Journal of cardiovascular computed tomography最新文献

{"title":"Coronary artery calcium comes of age: From risk marker to treatment threshold.","authors":"Ruben Mora, Matthew J Budoff","doi":"10.1016/j.jcct.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.10.002","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of cardiac CT imaging for structural heart interventions.","authors":"Ronen Rubinshtein","doi":"10.1016/j.jcct.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.10.006","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of artificial intelligence-based coronary CT angiography-derived fractional flow reserve across cohorts with different prevalence of obstructive coronary artery disease.","authors":"Casper F Coerkamp, Merel Gommers, Richard A P Takx, Roel S Driessen, Victor A Verpalen, Paul Knaapen, Ivana Išgum, Nick S Nurmohamed, José P S Henriques, Nils R Planken","doi":"10.1016/j.jcct.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) provides accurate anatomical assessment of coronary stenosis severity but has limited ability to determine lesion-specific ischemia as assessed by invasive fractional flow reserve (FFR). We aimed to evaluate the diagnostic performance of an artificial intelligence-based deep learning CCTA-derived FFR model (CT-FFR_AI) in cohorts undergoing CCTA and invasive FFR as part of a study protocol and a real-world cohort undergoing invasive FFR based on suspected coronary artery disease on CCTA in routine clinical care.</p><p><strong>Materials and methods: </strong>Diagnostic performance of CT-FFR_AI (CorEx, SPIMED-AI) was evaluated using an intention-to-diagnose approach and compared with CCTA using 50% and 70% stenosis thresholds, with invasive FFR as reference standard. In the PACIFIC-1 study cohort, 208 patients underwent CCTA and invasive FFR assessment of all major coronary vessels irrespective of CCTA findings. The real-world cohort included 202 patients with at least one CCTA-defined lesion ≥70% stenosis who underwent ICA with invasive FFR.</p><p><strong>Results: </strong>In the PACIFIC-1 cohort (612 vessels), per-vessel diagnostic accuracy was comparable between CT-FFR_AI (77%), when using a CCTA based ≥50% stenosis threshold (76%; P = 0.689), and when using a ≥70% stenosis threshold (74%; P = 0.183). In the real-world cohort (325 vessels), CT-FFR_AI demonstrated higher per-vessel diagnostic accuracy (63%) compared with CCTA using ≥50% and ≥70% stenosis thresholds (52% and 57%, respectively; P < 0.001 and P = 0.034). Net reclassification improvement for CT-FFR_AI beyond CCTA alone using ≥50% and ≥70% stenosis thresholds was 7.9% (P = 0.256) and 17.7% (P = 0.012) in the PACIFIC-1 cohort, compared with 23.2% (P < 0.001) and 13.6% (P = 0.070) in the real-world cohort, respectively.</p><p><strong>Conclusions: </strong>CT-FFR_AI may outperform anatomic assessment alone, with diagnostic accuracy depending on the prevalence of obstructive coronary artery disease and the range of stenosis severities among vessels undergoing invasive FFR assessment.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of aortic valve calcium and CT-derived aortic valve area in low-gradient aortic stenosis.","authors":"Dakota De Cecco, Christopher Scoma, Corey Powell, Megan Joseph, William Truesdell, Stanley Chetcuti, Andrew W Harris","doi":"10.1016/j.jcct.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Practice guidelines recommend the use of computed tomography (CT) aortic valve calcium (AVC) scores for patients with low-gradient aortic stenosis (LG-AS). AVC has not been studied in comparison to invasive aortic valve study (IAVS).</p><p><strong>Objectives: </strong>To determine the diagnostic performance of AVC and CT-derived aortic valve area (CT-AVA) compared to IAVS as a reference standard.</p><p><strong>Methods: </strong>We included consecutive patients with LG-AS with echocardiography, CT and IAVS performed within 1 year at a single tertiary center. Severe AS was defined by aortic valve area (AVA) ≤1.0 cm² measured by IAVS. CT-AVA was retrospectively measured by a blinded reader. CT-AVA and sex-based AVC were compared to AS defined by IAVS. Diagnostic performance was compared using receiver operating characteristic (ROC) curves. AVC and CT-AVA were compared to cardiac events consisting of death, aortic valve replacement and cardiovascular hospitalization.</p><p><strong>Results: </strong>Out of 294 patients in the overall cohort, 206 patients with definite AS severity by IAVS were included as the primary diagnostic cohort. Severe AS according to invasive AVA (≤1.0 cm²) was present in 72 patients (35.0%). Sex-based AVC scores had relatively poor diagnostic performance compared to the reference IAVS with AUCs of 0.59 (95% confidence interval [CI] 0.48-0.70) and 0.58 (95% CI 0.45-0.71) for men and women, respectively. CT-AVA had better diagnostic performance with an AUC of 0.82 (95% CI 0.77-0.87).</p><p><strong>Conclusions: </strong>In our study population, CT-AVA had significantly better diagnostic performance than AVC compared to the reference standard, IAVS.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized trial of counter-pressure and position maneuvers to prevent vasovagal syncope after intravenous cannulation for cardiac CT: The CoPPMan-IVC trial.","authors":"Sujie Fan, Rebecca Woodley, Sujith Seneviratne, John Troupis, Adam J Nelson, Rahul G Muthalaly, Nitesh Nerlekar, Adam J Brown, Stephen J Nicholls, Derek P Chew, Sean Tan","doi":"10.1016/j.jcct.