Lumen Volume Research Articles

Morphology of the human inner ear and vestibulocochlear nerve assessed using 7T MRI.

To optimize high-resolution 7T MRI of the cochlea and measure normal cochlea and the cochlear nerve morphometry in vivo. Eight volunteers with normal hearing were scanned at 7T using an optimized protocol. Two neuroradiologists independently scored image quality. The basal turn lumen diameter (BTLD), height, width, length and volume of the cochlear, long (LD) and short (SD) diameter the calculated cross-sectional area (CSA) of the cochlear nerve were measured. Intra and inter-observer reliability was assessed using intraclass correlation (ICC). 3D T2W DRIVE combined with dielectric pads, allowed acquisition of high-resolution images showing detailed structures, such as the crista ampullaris in the semicircular canals. The overall grading scores from neuroradiologists were excellent. In the left ear, averaging over all subjects gave BTLD of 2.6 ± 0.05mm, height of 4.9 ± 0.1mm, width of 4.4 ± 0.2mm, length of 36.5 ± 0.4mm, volume of 0.16 ± 0.02ml, LD of 1.31 ± 0.1mm, SD of 1.06 ± 0.1mm, and CSA of 1.1 ± 0.1 mm2. The right ear gave BTLD of 2.6 ± 0.04mm, height of 4.9 ± 0.1mm, width of 4.4 ± 0.3mm, length of 35.5 ± 0.4mm, volume of 0.16 ± 0.02ml, LD of 1.29 ± 0.1mm, SD of 1.07 ± 0.1mm, and CSA of 1.10 ± 0.2 mm2. No statistically significant difference was found between the sides of the head (p-value > 0.05). The intra-observer reliability was high (0.77-0.94), while the inter-observer reliability varied from moderate to high (0.55-0.81). 7T MRI can provide excellent visualization of the internal structure of the cochlear and of the vestibulocochlear nerve in vivo.

Impact of ultra-high-resolution on cardiac CT assessment of coronary artery stenoses, plaque burden/composition, and pericoronary adipose tissue attenuation

Abstract Background Conventional coronary computed tomography angiography (CCTA) overestimates stenoses within stents and calcified arteries due to "blooming" artifacts. Ultra-high-resolution coronary CT (UHR-CT) may overcome this limitation because of higher spatial resolution. Purpose To investigate differences in coronary arterial lumen volume, stenosis severity, and plaque composition, between CCTA and UHRCT in patients with stents and/or high coronary calcium scores. Methods As part of a prospective pilot study, 14 patients referred for invasive coronary angiography for evaluation of obstructive CAD underwent UHRCT (Canon Precision, 160 x 0.25mm slices) prior to catheterization. Images of identical cardiac phases were reconstructed in two badges for comparison: 1) Ultra-high resolution using a 1,024 x 1,024 matrix, 0.25 mm, and 2) conventional resolution with a 524 x 524 matrix, 0.5 mm. All images were reconstructed using iterative reconstruction algorithm (AIDR 3D) and a sharp kernel (FC05). For the left main and three coronary arteries, an automated contour analysis using a dedicated software (QAngioCT RE 3.2, Medis, Netherlands) was performed to compare conventional CCTA vs. UHR-CT resolution images across common vascular and plaque metrics, including lumen and vessel volume, plaque burden/volume, plaque composition based upon predefined fixed intensity cut-off values of CT attenuation, minimal and maximal plaque thickness, pericoronary adipose tissue attenuation (PCAT), minimal lumen area and diameter, and diameter stenosis. All lumen and vessel contours were generated by the software, without manual editing. The segment model proposed by the SCCT was used as reference and the lesions classified as greater than 25% stenosis by visual assessment were recorded. The quality of the images was subjectively assessed using a 5-point Likert scale. Vessel segments with scores 1 (severe artifacts) and 2 (pronounced artifacts) were not included in the analysis. Results The mean patient age was 68.5 years (±6.8), 2 were female (14.3%), 6 patients had stents (11 stented segments) and the mean Agatston score was 947.6 (±449) among the 8 non-stented patients. A total of 56 vessels, 133 segments, and 57 lesions were analyzed. Eight segments (6%) were excluded from the analysis due to poor quality. Results on a per segment and per lesion basis were summarized in the table. The mean PCAT value was significantly lower for the UHRCT images compared to NR reconstruction in both segment (p<0.001) and lesion based (p=0.002) analyses. Plaque differentiation varied by UHRCT resulted in a lower fibrous plaque volumes but higher necrotic (low attenuation) plaque volumes. Conclusions Ultra-high-resolution CT image analysis results in significantly different coronary artery plaque volume and PCAT assessment vs. conventional resolution CCTA. These findings have implications for evaluating high-risk plaque features and perivascular inflammation in patients.Table 1

