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  • Andersson, Malin, et al. (författare)
  • How to measure renal artery stenosis - a retrospective comparison of morphological measurement approaches in relation to hemodynamic significance
  • 2015
  • Ingår i: BMC Medical Imaging. - BIOMED CENTRAL LTD. - 1471-2342. ; 15:42
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Although it is well known that renal artery stenosis may cause renovascular hypertension, it is unclear how the degree of stenosis should best be measured in morphological images. The aim of this study was to determine which morphological measures from Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) are best in predicting whether a renal artery stenosis is hemodynamically significant or not. Methods: Forty-seven patients with hypertension and a clinical suspicion of renovascular hypertension were examined with CTA, MRA, captopril-enhanced renography (CER) and captopril test (Ctest). CTA and MRA images of the renal arteries were analyzed by two readers using interactive vessel segmentation software. The measures included minimum diameter, minimum area, diameter reduction and area reduction. In addition, two radiologists visually judged the diameter reduction without automated segmentation. The results were then compared using limits of agreement and intra-class correlation, and correlated with the results from CER combined with Ctest (which were used as standard of reference) using receiver operating characteristics (ROC) analysis. Results: A total of 68 kidneys had all three investigations (CTA, MRA and CER + Ctest), where 11 kidneys (16.2 %) got a positive result on the CER + Ctest. The greatest area under ROC curve (AUROC) was found for the area reduction on MRA, with a value of 0.91 (95 % confidence interval 0.82-0.99), excluding accessory renal arteries. As comparison, the AUROC for the radiologists visual assessments on CTA and MRA were 0.90 (0.82-0.98) and 0.91 (0.83-0.99) respectively. None of the differences were statistically significant. Conclusions: No significant differences were found between the morphological measures in their ability to predict hemodynamically significant stenosis, but a tendency of MRA having higher AUROC than CTA. There was no significant difference between measurements made by the radiologists and measurements made with fuzzy connectedness segmentation. Further studies are required to definitely identify the optimal measurement approach.
  • de Geer, Jakob, et al. (författare)
  • The efficacy of 2D, non-linear noise reduction filtering in cardiac imaging: a pilot study
  • 2011
  • Ingår i: Acta Radiologica. - Informa Healthcare / Wiley-Blackwell / Royal Society of Medicine Press. - 0284-1851. ; 52:7, s. 716-722
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Computed tomography (CT) is becoming increasingly popular as a non-invasive method for visualizing the coronary arteries but patient radiation doses are still an issue. Postprocessing filters such as 2D adaptive non-linear filters might help to reduce the dose without loss of image quality. less thanbrgreater than less thanbrgreater thanPurpose: To investigate whether the use of a 2D, non-linear adaptive noise reduction filter can improve image quality in cardiac computed tomography angiography (CCTA). less thanbrgreater than less thanbrgreater thanMaterial and Methods: CCTA examinations were performed in 36 clinical patients on a dual source CT using two patient dose levels: maximum dose during diastole and reduced dose (20% of maximum dose) during systole. One full-dose and one reduced-dose image were selected from each of the examinations. The reduced-dose image was duplicated and one copy postprocessed using a 2D non-linear adaptive noise reduction filter, resulting in three images per patient. Image quality was assessed using visual grading with three criteria from the European guidelines for assessment of image quality and two additional criteria regarding the left main artery and the overall image quality. Also, the HU value and its standard deviation were measured in the ascending and descending aorta. Data were analyzed using Visual Grading Regression and paired t-test. less thanbrgreater than less thanbrgreater thanResult: For all five criteria, there was a significant (P andlt; 0.01 or better) improvement in perceived image quality when comparing postprocessed low-dose images with low-dose images without noise reduction. Comparing full dose images with postprocessed low-dose images resulted in a considerably larger, significant (P andlt; 0.001) difference. Also, there was a significant reduction of the standard deviation of the HU values in the ascending and descending aorta when comparing postprocessed low-dose images with low-dose images without postprocessing. less thanbrgreater than less thanbrgreater thanConclusion: Even with an 80% dose reduction, there was a significant improvement in the perceived image quality when using a 2D noise-reduction filter, though not approaching the quality of full-dose images. This indicates that cardiac CT examinations could benefit from noise-reducing postprocessing with 2D non-linear adaptive filters.
