Journal of cardiovascular computed tomography最新文献

{"title":"Comparing coronary computed tomography angiography to single-photon emission computed tomography in the evaluation of chest pain in the emergency department.","authors":"Abdallah Rayyan, Daniel Bishev, Yvette Bazikian, Nasir Nawaz","doi":"10.1016/j.jcct.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.08.001","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) is an alternative to single-photon emission computed tomography (SPECT) for evaluating intermediate-risk chest pain in the emergency department, offering rapid assessment and potentially less unnecessary invasive testing. Despite guideline support, real-world comparative data remain limited.</p><p><strong>Methods: </strong>We retrospectively studied adults presenting with chest pain or angina-equivalent symptoms to emergency departments within the HCA Healthcare (United States) from January 2017 to June 2024 who underwent CCTA or SPECT at the index encounter. The primary outcome was invasive coronary angiography (ICA) during the index hospitalization. Secondary outcomes were length of stay (LOS), 30-, 60-, and 90-day all-cause readmissions, in-hospital mortality, and renal replacement therapy (RRT). Regression models adjusted for age, sex, diabetes, hypertension, and hyperlipidemia.</p><p><strong>Results: </strong>Among 22,195 patients, 2827 (12.7%) underwent CCTA and 19,368 (87.3%) SPECT. ICA occurred in 15.2% of CCTA versus 24.6% of SPECT patients (adjusted odds ratio [OR] 1.75 for SPECT vs CCTA, 95% confidence interval [CI] 1.56-1.95; p < 0.0001). LOS and readmissions did not differ significantly, but RRT was more frequent with SPECT (OR 2.28, 95% CI 1.44-3.62; p = 0.0004). In-hospital mortality was rare; mortality comparison was underpowered.</p><p><strong>Conclusion: </strong>In this multicenter cohort, CCTA was associated with lower downstream ICA utilization and lower RRT incidence than SPECT, without extending LOS or increasing readmissions. These associations are directionally consistent with the 2021 AHA/ACC Chest Pain Guidelines. Given substantial baseline imbalance between cohorts and likely residual confounding, the findings are hypothesis-generating and require prospective validation before informing practice.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763883","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":"Effect of a motion-correction algorithm on motion-related image quality in mid-diastolic CCTA using 320-detector row CT.","authors":"Tomoya Takayanagi, Takeshi Kondo, Takehiro Arai, Tomonari Sano, Hideki Nagaoka","doi":"10.1016/j.jcct.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.08.003","url":null,"abstract":"<p><strong>Background: </strong>Motion artifacts limit coronary CT angiography (CCTA) when mid-diastolic quiescence is short. RR-PQ estimates the low-motion interval available for reconstruction, whereas motion correction may improve image quality without changing cardiac physiology.</p><p><strong>Purpose: </strong>To primarily evaluate the incremental effect of Clear Motion Cardiac (CMC) compared with half-scan reconstruction and secondarily characterize the probability of diagnostic image quality across RR-PQ values and derive candidate operational RR-PQ values on a 0.24-s/rotation 320-detector row CT system.</p><p><strong>Methods: </strong>In 1012 consecutive CCTA examinations, paired half-scan and CMC series were reconstructed from identical raw data. Motion was graded A-D (A/B diagnostic). McNemar tests compared paired rates; logistic models estimated diagnostic probability and candidate RR-PQ values.</p><p><strong>Results: </strong>Diagnostic image quality increased from 841/1012 (83.1%) with half-scan to 939/1012 (92.8%) with CMC (p < 0.0001). Of 171 half-scan failures, 101 were rescued; degradation occurred in 3/1012. Benefit increased with heart rate and was greatest at ≥70 bpm. RR-PQ was strongly associated with the probability of diagnostic image quality; candidate values at 95% probability were 807 ms for half-scan and 739 ms for CMC.</p><p><strong>Conclusion: </strong>CMC improved diagnostic image quality, especially at higher heart rates and shorter RR-PQ. The derived values may aid workflow planning but are platform- and cohort-specific.