JOURNAL TRANSCRIPT

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464

KCR 2016

Cardiovascular



SE 03 CV-01

Diagnosis of Grave’s disease with pulmonary hypertension on chest CT Seung Min Yoo Bundang CHA General Hospital, Korea. [email protected]

Cardiovascular

PURPOSE: To evaluate the diagnostic accuracy of CT findings to diagnose Grave’s disease in pulmonary hypertension. MATERIALS AND METHODS: We retrospectively evaluated chest CT and the medical records of 13 patients with Grave’s disease with (group 1, n = 6) or without pulmonary hypertension (group 2, n = 7) and in 17 control patients (group 3). In all patients, thyroid function testing including autoantibody testing, chest CT, and echocardiography was performed within one month. RESULTS: Using iso-attenuation of diffusely enlarged thyroid glands compared with adjacent neck muscle on non-enhanced CT as a diagnostic clue of Grave’s disease, sensitivity, specificity, positive predictive valve (PPV), and negative predictive valve (NPV) were 84.6%, 94.1%, 91.7%, and 88.9%, respectively. Using visual assessment of pulmonary hypertension based on enlargement of the right atrium or ventricle on CT, sensitivity, specificity, PPV and NPV to detect pulmonary hypertension as measured on echocardiography was 100%, 87.5%, 66.7%, and 100%, respectively. CONCLUSION: Chest CT has the potential to diagnose concomitant Grave’s disease with pulmonary hypertension in the absence of other clinical and imaging information.

SE 03 CV-02

Indirect CT venography at 80 kVp with sinogramaffirmed iterative reconstruction compared to 120 kVp with filtered back projection: assessment of image quality and radiation dose Inyoung Song, Jeong Geun Yi, Jeong Hee Park, Sung Min Ko Konkuk University Medical Center, Korea. [email protected] PURPOSE: To evaluate the image quality and radiation dose of indirect CT venography (CTV) using 80 kVp with sinogram-affirmed iterative reconstruction (SAFIRE) and 120 kVp with filtered back projection (FBP). MATERIALS AND METHODS: This retrospective study was approved by our institution and informed consent was waived. Sixty-one consecutive patients (M:F =

27:34; mean age, 60 ± 16; mean BMI, 23.6 ± 3.6 kg/m2) underwent pelvic and lower extremity CTVs (group A [n = 31, 120 kVp, reconstructed with FBP] vs. group B [n = 30, 80 kVp, reconstructed with SAFIRE]). The vascular enhancement, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared. Subjective image analysis for image quality and noise was performed by two radiologists. Radiation dose was compared between the two groups. RESULTS: Compared with group A, higher mean vascular enhancement was observed in the group B (group A vs. B, 118.8 ± 15.7 HU vs. 178.6 ± 39.6 HU, p < 0.001), as well as image noise (12.0 ± 3.8 HU vs. 23.2 ± 8.0 HU, p < 0.001), CNR (5.1 ± 1.9 vs. 7.6 ± 3.0, p < 0.001) and SNR (10.0 ± 3.0 vs. 13.6 ± 3.5, p < 0.001). There was no difference in subjective image quality between the two groups (all ps > 0.05). The subjective image noise was higher in the group B (p = 0.036 in reader 1, p = 0.005 in reader 2). The inter-observer reliability for assessing subjective image quality was good (ICC 0.746-0.784, p < 0.001). The mean CT dose index volume (CTDIvol) and mean dose length product (DLP) were significantly lower in group B than group A (CTDIvol, 6.4 ± 1.3 vs. 2.2 ± 2.2 mGy [p < 0.001]; DLP, 499.1 ± 116.0 vs. 133.1 ± 45.7 mGy × cm [p < 0.001]). CONCLUSION: CTV using 80 kVp combined with SAFIRE provides lower radiation dose and improved objective image quality compared to CTV using 120 kVp with FBP.

SE 03 CV-03

Relationship between Indexed epicardial fat volume and coronary plaque volume assessed by cardiac multi-detector CT Seulgi You1, Joo Sung Sun2, Seon Young Park1, Yoolim Baek1, Doo Kyoung Kang2 1 Ajou University Hospital, 2Ajou University School of Medicine, Korea. [email protected] PURPOSE: We explored whether baseline indexed epicardial fat volume (EFVi) and serial changes in EFVi were associated with increase in coronary plaque volume as assessed by multi-detector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively reviewed 87 patients with coronary artery plaque, identified during either baseline or follow-up cardiac CT examinations. Each plaque volume was measured in volumetric units using a semiautomatic software tool. EFVi was quantified by calculating the total volume of epicardial tissue of CT density -190 to -30 Hounsfield units, indexed to the body surface area. Clinical cardiovascular risk factors were extracted by

