HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Juergens, K. U. Articles by Fischbach, R. Search for Related Content PubMed PubMed Citation Articles by Juergens, K. U. Articles by Fischbach, R. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Using ECG-Gated Multidetector CT to Evaluate Global Left Ventricular Myocardial Function in Patients with Coronary Artery Disease

¹ Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany.
² Department of Cardiology and Angiology, University of Muenster, D-48149 Muenster, Germany.

Received September 24, 2001; accepted after revision May 30, 2002.

 
Partially supported by grant B1, BMBF-01KS 9604 from the Interdisciplinary Center of Clinical Research and grant FI 1 2 00 29 from the Innovative Medizinische Forschung Foundation.

Address correspondence to K. U. Juergens.

Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
OBJECTIVE. Retrospectively ECG-gated three-dimensional volume data from multidetector CT (MDCT) coronary angiography enable image reconstruction of the cardiac cycle in the diastolic and systolic phases. The objective of our study was to investigate the feasibility of determining left ventricular function from MDCT coronary angiography data sets in 22 patients with coronary artery disease and to study the correlation of MDCT results with those of functional data from biplane cineventriculography.

CONCLUSION. Multiplanar reformations from three-dimensional MDCT data allowed good delineation of endocardial and epicardial left ventricular contours. In patients evaluated for coronary artery disease, MDCT coronary angiography with retrospective ECG gating provides functional data in an acceptable correlation (r = 0.8; p < 0.05) to biplane cineventriculography.

Introduction

Top Abstract Introduction Materials and Methods Results Discussion References

 
Quantitative values of ventricular volumes and of myocardial mass are independent predictors of morbidity and mortality in patients with coronary artery disease [1]. Therefore, the assessment of left ventricular function is an important basis for clinical diagnosis, management decisions, and follow-up of these patients [2].

Various noninvasive imaging modalities, such as echocardiography, radionuclide ventriculography, and gated perfusion single-photon emission CT, are used to determine left ventricular function. However, these methods are hampered either by low spatial or temporal resolution or, in regard to echocardiography, by the fact that image acquisition is operator- and acoustic window—dependent [3]. Left ventricular function parameters can be measured by electron beam CT [4], but access to this modality is restricted by the number of scanners available. The use of mechanical CT in cardiac imaging has been limited because it provides inadequate temporal resolution. Cardiac MR imaging provides excellent temporal and spatial resolution, image acquisition in any desired plane, and a high degree of accuracy and reproducibility concerning quantitative measurements [5, 6].

Ventricular function in patients with coronary artery disease who undergo coronary angiography can be assessed on biplane cineventriculography. Although this method is limited by the geometric assumptions made from projection images, it is currently serving as a clinically accepted standard [7].

Recently, multidetector CT (MDCT) has been introduced as a promising alternative coronary artery imaging method. MDCT acquired in a single breath-hold with retrospective ECG gating can cover the entire heart with 1-mm slice thickness and a temporal resolution of 125-250 msec per image, continuously acquiring data during the entire cardiac cycle [8, 9]. Because this method provides excellent longitudinal spatial resolution, image reformation can be performed in any desired plane, thus allowing anatomically optimized long-axis, short-axis, or four-chamber views (Fig. 1A,1B). Diastolic and systolic images can easily be produced from the same MDCT data set with a retrospective ECG-gating technique. Left ventricular volumes can be measured from diastolic and systolic MDCT images; thus, assessment of left ventricular ejection fraction seems possible.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —65-year-old man with two-vessel coronary artery disease and chronic myocardial infarction. Multidetector CT (MDCT) image shows circumscribed aneurysmatic dilatation of left ventricular apex with thinning of myocardial wall (white arrows) in long-axis view. MV = mitral valve, LV = left ventricle, PPM = posterior papillary muscle.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —65-year-old man with two-vessel coronary artery disease and chronic myocardial infarction. Image reformation in the four-chamber view from MDCT data sets shows that global left ventricular function was significantly reduced (left ventricular ejection fraction, 34%). Noncalcified plaque (asterisks) is present in lateral wall of descending aorta. White arrows point to thinning of myocardial wall. RV = right ventricle, LV = left ventricle, MV = mitral valve, DA = descending aorta.

The objective of our study was to investigate the feasibility of left ventricular function assessment from MDCT coronary angiography data sets in patients with suspected coronary artery disease and to compare MDCT results to those of biplane cineventriculography.