Correlation of coronary and carotid atheroma volume in patients with severe and familial hypercholesterolemia (VOCCA-3D HF)

Abstract Background Stratifying the risk of CV event of familial hypercholesterolemia (FH) patients is not always simple, as they usually are excluded from CV disease risk estimation scores. It has become increasingly clear over the last several years that the heterogeneity in risk among patients with FH is far greater than previously appreciated. To that end, not all patients with FH will require the use of PCSK9 inhibitors. Aim We described the type of coronary artery disease (CAD) in patients with severe and familial hypercholesterolemia and without known atherosclerotic cardiovascular disease and searched for the best determinants of CAD. We searched for correlation between epicardial adipose tissue and CAD. Methods We evaluated the atherosclerosis burden with a combination of calcium score (CAC), computed tomography angiography, and the quantification of coronary atheroma volume and the analysis of the composition of the plaques, alongside with the use of ultrasonography of supra-aortic trunks with 3D quantification of atheroma volume. We also evaluated epicardial adipose tissue volume with CT. Results We analyzed 89 individuals with LDL-c > 190 mg/dL, with a mean age of 56,7 years. LDL-c burden was high (maximal LDL-c level across life of 2.77 g/L in mean, duration of hypercholesterolemia of 21.5 years in mean). Forty percent of the individuals had a CAC score of zero, and only one patient had non-calcified atheroma despite a CAC score of zero. Among patients with CAD, 50% had a CAC > 100 AU, 9% had a stenosis > 50%. Coronary atheroma volume amounted to a median of 50.9 mm3 in patients with CAD, representing 4% of the analyzed coronary lumen volume, and was mainly made of calcified and non-calcified fibrous plaques. At-risk plaques were not frequent (9% of low-attenuation plaques, 15.2% of positive remodeling and 2% of napkin-ring sign) in patients with CAD. Fifty percent of the individuals had no carotid plaque. Among various clinical and biological risk factors (LDL-year-score, age, blood pressure, smoking, familial history, diabetes), the carotid atheroma volume was the only variable to be independently correlated with both CAC (t=3.1, p=0.006) and coronary atheroma volume (t=4.9, p<0.001). Epicardial adipose tissue was not associated with CAD. Conclusion A significant part of the patients with severe and familial hypercholesterolemia has no CAD, however half of the patients with CAD have an important atherosclerosis burden, which can be well predicted by the carotid atheroma volume. Such a screening could help identify the individuals who would benefit the most from intensive cholesterol-lowering drugs.CAC categoriesType of coronary plaques

Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA)

BackgroundDiscrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia. MethodsObservational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ​≥ ​50 ​% at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80. ResultsThe study population consisted of 192 patients, of whom 224 vessels (61 ​% LAD, 19 ​% LCX, 20 ​% RCA) had lesions with DS ​≥ ​50 ​% interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 ​% vs 43.2 ​% and 44.2 ​%, respectively, p ​= ​0.018). A significant correlation between DS and FFR was observed only in LAD (p ​= ​0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 ​%) for LAD, non-calcified plaque volume (threshold >130 ​mm3) for LCX, and lumen volume (threshold <844 ​mm3) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76–0.80). ConclusionsIntegrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients’ referral to the catheterization laboratory.

Low-Dose Whole-Chest Dynamic CT for the Assessment of Large Airway Collapsibility in Patients with Suspected Tracheobronchial Instability.