Scientific Exhibitions medical record review at the time of the cardiac CT examinations. The relationship between EFVi and coronary plaque volume was explored by regression analysis. R E S U LT S : A l t h o u g h t h e E F Vi d i d n o t c h a n g e significantly from baseline to the time of the follow-up CT (65.7 ± 21.8 cm3/m3 vs. 66.0 ± 21.8 cm3/m3, p = 0.620), the plaque volumes were increased significantly on the follow-up CT scans. The annual change in EFVi was not accompanied by a parallel change in coronary plaque volume (p = 0.096-0.500). On univariate analysis, smoking, hypercholesterolemia, 10-year coronary heart disease risk, obesity and baseline EFVi predicted rapid increases in lipid-rich and fibrous plaque volumes. On multivariate analysis, baseline EFVi (odds ratio = 1.029, p = 0.016) was an independent predictor of a rapid increase in lipid-rich plaque volume. CONCLUSION: EFVi was shown to be an independent predictor of a rapid increase in lipid-rich plaque volume. However, changes in EFVi were not associated with parallel changes in coronary plaque volume.

SE 03 CV-04

To learn the various CT findings of complications from the aortic valve surgery to transcatheter aortic valve implantation (TAVI). To correlate clinical characteristics with echocardiographic findings and CT findings of various complications in patients who have undergone aortic valve surgery or TAVI. To learn the evaluation methods for patients with subprosthetic pannus and its clinical implications 1. Introduction - Aortic valve surgery or TAVI - Emerging role of cardiovascular CT in detecting complications 2. Acute complications Mediastinitis with abscess Aortic dissection Thrombosis 3. Delayed complications Sternal osteomyelitis Infective endocarditis Prosthetic valve dehiscence Paravalvular leakage Hemolysis Subvalvular pannus formation

4. TAVI complications AV block Paravalvular aortic regurgitation Coronary artery injury or obstruction Device migration Annular and root rupture Infective endocarditis Thrombus Pannus formation

SE 03 CV-05

Coronary artery fistula from A to Z assessed by ECG-gated coronary CT angiography Gabin Yun1, Tae Hyun Nam1, Jeong Jae Kim1, Jee Hye Hur1, Whal Lee2, Eun Ju Chun1 1 Seoul National University Bundang Hospital, 2Seoul National University Hospital, Korea. [email protected] METHODS AND RESULTS: 1. Pathophysiology and clinical presentation of CAF 2. CCTA for evaluation of CAF 1) scan protocol and postprocessing technique of CCTA for evaluation of CAF 2) advantage and limitation of CCTA: comparison of other modalities 3. Imaging spectrum of CAF according to various connection 1) coronary-pulmonary fistula 2) coronary cameral fistula 3) coronary-bronchial fistula 4) coronary artery-sinus (cardiac vein) fistula 5) coronary artery to other systemic arteries (internal mammary artery, inferior phrenic artery, etc.) 4. Pre-treatment assessment of CAF on CCTA 1) location of CAF 2) origins 3) vessel size of CAF 4) complexity 5) drainage site 5. Post-treatment assessment of CAF on CCTA 1) presence or absence of postprocedural recanalization 2) thrombus 3) aneurysmal change of remained CAF CONCLUSION: - CAF is the anomalous connection from coronary artery to various site (pulmonary trunk, cardiac chamber, bronchial artery, and other systemic arteries) - ECG-gated CCTA is very effective for the evaluation of origin, complexity and drainage site of CAF. - CCTA is also helpful to guide the treatment plan and to assess the post-procedural complication.

Cardiovascular

From the valve surgery to transcatheter aortic valve implantation: postoperative and postprocedural complications Hyun Jung Koo, Joon-Won Kang, Dong Hyun Yang, Tae-Hwan Lim Asan Medical Center, Korea. [email protected]

465

466

KCR 2016

SE 03 CV-06

SE 03 CV-07

Cardiovascular

Feasibility of low-concentration contrast medium with lower-tube current lower extremity CT arteriography using iterative reconstruction: comparison with automatic exposure control CT arteriography Jae Woo Park, Song Soo Kim, Jae-Hwan Lee, Moonsang Ahn, Jin Hwan Kim Chungnam National University Hospital, Korea. [email protected]

Aortic valve area assessment in aortic stenosis by Doppler echocardiography and cardiac MR: comparison of transthoracic echocardiography continuity equation and hybrid method Dong Min Choo1, Song Soo Kim1, Sung Min Ko2, Hye Soo Shin1, Jae Hyeong Park1, Jin Hwan Kim1 1 Chungnam National University Hospital, 2Konkuk University Medical Center, Korea. [email protected]

