and harmonize. If we are to solve this inquiry, we shall inevitably have to understand the hormones, their impact, and the scars of time. The endocrine effects on laryngeal structures are numerous: The actions of estrogens and progesterone produce modification of glandular secretions. Low dose of androgens are secreted principally by the adrenal cortex, but they are also secreted by the ovaries. Their effect may increase the low pitch and decease the high pitch of the voice at menopause due to important diminution of estrogens and the privation of progesterone. The menopausal voice syndrome presents clinical signs, which we will describe. I consider menopausal patients to fit into 2 broad types: the “Modigliani” types, rather thin and slender with little adipose tissue, and the “Rubens” types, with a rounded figure with more fat cells. Androgen derivatives are transformed to estrogens in fat cells. Hormonal replacement therapy should be carefully considered in the context of premenopausal symptom severity as alternative medicine. Hippocrates: “Your diet is your first medicine.”

Native low-dose CT des Thorax in high-pitch Technik bei Kindern

2012 ◽  
Vol 184 (S 01) ◽  
Author(s):  
I Tsiflikas ◽  
M Teufel ◽  
C Thomas ◽  
S Fleischer ◽  
CD Claussen ◽  
...  
Keyword(s):  
Low Dose ◽  
High Pitch ◽  
Low Dose Ct

Evaluation of Low-Dose Gentamicin Once Daily Dosing Regimen at A General Hospital in Malaysia

2018 ◽  
Vol 9 (01) ◽  
Author(s):  
Ab Rahman A F ◽  
Md Sahak N. ◽  
Ali A. M.
Keyword(s):  
Medical Records ◽  
Public Hospital ◽  
Low Dose ◽  
Dosing Regimen ◽  
Once Daily ◽  
Neutropenic Sepsis ◽  
Wide Acceptance ◽  
The Mean ◽  
Initiation Of Therapy ◽  
Almost All

Objective: Once daily dosing (ODD) aminoglycoside is gaining wide acceptance as an alternative way of dosing. In our setting it is the regimen of choice whenever gentamicin is indicated. The objective of this study was to evaluate the practice of gentamicin ODD in a public hospital in Malaysia. Methods: We conducted a retrospective review of medical records of patients on gentamicin ODD who were admitted to Hospital Melaka during January 2002 until March 2010. All adult patients who were on ODD gentamicin with various level of renal function were included in the study. Patients on gentamicin less than 72 hours and pregnant women were excluded. Results: From 110 patients, 75 (68.2%) were male and 35 (31.8%) were female. Indications for ODD gentamicin included pneumonia, 34 (31.0%) neutropenic sepsis, 27 (24.5%) and sepsis, 11 (10.0%). The mean dose and duration of gentamicin was 3.2 mg/kg/day and 7 days, respectively. Almost all patients were on gentamicin combined with other antibiotics. Clinical cure based on fever resolution was found in 89.1% of patients treated with ODD. Resolution of fever took an average of 48 hours after initiation of therapy. The evaluation for bacteriologic cure could not be performed because of insufficient data on culture and sensitivity. Out of 38 patients with analyzable serum creatinine data, four patients might have developed nephrotoxicity. Conclusion: In our setting, lower dosages of ODD gentamicin when used in combination with other antibiotics seemed to be effective and safe in treating most gram negative infections.

scholarly journals Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nanae Tsuchiya ◽  
Michinobu Nagao ◽  
Yumi Shiina ◽  
Shohei Miyazaki ◽  
Kei Inai ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Main Pulmonary Artery ◽  
Vortex Formation ◽  
Cine Mri ◽  
Short Axis ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri ◽  
Rv Function

AbstractWe used 4D-flow MRI to investigate circulation, an area integral of vorticity, in the main pulmonary artery (MPA) as a new hemodynamic parameter for assessing patients with a repaired Tetralogy of Fallot (TOF). We evaluated the relationship between circulation, right ventricular (RV) function and the pulmonary regurgitant fraction (PRF). Twenty patients with a repaired TOF underwent cardiac MRI. Flow-sensitive 3D-gradient sequences were used to obtain 4D-flow images. Vortex formation in the MPA was visualized, with short-axis and longitudinal vorticities calculated by software specialized for 4D flow. The RV indexed end-diastolic/end-systolic volumes (RVEDVi/RVESVi) and RV ejection fraction (RVEF) were measured by cine MRI. The PR fraction (PRF) and MPA area were measured by 2D phase-contrast MRI. Spearman ρ values were determined to assess the relationships between circulation, RV function, and PRF. Vortex formation in the MPA occurred in 15 of 20 patients (75%). The longitudinal circulation (11.7 ± 5.1 m2/s) was correlated with the RVEF (ρ = − 0.85, p = 0.0002), RVEDVi (ρ = 0.62, p = 0.03), and RVESVi (ρ = 0.76, p = 0.003) after adjusting for the MPA size. The short-axis circulation (9.4 ± 3.4 m2/s) in the proximal MPA was positively correlated with the MPA area (ρ = 0.61, p = 0.004). The relationships between the PRF and circulation or RV function were not significant. Increased longitudinal circulation in the MPA, as demonstrated by circulation analysis using 4D flow MRI, was related to RV dysfunction in patients with a repaired TOF.

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