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762112","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":"Coronary Artery Calcium Scoring with Photon-Counting Detector CT: Ultra-Low-Dose Scan Versus Coronary CT Angiography-Derived Images.","authors":"Suguru Araki, Satoshi Nakamura, Mana Deguchi, Akio Yamazaki, Shintaro Yamaguchi, Naoki Hashimoto, Takanori Kokawa, Masafumi Takafuji, Yasutaka Ichikawa, Hajime Sakuma, Kakuya Kitagawa","doi":"10.1016/j.jcct.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.08.002","url":null,"abstract":"<p><strong>Purpose: </strong>To compare coronary artery calcium (CAC) scores from ultra-low-dose true non-contrast (TNC), virtual non-contrast (VNC), and virtual non-iodine (VNI) images with standard TNC on a dual-source photon-counting detector CT (PCD-CT).</p><p><strong>Methods: </strong>In this prospective single-center study (January 2025-March 2026), patients underwent standard TNC (sequential, 120 kVp), ultra-low-dose TNC (high-pitch helical, tin-filtered 100 kVp), and coronary CT angiography (CCTA); VNC and VNI images were generated from CCTA. CAC scores and burden categories were evaluated. Correlation and agreement with standard TNC were assessed using Pearson coefficients with Williams' test, Bland-Altman plots, and weighted Cohen's kappa.</p><p><strong>Results: </strong>Seventy-one patients (median age, 75 years; 52 men) were evaluated. Median dose-length product was 7.98, 71.8, and 428 mGy cm for ultra-low-dose TNC, standard TNC, and CCTA, respectively. Ultra-low-dose TNC showed the strongest correlation with standard TNC (r = 0.996), superior to VNI (r = 0.976, P < 0.001) and VNC (r = 0.900, P < 0.001). Agreement in CAC burden categorization was excellent for ultra-low-dose TNC (κ = 0.932) and good for VNI (κ = 0.827), whereas VNC showed moderate agreement (κ = 0.424). VNI had minimal bias (mean difference, -3.9) but wider limits of agreement than ultra-low-dose TNC (-356.5 to 348.6 vs. -163.2 to 105.9). VNC underestimated CAC scores (mean bias, -442.0).</p><p><strong>Conclusion: </strong>Ultra-low-dose TNC with dual-source PCD-CT showed excellent agreement with standard TNC while reducing radiation by nearly 90%. VNI was acceptable but less robust, whereas VNC substantially underestimated CAC scores. Ultra-low-dose TNC is a reliable, dose-efficient alternative to standard TNC for CAC scoring.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763715","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":"ECG-Gated Metal Artifact Reduction Rescues Post-Coil Embolization Cardiac CT After Watchman Device Failure.","authors":"Prashant Nagpal, Jakub M Siembida, Kelsey Schluter, Timothy P Szczykutowicz, Martin G Wagner, Sarv Priya","doi":"10.1016/j.jcct.2026.07.014","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.014","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765042","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":"Predictors and characterization of non-calcified plaques among patients with a zero coronary calcium score.","authors":"Sara Alsubai, Foziyah Alqahtani, Sara Sgreva, Emiliano Bianchini, Aduba Chukwunwike, Ruth Sharif, Hesham Elzomor, Naeif Almagal, Shahad Almotairi, Muhammad Yusha Malik, Aoife Joyce, Nicola Glynn, Michael G Madden, Faisal Sharif","doi":"10.1016/j.jcct.2026.07.013","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.013","url":null,"abstract":"<p><strong>Background: </strong>Non-calcified coronary atherosclerosis may be present despite a coronary artery calcium (CAC) score of zero, but its metabolic determinants are not well defined. This study investigated biomarker associations with non-calcified plaque and quantitative plaque characteristics in individuals with CAC = 0.</p><p><strong>Methods: </strong>From a prospective registry of 860 adults underwent coronary CT angiography (CCTA) for suspected coronary artery disease, 418 individuals with CAC = 0 were analyzed. Clinical risk factors and biomarkers-including HbA1c, LDL-C, HDL-C, triglycerides, ApoA-I, ApoB, the ApoB/ApoA-I ratio, lipoprotein(a) [Lp(a)], hs-CRP, and creatine kinase-were assessed. Propensity score matching (PSM) balanced clinical risk factors (age, sex, body mass index, hypertension, hyperlipidaemia, diabetes, smoking, statin therapy, and glucose-lowering therapy) between patients with and without plaque.