PURPOSE: To evaluate the feasibility of low-concentration contrast medium (CM) for vascular enhancement, image quality, and radiation dose on lower extremity computed tomography arteriography (CTA) using a combined low-tube current and iterative reconstruction (IR) technique. MATERIALS AND METHODS: 64 subjects underwent dual-source CT (DSCT) operating in dual-source, highpitch mode. DSCT scans were performed using both high-concentration CM (group A, n = 31; Iomeprol 400) and low-concentration CM (group B, n = 33; Iodixanol 270). Group A was scanned using a reference tube potential of 120 kVp and 100 reference mAs under automatic exposure control with IR. Group B was scanned using low-tube-voltage (80 kVp or 100 kVp if body mass index ≥ 25 kg/m2) and fixed 120 mAs, along with IR. Images of the two groups were compared regarding attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), iodine load, radiation dose and visual quality assessment (general, enhancement, sharpness, and noise) in various locations of CTA. RESULTS: In comparisons between group A and group B, the average of mean attenuation (765.29 ± 146.3 vs. 581.11 ± 163.99 HU), SNR (42.93 ± 10.85 vs. 30.97 ± 9.54), and CNR (39.89 ± 10.53 vs. 27.82 ± 9.12) in CTA in group A showed significantly greater values) than those in group B (all ps < 0.05), except for image noise value (18.76 ± 2.19 vs. 17.48 ± 3.34). However, visual quality in each location was not significantly different. Homogeneous contrast enhancement and preserved distal attenuation from the lower abdominal aorta to the popliteal artery were significantly superior in group A (p < 0.001). CONCLUSION: In lower extremity CTA, automatic exposure control using IR with high-concentration CM is still a proper technique enough to overcome the trail of reducing radiation dose and iodine load.

PURPOSE: To verify whether the corrected aortic valve area (AVA) using a hybrid method, which is calculated by substituting cardiac magnetic resonance (CMR)derived direct planimetry of left ventricular outflow tract (LVOT) area into continuity equation, improves congruence of aortic stenosis (AS) severity grading in patients with severe AS and to evaluate the influencing factors. MATERIALS AND METHODS: 123 patients (59.8 ± 12.2 years of age, 55% male) with severe AS who had undergone Doppler echocardiography (DE) and CMR prior to operation were retrospectively enrolled. The AVA was calculated by the continuity equation (CE) on DE and the corrected AVA was calculated by substituting the largest cross-sectional LVOT area in systole measured with CMR into continuity equation on DE. Left ventricular ejection fraction (EF), transvalvular mean pressure gradient, and severity of aortic regurgitation were also measured with DE. Comparison of AVAs and association of variables between each method were assessed with paired t-test, Bland-Altman plot, and Pearson correlation coefficient and multiple regression analysis. RESULTS: All patients had a DE-CE AVA < 1.0 cm2 and 103 (82%) patients had a mean transaortic gradient > 40 mmHg. The mean corrected AVA (1.08 ± 0.26 cm2) was significantly greater than that of DE-CE AVA (0.76 ± 0.16 cm2, p < 0.001). There was significant correlation between AVAs measured with hybrid method and DECE (r = 0.67, p < 0.0001). LVOT area measured on CMR was higher than on DE (5.18 ± 1.12 cm2 vs. 3.66 ± 0.73 cm2, p < 0.0001). Correlation between mean transaortic gradient and each DE-CE AVA and corrected AVA was significant, respectively (r = -0.596 and r = -0.517, all ps < 0.001). The difference in AVAs was significantly associated with body mass index, dimensionless index, transvalvular mean pressure gradient and the LVOT area difference between CMR and DE (adjusted R 2 = 0.903, p < 0.05). Using DE-CE AVA measurements alone, 82% of patients had concordant severe AS (AVA < 1.0 cm2 and mean transaortic gradient > 40 mmHg), which decreased to 34% when using corrected AVA. CONCLUSION: Even with the correction of LVOT area, corrected AVA does not show superior correlation to pressure gradient and congruence of AS severity in

Scientific Exhibitions severe AS patients.

and EF on DE-CE, and gender.

SE 03 CV-08

SE 03 CV-09

467

Hydatid disease of aorta - secondary dissemination of hydatid disease to the retroperitoneum, aorta and bilateral common iliac arteries complicated by pseudo-aneurysm formation Rohit Bhoil, RG Sood, Ashwani Tomar, Suresh Kumar, Sanjeev Sharma, Rajesh Chopra, Richa Verma, Shivani Bakshi Indira Gandhi Medical College, Shimla, India. [email protected]

