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

Dette arbejde blev støttet af National Institutes of Health [1TL1TR001997-01, 2016-2017].

Denne protokol følger retningslinjerne af institutionelle Review Board og menneskelige emne forskning protokol af University of Kentucky.
1. åbning af Billedfremviser
<ol><li>Åbn Billedfremviser bruges på institutionen, hvor forskningen udføres. Dobbeltklik på skrivebordsikonet at åbne fremviser.</li>
	<li>Log på ved hjælp af en institutionel username og password.</li>
</ol>2. at identificere passende patienten
<ol><li>Klik på ikonet Undersøgelse ...

<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>

Identifikation af CAC er et meget kraftfuldt prognostiske værktøj med en voksende mængde af litteratur støtter dets anvendelse i mange forskellige kliniske scenarier. Fleste af litteraturen fokuserer på gated hjerte CT-scanninger til identifikation af CAC, men der er solide beviser for begge sammenhængen af CAC på ikke-gated CT-scanninger, samt den prognostiske evne af denne konstatering. Givet en CT-scanning udnyttelse i USA, såvel som de voksende bekymringer om stråling, evnen til at udtrække CAC information ...

Koronararteriesygdom er en prædiktor for store negative kardiovaskulære hændelser. CAC på CT-scanninger giver objektive beviser af koronar arteriesygdom og kan identificere tidligere udiagnosticeret patienter. Derudover har CAC en betydelig prognostiske værdi. Specifikt, identificerer manglen CAC på gated hjerte CT scanninger en patientgruppe, der har en lav risiko for efterfølgende kardiovaskulære hændelser i mange forskellige delgrupper af patienter, herunder patienter med kardiale symptomer, samt asymptomatisk patienter1,2. Med ~ 70 millioner CT scanninger udføres i USA og stigende forbrug og ca 11-12 millioner af disse scanninger være CT scanninger af brystet, potentialet for identifikation af CAC i et stort antal patienter fortsat høje3. Men fleste af CT-scanning af thorax udføres i denne analyse ikke er dedikeret hjerte CT-scanninger. Dedikeret hjerte CT scanninger har standardiseret skive tykkelse, erhvervelse protokoller, elektrokardiografiske (EKG) gating for at minimere hjerte motion og genopbygning protokoller. Der er også en standardiseret kvantitering for gated hjerte CT scanner bruger Agatston score. Agatston pointsystem har været godt valideret og forbundet med kliniske resultater1,2.
CAC kan være let identificeres på disse ikke-gated CT scanner men er ofte overset4. Har vist god korrelation mellem CAC identificeret på ikke-gated CT-scanninger og Agatston score opnået fra gated CT scanninger (> 90% i samlet analyse)5,6,7,8,9 ,10. I ikke-gated CT scanninger, har tilstedeværelsen af CAC været forbundet med værre kliniske resultater; der henviser til, at der ikke er knyttet til sygelighed og dødelighed fordele10,11,12,13,14,15.
Mens forskellige studier har undersøgt prognose af CAC på ikke-gated undersøgelser, har der været begrænset offentliggjorte data om hvordan man bedst kan identificere CAC. Der har været forsøg på at identificere en automatiseret metode til identifikation af CAC i lav-dosis CT kister scanninger gjort for lungekræft screening formål; Oversættelse af dette til andre undersøgelse protokoller er dog ekstremt begrænset16. Indførelsen af differentieret CT scannere, protokoller og kontrast (både timing og mængde) begrænser anvendelsen af denne automatiserede tilgang. Forsøg på af den samfundet af hjerte-kar-beregnet tomografi og samfund af thorax radiologi fremme standardrapportering af CAC på alle CT kister er blevet mødt med blandede resultater17. Samtidig giver en generel ramme i denne retningslinje dokument, er detaljerne i identifikation af koronar forkalkning, især for udbydere, der ikke rutinemæssigt Visualiser koronar anatomi, begrænset. Også strategier specifikt for abdominal CT scanner, kontrast undersøgelser og afgørende udfordrende tilfælde behandles ikke. Mange undersøgelser udgive deres egne inter - og intra-observatør reproducerbarhed for protokollen de anvendes; der er imidlertid ikke en standard tilgang anvendes på tværs af forskellige undersøgelser.
Evnen til at konsekvent og pålideligt identificere CAC på disse ikke-gated CT scanninger giver mulighed for retrospektiv og prospektiv observationelle undersøgelser af CAC i forudsige kardiovaskulære udfald i mange forskellige forhold. Der skal dog være en standardmetode, der er taget til at identificere CAC på ikke-gated CT scanninger for at sikre reproducerbarheden af resultaterne, samt en sammenhæng i uddannelse for at hjælpe i klinisk praksis.

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identifying coronary artery calcification on non-gated computed tomography scans

Koronararterie forkalkning (CAC) giver et objektivt mål for koronar arteriesygdom og kan let identificeres på ikke-gated computertomografi (CT) scanninger med en høj korrelation med låge hjerte CT-scanninger. Denne standardiserede protokollen tager en trinvis tilgang ikke blot optimere et billede for identifikation af forkalkning, men også at skelne CAC fra andre almindelige årsager til forkalkning i hjertets silhuet. Anerkendelse af CAC på ikke-gated CT scanner hjælper med at identificere en meget kraftfuld prognostiske faktor, der kan påvirke terapeutiske indgreb eller downstream diagnostiske test uden at kræve en gated hjerte scanning. Disse ikke-gated CT-scanninger er ofte anskaffet som led i rutinemæssige pleje af patienten, og disse data er let tilgængelige uden en anden dosis af ioniserende stråling. Denne protokol giver mulighed for præcis og nøjagtig udvinding af disse data med henblik på retrospektive dataanalyse i kliniske forskningsundersøgelser, men også i den kliniske vurdering og forvaltning af patienter.

Koronar anatomi er relativt forudsigelige hos de fleste patienter som beskrevet ovenfor. De typiske steder at evaluere disse fartøjer identificeres også let hos de fleste patienter (figur 1). Efter den beskrevne metode, kunne tilstedeværelse eller fravær af CAC pålideligt identificeres i 84% af patienterne i en enkelt kohorte (267 af 317 mulige patienter)15. Langt størstedelen af patienterne udelukket har ikke en CT-scanning i de...

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

Vi præsenterer her, en protokol til at pålideligt og systematisk identificere koronararterie forkalkning (CAC) på ikke-gated computertomografi (CT) scanninger af brystet eller maven. CAC giver et objektivt mål for koronar arteriesygdom for både forskning og kliniske formål.

At identificere koronararterie forkalkning på beregnet ikke-gated tomografi scanninger

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

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