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 1183 Three-dimensional echocardiographic paramenters for mitral valve quantification: a feasibility and validation study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Tafciu ◽  
G Granata ◽  
F Ancona ◽  
S Stella ◽  
C Capogrosso ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Volumetric Method ◽  
Systolic Pulmonary Artery Pressure ◽  
Observer Variability ◽  
Vena Contracta ◽  
Valvular Surgery

Abstract Introduction Mitral regurgitation (MR) severity affects prognosis and a correct quantification is key for surgical indication. A multiparametric approach (MPA) is recommended, as singular parameters suffer pitfalls. Recently suggested three-dimensional echocardiographic (3DE) parameters lack clear reference values. No studies have assessed the feasibility of regurgitant volume (RV) and fraction (RF) using the 3D planimetric area of the mitral annulus (MAA) and of the left ventricular outflow tract (LVOTA). Purpose To assess the feasibility and reliability of 3DE, RV and RF obtained by doppler volumetric method using MAA and LVOTA, compare results with 2DE and 3D vena contracta area (VCA) and propose cut-offs for these parameters using MPA as gold standard. Methods Patients referred to our Department for MR assessment were enrolled from September 2018 to February 2019 without more than mild aortic regurgitation or severe stenosis, mitral stenosis and previous valvular surgery. Transthoracic 2DE was used to calculate a multiparametric index of MR severity including: jet area/left atrium (LA) area, CW characteristics, 2D vena contracta, PISA, pulmonary vein flow, LA volume and systolic pulmonary artery pressure. Transoesophageal 3DE was used to assess MAA and LVOTA from a 3D dataset. RV and RF were calculated by Doppler volumetric method using the planimetric areas instead of diameters. VCA 3D was calculated from a 3D color dataset as the cross-sectional area of the regurgitant jet. We compared the results between 2DE and 3DE and between functional and organic MR. ROC curves were analyzed to assess diagnostic performance and identify cut-offs for severity prediction. Intraclass correlation coefficient was calculated to assess variability in measurements. Results Population was composed by 87 patients (56 male, 65 ± 13 years), 72% organic MR. MAA was larger in 2DE (10.4 ± 3.2 vs 9.8 ± 2.9 cm2,) as was the RV (76.6 ± 36.1 vs 66.4 ± 31.9 ml) and RF (55.4 ± 12.4 vs 50.4 vs 10.9%, all p < 0.0001), while LVOTA was smaller (3.9 ± 0.98 vs 4.1 ± 1.0 cm2, p < 0.0001). RV 2D and RF 2D were larger in the organic MR group (p < 0.0001), meanwhile VCA 3D, RV 3D and RF 3D did not show a significant difference (all p > 0.1). VCA 3D had a good correlation with RV 3D (r = 0.593, p < 0.0001) and RF 3D (r = 0.576, p < 0.0001). We proposed a cut-off value of 41.5 mm2 for VCA 3D (94% sens, 96% spec, AUC 0.978), 52 ml for RV 3D (84% sens, 78% spec, AUC 0.901) and 47.6% for RF 3D (91% sens, 90% spec, AUC 0.966) to predict MR severity as assessed by MPA. Intraclass correlation coefficient was 0.980 for MAA and 0.985 for LVOTA for intra-observer variability, while for inter-observer variability it was 0.951 for MAA and 0.962 for LVOTA. Conclusion 2DE overestimates MA dimensions and underestimates LVOT dimensions thus overestimating RV and RF. 3DE measures are relatively simple and reproducible. Proposed cut-offs for RV, RF and VCA 3D have a good diagnostic power.

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.

scholarly journals Automated Left Ventricular Dimension Assessment Using Artificial Intelligence Developed and Validated by a UK-Wide Collaborative

2021 ◽  
Author(s):  
James P. Howard ◽  
Catherine C. Stowell ◽  
Graham D. Cole ◽  
Kajaluxy Ananthan ◽  
Camelia D. Demetrescu ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interventricular Septum ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Expert Consensus ◽  
Training Dataset ◽  
Validation Dataset ◽  
Online Platform

Background: Artificial intelligence (AI) for echocardiography requires training and validation to standards expected of humans. We developed an online platform and established the Unity Collaborative to build a dataset of expertise from 17 hospitals for training, validation, and standardization of such techniques. Methods: The training dataset consisted of 2056 individual frames drawn at random from 1265 parasternal long-axis video-loops of patients undergoing clinical echocardiography in 2015 to 2016. Nine experts labeled these images using our online platform. From this, we trained a convolutional neural network to identify keypoints. Subsequently, 13 experts labeled a validation dataset of the end-systolic and end-diastolic frame from 100 new video-loops, twice each. The 26-opinion consensus was used as the reference standard. The primary outcome was precision SD, the SD of the differences between AI measurement and expert consensus. Results: In the validation dataset, the AI’s precision SD for left ventricular internal dimension was 3.5 mm. For context, precision SD of individual expert measurements against the expert consensus was 4.4 mm. Intraclass correlation coefficient between AI and expert consensus was 0.926 (95% CI, 0.904–0.944), compared with 0.817 (0.778–0.954) between individual experts and expert consensus. For interventricular septum thickness, precision SD was 1.8 mm for AI (intraclass correlation coefficient, 0.809; 0.729–0.967), versus 2.0 mm for individuals (intraclass correlation coefficient, 0.641; 0.568–0.716). For posterior wall thickness, precision SD was 1.4 mm for AI (intraclass correlation coefficient, 0.535 [95% CI, 0.379–0.661]), versus 2.2 mm for individuals (0.366 [0.288–0.462]). We present all images and annotations. This highlights challenging cases, including poor image quality and tapered ventricles. Conclusions: Experts at multiple institutions successfully cooperated to build a collaborative AI. This performed as well as individual experts. Future echocardiographic AI research should use a consensus of experts as a reference. Our collaborative welcomes new partners who share our commitment to publish all methods, code, annotations, and results openly.