Purpose To quantify tracheal collapsibility using low-dose four-dimensional (4D) CT and to compare visual and quantitative 4D CT-based assessments with assessments from paired inspiratory-expiratory CT, bronchoscopy, and spirometry. Materials and Methods The authors retrospectively analyzed 4D CT examinations (January 2016-December 2022) during shallow respiration in 52 patients (mean age, 66 years ± 12 [SD]; 27 female, 25 male), including 32 patients with chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second percentage predicted [FEV1%], 50% ± 27), with suspected tracheal collapse. Paired CT data were available for 27 patients and bronchoscopy data for 46 patients. Images were reviewed by two radiologists in consensus, classifying patients into three groups: 50% or greater tracheal collapsibility, less than 50% collapsibility, or fixed stenosis. Changes in minimal tracheal lumen area, tracheal volume, and lung volume from inspiration to expiration were quantified using YACTA software. Tracheal collapsibility between groups was compared employing one-way analysis of variance (ANOVA). For related samples within one group, ANOVA with repeated measures was used. Spearman rank order correlation coefficient was calculated for collapsibility versus pulmonary function tests. Results At 4D CT, 25 of 52 (48%) patients had tracheal collapsibility of 50% or greater, 20 of 52 (38%) less than 50%, and seven of 52 (13%) had fixed stenosis. Visual assessment of 4D CT detected more patients with collapsibility of 50% or greater than paired CT, and concordance was 41% (P < .001). 4D CT helped identify more patients with tracheal collapsibility of 50% or greater than did bronchoscopy, and concordance was 74% (P = .39). Mean collapsibility of tracheal lumen area and volume at 4D CT were higher for 50% or greater visually assessed collapsibility (area: 53% ± 9 and lumen: 52% ± 10) compared with the less than 50% group (27% ± 9 and 26% ± 6, respectively) (P < .001), whereas both tracheal area and volume were stable for the fixed stenosis group (area: 16% ± 12 and lumen: 21% ± 11). Collapsibility of tracheal lumen area and volume did not correlate with FEV1% (rs = -0.002 to 0.01, P = .99-.96). Conclusion The study demonstrated that 4D CT is feasible and potentially more sensitive than paired CT for central airway collapse. Expectedly, FEV1% was not correlated with severity of tracheal collapsibility. Keywords: CT-Quantitative, Tracheobronchial Tree, Chronic Obstructive Pulmonary Disease, Imaging Postprocessing, Thorax Supplemental material is available for this article. © RSNA, 2024.

Vascular Remodeling in Coronary Microvascular Dysfunction.

Approximately half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD). This study aims to characterize patients with ANOCA by measuring their minimal microvascular resistance and to examine the pattern of vascular remodeling associated with these measurements. The authors prospectively included patients with ANOCA undergoing continuous thermodilution assessment. Lumen volume and vessel-specific myocardial mass were quantified using coronary computed tomography angiography (CTA). CMD was defined as coronary flow reserve<2.5 and high minimal microvascular resistance as >470 WU. A total of 153 patients were evaluated; 68 had CMD, and 22 of them showed high microvascular resistance. In patients with CMD, coronary flow reserve was 1.9 ± 0.38 vs 3.2 ± 0.81 in controls (P< 0.001). Lumen volume was significantly correlated with minimal microvascular resistance (r =-0.59 [95%CI:-0.45 to-0.71]; P< 0.001). In patients with CMD and high microvascular resistance, lumen volume was 40% smaller than in controls (512.8 ± 130.3mm3 vs 853.2 ± 341.2mm3; P< 0.001). Epicardial lumen volume assessed by coronary CTA was independently associated with minimal microvascular resistance (P< 0.001). The predictive capacity of lumen volume from coronary CTA for detecting high microvascular resistance showed an area under the curve of 0.79 (95%CI: 0.69-0.88). Patients with CMD and high minimal microvascular resistance have smaller epicardial vessels than those without CMD. Coronary CTA detected high minimal microvascular resistance with very good diagnostic capacity. Coronary CTA could potentially aid in the diagnostic pathway for patients with ANOCA.

Reproducibility for carotid wall segmentation using T1-weighted DANTE-SPACE sequence on high-resolution 3-T carotid MRI.

T1-weighted (T1W) magnetic resonance imaging (MRI) using the delay alternating with nutation for excitation-sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE) is the preferred imaging technique for evaluation of the vessel wall. To evaluate the intra- and inter-rater reproducibility of carotid wall segmentation on T1W DANTE-SPACE in patients with symptomatic (acute stroke or transient ischemic attack) internal carotid artery (ICA) stenosis. This prospective study included 25 patients with acute (≤3 months) stroke or transient ischemic attack and 50%-99% stenosis of the ICA. All patients underwent 3.0-T high-resolution carotid MRI. Two radiologists independently performed the manual segmentation of the vessel wall and inner lumen of the bilateral carotid artery on DANTE-SPACE. The intraclass correlation coefficient (ICC), Dice similarity coefficient (DSC), and Hausdorff distance (HD) were calculated. The ICCs for intra-rater reproducibility of carotid wall volume, inner lumen volume, and normalized wall index were 0.965, 0.990, and 0.962, respectively. The ICCs for inter-rater reproducibility of carotid wall volume, inner lumen, and normalized wall index were 0.856, 0.981, and 0.904. DSC and HD for intra- and inter-rater reproducibility of carotid wall segmentation were as follows: 0.873 and 0.809 (DSC); and 0.079 and 0.118 (HD), respectively. For evaluation of reproducibility only in the carotid artery with symptomatic stenosis, the ICCs for intra- and inter-rater reproducibility indicated all perfect agreement. T1W DANTE-SPACE is a reproducible sequence for evaluation of the carotid wall using carotid MRI in patients with symptomatic ICA stenosis.