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.10.004","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretation and reporting of coronary computed tomographic angiography: Bridging the gap between reporting and clinical decision-making.","authors":"Anam Waheed, Kevin J O'Gorman, Ron Blankstein","doi":"10.1016/j.jcct.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.09.011","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of shuttle-mode myocardial CT late enhancement: Comparison with late gadolinium enhancement cardiovascular MR.","authors":"Takanori Kokawa, Satoshi Nakamura, Shiro Nakamori, Tairo Kurita, Naoki Nagasawa, Kaoru Dohi, Hajime Sakuma, Kakuya Kitagawa","doi":"10.1016/j.jcct.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.09.008","url":null,"abstract":"<p><strong>Objectives: </strong>Although myocardial CT late enhancement (CT-LE) has been reported in various studies, its diagnostic performance using shuttle-mode dual-source CT has not been fully validated for detecting myocardial infarction (MI) and assessing its transmural extent against late gadolinium enhancement cardiovascular MR (LGE-CMR). This study aimed to evaluate the diagnostic performance of shuttle-mode myocardial CT-LE in detecting MI with LGE-CMR as a reference standard.</p><p><strong>Materials & methods: </strong>This study included 56 patients with suspected or known coronary artery disease who underwent both comprehensive cardiac CT, including myocardial CT-LE, and LGE-CMR from a prospective, multicenter trial (AMPLIFiED). Sixteen myocardial segments per patient (excluding the apical cap based on AHA classification) were assessed. Segments were classified as having or not having MI; segments with MI were further categorized by transmural extent: <50%, 50-99%, or 100%. Two observers independently assessed myocardial CT-LE images. LGE-CMR findings were determined by consensus between two observers.</p><p><strong>Results: </strong>In the segment-based analysis (n = 896), myocardial CT-LE showed a sensitivity of 97.6% and a positive predictive value (PPV) of 93.0%-94.1% for MI detection (specificity, 99.3%-99.4%; negative predictive value [NPV], 99.8%). Agreement for transmural extent was high (weighted kappa, 0.82-0.83). Inter-reader reproducibility for binary MI detection was excellent (agreement, 99.4%; kappa, 0.97). In an exploratory patient-level analysis based on 19 LGE-CMR-positive patients, sensitivity was 94.7% (95% confidence interval [CI], 74.0%-99.9%) for Observer A and 100% (95% CI, 82.4%-100%) for Observer B; the corresponding PPVs were 94.7% and 90.5%.</p><p><strong>Conclusion: </strong>Shuttle-mode myocardial CT-LE demonstrated excellent agreement with LGE-CMR for the detection and transmural assessment of MI. Its high sensitivity for subendocardial MI supports its value as a reliable alternative to LGE-CMR.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popcorn type calcification: A feature of calcified nodules observed by coronary computed tomography angiography.","authors":"Yuka Tanizaki, Yuki Ishii, Yuki Numaziri, Yosuke Takei, Hiromoto Sone, Kazuma Tashiro, Tokutada Sato, Hiroshi Suzuki, Hiroyoshi Mori","doi":"10.1016/j.jcct.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>Calcified nodule is one of the most difficult lesions to treat in interventional cardiology. Optical coherence tomography (OCT)/optical frequency domain imaging (OFDI) enables detailed assessment of calcified plaques, including calcified nodule (CN). In contrast, coronary CT angiography (CCTA) is a non-invasive modality widely used to detect coronary artery stenosis and calcification; however, its role in identifying CN remains unclear.</p><p><strong>Objective: </strong>To compare the subsequent characteristics of calcifications observed on CCTA and OFDI.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent preprocedural CCTA and percutaneous coronary intervention with OCT/OFDI between March 2016 and August 2024. Calcifications on OCT/OFDI were classified as CN, nodular calcification (NC), or sheet calcification (SC). On CCTA, calcifications were categorized as \"popcorn type\" (irregular morphology) or \"linear type\" (regular morphology). Each culprit lesion was also evaluated using the Agatston score. Imaging findings were compared across groups.</p><p><strong>Results: </strong>A total of 216 lesions from 192 patients were analyzed in this study. Popcorn-type calcification on CCTA was more common in CN than in NC and SC (91.3%, 44.3%, and 3.8%, respectively; p < 0.001), whereas linear-type calcification was less prevalent in CN than in NC and SC (8.7%, 55.6%, and 96.2%, respectively; p < 0.001). Popcorn-type calcification identified CN or NC with 64% sensitivity, 96% specificity, 86% positive predictive value, and 88% negative predictive value. The median calcium score (IQR) for the culprit coronary artery was the highest in CN, followed by NC and SC (1105, 660, and 537, respectively; P < 0.001).</p><p><strong>Conclusion: </strong>Popcorn-type calcification on CCTA may be associated with CN on OCT/OFDI.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance of CT-detected hypoattenuated leaflet thickening after transcatheter aortic valve replacement: A systematic review and meta-analysis.","authors":"Naofumi Yasuda, Shingo Kato, Nobuyuki Horita, Shungo Sawamura, Daisuke Utsunomiya","doi":"10.1016/j.jcct.