| 1. |
- Bergström, Göran, 1964, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 2. |
- Bergström, Göran, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 3. |
- Ekblom Bak, Elin, 1981-, et al.
(author)
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Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis : cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:11
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Journal article (peer-reviewed)abstract
- OBJECTIVES: The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours.DESIGN: Cross-sectional.SETTING: Multisite study at university hospitals.PARTICIPANTS: A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer.PRIMARY AND SECONDARY OUTCOMES: Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound.RESULTS: High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73).CONCLUSIONS: MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.
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| 4. |
- Oldgren, Jonas, 1964-, et al.
(author)
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Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study
- 2021
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In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 28:3, s. 250-259
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Journal article (peer-reviewed)abstract
- Background It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. Design The design of this study was as a cross-sectional analysis from a population-based study cohort. Methods From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Results Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have >1 carotid plaques (1.67 (1.61-1.74)). Conclusion Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.
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| 5. |
- Bornefalk, Hans, 1974-, et al.
(author)
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Allowable forward model misspecification for accurate basis decomposition in a silicon detector based spectral CT
- 2015
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In: IEEE Transactions on Medical Imaging. - : IEEE Press. - 0278-0062 .- 1558-254X. ; 34:3, s. 788-795
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Journal article (peer-reviewed)abstract
- Material basis decomposition in the sinogram domain requires accurate knowledge of the forward model in spectral computed tomography (CT). Misspecifications over a certain limit will result in biased estimates and make quantum limited (where statistical noise dominates) quantitative CT difficult. We present a method whereby users can determine the degree of allowed misspecification error in a spectral CT forward model and still have quantification errors that are limited by the inherent statistical uncertainty. For a particular silicon detector based spectral CT system, we conclude that threshold determination is the most critical factor and that the bin edges need to be known to within 0.15 keV in order to be able to perform quantum limited material basis decomposition. The method as such is general to all multibin systems.
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| 6. |
- Bornefalk, Hans, et al.
(author)
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Effect of Temperature Variation on the Energy Response of a Photon Counting Silicon CT Detector
- 2013
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In: IEEE Transactions on Nuclear Science. - : Institute of Electrical and Electronics Engineers (IEEE). - 0018-9499 .- 1558-1578. ; 60:2, s. 1442-1449
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Journal article (peer-reviewed)abstract
- The effect of temperature variation on pulse height determination accuracy is determined for a photon counting multibin silicon detector developed for spectral CT. Theoretical predictions of the temperature coefficient of the gain and offset are similar to values derived from synchrotron radiation measurements in a temperature controlled environment. By means of statistical modeling, we conclude that temperature changes affect all channels equally and with separate effects on gain and threshold offset. The combined effect of a 1 degrees C temperature increase is to decrease the detected energy by 0.1 keV for events depositing 30 keV. For the electronic noise, no statistically significant temperature effect was discernible in the data set, although theory predicts a weak dependence. The method is applicable to all x-ray detectors operating in pulse mode.
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| 7. |
- Bornefalk, Hans, et al.
(author)
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Necessary forward model specification accuracy for basis material decomposition in spectral CT
- 2014
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In: Medical Imaging 2014. - : SPIE - International Society for Optical Engineering. - 9780819498267 ; , s. 90332I-
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Conference paper (peer-reviewed)abstract
- Material basis decomposition in the sinogram domain requires accurate knowledge of the forward model in spectral CT. Misspecifications over a certain limit will result in biased estimates and make quantum limited quantitative CT difficult. We present a method whereby users can determine the degree of allowed misspecification error in a spectral CT forward model, and still have quantification errors that are quantum limited.
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| 8. |
- Brunskog, Rickard, et al.