scholarly journals Original and Modified Graeb Score Correlation With Intraventricular Hemorrhage and Clinical Outcome Prediction in Hyperacute Intracranial Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1696-1702
Author(s):  
Daniel-Alexandre Bisson ◽  
Mathew L. Flaherty ◽  
Anwar S. Shatil ◽  
David Gladstone ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Outcome Prediction ◽  
Intraclass Correlation ◽  
Observer Agreement ◽  
Modified Rankin Scale ◽  
Head Ct ◽  
Scale Scores

Background and Purpose— The Graeb score is a visual rating scale of intraventricular hemorrhage (IVH) on noncontrast head CT. Little data exist in the hyperacute (<6 hour) period for reliability and predictive value of the modified Graeb Score (mGS) or the original Graeb Score (oGS) for clinical outcomes or their correlation with quantitative IVH volumes. Methods— A retrospective analysis of multicenter prospective intracranial hemorrhage study was performed. oGS and mGS inter-observer agreement and IVH volume correlation on the baseline noncontrast head CT were calculated by intraclass correlation coefficient and Pearson coefficient respectively. Predictors of poor outcome (modified Rankin Scale scores ≥4) at 3 months were identified using a backward stepwise selection multivariable analysis. oGS and mGS performance for modified Rankin Scale scores ≥4 was determined by receiver operating characteristic analysis. Results— One hundred forty-one patients (65±12 years) with median (interquartile range) time to CT of 82.5 (70.3–157.5) minutes were included. IVH was observed in 43 (30%) patients. Inter-observer agreement was excellent for both oGS (intraclass correlation coefficient, 0.90 [95% CI, 0.80–0.95]) and mGS (intraclass correlation coefficient, 0.97 [95% CI, 0.84–0.99]). mGS (R=0.79; P <0.01) correlated better than oGS (R=0.71; P <0.01) with IVH volumes ( P =0.02). Models of thresholded oGS and mGS were not different from a model of planimetric baseline intracranial hemorrhage and IVH volume for poor outcome prediction. Area under the curves were 0.70, 0.73, and 0.72, respectively. Conclusions— Excellent correlation for oGS and mGS with IVH volume was seen. Thresholded oGS and mGS are reasonable surrogates for planimetric IVH volume for hyperacute intracranial hemorrhage studies.

scholarly journals Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Alexandre Dias Mançano ◽  
Rosana Souza Rodrigues ◽  
Miriam Menna Barreto ◽  
Gláucia Zanetti ◽  
Thiago Cândido de Moraes ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Lower Lobe ◽  
Pulmonary Infarction ◽  
Halo Sign ◽  
Reversed Halo Sign ◽  
The Right

ABSTRACT Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

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.

Abstract 2211: Left Ventricular Stroke Volume Values Measured by 2- D Echocardiographic Volumetric and Doppler-Based Methods Cannot be Used Interchangeably

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Eddy Barasch ◽  
Jing Han ◽  
Florentina Petillo ◽  
Michael Passick ◽  
Nathaniel Reichek
Keyword(s):  
Stroke Volume ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Coefficient Of Variation ◽  
Healthy Subjects ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Left Ventricular Stroke Volume ◽  
Ventricular Stroke Volume ◽  
The Mean

The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently reported as if they were interchangeable. No systematic evaluation of the agreement between these methods has been done. To determine the agreement, correlation and reproducibility of SV values measured by 2-D echo and Doppler methods. 107 healthy subjects (mean age 59 ± 14 yrs, 59 % females), had comprehensive echocardiographic evaluation. 2-D LV volumes (2D) were measured by the biplane Simpson’s method. For Doppler, the product of the area of the LV outflow tract (LVOT) x LVOT time velocity integral (TVI), and the area of aortic annulus (AA), and the product of aortic cusp separation (ACS) x aortic TVI were used. Mixed model analysis of variance was performed and Bland Altman agreement limits, Pearson correlation and within-subject coefficient of variation and intraclass correlation coefficient were determined. The mean SV (ml/beat) measured by 2-D and Doppler methods using LVOT, AA and ACS area were: 64 ± 18, 65 ± 15, 76±14, 70 ± 16, respectively. No differences were found between LVOT and 2-D (p = 0.99), borderline between LVOT and ACS (p = 0.051) and significant differences were found between all the other methods. The within-subject coefficient of variation was 19.3% and the intraclass correlation coefficient =0.71, for all the methods indicating good reproducibility. Bland Altman 95% agreement limits for LVOT vs. 2-D were −38.0 and 38.6 ml/beat. The correlation coefficients for all 4 methods are given below. 1. In healthy subjects, although no significant differences were found between mean SV values measured by 2-D and Doppler LVOT methods, the correlation was weak and the agreement limits were large. 2. There was a modest correlation between the Doppler methods and between AA, ACS and 2-D, but the mean SV values were significantly different. 3. SV values measured by these 4 methods cannot be used interchangeably.

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