Hee Yeong Kim

Dual-Enhanced Cardiac CT for Detection of Left Atrial Appendage Thrombus in Patients With Stroke A Prospective Comparison Study With Transesophageal Echocardiography

Background and Purpose— A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. Methods— We studied 83 consecutive patients with stroke (56 men and 27 women; mean age, 62.6 years) who had high risk factors for thrombus formation and had undergone both dual-source CT and transesophageal echocardiography within a 3-day period. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Results— Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined with spontaneous echo contrast were correctly diagnosed on CT. Using transesophageal echocardiography as the reference standard, the overall sensitivity and specificity of CT for the detection of thrombi and circulatory stasis in the left atrial appendage were 96% (95% CI, 78% to 99%), and 100% (95% CI, 92% to 100%), respectively. On CT, the mean left atrial appendage/ascending aorta Hounsfield unit ratios were significantly different between thrombus and circulatory stasis (0.15 Hounsfield unit versus 0.27 Hounsfield unit, P=0.001). The mean effective radiation dose was 3.11 mSv. Conclusions— Dual-enhanced cardiac CT with prospective electrocardiographic gating is a noninvasive and sensitive modality for detecting left atrial appendage thrombus with an acceptable radiation dose.

Cardioembolic Stroke: Dual-Energy Cardiac CT for Differentiation of Left Atrial Appendage Thrombus and Circulatory Stasis

PURPOSE To assess the diagnostic performance of dual-energy cardiac computed tomography (CT) in the detection of left atrial appendage (LAA) thrombi and differentiation between thrombus and circulatory stasis in patients with stroke, by using transesophageal echocardiography (TEE) as the reference standard. MATERIALS AND METHODS The institutional review board approved this study, and patients provided informed consent. Thirty-two patients with stroke who had atrial fibrillation (AF) and either thrombus or the spontaneous echo contrast (SEC) echo pattern at TEE were prospectively enrolled. For the control group, 31 patients who were planning to undergo AF ablation and who had no abnormalities at TEE were enrolled. All patients underwent dual-energy cardiac CT that was not electrocardiographically gated. For quantitative analysis, iodine concentration was measured on CT images. The statistical significance of differences in mean iodine concentration between thrombus and SEC as measured at CT was assessed by using the Student t test. RESULTS Among the 63 patients, a total of 13 thrombi and 19 instances of SEC were detected at TEE. Using TEE as the reference standard, the overall sensitivity, specificity, positive predictive value, and negative predictive value of dual-energy cardiac CT in the detection of thrombi and SEC in the LAA were 97% (95% confidence interval [CI]: 82%, 100%), 100% (95% CI: 86%, 100%), 100%, and 97%, respectively. At CT, the mean iodine concentration was 1.23 mg/mL ± 0.34 (standard deviation) for thrombus and 3.61 mg/mL ± 1.01 for SEC (P = .001). CONCLUSION Dual-energy cardiac CT is a highly sensitive modality for detecting LAA thrombus and for differentiating thrombus from SEC in patients with stroke.

Anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course: subtypes and clinical importance.

PURPOSE To classify anomalous origins of the right coronary artery (RCA) from the left coronary sinus (AORL) with an interarterial course into two subtypes and to evaluate the clinical importance of each. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study, and informed consent was waived. Through a retrospective review of 22,925 consecutive cardiac computed tomographic (CT) scans, 124 cases of AORL with an interarterial course were identified. These anomalies were classified into two subtypes according to the location of the anomalous RCA ostium: high interarterial course (between the aorta and the pulmonary artery) and low interarterial course (between the aorta and the right ventricular outflow tract). The clinical records were evaluated, and differences in prevalence of typical angina and major adverse cardiac events (MACEs) between the subtypes were analyzed through the χ(2) contingency tables or Fisher exact test. RESULTS After excluding patients with combined cardiac disease, 87 patients (51 [59%] men, 36 [41%] women; mean age, 56.0 years) were enrolled. Of the 87 patients, 53 had a high interarterial course and 34 had a low interarterial course. A significant difference in the prevalence of typical angina (high [43%] vs low [6%], P = .001) and MACE (high [28%] vs low [6%], P = .012) was observed between the two subtypes. For patients with a high interarterial course, the odds ratio for typical angina was 12.3 (95% confidence interval: 2.7, 56.6), and the odds ratio for MACE was 6.3 (95% confidence interval: 1.3, 29.7). CONCLUSION The prevalence of typical angina and that of MACE were significantly higher in patients with a high interarterial course than in those with a low interarterial course.

