A simple mathematical method to identify optimal biplane fluoroscopic angulations for chronic total occlusion percutaneous coronary intervention using CT angiography
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PROVIDER: S-EPMC10507606 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo evaluate whether the use of multiphase CT angiography (CTA) improves interrater agreement for intracranial occlusion detection between stroke neurology trainees and an expert neuroradiologist.MethodsA neuroradiologist and 2 stroke neurology fellows independently reviewed 100 prospectively collected single-phase and multiphase CTA scans from acute ischemic stroke patients with mild symptoms (NIH Stroke Scale score ≤5). The presence and location of a vascular occlusion(s) were documented. Interrater agreement single- and multiphase CTA was quantified using unweighted κ statistics. We assessed for any occlusions, anterior vs posterior occlusions, and pial vessel asymmetry.ResultsUsing multiphase CTA, the neuroradiologist detected 50 scans with anterior circulation occlusions and 15 scans with posterior circulation occlusions. Median reading time was 2 minutes per scan. Median reading time for the neurologists was 3 minutes per multiphase CTA scan. Interrater agreement was fair between the 2 neurologists and neuroradiologist when using single-phase CTA (κ = 0.45 and 0.32). Agreement improved minimally when stratified by anterior vs posterior circulation. When using multiphase CTA, agreement was high for detection of occlusion or asymmetry of pial vessels in the anterior circulation (κ = 0.80 and 0.84).ConclusionsMultiphase CTA improves diagnostic accuracy in minor ischemic stroke for detection of anterior circulation intracranial occlusion.Classification of evidenceThis study provides Class II evidence that multiphase CTA, compared to single-phase CTA, improves the interrater agreement between stroke neurology trainees and an expert neuroradiologist for detecting anterior circulation intracranial vascular occlusion in patients with minor acute ischemic strokes.
| S-EPMC4977373 | biostudies-literature
Project description:We report the case of an 89-year-old woman with prior transcatheter aortic valve replacement who underwent successful left coronary artery engagement and left circumflex percutaneous coronary intervention using patient-specific computed tomography fluoroscopic projections. (Level of Difficulty: Advanced.).
| S-EPMC9998712 | biostudies-literature
Project description: Not available
| S-EPMC11308485 | biostudies-literature
Project description:Background and aimThe aim of this study was to assess the diagnostic accuracy of e-CTA (product name) (Brainomix) in the automatic detection of large vessel occlusions in anterior circulation stroke.MethodsOf 487 CT angiographies from patients with large vessel occlusions stroke, 327 were used to train the algorithm while the remaining cases together with 140 negative CT angiographies were used to validate its performance against ground truth. Of these 301 cases, 144 were randomly selected and used for an additional comparative analysis against 4 raters. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), accuracy and level of agreement with ground truth (Cohen's Kappa) were determined and compared to the performance of a neuroradiologist, a radiology resident, and two neurology residents.Resultse-CTA had a sensitivity and specificity of 0.84 (0.77-0.89) and 0.96 (0.91-0.98) respectively for the detection of any large vessel occlusions on the correct side in the whole validation cohort. This performance was identical in the comparative analysis subgroup and was within the range of physicians at different levels of expertise: 0.86-0.97 and 0.91-1.00, respectively. For the detection of proximal occlusions, it was 0.92 (0.84-0.96) and 0.98 (0.94-1.00) for the whole cohort and 0.93 (0.80-0.98) and 1.00 (0.95-1.00) for the comparative analysis, respectively for e-CTA. The range was 0.8-0.97 for sensitivity and 0.97-1.00 for specificity for the four physicians.ConclusionsThe performance of e-CTA in detecting any large vessel occlusions is comparable to less experienced physicians but is similar to experienced physicians for detecting proximal large vessel occlusions.