Long-Term Volumetric Evaluation of Stent-Assisted Balloon-Induced Intimal Disruption and Relamination of Aortic Dissection (STABILISE) in Acute Type B Aortic Dissection

ObjectiveTo quantify the volumetric aortic remodeling of patients with acute type B aortic dissection (ATBAD) treated with the stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. MethodsAll patients with ATBAD operated with the STABILISE technique between 2014 and 2017 with pre-operative (PreOp), post-operative (PostOp) and >12 months (follow-up) computed tomography scans were included in this study. True lumen and total aortic volume were accurately assessed in the thoracic and abdominal portions with a semi-automatic 3D tool. Associations with long-term adverse events were estimated. ResultsSeventeen patients were measured at PreOp, PostOp and a mean follow-up of 19±8 months. The false lumen to total volume ratio decreased on average from 63% to 18% after STABILISE (p<0.001) and remained around 12% at follow-up. These remodeling was more pronounced in the thoracic aorta (7%) than in the abdominal aorta (28%). The trend in aortic size growth was stronger for volumes than for maximum areas or diameters (p<0.001, p<0.05 and p<0.05, respectively). Adverse events were identified in 4 patients during a long-term follow-up of 76±18 months. The only aortic size variable assessed preoperatively that was associated with undesirable events was the total volume of the abdominal aorta (p<0.05). ConclusionsA volumetric analysis of dissected aortic size after the STABILISE procedure allowed accurate quantification of mid-term aortic remodeling and helped to identify the abdominal aortic volume as a preoperative variable associated with undesirable long-term events.

Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease

BackgroundCoronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium. MethodsThe V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD. ResultsThe V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFRCT [43.1 (15.2) vs 41.1 (16.5), p ​< ​0.001]. Mean V, M, and V/M were 2204 ​mm3, 137 ​g, and 16.5 ​mm3/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r ​= ​−0.26 and −0.34). V and V/M had a strong correlation (r ​= ​0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]). ConclusionSystematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFRCT.

The Value of Aortic Volume and Intraluminal Thrombus Quantification for Predicting Aortic Events after Endovascular Thoracic Aneurysm Repair.

Objectives: To assess the ability of the aortic aneurysm volume (AAV), aneurysmal lumen volume (ALV), and aneurysmal thrombus volume (ATV) to predict the need for aortic reintervention when using the maximal aortic diameter as a reference. Methods: This monocentric retrospective study included 31 consecutive patients who underwent successful thoracic endovascular aortic repair (TEVAR) to treat an atheromatous thoracic aortic aneurysm. All patients underwent clinical and computed tomography angiography (CTA) for 3 years after TEVAR. The patients were categorized into group 0 if no aortic reintervention was required during the follow-up period and categorized into group 1 if they experienced a type I or III endoleak or aneurysm diameter increase requiring intervention. The maximum aneurysm sac diameter and the AAV, ALV, and ATV were calculated using CTA images obtained preoperatively (T0) and at 6-12 months (T1), 24 months (T2), and 36 months (T3) postoperatively, and their changes over time were analyzed. Correlations between diameter and changes in AAV, ALV, and ATV were assessed, and the association between diameter and volume changes and reintervetion was examined. The cutoff values for predicting the need for reintervention was determined using a receiver operating characteristic (ROC) curve. The accuracy of volume change versus diameter change for predicting the need for reintervention was analyzed. Results: There were no significant differences in terms of the mean aneurysm diameter or AAV, ALV or ATV between the groups at preoperative CTA or after one year of follow-up imaging. The mean ATV was higher in group 1 than in group 0 at 2 years (187.6 ± 86.3 mL vs. 114.7 ± 64.7 mL; p = 0.057) and after 3 years (195.0 ± 86.7 mL vs. 82.1 ± 39.9 mL; p = 0.013). The maximal diameter was greater in group 1 than in group 0 at 3 years (67.3 ± 9.5 mm vs. 55.3 ± 12.6 mm; p = 0.044). The rate of AAV change between T0 and T1 was significantly higher in group 1 (7 ± 4.5%) than in group 0 (-6 ± 6.8%; p < 0.001). The rate of ATV change between T1-T3 was significantly higher in group 1 than in group 0 (34 ± 40.9% vs. -13 ± 14.4% (p = 0.041)); similar results were observed for the rate of ATV change between T2 and T3 (27 ± 50.1% for group 1 vs. -8 ± 49.5% in group 0 (p < 0.001)). According to our multivariate analysis, the annual growth rate for AAV between T0 and T1 was the only independent factor that was significantly associated with aortic reintervention (area under the curve (AUC) = 0.84, OR = 1.57, p = 0.025; optimal cutoff +0.4%). An increase in the annual growth rate of the ATV between T0 and T3 was independently associated with the need for aortic reintervention (area under the curve (AUC) = 0.90, OR = 1.11, p = 0.0347; optimal cutoff +10.1%). Conclusions: Aortic volume analysis can predict the need for aortic reintervention more accurately and earlier than maximal aortic diameter.