Materials and Methods

Top Abstract Introduction Materials and Methods Results Discussion References

 
The study presented in this article draws on research from a larger, prospective study we have in progress, in which we are comparing MDCT coronary angiography with catheter angiography for the detection of significant (>50%) coronary artery stenosis. Our study was approved by our institutional review board, and patients' written informed consent was obtained. All patients underwent standard coronary angiography including biplane cineventriculography to assess left ventricular ejection fraction. A subgroup of 22 consecutive patients (19 men and three women; age range, 37-76 years; mean age, 62.7 ± 7.1 years) from our ongoing study was selected for the study described here.

MDCT
MDCT coronary angiography was performed in the craniocaudal direction (with the patient in the supine position) within a single breath-hold at end-inspiratory suspension preceded by mild hyper-ventilation using a four-slice scanner (Somatom Volume Zoom, software version VA 11; Siemens, Forchheim, Germany). The patient's ECG trace was recorded simultaneously (mean heart rate range, 52-88 beats per minute). Scanning parameters included 500-msec gantry rotation time, 120 kV, 300 mA, 4 x 1 mm detector configuration, 3-mm/sec table feed, 140 mL of contrast media (iomeprol, 300 mg I/mL; flow, 3 mL/sec), and 50-mL saline chaser bolus (power injector LF 903000; Liebel Flarsheim, Cincinnati, OH). The estimated radiation dose ranged between 6 and 8 mSv, depending on the scanning range and patient's sex.

The raw data and the recorded ECG trace then were transferred to a separate 850-MHz Pentium III PC (Fujitsu Siemens Computers, Darmstadt, Germany) for retrospectively ECG-gated image reconstruction (slice thickness, 1.25 mm; increment, 0.6 mm; matrix, 512 x 512; medium-soft kernel; field of view, 200 mm) by means of a work-in-progress cardiac CT reconstruction software (Cardio Recon, version 6, Siemens; and MatLab, version 5.3, MathWorks, Natick, MA). Using a table feed of 1.5 mm per rotation and a rotation time of 500 msec, the Adaptive Cardiac Volume reconstruction algorithm implemented in our system allows for a continuous coverage of the entire heart volume and cardiac cycle without data gaps down to a heart rate of 50 beats per minute [10].

We performed an axial image series at the mid ventricular level showing the anterior left ventricular papillary muscle in 50-msec steps through the entire cardiac cycle to visually identify the maximal systolic constriction phase and diastolic phase as the images showing the largest and smallest left ventricular cavity area, respectively. The corresponding delay in milliseconds from the R peak of the ECG was used for image reconstruction. Diastolic and systolic axial image sets were then transferred to the scanner's workstation (Volume Wizard; Siemens).

Using the workstation's standard three-dimensional software, we obtained multiplanar reformations according to the long axis and the short axis of the left ventricle. A multiplanar reformation was obtained from the axial images in a long-axis orientation by using a plane parallel to the interventricular septum connecting the left ventricular apex and the middle level of the mitral valve (Fig. 2A). This image was stored for further assessment. Then, the plane for creating multiplanar reformations was tilted perpendicular to the interventricular septum in the axial images. To obtain true short-axis images, the plane for image reformation was additionally adjusted parallel to the plane of the mitral valve in the long-axis view (Fig. 2B). Using this geometry, multiple short-axis multiplanar reformations (12-18 slices) with a section thickness of 6 mm and no gap were produced to encompass the entire left ventricle from base to apex.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —62-year-old man with single-vessel coronary artery disease. Image shows multiplanar reformation generated from multidetector CT (MDCT) data sets from axial images using scanner's standard three-dimensional software. Sagittal plane (Sag, arrows) was tilted parallel to interventricular septum connecting left ventricular apex and middle level of mitral valve according to long-axis orientation of left ventricle. Then, plane for creating multiplanar reformations was tilted perpendicular to interventricular septum in axial images. SA = short-axis image orientation (arrows).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —62-year-old man with single-vessel coronary artery disease. Image shows reformation from MDCT data sets with plane adjusted for image reformation parallel to plane of mitral valve in long-axis view to obtain images according to short-axis (SA, dashed arrows) orientation of left ventricle. AX = axial plane (arrows).

MDCT Data Analysis
Diastolic and systolic left ventricular volumes were calculated using the area—length method based on the long-axis view and by Simpson's method applied to contiguous short-axis reformations.

