Name: identifying coronary artery calcification on non-gated computed tomography scans
Uploaded: 2018-08-28T13:30:00
Description: Watch this Scientific Journal Video about Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans at JoVE.com

这项工作得到了国立卫生研究院的支持 [1TL1TR001997-01, 2016-2017]。

本议定书遵循肯塔基大学机构审查委员会和人类专题研究议定书规定的指导方针。
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<ol><li>打开在进行研究的机构中使用的图像查看器。双击桌面图标以打开查看器。</li>
	<li>使用机构用户名和密码登录。</li>
</ol>2. 确定适当的病人
<ol><li>单击工具栏中的 "学习列表" 图标。</li>
	<li>在 "搜索条件" 下拉列表中, 选择?...

<ol>
	<li>Douglas, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+anatomical+versus+function+testing+for+coronary+artery+disease.">Outcomes of anatomical versus function testing for coronary artery disease.</a> The New England Journal of Medicine. 372 (14), 1291-1300 (2015).</li><li>Detrano, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+calcium+as+a+predictor+of+coronary+events+in+four+racial+or+ethnic+groups.">Coronary calcium as a predictor of coronary events in four racial or ethnic groups.</a> The New England Journal of Medicine. 358, 1336-1345 (2008).</li><li>Sarma, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+and+chest+CT+scan+examinations:+what+do+we+know.">Radiation and chest CT scan examinations: what do we know.</a> CHEST. 142, 750-760 (2012).</li><li>Winkler, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+coronary+artery+calcification+and+diagnosis+of+coronary+artery+disease+by+abdominal+CT:+A+resident+education+continuous+quality+improvement+project.">Identification of coronary artery calcification and diagnosis of coronary artery disease by abdominal CT: A resident education continuous quality improvement project.</a> Academic Radiology. 22 (6), 704-707 (2015).</li><li>Budoff, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+artery+and+thoracic+calcium+on+noncontrast+thoracic+CT+scans:+comparison+of+ungated+and+gated+examinations+in+patients+from+the+COPD+Gene+cohort.">Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD Gene cohort.</a> Journal of Cardiovascular Computed Tomography. 5, 113-118 (2011).</li><li>Einstein, A. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Agreement+of+visual+estimation+of+coronary+artery+calcium+from+low-dose+CT+attenuation+correction+scans+in+hybrid+PET/+CT+and+SPECT/CT+with+standard+Agatston+score.">Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/ CT and SPECT/CT with standard Agatston score.</a> JACC: Journal of the American College of Cardiology. 56, 1914-1921 (2010).</li><li>Kim, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+calcium+screening+using+low-dose+lung+cancer+screening:+effectiveness+of+MDCT+with+retrospective+reconstruction.">Coronary calcium screening using low-dose lung cancer screening: effectiveness of MDCT with retrospective reconstruction.</a> AJR. American Journal of Roentgenology. 190, 917-922 (2008).</li><li>Kirsch, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+coronary+calcium+during+standard+chest+computed+tomography+correlates+with+multi-detector+computed+tomography+coronary+artery+calcium+score.">Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score.</a> The International Journal of Cardiovascular Imaging. 28, 1249-1256 (2012).</li><li>Wu, M. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+arterial+calcification+on+low-dose+ungated+MDCT+for+lung+cancer+screening:+concordance+study+with+dedicated+cardiac+CT.">Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: concordance study with dedicated cardiac CT.