Prospective deep learning-based quantitative assessment of coronary plaque by computed tomography angiography compared with intravascular ultrasound: the REVEALPLAQUE study.

Coronary computed tomography angiography provides non-invasive assessment of coronary stenosis severity and flow impairment. Automated artificial intelligence (AI) analysis may assist in precise quantification and characterization of coronary atherosclerosis, enabling patient-specific risk determination and management strategies. This multicentre international study compared an automated deep learning-based method for segmenting coronary atherosclerosis in coronary computed tomography angiography (CCTA) against the reference standard of intravascular ultrasound (IVUS). The study included clinically stable patients with known coronary artery disease from 15 centres in the USA and Japan. An AI-enabled plaque analysis was utilized to quantify and characterize total plaque (TPV), vessel, lumen, calcified plaque (CP), non-calcified plaque (NCP), and low-attenuation plaque (LAP) volumes derived from CCTA and compared with IVUS measurements in a blinded, core laboratory-adjudicated fashion. In 237 patients, 432 lesions were assessed; mean lesion length was 24.5 mm, and mean IVUS-TPV was 186.0 mm3. AI-enabled plaque analysis on CCTA showed strong correlation and high accuracy when compared with IVUS; correlation coefficient, slope, and Y intercept for TPV were 0.91, 0.99, and 1.87, respectively; for CP volume 0.91, 1.05, and 5.32, respectively; and for NCP volume 0.87, 0.98, and 15.24, respectively. Bland-Altman analysis demonstrated strong agreement with little bias for these measurements. AI-enabled CCTA quantification and characterization of atherosclerosis demonstrated strong agreement with IVUS reference standard measurements. This tool may prove effective for accurate evaluation of coronary atherosclerotic burden and cardiovascular risk assessment.

Predictors of late lumen enlargement after drug-coated balloon angioplasty for de novo coronary lesions.

Late lumen enlargement (LLE) - a positive remodelling phenomenon - after drug-coated balloon (DCB) angioplasty for stable coronary disease contributes to a lower restenosis rate. However, lesion characteristics promoting LLE remain unclear. This study aimed to investigate predictive lesion characteristics for LLE using serial optical frequency domain imaging (OFDI) following DCB angioplasty for de novo coronary artery lesions. This retrospective, single-centre observational study included patients with angina pectoris who underwent paclitaxel-coated balloon angioplasty without stenting under OFDI guidance as well as follow-up OFDI. OFDI endpoints were lumen volume, plaque phenotype, and procedure-associated dissection. LLE was defined as a ≥10% increase in the lumen volume of the treated lesion at follow-up. Between August 2016 and December 2019, among patients with successful DCB angioplasty, 108 lesions (83 patients) had available follow-up imaging after a median of 6.1 months. LLE was detected in 44 (40.7%) lesions. Fibrous/fibrocalcific and layered plaques had significantly larger lumen volumes at follow-up than immediately after the index procedure, whereas lipid plaques exhibited no significant difference. Medial dissection with an arc >90° revealed an increased lumen volume. Multivariate analysis showed that layered plaques (odds ratio [OR] 8.73, 95% confidence interval [CI]: 1.92-39.7; p=0.005) and medial dissection with an arc >90° (OR 4.65, 95% CI: 1.63-13.3; p=0.004) were independent LLE predictors. Layered plaques and extensive medial dissection after DCB angioplasty were associated with higher LLE occurrence in de novo coronary lesions. These findings may be clinically applicable to DCB therapeutic strategies based on plaque features.

