scholarly journals Patient-Specific Computer Simulation of Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Morphology

2019 ◽  
Vol 12 (10) ◽  
Author(s):  
Cameron Dowling ◽  
Alessandra M. Bavo ◽  
Nahid El Faquir ◽  
Peter Mortier ◽  
Peter de Jaegere ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computer Simulation ◽  
Aortic Valve ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Bicuspid Aortic Valve ◽  
Intraclass Correlation ◽  
Patient Specific ◽  
Computed Tomography Imaging ◽  
Tomography Imaging

Background: A patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in tricuspid aortic valve has been developed, which can predict paravalvular regurgitation and conduction disturbance. We wished to validate a patient-specific computer simulation of TAVR in bicuspid aortic valve and to determine whether patient-specific transcatheter heart valve (THV) sizing and positioning might improve clinical outcomes. Methods: A retrospective study was performed on TAVR in bicuspid aortic valve patients that had both pre- and postprocedural computed tomography imaging. Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis and computational fluid dynamics was performed. The simulation output was compared with postprocedural computed tomography imaging, cineangiography, echocardiography, and electrocardiograms. For each patient, multiple simulations were performed, to identify an optimal THV size and position for the patient’s specific anatomic characteristics. Results: A total of 37 patients were included in the study. The simulations accurately predicted the THV frame deformation (minimum-diameter intraclass correlation coefficient, 0.84; maximum-diameter intraclass correlation coefficient, 0.88; perimeter intraclass correlation coefficient, 0.91; area intraclass correlation coefficient, 0.91), more than mild paravalvular regurgitation (area under the receiver operating characteristic curve, 0.86) and major conduction abnormalities (new left bundle branch block or high-degree atrioventricular block; area under the receiver operating characteristic curve, 0.88). When compared with the implanted THV size and implant depth, optimal patient-specific THV sizing and positioning reduced simulation-predicted paravalvular regurgitation and markers of conduction disturbance. Conclusions: Patient-specific computer simulation of TAVR in bicuspid aortic valve may predict the development of important clinical outcomes, such as paravalvular regurgitation and conduction abnormalities. Patient-specific THV sizing and positioning may improve clinical outcomes of TAVR in bicuspid aortic valve.

Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Kenneth Ouriel ◽  
Richard L Ouriel ◽  
Yeun J Lim ◽  
Gregory Piazza ◽  
Samuel Z Goldhaber
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Computed Tomography Angiography ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Observer Agreement ◽  
Left Ventricular Diameter ◽  
The Right

Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

scholarly journals Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods

2019 ◽  
Vol 8 (6) ◽  
pp. 205846011985518 ◽  
Author(s):  
Erika Phexell ◽  
Anna Åkesson ◽  
Marcus Söderberg ◽  
Anetta Bolejko
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Confidence Interval ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Measurement Reliability ◽  
Cross Sectional ◽  
Rater Reliability ◽  
Short Spiral

Background Different low-dose computed tomography (CT) pelvimetry methods can be used to evaluate the size of birth canal before delivery. CT pelvimetry might generate an acceptable low fetal radiation dose but its measurement accuracy is unknown. Purpose To investigate intra- and inter-rater measurement reliability of cross-sectional and two spiral CT pelvimetry methods: standard spiral and short spiral. Material and Methods Ten individuals (age ≥60 years, body mass index ≥30 kg/m2) having a CT scan of the abdomen also had CT pelvimetry scans. Three radiologists made independent measurements of each pelvimetry method on two occasions and also in consensus for a reference pelvimetry computed from the standard-dose CT scan of the abdomen. Inter- and intra-rater reliability was analyzed by intraclass correlation coefficient. Results Measurements in the short spiral pelvimetry demonstrated excellent intra- and inter-rater reliability, intraclass correlation coefficient ≥0.93, and good to excellent 95% confidence interval 0.87–0.99. Corresponding results of the standard spiral and cross-sectional pelvimetry showed good to excellent intraclass correlation coefficient ≥0.85 and ≥0.76, and 95% confidence interval was least good and moderate 0.73–0.98 and 0.59–0.97, respectively. Intraclass correlation coefficient between reference pelvimetry and other CT methods showed analogous results. Conclusion The short spiral pelvimetry demonstrated high and best reliability in comparison to other methods. Standard spiral method showed also good measurement reliability but the short spiral pelvimetry generates lower fetal radiation dose. This method might be suitable for measurements at narrow pelvis. Patient acceptance and attitude to CT pelvimetry should be investigated.

scholarly journals Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

2020 ◽  
Vol 25 (5) ◽  
pp. 51-56
Author(s):  
Giovanni Bruno ◽  
Alberto De Stefani ◽  
Celeste Benetazzo ◽  
Francesco Cavallin ◽  
Antonio Gracco
Keyword(s):  
Computed Tomography ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Cone Beam Computed Tomography ◽  
Nasal Septum ◽  
Intraclass Correlation ◽  
Rapid Maxillary Expansion ◽  
Cone Beam ◽  
Maxillary Expansion ◽  
Over Time

ABSTRACT Introduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient. Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

Computed Tomography Imaging for Aortic Valve Disease

2017 ◽  
pp. 277-301
Author(s):  
Mickaël Ohana ◽  
Anthony Shaw ◽  
Romi Grover ◽  
John Mooney ◽  
Jonathon Leipsic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Computed Tomography Imaging ◽  
Tomography Imaging
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