</a> AJR. American Journal of Roentgenology. 190, 923-928 (2008).</li><li>Xie, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+and+prognosis+of+coronary+artery+calcium+scoring+in+non-triggered+thoracic+computed+tomography:+systematic+review+and+meta-analysis.">Validation and prognosis of coronary artery calcium scoring in non-triggered thoracic computed tomography: systematic review and meta-analysis.</a> Circulation: Cardiovascular Imaging. 6, 514-521 (2013).</li><li>Itani, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+artery+calcification+detected+by+a+mobile+helical+computed+tomography+unit+and+future+cardiovascular+death:+4-year+follow-up+of+6120+asymptomatic+Japanese.">Coronary artery calcification detected by a mobile helical computed tomography unit and future cardiovascular death: 4-year follow-up of 6120 asymptomatic Japanese.</a> Heart and Vessels. 19, 161-163 (2004).</li><li>Hughes-Austin, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+of+coronary+calcium+on+standard+chest+CT+scans+with+mortality.">Relationship of coronary calcium on standard chest CT scans with mortality.</a> JACC: Cardiovascular Imaging. 9, 152-159 (2016).</li><li>Shemesh, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ordinal+scoring+of+coronary+artery+calcifications+on+low-dose+CT+scans+of+the+chest+is+predictive+of+death+from+cardiovascular+disease.">Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.</a> Radiology. 257, 541-548 (2010).</li><li>Sarwar, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+and+prognostic+value+of+absence+of+coronary+artery+calcification.">Diagnostic and prognostic value of absence of coronary artery calcification.</a> JACC: Cardiovascular Imaging. 2, 675-688 (2009).</li><li>Gupta, V. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+artery+calcification+predicts+cardiovascular+complications+after+sepsis.">Coronary artery calcification predicts cardiovascular complications after sepsis.</a> Journal of Critical Care. 44, 261-266 (2017).</li><li>Takx, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automated+coronary+artery+calcification+scoring+in+non-gated+chest+CT:+agreement+and+reliability.">Automated coronary artery calcification scoring in non-gated chest CT: agreement and reliability.</a> PLoS One. 9 (3), 91239 (2014).</li><li>Hecht, H. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2016+SCCT/STR+guidelines+for+coronary+artery+calcium+scoring+of+noncontrast+noncardiac+chest+CT+scans:+A+report+of+the+Society+of+Cardiovascular+Computed+Tomography+and+Society+of+Thoracic+Radiology.">2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology.</a> Journal of Cardiovascular Computed Tomography. 11 (1), 74-84 (2016).</li><li>Erbel, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progression+of+coronary+artery+calcification+seems+to+be+inevitable,+but+predictable+-+results+of+the+Heinz+Nixdorf+recall+(HNR)+study.">Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf recall (HNR) study.</a> European Heart Journal. 35 (42), 2960-2971 (2014).</li><li>Blaha, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+the+CAC+score+by+addition+of+regional+measures+of+calcium+distribution.">Improving the CAC score by addition of regional measures of calcium distribution.</a> JACC: Cardiovascular Imaging. 9, 1407-1416 (2016).</li></ol>