Area—length-method.—On the long-axis view, endocardial contours were manually traced using standard planimetric software implemented in the workstation. The resulting area (A) and the length (L) from the left ventricular apex to the level of mitral valve (Fig. 2C) were used to calculate the left ventricular volume (V_LA), according to

(1)

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C. —62-year-old man with single-vessel coronary artery disease. Image shows diastolic and systolic left ventricular volumes calculated using area—length method based on long-axis view. Endocardial contours were manually traced using standard planimetric software implemented in workstation. LA = left atrium, LV = left ventricle.

Simpson's method.—Endocardial contours of all short-axis reformations showing the left ventricular cavity were manually traced using planimetric software (Fig. 2D). Papillary muscles were included in the left ventricular cavity. Left ventricular volumes (V_SA) were calculated by adding all measured cross-sectional areas (A_N) multiplied by the intersection thickness S

(2)

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D. —62-year-old man with single-vessel coronary artery disease. Images in end diastolic (D) and end systolic (E) phases of cardiac cycle show volumetric measurements of left ventricle (LV) calculated according to Simpson's method based on short-axis reformations. Endocardial contours of all short-axis reformations showing left ventricular cavity were manually traced using planimetric software; papillary muscles were included in left ventricular cavity. Left ventricular volumes were calculated by adding all measured cross-sectional areas multiplied by intersection thickness.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E. —62-year-old man with single-vessel coronary artery disease. Images in end diastolic (D) and end systolic (E) phases of cardiac cycle show volumetric measurements of left ventricle (LV) calculated according to Simpson's method based on short-axis reformations. Endocardial contours of all short-axis reformations showing left ventricular cavity were manually traced using planimetric software; papillary muscles were included in left ventricular cavity. Left ventricular volumes were calculated by adding all measured cross-sectional areas multiplied by intersection thickness.

(3)

Two radiologists unaware of the results from biplane cineventriculography independently performed MDCT data analysis. Using the MDCT data sets, determination of left ventricular ejection fraction was repeated after an 8-week interval to assess interobserver variability (Var) in 15 randomly chosen cases, according to

(4)

Biplane Cineventriculography
Biplane cineventriculography (5-French pigtail catheter; 36 mL contrast media [iopromide 370 mg I/mL; flow rate, 12 mL/sec]) was performed as a part of a diagnostic coronary angiography 1-3 days after MDCT (Integris BH 3000; Philips, Eindhoven, The Netherlands). Ventriculograms were acquired in standardized 60° left anterior oblique and 30° right anterior oblique projections. A cardiologist who was unaware of the MDCT results used the area—length method to analyze the ventriculograms. Because the catheter angiograms were obtained without a calibration device, an exact determination of systolic and diastolic volumes was not feasible.

Statistical Analysis
The mean left ventricular ejection fraction as assessed from MDCT was compared with that found on biplane cineventriculography using Wilcoxon's signed rank test; a p value of less than 0.05 was considered significant. For linear correlation analysis, the correlation coefficient r was computed using SPSS analysis software (version 9.0; Statistical Package for the Social Sciences, Chicago, IL).

Results

Top Abstract Introduction Materials and Methods Results Discussion References

 
Long-axis and short-axis reformations allowed clear delineation of endocardial and epicardial contours in all cases. Diastolic image reconstructions were without motion artifacts, whereas systolic reformations from patients with heart rates above 65 beats per minute did show motion effects, which resulted in minor stairstep artifacts.

The mean left ventricular ejection fraction determined by cineventriculography was 69.9% ± 12.4%. The left ventricular ejection fraction assessment by MDCT using the area—length method (mean, 60.1% ± 11%) showed a moderate correlation (r = 0.76, p < 0.05; Fig. 3A). The MDCT measurements using Simpson's method (mean, 57.9% ± 11.5%) yielded a slightly better correlation (r = 0.8, p < 0.05; Fig. 3B). A summary of the results is given in Table 1.

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —Plots show left ventricular ejection fraction determined from multidetector CT coronary angiographic data sets in patients with coronary artery disease. Graph shows correlation of results determined from short-axis reformations in comparison with data from biplane cineventriculography (r = 0.80, p < 0.05).