| S-EPMC8739618 | biostudies-literature
Project description:BackgroundInternal rotation in adduction is often limited after reverse total shoulder arthroplasty (rTSA), but the origins of this functional deficit are unclear. Few studies have directly compared individuals who can and cannot perform internal rotation in adduction. Little data on underlying 3D humerothoracic, scapulothoracic, and glenohumeral joint relationships in these patients are available.MethodsIndividuals >1-year postoperative to rTSA were imaged with biplane fluoroscopy in resting neutral and internal rotation in adduction poses. Subjects could either perform internal rotation in adduction with their hand at T12 or higher (high, N = 7), or below the hip pocket (low, N = 8). Demographics, the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and scapular notching grade were recorded. Joint orientation angles were derived from model-based markerless tracking of the scapula and humerus relative to the torso. The 3D implant models were aligned to preoperative computed tomography models to evaluate bone-implant impingement.ResultsThe Simple Shoulder Test was highest in the high group (11 ± 1 vs. 9 ± 2, P = .019). Two subjects per group had scapular notching (grades 1 and 2), and 3 high group and 4 low group subjects had impingement below the glenoid. In the neutral pose, the scapula had 7° more upward rotation in the high group (P = .100), and the low group demonstrated 9° more posterior tilt (P = .017) and 14° more glenohumeral elevation (P = .047). In the internal rotation pose, axial rotation was >45° higher in the high group (P ≤ .008) and the low group again had 11° more glenohumeral elevation (P = .058). Large rotational differences within subject groups arose from a combination of differences in the resting neutral and maximum internal rotation in adduction poses, not only the terminal arm position.ConclusionsIndividuals who were able to perform high internal rotation in adduction after rTSA demonstrated differences in joint orientation and anatomic biases versus patients with low internal rotation. The high rotation group had 7° more resting scapular upward rotation and used a 15°-30° change in scapular tilt to perform internal rotation in adduction versus patients in the low group. The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. In addition, inter-patient variation in humeral torsion may contribute substantially to postoperative internal rotation differences. These data point toward modifiable implant design and placement factors, as well as foci for physical therapy to strengthen and mobilize the scapula and glenohumeral joint in response to rTSA surgery.
| S-EPMC10023281 | biostudies-literature
Project description:PurposeComputed tomography angiography (CTA) is routinely used to detect large-vessel occlusion (LVO) in patients with suspected acute ischemic stroke; however, visual analysis is time consuming and prone to error. To evaluate solutions to support imaging triage, we tested performance of automated analysis of CTA source images (CTASI) at identifying patients with LVO.MethodsStroke patients with LVO were selected from a prospectively acquired cohort. A control group was selected from consecutive patients with clinically suspected stroke without signs of ischemia on CT perfusion (CTP) or infarct on follow-up. Software-based automated segmentation and Hounsfield unit (HU) measurements were performed on CTASI for all regions of the Alberta Stroke Program Early CT score (ASPECTS). We derived different parameters from raw measurements and analyzed their performance to identify patients with LVO using receiver operating characteristic curve analysis.ResultsThe retrospective analysis included 145 patients, 79 patients with LVO stroke and 66 patients without stroke. The parameters hemispheric asymmetry ratio (AR), ratio between highest and lowest regional AR and M2-territory AR produced area under the curve (AUC) values from 0.95-0.97 (all p < 0.001) for detecting presence of LVO in the total population. Resulting sensitivity (sens)/specificity (spec) defined by the Youden index were 0.87/0.97-0.99. Maximum sens/spec defined by the specificity threshold ≥0.70 were 0.91-0.96/0.77-0.83. Performance in a small number of patients with isolated M2 occlusion was lower (AUC: 0.72-0.85).ConclusionAutomated attenuation measurements on CTASI identify proximal LVO stroke patients with high sensitivity and specificity. This technique can aid in accurate and timely patient selection for thrombectomy, especially in primary stroke centers without CTP capacity.
| S-EPMC8463515 | biostudies-literature
Project description:BackgroundComputed tomography (CT) angiography collateral score (CTA-CS) is an important clinical outcome predictor following mechanical thrombectomy for ischemic stroke with large vessel occlusion (LVO). The present multireader study aimed to evaluate the performance of e-CTA software for automated assistance in CTA-CS scoring.Materials and methodsBrain CTA images of 56 patients with anterior LVO were retrospectively processed. Twelve readers of various clinical training, including junior neuroradiologists, senior neuroradiologists, and neurologists graded collateral flow using visual CTA-CS scale in two sessions separated by a washout period. Reference standard was the consensus of three expert readers. Duration of reading time, inter-rater reliability, and statistical comparison of readers' performance metrics were analyzed between the e-CTA assisted and unassisted sessions.Resultse-CTA assistance resulted in significant increase in mean accuracy (58.6% to 67.5%, p = 0.003), mean F1 score (0.574 to 0.676, p = 0.002), mean precision (58.8% to 68%, p = 0.007), and mean recall (58.7% to 69.9%, p = 0.002), especially with slight filling deficit (CTA-CS 2 and 3). Mean reading time was reduced across all readers (103.4 to 59.7 s, p = 0.001), and inter-rater agreement in CTA-CS assessment was increased (Krippendorff's alpha 0.366 to 0.676). Optimized occlusion laterality detection was also noted with mean accuracy (92.9% to 96.8%, p = 0.009).ConclusionAutomated assistance for CTA-CS using e-CTA software provided helpful decision support for readers in terms of improving scoring accuracy and reading efficiency for physicians with a range of experience and training backgrounds and leading to significant improvements in inter-rater agreement.
