Sudden cardiac death patients inform optimal CT imaging parameters

by Lisa Chamoff, Contributing Reporter | March 21, 2017
Cardiology CT Heart Disease X-Ray
WASHINGTON, D.C. — It may be too late to treat adults who have succumbed to sudden cardiac death, but these individuals may help physicians diagnose patients at risk for developing acute coronary syndrome.

Researchers from the Dalio Institute of Cardiovascular Imaging and NewYork-Presbyterian Hospital, a joint venture with Weill Cornell Medicine, looked at how dual-energy CT (DECT) can help identify diseased arteries, using patients undergoing autopsy to determine how to get the best image quality for detecting high-risk plaques, comparing it with single-energy CT (SECT).

“The single-energy CT, which is mostly used, is limited in its ability to identify these high-risk plaque features, because it cannot identify the tissue characterization, and the CT images mostly show artifacts,” Dr. Asim Rizvi, a research fellow at Weill Cornell Medical College, told HCB News.

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Rizvi presented the study — co-investigators included Dr. Fay Lin, Dr. Jessica Peña, Dr. Renu Virmani and Dr. James Min, director of the Dalio Institute — at the American College of Cardiology scientific meeting in Washington.

The researchers performed both SECT and DECT using GE Healthcare’s Revolution HD CT scanner on the hearts of 40 patients with suspected sudden cardiac death, who were autopsy candidates at the Office of the Chief Medical Examiner in Baltimore, Md.

“Currently, we don’t know which is the optimal monochromatic energy mode for dual-energy CT,” Rizvi said.

The researchers imaged the patients using DECT from 40 kiloelectronvolts (keV) to 140 keV and calculated signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each energy level. They found that 40 keV provided the highest, and optimal, SNR and CNR for identifying the high-risk plaques.

Rizvi noted that the study is still ongoing and that the researchers are planning to use a larger sample size.

Testing patients who have already died is the safest way to determine the parameters for the best CT image quality, Rizvi said.

“[You’re] giving the highest contrast dose, which is not very beneficial to the patient,” Rizvi said. “In the future, if we prove that dual-energy CT (with) this monochromatic energy form can best identify this high-risk plaque, it will be much better and then we don’t have to give that kind of radiation dose. We would just go directly to that energy level.”

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