Highlights
Artifacts by cardiac arrhythmias often hinder radiological evaluation in cardiac CT.
RIMM technique (RIF in motion mapping) considerably eliminates artifacts.
This enhanced visualization by RIMM precludes further invasive diagnostic procedures.
Rationale and Objectives
Particularly for patients with heart arrhythmias, conventional BestSystole (BS) and BestDiastole (BD) reconstruction techniques in computed tomography (CT) frequently show artifacts that hinder the readability of the coronary tree. To address this problem, this paper presents an alternative reconstruction method that combines the technique “reconstructions with identical filling” (RIF) with motion mapping: This new technique is called “RIF in motion mapping” (RIMM). This study compares the diagnostic quality of images generated with RIMM to that of the other reconstruction techniques.
Materials and Methods
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Results
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Conclusions
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Introduction
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Materials and Methods
RIMM Concept
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Patients
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Imaging Protocol
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Image Reconstruction
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Visual Assessment of Image Quality
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TABLE 1
Likert Scale Was Used for Stratifying Image Quality Into Non-diagnostic (Likert 1 and 2) and Diagnostic Datasets (Likert 3–5)
Likert Value Interpretation 0 Segment anatomically not existing 1 Non-diagnostic image quality Segment existing due to reference (conventional coronary angiography (CCA) or cCTA), but not identifiable because of severe artifacts 2 Segment existing and identifiable, but not evaluable due to artifacts, representing image with non-diagnostic quality. 3 Diagnostic image quality Moderate image quality: vessel wall and plaques adequately defined, artifacts not influencing diagnostic performance 4 Good image quality: vessel wall and plaques well but not entirely sharply defined; minor artifacts allowed 5 Excellent image quality: vessel wall and plaques sharply delineated; no artifacts
cCTA, coronary computed tomography angiography.
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Statistical Analysis
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Results
Cohort Analysis
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TABLE 2
Summary of Patient Characteristics
Entire Cohort ( n = 23) Subgroups SR ( n = 14) ARR ( n = 9)P cCTA ( n = 12) TAVR ( n = 11)P Demographics Age (y) 71.0(±12) 70.0(±14) 77.2(±10) 0.04 62.8(±12) 80.0(±7) 0.001 Gender(male) 10(43%) 22(40%) 9(47%) n.s. 16(46%) 15(39%) n.s. Heart rate(HR) HR mean(bpm) 69.2(±14) 67.0(±14) 75.7(±15) 0.026 65.9(±11) 72.2(±17) n.s. HR submax(bpm) 76.4(±21) 69.5(±16) 96.6(±22) <0.001 70.4(±14) 81.9(±25) 0.01 Risk factors Arterial hypertension 15(88%) 40(73%) 18(95%) n.s. 23(31%) 35(47%) 0.024 Diabetes 5(30%) 6(11%) 4(21%) n.s. 3(4%) 7(10%) n.s. Hypercholesterolemia 5(30%) 22(40%) 8(42%) n.s. 12(16%) 17(23%) n.s. Obesity 4(24%) 10(18%) 4(21%) n.s. 4(5%) 10(14%) n.s. Smoking 3(18%) 11(20%) 6(32%) n.s. 8(11%) 9(12%) n.s. Family history of CAD 5(15%) 9(12%) 2(3%) n.s. 10(14%) 1(2%) 0.003
ARR, arrhythmic; CAD, coronary artery disease; cCTA, coronary computed tomography angiography; HR, heart rate; SR, sinus rhythm; TAVR, transcatheter aortic valve replacement. Significant differences between subgroups are denoted with P values.
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Per Segment Analysis
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TABLE 3
Results on Per Segment, Per Vessel, and Per Patient Analysis with Regard to the Entire Cohort and Subgroups
Entire Cohort ( n = 23) SR ( n = 14) ARR ( n = 9) cCTA ( n = 12) TAVR ( n = 11) RIMM RIF BD_BS_ RIMM RIF BD_BS_ RIMM RIF BD_BS_ RIMM RIF BD_BS_ RIMM RIF BD_BS_ Per segment AHA-segments ( n = 345) 228(66%) 199(58%) 174(50%) 128(37%) 162(77%) 133(63%) 142(68%) 49(23%) 66(49%) 66(49%) 32(23%) 79(58%) 133(74%) 115(63%) 110(61%) 64(36%) 95(58%) 84(51%) 55(33%) 64(39%) Per vessel LAD(AHA 5, 6, 7, 8) 15(65%) 13(57%) 8(35%) 6(26%) 11(79%) 8(57%) 7(50%) 2(14%) 4(44%) 5(55%) 1(11%) 4(44%) 10(83%) 7(58%) 6(50%) 3(25%) 5(45%) 6(55%) 2(18%) 3(27%) LCX(AHA 11, 13, 15) 12(52%) 9(39%) 7(30%) 7(30%) 4(29%) 5(36%) 7(50%) 2(14%) 2(22%) 4(44%) 0(0%) 5(55%) 9(75%) 4(33%) 6(50%) 4(33%) 3(27%) 5(45%) 1(9%) 3(27%) RCA(AHA 1, 2 ,3) 12(52%) 7(30%) 6(26%) 5(22%) 10(71%) 5(36%) 6(43%) 1(7%) 2(22%) 2(22%) 0(0%) 4(44%) 8(67%) 4(33%) 5(42%) 2(17%) 4(36%) 3(27%) 1(9%) 3(27%) Per patient 10 of 15 17(74%) 12(52%) 9(39%) 6(26%) 14(100%) 9(60%) 9(60%) 2(14%) 3(33%) 3(33%) 0(0%) 4(44%) 11(92%) 8(67%) 7(58%) 3(25%) 6(55%) 4(36%) 2(18%) 3(27%)
AHA, American Heart Association; ARR, arrhythmic subgroup; BD, BestDiastole; BS, BestSystole; cCTA, coronary computed tomography angiography; LAD, left anterior descending; LCX, left circumflex artery; RCA, right coronary artery; RIF, reconstructions with identical filling; RIMM, RIF in motion mapping; SR, sinus rhythm; TAVR, transcatheter aortic valve replacement.
In case of significant differences, P values are provided.
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Per Vessel Analysis
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Per Patient Analysis
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Discussion
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Limitations
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Conclusions
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References
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