PURPOSE: We aimed to evaluate the influencing factors of discordance in aortic valve areas (AVA) between the two methods of using a continuity equation (CE) on Doppler echocardiography (DE) and CMR planimetry of AVA in severe aortic stenosis (AS). MATERIALS AND METHODS: 100 patients (60.2 ± 12.4 years of age, 57% male) with severe AS (AVA < 1.0 cm2 and mean transaortic gradient > 40 mmHg) who had undergone DE and CMR prior to operation were retrospectively enrolled. AVA-planimetry using CMR were measured at maximal aortic valve in systole. To account for differences in body size, AVA index, which is calculated by dividing AVA by body surface area, was used. Body mass index, gender, presence of bicuspid valve and aneurysmal dilatation of ascending aorta, LVOT area, left ventricular ejection fraction (EF), dimensionless index (echo LVOTvelocity time integral/ AVvelocity time integral), grade of aortic regurgitation, and mean transvalvular gradient were also recorded. Comparisons of the index of AVAs and association of variables between each method were assessed with paired t-test, Bland-Altman plot, Pearson correlation coefficient, and multiple regression analysis. RESULTS: 93 patients (59.9 ± 12.2 years of age, 61% male) belonged to the severe AS (DE-CE AVA index < 0.6 cm2/m2 and mean transaortic gradient > 40 mmHg). Mean AVA index on MR planimetry (0.47 ± 0.10 cm2/ m2) was significantly greater than that of AVA index on DE-CE (0.43 ± 0.82 cm2/m2, p < 0.0001). There was significant correlation of the index of AVAs between MR planimetry and DE-CE (r = 0.421, p < 0.001). Correlation between mean transvalvular gradient and AVA index of DE-CE was significantly greater than that between mean transvalvular gradient and AVA index of MR planimetry (r = -0.528 and r = -0.317, respectively, all ps < 0.001). The difference in the index of AVAs was significantly associated with LVOT area, EF, and female gender (adjusted R2 = 0.321, p = 0.002). CONCLUSION: In severe AS patients, significant differences in AVA between MR planimetry and DE-CE may be attributed to the influencing factors of LVOT area

Human echinococcosis is a zoonotic infection, caused by larval stage of Echinococcus, having a world-wide distribution with highest prevalence in live-stock raising countries. It may be seen in any part of body; liver is affected in more than two-third of cases followed by lungs, with less common sites being kidneys, brain, heart, muscles and bone. Aorta as a site of localization of hydatid disease is extremely rare with less than 10 such cases reported till now. We report an extremely rare case of a retroperitoneal hydatid cyst involving the abdominal aorta and its bifurcation resulting in a false aneurysm formation in a 37-year-old man presenting with mild low back-ache. He gave history of being operated three times earlier; at the age of 5, 17 and 33 years of age for hydatid disease in the liver, left lung and left retroperitoneum respectively. His histopathology report revealing it to be hydatid, at that time the result of an indirect hemagglutination test for E granulosus was positive in high (1/616) titers. Our case is probably the first reported case in the world in which a patient of aortic hydatid has been followed up for two years and is still asymptomatic.

SE 03 CV-10

Correlation of coronary artery calcium score with Alberta stroke program early CT score in acute ischemic stroke Hye In Yun, Sung Shine Shim, Yookyung Kim Ewha Womans University Mokdong Hospital, Korea. [email protected] PURPOSE: To determine the correlation between coronary artery calcium score (CACS) on cardiac CT the Alberta stroke program early CT score (ASPECTS) on brain MRI with diffusion weighted images (DWI) and fluid-attenuated inversion recovery (FLAIR) images. MATERIALS AND METHODS: Cardiac computed tomography (CT) and brain magnetic resonance image (MRI) was performed for all ninety one acute ischemic

Cardiovascular

Influencing factors in discordance of aortic valve area using Doppler echocardiography and cardiac MR in aortic stenosis: comparisons of valve area by continuity equation and MR planimetry Hyeon Ji Jang1, Song Soo Kim1, Sung Min Ko2, Hye Soo Shin1, Jae Hyeong Park1, Jin Hwan Kim1 1 Chungnam National University Hospital, 2Konkuk University Medical Center, Korea. [email protected]

468

KCR 2016

stroke patients. CACS and ASPECTS using DWI and FLAIR images were determined in each patient. ASPECTS was scored on a scale of 1-10 and also divided into two groups (ASPECTS > 7 and ASPECTS < 7). Spearman correlation rank test and Mann-Whitney test were performed for the correlation between these two scores. The presence and type of atheroma in scanned ascending aorta on cardiac CT was also correlated with ASPECTS. RESULTS: A statistically significant negative correlation (r = - 0.376, p < 0.001) was observed between ASEPCTS and CACS. Among coronary arterial branches, left circumflex artery showed best correlation with ASPECTS (r = -0.426, p < 0.001). Comparison of cardiac CT obtained atheroma and ASPECTS showed an also correlation (r = -0.313, p = 0.003). CONCLUSION: The result supports the value of CACS in cardiac CT can be an appropriate predictor of grade to assess early ischemic changes.

Cardiovascular

Table 1. Correlation between CACS and ASPECTS in acute ischemic stroke Cardiac CT R P -0.376*