</p><p><strong>Results: </strong>Non-calcified plaque was detected in 10.3% of CAC-zero individuals. Before matching, those with plaque were older (55.2 ± 10.3 vs 51.9 ± 10.5 yrs; p = 0.055) and had higher rates of hypertension, hyperlipidaemia, and diabetes, as well as higher HbA1c and Lp(a) levels. After PSM (n = 86; 43 with plaque and 43 without plaque), HbA1c remained significantly higher in individuals with plaque (39.76 ± 5.36 vs 37.60 ± 3.65 mmol/mol; p = 0.026), while other biomarkers were not significant. In exploratory analysis, elevated Lp(a) ≥50 mg/dL may be associated with greater total plaque volume (≥70 mm³) (OR 4.89, 95% CI 1.17-20.41; p = 0.03), and higher Lp(a) levels were observed in patients with low-attenuation plaque compared with those without low-attenuation plaque.</p><p><strong>Conclusion: </strong>Among individuals with CAC = 0, higher HbA1c was associated with non-calcified coronary plaque. Elevated Lp(a) may be associated with greater plaque burden and plaque characteristics. These findings suggest a potential role for metabolic factors and CCTA in detecting subclinical atherosclerosis beyond CAC scoring.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803824","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 road less invasive: Cardiac CT for evaluation of major aortopulmonary collaterals.","authors":"Hunter C Wilson, Timothy C Slesnick","doi":"10.1016/j.jcct.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.010","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709184","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":"Radiomics-based characterization of valvular calcium improves risk stratification for paravalvular regurgitation after TAVI.","authors":"Thamara Carvalho Morais, Antonildes Nascimento Assunção Júnior, Sérgio Figueiredo Câmara, Carla Franco Grego da Silva, Gabriela Liberato, Bruna Morhy Borges Leal Assunção, Gabriel Kanhouche, Vinícius Cardoso Serra, André Vaz, Marco Antonio Gelain, Fabio Sandoli de Brito, Alexandre Abizaid, Henrique Barbosa Ribeiro, Cesar Higa Nomura","doi":"10.1016/j.jcct.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.012","url":null,"abstract":"<p><strong>Background: </strong>Significant paravalvular regurgitation (sPVR) remains a clinically relevant complication after transcatheter aortic valve implantation (TAVI) and is influenced by valvular calcium characteristics that are incompletely captured by conventional CT metrics.</p><p><strong>Purpose: </strong>To evaluate whether CT-based radiomics of aortic valvular calcium can predict sPVR after TAVI and to assess the incremental value of radiomic features beyond standard anatomic and procedural parameters.</p><p><strong>Materials and methods: </strong>This retrospective multicenter study included 393 patients undergoing TAVI with preprocedural contrast-enhanced, ECG-gated CT. Predictive models were developed in a development cohort (n = 195) and tested in an external validation cohort (n = 198). Aortic valvular calcium was manually segmented on CT images. A radiomics-derived score (RDS) composed of five features was generated using least absolute shrinkage and selection operator logistic regression. Model performance for predicting postprocedural sPVR (moderate or severe), assessed by transthoracic echocardiography according to VARC-3 criteria, was compared between a traditional model based on procedural and CT anatomic variables and an enhanced model incorporating the RDS.</p><p><strong>Results: </strong>Among 393 patients undergoing TAVI (development cohort, n = 195; external validation cohort, n = 198), the RDS showed consistent discrimination for sPVR in the development (AUC, 0.76) and validation (AUC, 0.74) cohorts. Incorporation of the RDS significantly improved model discrimination (AUC, 0.76 to 0.84; p = 0.004), risk reclassification, and model calibration. In multivariable analysis, the RDS remained independently associated with sPVR (odds ratio, 2.31 per 0.1-unit increase; p = 0.018).