Automatic Tube Potential Selection with Tube Current Modulation (APSCM) in coronary CT angiography: Comparison of image quality and radiation dose with conventional body mass index-based protocol

BACKGROUND The use of Automatic Tube Potential Selection with Tube Current Modulation (APSCM) may lower radiation dose, but it is unknown whether image quality is maintained. OBJECTIVE The aim of this study was to evaluate the radiation dose and image quality of APSCM application compared with conventional body mass index (BMI)-based examination protocol for coronary computed tomography angiography (CTA). METHODS Consecutive patients (n = 487) were retrospectively enrolled: 239 patients who underwent coronary CTA with APSCM (APSCM group) and 248 patients who underwent coronary CTA with a BMI-based tube potential (in kV) and tube current-time product (in mAs) protocol (BMI-based group). Comparison of quantitative and qualitative image quality and radiation dose was performed. RESULTS The use of APSCM found significant reduction in radiation dose compared with the BMI-based protocol, with a significantly more frequent use of 80 kV (P < 0.0001). Diagnostic image quality was maintained, with no significant difference between the 2 groups (P = 0.887). CONCLUSION The use of APSCM for coronary CTA significantly reduced radiation dose while maintaining image quality; therefore, it is feasible in daily practice which covers patients with various BMI values.

Additional diagnostic value of tumor markers in cytological fluid for diagnosis of non-small-cell lung cancer

BackgroundCytological fluid from a needle aspiration biopsy (NAB) is obtained directly from tumor tissue, therefore many biomarker candidates will be present in high concentrations. The aim of this study was to prospectively assess and validate the tumor markers CYFRA 21–1, CEA, and SCC in cytological fluid obtained from NAB samples to determine if they improved the performance of NAB for diagnosing non-small cell lung cancer (NSCLC).MethodsA total of 194 patients (M:F = 128:66, mean age 63.7 years) with suspected malignant pulmonary lesions were prospectively enrolled and underwent percutaneous NAB. Levels of CYFRA 21–1, CEA, and SCC were measured by immunoassay in serum and cytological fluid obtained during aspiration biopsy. Cut-off values to determined malignancy were 3.3 ng/mL in serum and 15.7 ng/mL in cytological fluid for CYFRA 21–1, 5 ng/mL and 0.6 ng/mL for CEA, and 2 ng/mL and 0.86 ng/mL for SCC.ResultsOf 194 patients, 139 patients (71.6%) had NSCLC and 55 (28.4%) had benign lesions. Sensitivity increased significantly for NAB combined with cytological tumor markers compared with NAB alone (CYFRA 21–1: 95% versus 83.5%, p < 0.001, CEA: 92.1% versus 83.5%, p = 0.002, SCC: 91.4% versus 83.5%, p = 0.003). Accuracy improved significantly for NAB combined with cytological CYFRA 21–1 compared with NAB alone (95.9% versus 88.1%, p < 0.001). The area under curve (AUC) of NAB with cytological CYFRA 21–1 was significantly larger than for NAB alone (0.966 versus 0.917, p = 0.009).ConclusionOf the tested tumor markers, cytological fluid measurements of CYFRA 21–1 improved the diagnostic performance of NAB for NSCLC.

Analysis of Tumor Markers in the Cytological Fluid Obtained from Computed Tomography-Guided Needle Aspiration Biopsy for the Diagnosis of Non-small Cell Lung Cancer

Purpose: The aim of this study was to prospectively assess whether analysis of the tumor markers cytokeratin 19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), and squamous cell carcinoma (SCC) antigen in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) in the diagnosis of non-small cell lung cancer (NSCLC). Methods: A total of 100 patients (men:women = 41:59, mean age: 63 years) with suspected malignant pulmonary lesions were prospectively enrolled for CT-guided NAB procedures. Levels of CYFRA 21-1, CEA, and SCC in the cytological fluid were measured by immunoradiometric assays. The cutoff value for tumor markers was selected on the basis of best accuracy through receiver operating characteristic curves. The sensitivity and areas under the curve (AUC) of NAB alone were compared with those of NAB combined with cytological tumor markers (CYFRA 21-1, CEA, and SCC). Results: Among 100 patients, 71 (71%) had NSCLC and 29 (29%) had benign lesions. The sensitivity, specificity, and accuracy for diagnosing NSCLC were 85.7%, 100%, and 89%, respectively, for NAB alone. The sensitivity increased significantly for NAB combined with a tumor marker compared with NAB alone (100% for CYFRA 21-1, 92.9% for CEA, and 94.2% for SCC; p = 0.001, p = 0.025, and p = 0.014, respectively). The AUC of NAB with CYFRA 21-1 was significantly larger than the AUC of NAB alone (p = 0.001). Conclusion: Evaluation of tumor markers CYFRA 21-1, CEA, and SCC in the cytological fluid can improve the diagnostic performance of CT-guided NAB for NSCLC. Of these markers, CYFRA 21-1 is the most useful cytological tumor marker.