A comparative analysis of deep learning-based location-adaptive threshold method software against other commercially available software

Automatic segmentation of the coronary artery using coronary computed tomography angiography (CCTA) images can facilitate several analyses related to coronary artery disease (CAD). Accurate segmentation of the lumen or plaque region is one of the most important factors. This study aimed to analyze the performance of the coronary artery segmentation of a software platform with a deep learning-based location-adaptive threshold method (DL-LATM) against commercially available software platforms using CCTA. The dataset from intravascular ultrasound (IVUS) of 26 vessel segments from 19 patients was used as the gold standard to evaluate the performance of each software platform. Statistical analyses (Pearson correlation coefficient [PCC], intraclass correlation coefficient [ICC], and Bland-Altman plot) were conducted for the lumen or plaque parameters by comparing the dataset of each software platform with IVUS. The software platform with DL-LATM showed the bias closest to zero for detecting lumen volume (mean difference = -9.1 mm3, 95% confidence interval [CI] = -18.6 to 0.4 mm3) or area (mean difference = -0.72 mm2, 95% CI = -0.80 to -0.64 mm2) with the highest PCC and ICC. Moreover, lumen or plaque area in the stenotic region was analyzed. The software platform with DL-LATM showed the bias closest to zero for detecting lumen (mean difference = -0.07 mm2, 95% CI = -0.16 to 0.02 mm2) or plaque area (mean difference = 1.70 mm2, 95% CI = 1.37 to 2.03 mm2) in the stenotic region with significantly higher correlation coefficient than other commercially available software platforms (p < 0.001). The result shows that the software platform with DL-LATM has the potential to serve as an aiding system for CAD evaluation.

FL% is associated with the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk and total arch replacement.

The diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement. In this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection. The patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421-100.11); P = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47-0.98); P = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15-3.30); P = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01-2.12); P = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914-0.967; P < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798-0.884; P < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Ascending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.

Atherosclerotic coronary plaque regression from lipid-lowering therapies: A meta-analysis and meta-regression

BackgroundStudies reporting collective and comprehensive data on plaque regression of different lipid-lowering therapies (LLTs) are limited. ObjectivesWe evaluated plaque regression of LLTs based on multiple markers and performed subgroup analyses based on LLT type and post-treatment LDL-C levels MethodsA literature search was performed to identify studies assessing plaque regression from LLTs. The following LLTs groups were included: High-intensity statin (HIS), HIS+ eicosapentaenoic acid (EPA), HIS + ezetimibe, Low-intensity statin (LIS), LIS + EPA, LIS + Ezetimibe, and PCSK9 inhibitors. Our primary outcomes were change in percent atheroma volume (PAV). Secondary outcomes included mean differences in total atheroma volume (TAV), lumen, plaque, and vessel volumes, fibrous cap thickness (FCT), and lipid arc (LA). Subgroup analyses were performed on LLT type and post-treatment LDL-C levels. Meta-regression was performed to control for covariates. ResultsWe identified 51 studies with 9,113 adults (22 % females). LLTs reduced PAV levels (-1.10 % [-1.63, -0.56], p < 0.01), with significant reduction observed with HIS, LIS + ezetimibe, LIS + EPA, and PCSK9 inhibitors. LLTs reduced TAV levels (-5.84 mm3 [-8.64 to -3.04] p < 0.01), mainly driven by HIS (-7.60 mm3 [-11.89, -3.31] p < 0.01). LLTs reduced plaque volume and LA and increased FCT. ConclusionThe plaque regression associated with LLTs is observed to be mainly driven by HIS, reducing both TAV and PAV. This suggest that HIS is the most effective LLT for plaque regression Unstructured abstractWe evaluated plaque regression of LLTs from 51 studies. We found that while reduction of PAV (-1.10 % [-1.63, -0.56], p < 0.01) were present across different LLT types, reduction of TAV (-5.84 mm3 [-8.64 to -3.04] p < 0.01) was mainly driven by HIS (-7.60 mm3 [-11.89, -3.31] p < 0.01). These results suggest that HIS is the most effective LLT for plaque regression.

Protective effect of co-enzyme Q10 on testicular tissue and sperm parameters in adult male rats treated with Sunset Yellow FCF

Objective: To determine the protective effect of co-enzyme Q10 (CoQ10) on testicular tissue and sperm parameters in male rats treated with Sunset Yellow FCF. Methods: Sixty male Sprague-Dawley rats were randomly divided into 6 groups of the control, CoQ10 (10 mg/kg/day), low dose of Sunset Yellow (2.5 mg/kg), high dose of Sunset Yellow (70 mg/kg), low dose of Sunset Yellow (2.5 mg/kg) plus CoQ10, and high dose of Sunset Yellow (70 mg/kg) plus CoQ10. The drugs were administered via daily oral gavages for 6 weeks. At the end of the experiment, sperm analysis, stereological and histological assessments of the testis were carried out. Results: The normal morphology (by 41.1%) and progressive spermatozoa (by 74.8%), testicle volume (by 33.4%), lumen volume (by 38.3%), interstitial tissue volume (by 44.7%), seminiferous tubule volume (by 40.7%), and number of spermatogonia (by 53.9%) and Leydig cells (by 70.7%) reduced in the rats that received high doses of Sunset Yellow in comparison to the control group. Nonetheless, all these alterations were recovered by CoQ10 treatment in the CoQ10 plus high dose of Sunset Yellow group. Furthermore, low doses of Sunset Yellow did not affect different parameters of the testis and sperm. Conclusions: CoQ10 could, to some extent, prevent structural changes of the testis induced by the high dose of Sunset Yellow.