CAC 的识别是一个非常强大的预后工具, 越来越多的文献支持它在许多不同的临床情况下使用。大多数文献集中在门控心脏 ct 扫描, 以确定 cac, 但有有力的证据表明, cac 的相关性, 非门控 CT 扫描, 以及预后的能力, 这一发现。考虑到美国的 ct 扫描利用情况, 以及对辐射暴露的越来越多的关注, 从已经获得的 ct 扫描中提取 CAC 信息的能力似乎提供了额外的价值 (即, 提高质量最低限度到无需额外费...

冠状动脉疾病是主要的不良心血管事件的预测因素。CT 扫描为冠状动脉疾病提供了客观证据, 可以识别以前未确诊的患者。此外, CAC 具有重要的预后价值。具体来说, 在门控心脏 CT 扫描中没有 CAC, 确定了在许多不同的病人中, 包括患有心脏病症状的病人, 以及无症状的患者, 在随后的心血管事件中有低风险的患者人数。患者1,2。7000万的 ct 扫描在美国进行, 使用率上升, 其中大约 11-1200万的扫描是胸部 CT 扫描, 在许多患者中发现 CAC 的可能性仍然很高3。然而, 大多数的 CT 扫描的胸部进行的分析, 不是专门的心脏 CT 扫描。专用的心脏 CT 扫描有标准化的切片厚度, 采集协议, 心电图 (ECG) 门, 以尽量减少心脏运动, 和重建协议。还有一个标准化定量的门控心脏 CT 扫描使用 Agatston 评分。Agatston 评分系统已得到良好的验证, 并与临床结果1,2。
CAC 可以很容易地识别这些非门控 CT 扫描, 但往往被忽视4。在非门控 ct 扫描和从门控 ct 扫描获得的 Agatston 评分之间有良好的相关性 (> 90% 在联合分析中)5、6、7、8、9 ,10。在非门控 CT 扫描中, CAC 的存在与更糟糕的临床结局有关;然而, 这种缺席与发病率和死亡率的好处有关,10,11,12,13,14,15。
虽然不同的研究观察了 cac 对非门控研究的预后, 但已发表的关于如何最好地确定 cac 的公布数据有限。有人试图确定一种自动的方法来识别在低剂量 CT 胸部扫描为肺癌筛查目的的 CAC;然而, 对其他研究协议的翻译是非常有限的16。采用差分 CT 扫描仪、协议和对比 (定时和数量) 限制了这种自动方法的应用。心血管计算机断层扫描学会和胸腔放射学会的尝试, 以促进对所有 CT 胸腔的 CAC 标准报告已达到17混合结果。虽然在本指南文件中提供了一个总体框架, 但确定冠状动脉钙化的具体细节, 特别是对于那些不经常可视化冠状动脉解剖的提供者来说, 是有限的。此外, 针对腹部 CT 扫描、对比研究和裁决具有挑战性的病例的策略没有得到解决。许多研究公布了它们自己所使用的协议的内部和观察者的重复性;然而, 在不同的研究中没有使用标准方法。
在这些非门控 CT 扫描中持续可靠地识别 cac 的能力, 允许对 cac 在许多不同情况下预测心血管结局的回顾和前瞻性观察研究。然而, 需要有一个标准的方法来识别非门控 CT 扫描的 CAC, 以确保结果的重现性, 以及在训练中的一致性, 以帮助临床实践。

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			<td height="20" style="height:20px;width:267px;">Microsoft Windows Server 2012 R2 Standard</td>
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			<td>IP version 8.0.31.0</td>
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			<td height="42" style="height:42px;width:267px;">Computer Desktop and Monitor: Optiplex 9030 AIO</td>
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identifying coronary artery calcification on non-gated computed tomography scans

冠状动脉钙化 (CAC) 是一种客观的冠状动脉疾病测量方法, 可以在非门控计算机断层扫描 (CT) 检查中发现, 与门控心脏 CT 扫描有很高的相关性。这个标准化的协议采取了一个步骤明智的方法, 不仅优化图像的钙化鉴别, 而且还区分 CAC 与其他常见的原因钙化的心脏剪影。在非门控 CT 扫描中对 CAC 的识别有助于确定一个非常强大的预后因素, 可以影响治疗干预或下游诊断测试, 而不需要进行门控心脏扫描。这些非门控的 CT 扫描通常是作为病人例行护理的一部分获得的, 而这一数据在没有另一剂量电离辐射的情况下是容易得到的。该协议允许准确准确地提取这些数据, 用于临床研究研究的回顾性数据分析, 也可用于患者的临床评估和管理。

如上文所述, 冠状动脉解剖在大多数患者中是相对可预测的。在大多数患者中, 评估这些血管的典型地点也很容易被发现 (图 1)。使用所述方法, 在84% 的患者中可以可靠地确定 CAC 的存在或缺失 (267 的317例可能的患者)15。绝大多数被排除的患者没有 ct 扫描在指定的时间框架内, 或有腹部 ct 扫描, 其中完全冠状动脉血管没有看到, 并没有...

Watch this Scientific Journal Video about Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans at JoVE.com

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

在这里, 我们提出了一个协议, 以可靠和系统地识别冠状动脉钙化 (CAC) 的非门控计算机断层扫描 (CT) 的胸部或腹部。CAC 为研究和临床目的提供了一种客观的冠状动脉疾病测量方法。

非门控断层扫描的冠状动脉钙化识别

Coronary artery calcification (CAC) provides an objective measure of coronary artery disease and can readily be identified on non-gated computed ...

Research

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Medicine

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改性技术在小鼠冠状动脉结扎

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

科研

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Retrograde Perfusion and Filling of Mouse Coronary Vasculature as Preparation for Micro Computed Tomography Imaging

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