  • Eriksson, Per, et al. (författare)
  • Non-invasive investigations of potential renal artery stenosis in renal insufficiency
  • 2010
  • Ingår i: Nephrology, Dialysis and Transplantation. - Oxford University Press. - 0931-0509. ; 25:11, s. 3607-3614
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The diagnostic value of non-invasive methods for diagnosing renal artery stenosis in patients with renal insufficiency is incompletely known. Methods. Forty-seven consecutive patients with moderately impaired renal function and a clinical suspicion of renal artery stenosis were investigated with computed tomography angiography (CTA), gadolinium-enhanced magnetic resonance angiography (MRA), contrast-enhanced Doppler ultrasound and captopril renography. The primary reference standard was stenosis reducing the vessel diameter by at least 50% on CTA, and an alternative reference standard (‘morphological and functional stenosis’) was defined as at least 50% diameter reduction on CTA or MRA, combined with a positive finding from ultrasound or captopril renography. Results. The frequency of positive findings, calculated on the basis of individual patients, was 70% for CTA, 60% for MRA, 53% for ultrasound and 30% for captopril renography. Counting kidneys rather than patients, corresponding frequencies were 53%, 41%, 29% and 15%, respectively. In relation to the CTA standard, the sensitivity (and specificity) at the patient level was 0.81 (0.79) for MRA, 0.70 (0.89) for ultrasound and 0.42 (1.00) for captopril renography, and at the kidney level 0.76 (0.82), 0.53 (0.81) and 0.30 (0.86), respectively. Relative to the alternative reference standard, corresponding values at the patient level were 1.00 (0.62) for CTA, 0.90 (0.69) for MRA, 0.91 (1.00) for ultrasound and 0.67 (1.00) for captopril renography, and at the kidney level 0.96 (0.76), 0.85 (0.79), 0.71 (0.97) and 0.50 (0.97), respectively. Conclusions. CTA and MRA are superior to ultrasound and captopril renography at diagnosing morphological stenosis, but ultrasound may be useful as a screening method and captopril renography for verifying renin-dependent hypertension.
  • Larsson, Martin, et al. (författare)
  • Renal artery stenosis extracting quantitative parameters with a mathematical model fitted to magnetic resonance blood flow data
  • 2008
  • Ingår i: Journal of Magnetic Resonance Imaging. - John Wiley & Sons. - 1053-1807. ; 27:1, s. 140-147
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate the feasibility of quantitative parameter extraction from a mathematical model fitted to renal artery magnetic resonance flow data.Material and methods: Sixteen subjects, 8 patients and 8 normal controls, were examined with cine phase-contrast velocity measurements, and blood flow data from the aorta and both renal arteries were extracted by means of contour detection. A mathematical model with eight parameters describing the time, duration and amplitude of the systolic acceleration and the diastolic deceleration was fitted to the aorta and renal artery blood flow data from each subject. The curve fitting was evaluated with R2 values. Statistical analysis was performed with unpaired Wilcoxon tests and stepwise logistic regression.Results: Three data sets out of 48 yielded R2 values below 0.80 and were considered unreliable for parameter estimation. Basal flow was significantly, and systolic peak amplitude almost significantly, lower in stenotic arteries. Logistic regression indicated that two parameters describing basal flow and the duration of acceleration can accurately predict stenosis.Conclusion: The results suggest that it is technically feasible to fit a mathematical model to renal blood flow data, extracting quantitative parameters that may prove useful for quantification and diagnosis of renal artery stenosis.
  • Löfving, Adam, et al. (författare)
  • Angiographic visualization of the coronary arteries in computed tomography with virtual contrast injection
  • 2006
  • Ingår i: The Internet Journal of Radiology. - Internet Scientific Publications, Llc.. - 1528-8404. ; 4:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Computed Tomography Angiography (CTA) is a non-invasive alternative to catheter angiography but has had limited use in the coronary arteries due to resolution and visualization problems. Maximum intensity projection (MIP) is difficult to apply in the heart with numerous overlying contrast-filled structures. The study proposes virtual contrast injection, originally introduced for MR angiography, for visualizing the coronaries in CTA. Examination after i.v. contrast injection was made in a 16-slice CT. After virtual contrast injection (concurrent grayscale connectedness) separating the vessels, rendering of the right and left coronary separately was made with MIP and volume rendering (VRT). Images similar to invasive angiography were obtained in all 7 projections used in the clinical routine. The observer also has the possibility to freely select an optimal projection. After validation in larger materials, this may become a clinically useful non-invasive alternative for examining coronary arteries.
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