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>Hypoattenuated leaflet thickening (HALT) is a CT-detected finding increasingly recognized after transcatheter aortic valve replacement (TAVR), but its predictors, association with valve platform and antithrombotic regimen, and clinical significance remain uncertain.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of studies reporting HALT after TAVR. PubMed, Web of Science Core Collection, and the Cochrane Library were searched. Pairwise meta-analyses evaluated associations between HALT and patient characteristics, antithrombotic regimen, valve hemodynamics, and clinical outcomes. Network meta-analyses compared valve platform and valve size.</p><p><strong>Results: </strong>Fifty-nine studies including 16,269 patients were analyzed, with HALT observed in 1792 patients (11.0%). Most baseline patient characteristics were not associated with HALT. Compared with balloon-expandable valves, self-expanding supra-annular valves were associated with lower HALT risk, whereas self-expanding intra-annular and Lotus valves were associated with higher risk. Direct oral anticoagulants and warfarin did not differ in HALT risk, whereas oral anticoagulation was associated with lower risk than no oral anticoagulation. HALT was associated with a small increase in mean transvalvular gradient, but not with major clinical outcomes at short-term follow-up.</p><p><strong>Conclusion: </strong>HALT after TAVR was associated mainly with valve platform and antithrombotic regimen rather than baseline patient characteristics. Its hemodynamic and clinical impact appeared limited, supporting individualized interpretation of this CT-detected finding. Further long-term follow-up studies are warranted to clarify the clinical sequelae of HALT and its potential impact on valve durability.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-endorsed but devalued: Fee schedule-wide and code-specific declines in Medicare payment for cardiac computed tomography, 2010-2026.","authors":"Muhammad Naeem, Robert J French, Carlos A Rojas, Matthew T Stib, Michael B Gotway, Clinton E Jokerst, Michael F Morris, Kristopher W Cummings","doi":"10.1016/j.jcct.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.09.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary CT angiography (CCTA) received a Class 1 recommendation in the 2021 AHA/ACC chest pain guideline, yet the trajectory of Medicare payment for cardiac CT over the Category I era has not been systematically quantified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;January-effective Physician Fee Schedule Relative Value Files were compiled for 2010 through 2026 for CPT 75571-75574, with FFR-CT (75580) and AI-based plaque analysis (75577) from their Category I dates, and CT angiography of the chest (71275) as a non-cardiac comparator. National unadjusted non-facility payment (all geographic indices 1.000) was calculated for global, professional, and technical components as total relative value units (RVUs) multiplied by the conversion factor, adjusted to 2026 dollars using the Consumer Price Index for All Urban Consumers (CPI-U), with the Medicare Economic Index (MEI) as a sensitivity analysis, and summarized as total real change and compound annual growth rate (CAGR). Claims volumes for 2013-2024 were obtained from CMS public use files, expressed per 1000 fee-for-service Part B enrollees, and the change in real allowed fee schedule spending was partitioned into unit revenue, volume, and interaction effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Inflation-adjusted global payment declined for all four core codes between 2010 and 2026: -68.3% for CCTA (75574; CAGR -6.93%/y), -53.6% for congenital cardiac CT (75573), -50.2% for structural cardiac CT (75572), and -27.4% for coronary calcium scoring (75571). Declines concentrated in the technical component (-74.8% for 75574; RVU reductions of up to 58.7%), whereas professional payment fell 35.9%-37.5% with work RVUs unchanged until the 2.5% efficiency adjustment of 2026, attributable to a 38.8% real decline in the conversion factor. Results were unchanged under the MEI (-68.6% for CCTA) and modestly attenuated under the MEI net of productivity (-65.0%). Chest CT angiography fell 57.9%, with a professional decline close to the cardiac codes (-40.7%) but a smaller technical decline (-62.5% vs -74.8%). The largest single-year reduction occurred in 2011 (-36.4% for 75574). In the five years after the 2021 guideline, real global payment fell a further 24.2%-34.2%. Over 2013-2024, CCTA volume rose 408% while mean real allowed charge per service fell 45.9%, a decline that partly reflects migration of billing to facility settings. Real allowed fee schedule spending rose $22.0 million, comprising a $51.4 million volume effect offset by unit revenue (-$5.8 million) and interaction (-$23.6 million) effects; hospital technical payment is not captured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Medicare payment for cardiac CT has declined steeply in real terms since Category I code adoption, and the decline accelerated during the period of strongest guideline endorsement. It exceeded the decline of a non-cardiac comparator and was insensitive to the choice of deflator. This discordance has implications for","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}