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —Plots show left ventricular ejection fraction determined from multidetector CT coronary angiographic data sets in patients with coronary artery disease. Graph shows correlation of results as assessed from reformations according to long-axis view in comparison with biplane cineventriculography (r = 0.76, p < 0.05).

Using either Simpson's method or the area—length method gave similar results for the left ventricular ejection fraction assessment from MDCT. Measurements using MDCT had a tendency to underestimate the left ventricular ejection fraction obtained with biplane cineventriculography. The mean difference between cineventriculography and MDCT measurements was 11.5% ± 5.7% when we used Simpson's method and 12.4% ± 6.9% when we used the area—length method.

Discussion

Top Abstract Introduction Materials and Methods Results Discussion References

 
Application of mechanical CT to cardiac imaging has long been limited by insufficient temporal resolution because of the slow gantry rotation and the long total acquisition time that result from slow volume coverage with single-slice imaging. Analysis of cardiac function had been possible only in experimental setups and was restricted to a transaxial slice orientation.

Electron beam CT scanners, which provide 50-100 msec temporal resolution, have been successfully used for coronary calcium measurement [11], coronary artery angiography, and acquisition of functional data [12]. These systems are costly and are available only in specialized centers. Prospectively ECG-triggered sequential single-slice image acquisition is vulnerable to sudden changes in heart rate or cardiac rhythm. The fixed setup of an electron beam CT scanner impairs assessment of left ventricular functional parameters in the anatomically true short-axis orientation.

Recently introduced MDCT scanners with subsecond rotation times and dedicated cardiac reconstruction algorithms have shown their capability to perform high-resolution helical CT coronary angiograms. Initial results are promising regarding the detection of significant coronary artery stenosis [9]. Current partial scan reconstruction algorithms reach a temporal resolution of 125-250 msec, depending on the patient's heart rate [10]. MDCT coronary angiography usually uses only data from the diastolic rest phase of the cardiac cycle. Because data from all other heart phases are stored and image reconstruction is performed in a retrospective manner, multiple image series from a single scan can be reconstructed to display images from any cardiac phase after identification of the proper reconstruction interval in relation to the R peak of the recorded ECG [8]. Thin section MDCT angiograms allow for high-resolution secondary reformations in any desired plane. True short-axis and long-axis views can easily be produced, which can then be used to calculate left or right ventricular volumes.

Our results show that functional and temporal information contained in a coronary MDCT study intended for coronary artery imaging can be used to assess left ventricular ejection fraction with an acceptable correlation with data from cineventriculography. Measurements from short-axis reformations using Simpson's method and long-axis reformations using the area—length method produced comparable results. We found a slightly better correlation if Simpson's method was used as opposed to the area—length method. This result could be expected, because short-axis-oriented left ventricular volume measurements should yield more exact results than a volume calculation based on geometric assumptions.

MR imaging studies have shown that short-axis-oriented images result in better reproducibility regarding functional analysis [13, 14]. An interobserver variability of 7.4% for short-axis images (Simpson's method) versus 9.8% by the area—length method for left ventricular ejection fraction was found in our study. These results are in concordance with a reported interobserver variability of 8% for left ventricular ejection fraction by short-axis-oriented MR imaging [5] and 6% interobserver variability for left ventricular volume measurements [6].

One limitation of the current CT technique is its temporal resolution of 125-250 msec, which is inferior to electron beam CT and MR imaging. In contrast to diastolic images, systolic reconstructions in patients with a mean heart rate greater than 65 beats per minute were of lower quality because of motion artifacts. In these patients, manual tracing of endocardial contours may have had a limited accuracy. Further scanner developments will offer increased gantry rotation times, which will directly improve the achievable temporal resolution. New data reconstruction algorithms using segmented data from several heart beats will likely optimize the analysis of cardiac function with CT as well.

Another limitation related to the temporal resolution is the exact definition and depiction of the peak systole or minimal systolic left ventricular volume. Although the duration of the total electromechanical systole is about 0.3 sec, the minimal ventricular volume is maintained only for 80-200 msec. Thus, an obvious discrepancy exists between temporal resolution and cardiac motion, which might result in overestimation of the left ventricular systolic volume and hence underestimation of the left ventricular ejection fraction. This factor might explain the differences between measurements from biplane cineventriculography and those based on MDCT. Further data are required to determine whether this assumption is true and whether regional wall motion abnormalities will be detectable by means of MDCT.