Volumetric analysis in primary and residual type B aortic dissection treated with stented-assisted balloon-induced intimal disruption and relamination technique can predict aortic reintervention

ObjectiveThe aim of this study was to investigate the mid-term results of stented-assisted balloon-induced intimal disruption and relamination (STABILISE) in patients with aortic dissection with the implementation of volumetric analysis. MethodsThis was a single-center retrospective analysis of prospectively collected data. From May 2017 to September 2022, 42 patients underwent STABILISE for acute complicated or subacute high-risk aortic dissection. STABILISE was completed with distal extended endovascular aortic repair in 24 patients. A computed tomography scan was performed at baseline, before hospital discharge, and at 1, 3, and 5 years. Perfused total aortic, true lumen, and false lumen volumes were assessed for thoracic, visceral, and aorto-iliac segment. The ratio between false lumen and total volume was named perfusion dissection index (PDI). Complete remodeling was defined as PDI = 0, and positive remodeling as PDI ≤0.1. ResultsTechnical success was 97.6%. No 30-day deaths, spinal cord injuries, or retrograde dissections were observed. Mean follow-up was 44 ± 19.4 months. Thoracic diameter was lower at last available computed tomography scan (36.7 vs 33.0 mm; P = .01). Aortic growth >5 mm was observed in 9.5% of the patients. Thoracic and visceral aortic complete remodeling were 92.8% and 83.3%, respectively, with no difference between acute and subacute group. Distal extended endovascular aortic repair significantly increased complete remodeling in the aorto-iliac segment, compared with STABILISE alone (69.6% vs 21.4%; P < .001). Freedom from vascular reinterventions at 3 years was 83.1% (95% confidence interval, 71.5%-96.6%). Total PDI ≤0.1 at first postoperative control was a predictor of vascular reinterventions (P < .0001). ConclusionsSTABILISE is a safe and feasible technique associated with high mid-term rates of complete remodeling in the thoracic and visceral aorta. Volumetric analysis allows the quantification of aortic remodeling and represents a predictor of aortic reinterventions.

One-year follow-up after active aortic aneurysm sac treatment with shape memory polymer devices during endovascular aneurysm repair

ObjectiveTo determine the safety and efficacy of treating abdominal aortic aneurysm (AAA) sacs with polyurethane shape memory polymer (SMP) devices during endovascular aneurysm repair (EVAR), using a technique to fully treat the target lumen after endograft placement (aortic flow volume minus the endograft volume). SMP devices self-expand in the sac to form a porous scaffold that supports thrombosis throughout its structure. MethodsTwo identical prospective, multicenter, single-arm studies were conducted in New Zealand and the Netherlands. The study population was adult candidates for elective EVAR of an infrarenal AAA (diameter of ≥55 mm in men and ≥50 mm in women). Key exclusion criteria were an inability to adequately seal a common iliac artery aneurysm, patent sac feeding vessels of >4 mm, and a target lumen volume of <20 mL or >135 mL. Target lumen volumes were estimated by subtracting endograft volumes from preprocedural imaging-based flow lumen volumes. SMP devices were delivered immediately after endograft deployment via a 6F sheath jailed in a bowed position in the sac. The primary efficacy end point was technical success, defined as filling the actual target lumen volume with fully expanded SMP at the completion of the procedure. Secondary efficacy outcome measures during follow-up were the change in sac volume and diameter, rate of type II endoleak and type I or III endoleaks, and the rate of open repair and related reinterventions, with data collection at 30 days, 6 months, and 1 year (to date). Baseline sac volumes and diameters for change in sac size analyses were determined from 30-day imaging studies. Baseline and follow-up volumes were normalized by subtraction of the endograft volume. ResultsOf 34 patients treated with SMP devices and followed per protocol, 33 patients were evaluable at 1 year. Preprocedural aneurysm volume was 181.4 mL (95% confidence interval [CI], 150.7-212.1 mL) and preprocedural aneurysm diameter was 60.8 mm (95% CI, 57.8-63.9 mm). The target lumen volume was 56.3 mL (95% CI, 46.9-65.8 mL). Technical success was 100% and the ratio of SMP fully expanded volume to estimated target lumen volume was 1.4 ± 0.3. Baseline normalized sac volume and diameter were 140.7 mL (95% CI, 126.6-154.9 mL) and 61.0 mm (95% CI, 59.7-62.3 mm). The adjusted mean percentage change in normalized volume at 1 year was −28.8% (95% CI, −35.3 to −22.3%; P < .001). The adjusted mean change in sac diameter at 1 year was −5.9 mm (95% CI, −7.5 to −4.4 mm; P < .001). At 1 year, 81.8% of patients (95% CI, 64.5%-93.0%) achieved a ≥10% decrease in normalized volume and 57.6% of patients (95% CI, 39.2%-74.5%) achieved a ≥5 mm decrease in diameter. No device- or study procedure-related major adverse events occurred through 1 year after the procedure. ConclusionsTreatment of AAA sacs with SMP devices during EVAR resulted in significant sac volume and diameter regression at 1 year with an acceptable safety profile in this prospective study.