| S-EPMC11833891 | biostudies-literature
Project description:Rationale and objectivesSYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI.Materials and methodsSYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA. PCI complexity in 113 patients who underwent intervention was defined by total fluoroscopy time and contrast volume.ResultsCompared to ICA, CCTA detected 285 of 302 (94%) obstructive lesions in 230 vessels, for which PCI was performed for 154 lesions in 131 vessels. Overall, on a per-patient basis, ICA-derived SYNTAX score was lower in comparison to CCTA-derived score (10.2 ± 8.0 vs 10.9 ± 8.3, P = 0.001). As compared to lesions in the lowest CCTA-derived segmental SYNTAX tertile, lesions in the highest tertile required longer fluoroscopy time (17.5 ± 12 min vs 11.5 ± 7.9 min, P = 0.01) and greater contrast volume (215.4 ± 125.5 mL vs 144.3 ± 49 mL, P = 0.02).ConclusionSYNTAX scores derived from CCTA are concordant with those derived from ICA and correspond with complex PCI.
| S-EPMC5324777 | biostudies-literature
Project description:PurposeTo compare technical success, clinical success, complications and radiation dose for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation using fluoroscopic guidance versus conventional computed tomography (CT) guidance.Materials and methodsBetween March 2018and March 2021, 124consecutive percutaneous intradiscal ozone therapies wereperformedon111 patients with low back pain (LBP) and/or sciatic pain due to lumbar disc herniation, using fluoroscopic or conventional CT guidance, respectively in 53 and 58 herniated lumbar discs, with at least 1-month follow up. Dose area product (DAP) and dose length product (DLP) were recorded respectively for fluoroscopy and CT, and converted to effective dose (ED).ResultsFluoroscopic and CT groups were similar in terms of patient age (p-value 0.39), patient weight (p-value 0.49) and pre-procedure Oswestry Disability Index (ODI, p-value 0.94). Technical success was achieved in all cases. Clinical success was obtained in 83.02% (44/53) patients in fluoroscopic group and 79.31% (46/58) in CT group. Mean DAP was 11.63Gy*cm2 (range 5.42-21.61). Mean DLP was 632.49mGy-cm (range 151.51-1699). ED was significantly lower in the fluoroscopic group compared toCT group (0.34 vs. 5.53mSv, p = 0.0119). No major complication was registered. Minor complications were observed in 4 cases (2 in fluoroscopic group; 2 in CT group).ConclusionsCompared to conventional CT guidance, fluoroscopic guidance for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation shows similar technical and clinical success rates, with lower radiation dose. This technique helps sparing dose exposure to patients.
| S-EPMC8923460 | biostudies-literature
Project description:IntroductionThis descriptive study explores typical patterns of vascular territory mapping (VTM) in ischaemic stroke patients with proximal vessel occlusion. VTM is a novel process using CT perfusion that can identify the source and extent of collateral blood flow in patients with vessel occlusion. It functions by determining which vessel provides dominant blood flow to a brain voxel.MethodsA total of 167 consecutive patients were analysed from INSPIRE (International Stroke Perfusion Imaging Registry) with their CT perfusion reprocessed through VTM software. We explored the typical territory maps generated by this software relating to common large vessel occlusion location sites (ACA/MCA/PCA).Results/conclusionIn the presence of occlusion, VTM demonstrated a reciprocal increase in collateral vessel territories.
| S-EPMC9816260 | biostudies-literature