The rather high radiation dose (6-8 mSv) in this study results from the protocol optimized for thin-slice high-resolution imaging of the coronary arteries. If cardiac function evaluation had been the main focus, a considerable reduction of the radiation dose would have been feasible.

Currently, MR imaging is the noninvasive diagnostic standard of reference for determination of left ventricular volumes and ejection fraction and of global and regional myocardial function [5, 6]. Short-axis images are readily available, and time-consuming secondary reformations, as in cardiac MDCT, are not needed. Functional analysis by means of MDCT is further limited by the lack of standardized analysis software, but adaptations of MR imaging or echocardiographic software should soon be available.

Because of the radiation exposure and limited temporal resolution, cardiac MDCT solely for analysis of cardiac function parameters does not appear to be reasonable. The combination of noninvasive coronary artery imaging and assessment of cardiac function with a single breath-hold MDCT study, however, might be an interesting approach to a conclusive cardiac workup in patients with suspected coronary artery disease, especially when standardized automatic (or semiautomatic) analysis software that reduces postprocessing and analysis time becomes available.

References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987;76:44 -51[Abstract/Free Full Text]
2. Gerber TC, Behrenbeck T, Allison T, Mullan BP, Rumberger JA, Gibbons RJ. Comparison of measurement of left ventricular ejection fraction by Tc-99m sestamibi first-pass angiography with electron beam computed tomography in patients with anterior wall acute myocardial infarction. Am J Cardiol 1999;83:1022 -1026[Medline]
3. Lethimonnier F, Furber A, Balzer P, et al. Global left ventricular cardiac function: comparison between magnetic resonance imaging, radionuclide angiography, and contrast angiography. Invest Radiol 1999;34:199 -203[Medline]
4. Woo P, Mao S, Wang S, Detrano RC. Left ventricular size determined by electron beam computed tomography predicts significant coronary artery disease and events. Am J Cardiol 1997;79:1236 -1238[Medline]
5. Pattynama PMT, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A. Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 1993;187:261 -268[Abstract/Free Full Text]
6. Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson 1999;1:7 -21[Medline]
7. Dodge HAT, Sandler H, Ballew DW, Lord JD Jr. The use of biplane angiocardiography for the measurement of left ventricular volume in man. Am Heart J 1960;60:762 -766[Medline]
8. Ohnesorge B, Flohr T, Becker C, et al. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 2000;217:564 -571[Abstract/Free Full Text]
9. Nieman K, Oudkerk M, Rensing BJ, et al. Coronary angiography with multi-slice computed tomography. Lancet 2001;357:599 -603[Medline]
10. Flohr T, Ohnesorge B. Heart rate adaptive optimization of spatial and temporal resolution for electro-cardiogram-gated multislice spiral CT of the heart. J Comput Assist Tomogr 2001;25:907 -923[Medline]
11. Becker CR, Knez A, Ohnesorge B, et al. Visualization and quantification of coronary calcifications with electron beam and spiral computed tomography. Eur Radiol 2000;10:629 -635[Medline]
12. Lipton MJ, Higgins CB, Boyd DP. Computed tomography of the heart: evaluation of anatomy and function. J Am Coll Cardiol 1985;5[suppl 1]:55S -69S
13. Higgins CB, Sakuma H. Heart disease: functional evaluation with MR imaging. Radiology 1996;199:307 -315[Abstract/Free Full Text]
14. Cottin Y, Touzery C, Guy F, et al. MR imaging of the heart in patients after myocardial infarction: effect of increasing intersection gap on measurements of left ventricular volume, ejection fraction, and wall thickness. Radiology 1999;213:513 -520[Abstract/Free Full Text]

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				B. Sundaram, S. Patel, P. Agarwal, and E. A. Kazerooni Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings Am. J. Roentgenol., March 1, 2009; 192(3): 584 - 598. [Abstract] [Full Text] [PDF]

				H DOGAN, W J H VELDKAMP, P DIBBETS-SCHNEIDER, A M SPIJKERBOER, B J A MERTENS, L J M KROFT, A DE ROOS, and J GELEIJNS Effects of heart rate, filling and slice thickness on the accuracy of left ventricular volume measurements in a dynamic cardiac phantom using ECG-gated MDCT Br. J. Radiol., July 1, 2008; 81(967): 577 - 582. [Abstract] [Full Text] [PDF]