3-D Contrast-Enhanced Fusion Ultrasound for Accurate Volume Assessment of Vessel Lumen and Plaque in Carotid Artery Disease as Compared With Computed Tomography Angiography

ObjectiveThree-dimensional contrast-enhanced fusion ultrasound (3D-CEFUS) of atherosclerotic carotid arteries provides spatial visualisation of the vessel lumen, creating a lumenography. As in 3D computed tomography angiography (3D-CTA), 3D-CEFUS outlines the contrast-filled lumen. Plaque and vessel contours are distinguished in 3D-CEFUS, allowing plaque volume quantification as a valid estimate of carotid plaque burden. 3D-CEFUS is unproven in inter-modality studies, vindicating the assessment of 3D-CEFUS applicability and comparing 3D-CEFUS and 3D-CTA lumenography as a proof-of-concept study. MethodsUsing an ultrasound system with magnetic tracking, a linear array transducer, and SonoVue contrast agent generated 3D-CEFUS acquisitions by spatial stitching of serial 2D images. From 3D-CEFUS and 3D-CTA imaging, the atherosclerotic carotid arteries were reconstructed with lumenography in an offline software programme for lumen and plaque volume quantification. Bland-Altman analysis was used for inter-image-modality agreement. ResultsThe study included 39 carotid arteries. Mean lumen and plaque volume in 3D-CEFUS were 0.63 cm3 (SD 0.26) and 0.62 cm3 (SD 0.26), respectively. Lumen volume differences between 3D-CEFUS and 3D-CTA were non-significant, with mean difference of 0.01 cm3 (SD 0.02, p = .26) and limits of agreement range (LoA-range) of ±0.11 cm3. Mean plaque volume difference was -0.12 cm3 (SD 0.19, p = .006) with LoA-range of ±0.39 cm3. ConclusionStrong agreement in lumenography between 3D-CEFUS and 3D-CTA was found. The inter-image-modality difference in plaque volumes was substantial due to challenging vessel wall definition in 3D-CTA. 3D-CEFUS is viable in quantifying carotid plaque volume burden and can potentially monitor plaque development over time.

Deep Learning-Based Lumen and Vessel Segmentation of Intravascular Ultrasound Images in Coronary Artery Disease.

Intravascular ultrasound (IVUS) evaluation of coronary artery morphology is based on the lumen and vessel segmentation. This study aimed to develop an automatic segmentation algorithm and validate the performances for measuring quantitative IVUS parameters. A total of 1,063 patients were randomly assigned, with a ratio of 4:1 to the training and test sets. The independent data set of 111 IVUS pullbacks was obtained to assess the vessel-level performance. The lumen and external elastic membrane (EEM) boundaries were labeled manually in every IVUS frame with a 0.2-mm interval. The Efficient-UNet was utilized for the automatic segmentation of IVUS images. At the frame-level, Efficient-UNet showed a high dice similarity coefficient (DSC, 0.93±0.05) and Jaccard index (JI, 0.87±0.08) for lumen segmentation, and demonstrated a high DSC (0.97±0.03) and JI (0.94±0.04) for EEM segmentation. At the vessel-level, there were close correlations between model-derived vs. experts-measured IVUS parameters; minimal lumen image area (r=0.92), EEM area (r=0.88), lumen volume (r=0.99) and plaque volume (r=0.95). The agreement between model-derived vs. expert-measured minimal lumen area was similarly excellent compared to the experts' agreement. The model-based lumen and EEM segmentation for a 20-mm lesion segment required 13.2 seconds, whereas manual segmentation with a 0.2-mm interval by an expert took 187.5 minutes on average. The deep learning models can accurately and quickly delineate vascular geometry. The artificial intelligence-based methodology may support clinicians' decision-making by real-time application in the catheterization laboratory.