</p><p><strong>Conclusion: </strong>CT-based radiomics of valvular calcium provides incremental information beyond conventional CT metrics for identifying patients at risk of incomplete prosthesis sealing after TAVI. These findings support the integration of radiomics into routine preprocedural CT assessment to enhance individualized risk stratification in TAVI candidates.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957657","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":"Optimizing Heart Rate for Coronary CT Angiography-A Practical Framework.","authors":"Allen Wang, Quynh A Truong","doi":"10.1016/j.jcct.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.005","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623426","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 quality (feasibility and utility) of cardiac CT imaging in pediatric patients on mechanical circulatory support.","authors":"Ahmed Badran, Caitlin Milligan, Spencer Barfuss, Sanja Dzelebdzic, Shawn Shaji, Brandon Kirkland, Michael Profsky, B Kelly Han","doi":"10.1016/j.jcct.2026.07.008","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.008","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients on ventricular assist devices (VAD) and Venoarterial extracorporeal membrane oxygenation (VA-ECMO) increasingly undergo cardiac computed tomography (CT) for device assessment, complication evaluation, and transplant planning. Imaging this population is challenged by metallic device components, contrast timing in altered hemodynamics, need for sedation, and small patient size. The diagnostic quality and utility of cardiac CT in pediatric patients on mechanical support have not been systematically described.</p><p><strong>Methods: </strong>We retrospectively reviewed electrocardiogram (ECG)-gated cardiac CT studies performed in pediatric patients (<18 years) on VAD or VA-ECMO support at our institution from January 2022 to November 2025. Two pediatric cardiac imaging experts independently scored diagnostic image quality on a 4-point scale (1 = fully diagnostic, 2 = mildly degraded, 3 = significantly degraded, 4 = non-diagnostic). Adverse events, clinically relevant findings, and post-scan management changes were collected.</p><p><strong>Results: </strong>Twenty-four ECG-gated cardiac CT studies were performed in 17 patients (median age 1.5 years, interquartile range [IQR] 0.8-2.7; median weight 11.2 kg, IQR 8.0-13.9). Twenty-one studies (87.5%) were performed on VAD support and 3 (12.5%) on VA-ECMO. Berlin Heart EXCOR was the predominant device (76.2% of VAD studies). Fourteen studies were done for cause and ten for routine pre-transplant sizing. All 24 studies (100%) were rated as diagnostic by both reviewers. Mean image quality scores were 1.21 ± 0.51 for Reviewer 1 and 1.54 ± 0.59 for Reviewer 2; the two reviewers agreed within one point on every study. Clinically relevant findings were identified in 8 studies (33.3% overall and 57.1% of for cause scans), including thrombus (n = 2), cannula obstruction (n = 4), and other (n = 2). Cardiac CT directly contributed to a change in management in 9 studies (37.5% overall), including anticoagulation modification, surgical or catheter-based intervention, and VAD parameter adjustment. One adverse event occurred (4.2%): transient hypotension requiring epinephrine in an ECMO patient during scan-related flow reduction.</p><p><strong>Conclusion: </strong>ECG-gated cardiac CT provides diagnostic-quality imaging in 100% of pediatric patients on VAD or VA-ECMO at our center. The technique frequently revealed clinically relevant findings and informed management decisions, with a low rate of adverse events.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611488","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":"Use of Advanced Coronary Artery Disease Imaging Within Veterans Affairs Facilities Compared to Medicare Beneficiaries.","authors":"Yosef A Cohen, Nishant R Shah, Kevin J O'Gorman, Mrinali Shetty, David E Winchester, Andrew J Einstein","doi":"10.1016/j.jcct.2026.07.004","DOIUrl":"https://doi.org/10.1016/j.jcct.2026.07.004","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595307","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}