				C. Plumhans, G. Muhlenbruch, A. Rapaee, K.-H. Sim, T. Seyfarth, R. W. Gunther, and A. H. Mahnken Assessment of Global Right Ventricular Function on 64-MDCT Compared with MRI Am. J. Roentgenol., May 1, 2008; 190(5): 1358 - 1361. [Abstract] [Full Text] [PDF]

				K. U. Juergens, H. Seifarth, F. Range, S. Wienbeck, M. Wenker, W. Heindel, and R. Fischbach Automated Threshold-Based 3D Segmentation Versus Short-Axis Planimetry for Assessment of Global Left Ventricular Function with Dual-Source MDCT Am. J. Roentgenol., February 1, 2008; 190(2): 308 - 314. [Abstract] [Full Text] [PDF]

				J.-P. Laissy, D. Messika-Zeitoun, J.-M. Serfaty, V. Sebban, E. Schouman-Claeys, B. Iung, and A. Vahanian Comprehensive evaluation of preoperative patients with aortic valve stenosis: usefulness of cardiac multidetector computed tomography Heart, September 1, 2007; 93(9): 1121 - 1125. [Abstract] [Full Text] [PDF]

				A.-C. Pouleur, J.-B. le Polain de Waroux, A. Pasquet, J.-L. J. Vanoverschelde, and B. L. Gerber Aortic Valve Area Assessment: Multidetector CT Compared with Cine MR Imaging and Transthoracic and Transesophageal Echocardiography Radiology, September 1, 2007; 244(3): 745 - 754. [Abstract] [Full Text] [PDF]

				N. R. Bogot, R. Durst, D. Shaham, and D. Admon Cardiac CT of the Transplanted Heart: Indications, Technique, Appearance, and Complications RadioGraphics, September 1, 2007; 27(5): 1297 - 1309. [Abstract] [Full Text] [PDF]

				J. D. Dodd, S. L. Aquino, G. Holmvang, R. C. Cury, U. Hoffmann, T. J. Brady, and S. Abbara Cardiac Septal Aneurysm Mimicking Pseudomass: Appearance on ECG-Gated Cardiac MRI and MDCT Am. J. Roentgenol., June 1, 2007; 188(6): W550 - W553. [Abstract] [Full Text] [PDF]

				D. Delhaye, M. Remy-Jardin, A. Teisseire, C. Hossein-Foucher, S. Leroy, A. Duhamel, and J. Remy MDCT of Right Ventricular Function: Comparison of Right Ventricular Ejection Fraction Estimation and Equilibrium Radionuclide Ventriculography, Part 1. Am. J. Roentgenol., December 1, 2006; 187(6): 1597 - 1604. [Abstract] [Full Text] [PDF]

				M. Remy-Jardin, D. Delhaye, A. Teisseire, C. Hossein-Foucher, A. Duhamel, and J. Remy MDCT of Right Ventricular Function: Impact of Methodologic Approach in Estimation of Right Ventricular Ejection Fraction, Part 2. Am. J. Roentgenol., December 1, 2006; 187(6): 1605 - 1609. [Abstract] [Full Text] [PDF]

				D. Utsunomiya, K. Awai, T. Sakamoto, T. Nishiharu, J. Urata, A. Taniguchi, T. Nakaura, and Y. Yamashita Cardiac 16-MDCT for anatomic and functional analysis: assessment of a biphasic contrast injection protocol. Am. J. Roentgenol., September 1, 2006; 187(3): 638 - 644. [Abstract] [Full Text] [PDF]

				L. Sugeng, V. Mor-Avi, L. Weinert, J. Niel, C. Ebner, R. Steringer-Mascherbauer, F. Schmidt, C. Galuschky, G. Schummers, R. M. Lang, et al. Quantitative Assessment of Left Ventricular Size and Function: Side-by-Side Comparison of Real-Time Three-Dimensional Echocardiography and Computed Tomography With Magnetic Resonance Reference Circulation, August 15, 2006; 114(7): 654 - 661. [Abstract] [Full Text] [PDF]

				L. P. Salm, J. D. Schuijf, A. de Roos, H. J. Lamb, H. W. Vliegen, J. W. Jukema, R. Joemai, E. E. van der Wall, and J. J. Bax Global and regional left ventricular function assessment with 16-detector row CT: Comparison with echocardiography and cardiovascular magnetic resonance Eur J Echocardiogr, August 1, 2006; 7(4): 308 - 314. [Abstract] [Full Text] [PDF]