(author)
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First experimental evaluation of a high-resolution deep silicon photon-counting sensor
- 2024
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In: Journal of Medical Imaging. - : SPIE-Intl Soc Optical Eng. - 2329-4302 .- 2329-4310. ; 11:1
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Journal article (peer-reviewed)abstract
- Purpose: Current photon-counting computed tomography detectors are limited to a pixel size of around 0.3 to 0.5 mm due to excessive charge sharing degrading the dose efficiency and energy resolution as the pixels become smaller. In this work, we present measurements of a prototype photon-counting detector that leverages the charge sharing to reach a theoretical sub-pixel resolution in the order of 1 μm. The goal of the study is to validate our Monte-Carlo simulation using measurements, enabling further development. Approach: We measure the channel response at the MAX IV Lab, in the DanMAX beamline, with a 35 keV photon beam, and compare the measurements with a 2D Monte Carlo simulation combined with a charge transport model. Only a few channels on the prototype are connected to keep the number of wire bonds low. Results: The measurements agree generally well with the simulations with the beam close to the electrodes but diverge as the beam is moved further away. The induced charge cloud signals also seem to increase linearly as the beam is moved away from the electrodes. Conclusions: The agreement between measurements and simulations indicates that the Monte-Carlo simulation can accurately model the channel response of the detector with the photon interactions close to the electrodes, which indicates that the unconnected electrodes introduce unwanted effects that need to be further explored. With the same Monte-Carlo simulation previously indicating a resolution of around 1 μm with similar geometry, the results are promising that an ultra-high resolution detector is not far in the future.
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| 9. |
- Chen, Han, et al.
(author)
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A photon-counting silicon-strip detector for digital mammography with an ultrafast 0.18-mu m CMOS ASIC
- 2014
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In: Nuclear Instruments and Methods in Physics Research Section A. - : Elsevier. - 0168-9002 .- 1872-9576. ; 749, s. 1-6
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Journal article (peer-reviewed)abstract
- We have evaluated a silicon-strip detector with a 0.18-mu m CMOS application specific integrated circuits (ASIC) containing 160 channels for use in photon-counting digital mammography. Measurements were performed at the Elettra light source using monochromatic X-ray beams with different energies and intensities. Energy resolution, Delta E/E-in, was measured to vary between 0.10 and 0.23 in the energy range of 15-40 keV. Pulse pileup has shown little effect on energy resolution.
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| 10. |
- Chen, Han, 1986-, et al.
(author)
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Optimization Of Beam Quality For Photon-Counting Spectral Computed Tomography In Head Imaging: Simulation Study
- 2015
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In: Journal of Medical Imaging. - : SPIE. - 2329-4302 .- 2329-4310. ; 2:4, s. 043504-1-043504-16
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Journal article (peer-reviewed)abstract
- Head computed tomography (CT) plays an important role in the comprehensive evaluation of acutestroke. Photon-counting spectral detectors, as promising candidates for use in the next generation of x-ray CTsystems, allow for assigning more weight to low-energy x-rays that generally contain more contrast information.Most importantly, the spectral information can be utilized to decompose the original set of energy-selectiveimages into several basis function images that are inherently free of beam-hardening artifacts, a potential ad-vantage for further improving the diagnosis accuracy. We are developing a photon-counting spectral detector forCT applications. The purpose of this work is to determine the optimal beam quality for material decomposition intwo head imaging cases: nonenhanced imaging and K-edge imaging. A cylindrical brain tissue of 16-cm diam-eter, coated by a 6-mm-thick bone layer and 2-mm-thick skin layer, was used as a head phantom. The imagingtarget was a 5-mm-thick blood vessel centered in the head phantom. In K-edge imaging, two contrast agents,iodine and gadolinium, with the same concentration (5mg∕mL) were studied. Three parameters that affect beamquality were evaluated: kVp settings (50 to 130 kVp), filter materials (Z¼13to 83), and filter thicknesses [0 to 2half-value layer (HVL)]. The image qualities resulting from the varying x-ray beams were compared in terms oftwo figures of merit (FOMs): squared signal-difference-to-noise ratio normalized by brain dose (SDNR2∕BD) andthat normalized by skin dose (SDNR2∕SD). For nonenhanced imaging, the results show that the use of the 120-kVp spectrum filtered by 2 HVL copper (Z¼29) provides the best performance in both FOMs. When iodine isused in K-edge imaging, the optimal filter is 2 HVL iodine (Z¼53) and the optimal kVps are 60 kVp in terms ofSDNR2∕BD and 75 kVp in terms of SDNR2∕SD. A tradeoff of 65 kVp was proposed to lower the potential riskof skin injuries if a relatively long exposure time is necessarily performed in the iodinated imaging. In the case ofgadolinium imaging, both SD and BD can be minimized at 120 kVp filtered with 2 HVL thulium (Z¼69). Theresults also indicate that with the same concentration and their respective optimal spectrum, the values ofSDNR2∕BD and SDNR2∕SD in gadolinium imaging are, respectively, around 3 and 10 times larger thanthose in iodine imaging. However, since gadolinium is used in much lower concentrations than iodine in theclinic, iodine may be a preferable candidate for K-edge imaging.
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