Comparison of CT-Determined Pulmonary Artery Diameter, Aortic Diameter, and Their Ratio in Healthy and Diverse Clinical Conditions.

Background The main pulmonary artery diameter (mPA), aortic diameter (Ao), and the mPA/Ao ratio, easily measured using chest computed tomography (CT), provide information that enables the diagnosis and evaluation of cardiopulmonary diseases. Here, we used CT to determine the sex- and age-specific distribution of normal reference values for mPA, Ao, and mPA/Ao ratio in an adult Korean population. Methods Data from non-contrast, ECG-gated, coronary-calcium-scoring CT images of 2,547 individuals who visited the Health Screening Center of the Severance Hospital were analyzed. Healthy individuals (n = 813) included those who do not have hypertension, diabetes, asthma, obstructive lung disease, ischemic heart disease, stroke, smoking, obesity, and abnormal CT findings. Both mPA and Ao were measured at the level of bifurcation of the main pulmonary artery. Results The mean mPA and Ao were 25.9 mm and 30.0 mm in healthy participants, respectively, while the mean mPA/Ao ratio was 0.87. Medical conditions associated with a larger mPA were male, obesity, smoking history, hypertension, and diabetes. A larger mPA/Ao ratio was associated with female, the obese, non-smoker, normotensive, and normal serum level of lipids, while a smaller mPA/Ao ratio was associated with older age. In healthy individuals, the 90th percentile sex-specific mPA, Ao, and mPA/Ao ratio were, 31.3 mm (95% CI 29.9–32.2), 36.8 mm (95% CI 35.7–37.5), and 1.05 (95% CI 0.99–1.07) in males, and 29.6 mm (95% CI 29.1–30.2), 34.5 mm (95% CI 34.1–34.9), and 1.03 (95% CI 1.02–1.06) in females, respectively. Conclusion In the Korean population, the mean mPA reference values in male and female were 26.5 mm and 25.8 mm, respectively, while the mean mPA/Ao ratio was 0.87. These values were influenced by a variety of underlying medical conditions.

NSCLC Subtype Prediction Using Cytologic Fluid Specimens From Needle Aspiration Biopsies

This study evaluated the diagnostic usefulness of tumor marker concentrations in cytologic fluids (CF) for subtyping non-small cell lung cancer (NSCLC) and assessed the relationship between fluorine-18-fluorodeoxyglucose ((18)F-FDG) uptake with serum and CF tumor marker levels. This prospective study included 88 patients diagnosed with adenocarcinoma or squamous cell carcinoma (SCC). Cytokeratin-19 fragment (CYFRA 21-1), carcinoembryonic antigen (CEA), and squamous cell carcinoma antigen (SCCA) concentrations in the CF samples were correlated with serum tumor marker concentrations, (18)F-FDG uptake, and NSCLC subtype. Fifty-eight patients were diagnosed with adenocarcinoma. Multivariate analysis revealed higher CF and serum SCCA levels; smoking status predicted SCC from adenocarcinoma. CF SCCA showed the highest accuracy (83%) in distinguishing between SCC and adenocarcinoma. CF samples obtained during routine needle aspiration biopsy procedure contain tumor marker levels sufficient to distinguish between SCC and adenocarcinoma; CF SCCA had the highest diagnostic accuracy.

Analysis of tumor markers in cytological fluid obtained from computed tomography-guided needle aspiration biopsies for the diagnosis of ground-glass opacity pulmonary lesions.

The purpose of this study was to assess whether analyses of tumor markers in cytological fluid can improve the performance of computed tomography (CT)‐guided needle aspiration biopsy (NAB) for the diagnosis of ground‐glass opacity (GGO) pulmonary lesions.

Epicardial adipose tissue thickness assessed by cardiac magnetic resonance is an independent indicator for coronary artery stenosis in asymptomatic type 2 diabetic patients

Results EAT thickness was positively correlated with BMI, waist-to-hip ratio, systolic blood pressure, postprandial glucose, fasting/postprandial triglyceride, HbA1c level, and HOMA-IR. A total of 24 patients had significant coronary artery stenosis and 14 patients had silent myocardia ischemia in CMR (3 with silent myocardial infarction, 13 with inducible ischemia, 2 with both). EAT thickness was higher in patients who had significant stenosis; however, it was not different between the subjects with silent myocardial ischemia and the subjects with no evidence of silent myocardial ischemia in CMR (13.0 ± 2.6 mm vs. 11.5 ± 2.1 mm, p=0.01, 12.8 ± 2.1 vs. 11.7 ± 2.3 mm, p=0.11, respectively). In multivariate logistic regression analysis, EAT thickness was an independent indicator for significant coronary artery stenosis after adjusting for traditional risk factors (OR 1.353, p=0.031).