				K. U. Juergens, H. Seifarth, D. Maintz, M. Grude, M. Ozgun, T. Wichter, W. Heindel, and R. Fischbach MDCT Determination of Volume and Function of the Left Ventricle: Are Short-Axis Image Reformations Necessary? Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S371 - S378. [Abstract] [Full Text] [PDF]

				D. T. Boll, A. S. Bossert, A. J. Aschoff, M. H. Hoffmann, and R. C. Gilkeson Synergy of MDCT and Cine MRI for the Evaluation of Cardiac Motility Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S379 - S386. [Abstract] [Full Text] [PDF]

				M. A.S. Cordeiro and J. A.C. Lima Atherosclerotic plaque characterization by multidetector row computed tomography angiography. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C40 - C47. [Abstract] [Full Text] [PDF]

				K. Sakakura, T. Yasu, Y. Kobayashi, T. Katayama, Y. Sugawara, H. Funayama, Y. Takagi, N. Ikeda, T. Ishida, Y. Tsuruya, et al. Noninvasive Tissue Characterization of Coronary Arterial Plaque by 16-Slice Computed Tomography in Acute Coronary Syndrome Angiology, March 1, 2006; 57(2): 155 - 160. [Abstract] [PDF]

				T. H. Kim, J. Hur, S. J. Kim, H. S. Kim, B. W. Choi, K. O. Choe, Y. W. Yoon, and H. M. Kwon Two-Phase Reconstruction for the Assessment of Left Ventricular Volume and Function Using Retrospective ECG-Gated MDCT: Comparison with Echocardiography Am. J. Roentgenol., August 1, 2005; 185(2): 319 - 325. [Abstract] [Full Text] [PDF]

				A. H. Mahnken, M. Katoh, P. Bruners, E. Spuentrup, J. E. Wildberger, R. W. Gunther, and A. Buecker Acute Myocardial Infarction: Assessment of Left Ventricular Function with 16-Detector Row Spiral CT versus MR Imaging--Study in Pigs Radiology, July 1, 2005; 236(1): 112 - 117. [Abstract] [Full Text] [PDF]

				A. Lembcke, P. M. Dohmen, M. Dewey, C. Klessen, T. Elgeti, K.-G. A. Hermann, W. F. Konertz, B. Hamm, and D. E. Kivelitz Multislice Computed Tomography for Preoperative Evaluation of Right Ventricular Volumes and Function: Comparison With Magnetic Resonance Imaging Ann. Thorac. Surg., April 1, 2005; 79(4): 1344 - 1351. [Abstract] [Full Text] [PDF]

				N. R Mollet, F. Cademartiri, and P. J de Feyter Non-invasive multislice CT coronary imaging Heart, March 1, 2005; 91(3): 401 - 407. [Full Text] [PDF]

				M. Yamamuro, E. Tadamura, S. Kubo, H. Toyoda, T. Nishina, M. Ohba, R. Hosokawa, T. Kimura, N. Tamaki, M. Komeda, et al. Cardiac Functional Analysis with Multi-Detector Row CT and Segmental Reconstruction Algorithm: Comparison with Echocardiography, SPECT, and MR Imaging Radiology, February 1, 2005; 234(2): 381 - 390. [Abstract] [Full Text] [PDF]

				U. J. Schoepf, C. R. Becker, B. M. Ohnesorge, and E. K. Yucel CT of Coronary Artery Disease Radiology, July 1, 2004; 232(1): 18 - 37. [Abstract] [Full Text] [PDF]

				K. U. Juergens, M. Grude, D. Maintz, E. M. Fallenberg, T. Wichter, W. Heindel, and R. Fischbach Multi-Detector Row CT of Left Ventricular Function with Dedicated Analysis Software versus MR Imaging: Initial Experience Radiology, February 1, 2004; 230(2): 403 - 410. [Abstract] [Full Text] [PDF]

				H. K. Pannu, T. G. Flohr, F. M. Corl, and E. K. Fishman Current Concepts in Multi-Detector Row CT Evaluation of the Coronary Arteries: Principles, Techniques, and Anatomy RadioGraphics, October 1, 2003; 23(90001): S111 - 125. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Juergens, K. U. Articles by Fischbach, R. Search for Related Content PubMed PubMed Citation Articles by Juergens, K. U. Articles by Fischbach, R. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?