Cardiac computed tomography angiography-derived pulmonary vein volumetry as a predictor for atrial fibrillation recurrence after catheter ablation.

Background: There is an increasing evidence that pulmonary vein (PV) enlargement is associated with atrial fibrillation (AF); however, the predictive value of PV enlargement in AF recurrence remains unclear. This study sought to evaluate whether PV volume quantification derived from cardiac computed tomographic angiography (CCTA) could serve as a predictive indicator of the success of the catheter ablation (CA) procedure. Methods: The data of 160 patients diagnosed with AF who underwent both CCTA and CA treatments from January to June 2020 were retrospectively examined; the CCTA was conducted before the CA surgery. The study focused on documenting the PV structure, and the volume of the PV and left atrium (LA). The clinical, CCTA, and echocardiographic predictors of the recurrence and no-recurrence groups were compared. A multivariable logistic regression analysis was performed to adjust for confounders. Receiver operating characteristic (ROC) curves were analyzed to assess the predictive performance of the predictors of AF recurrence. Results: Of the 160 patients [55.6% male, 62.00 (55.25-68.00) years, 23.1% with persistent AF], 45 (28.1%) experienced AF recurrence within a one-year period. Notably, patients with AF recurrence had elevated CHADS2 scores (P=0.020) and increased LA and PV volumes (P<0.05). Patients with persistent AF (n=37) had significantly larger LA volume indexes (P<0.001) than those with paroxysmal AF, but there was no difference between the two groups in terms of the PV maximum volume index (P=0.200). Moreover, the PV maximum volume index [odds ratio (OR): 1.244, 95% confidence interval (CI): 1.008-1.536, P=0.042] and the LA minimum volume index (OR: 1.026, 95% CI: 1.001-1.052, P=0.038) were found to be significant predictors of AF recurrence. The ROC curves revealed that the PV maximum volume index threshold for predicting AF recurrence was 7.13 mL/m2, with a sensitivity of 84.4% and a specificity of 34.8% [area under the curve (AUC): 0.635, 95% CI: 0.540-0.730, P=0.008], and the LA minimum volume index threshold for predicting AF recurrence was 46.16 mL/m2, with a sensitivity of 88.9% and a specificity of 31.3% (AUC: 0.629, 95% CI: 0.534-0.723, P=0.012). A sub-analysis of patients with a lower left atrial dimension (LAD ≤38 mm in females, LAD ≤40 mm in males, n=120) demonstrated that the PV maximum volume index was a noteworthy indicator of AF recurrence (OR: 1.443: 95% CI: 1.145-1.820, P=0.002). Conversely, no significant correlation between AF recurrence and the LA volume index was found. The AUC value for the PV maximum volume index predictive of recurrent AF was 0.680 (95% CI: 0.577-0.781, P=0.003), with a sensitivity of 75.8%, specificity of 54%, and the cut-off value of the maximum AUC was 7.89 mL/m2. Conclusions: PV volume, derived from CCTA, may help to predict the recurrence of AF after CA, and is superior to the LA size in patients with less pronounced LA enlargement.

Quantitative analysis of the relationship between the myocardial bridge and the FAI of pericoronal fat on computed tomography.

We performed this cohort study to investigate whether the myocardial bridge (MB) affects the fat attenuation index (FAI) and to determine the optimal cardiac phase to measure the volume and the FAI of pericoronary adipose tissue (PCAT). The data of 300 patients who were diagnosed with MB of the left anterior descending (LAD) coronary artery were retrospectively analyzed. All of patients were divided into the MB group and the MB with atherosclerosis group. In addition, 104 patients with negative CCTA results were enrolled as the control group. There was no significant difference between FAI values measured in systole and diastole (P > 0.05). There was no significant difference in FAI among the MB group, the MB with atherosclerosis group, and the control group (P > 0.05). In MB with atherosclerosis group, LAD stenosis degree (< 50%) (OR = 0.186, 95% CI 0.036-0.960; P = 0.045) and MB located in the distal part of LAD opening (OR = 0.880, 95% CI 0.789-0.980; P = 0.020) were protective factors of FAI value. A distance (from the LAD opening to the proximal point of the MB) of 29.85 mm had the highest predictive value for abnormal FAI [area under the curve (AUC), 0.798], with a sensitivity of 81.1% and a specificity of 74.6%.

Quantitative computed tomography angiography evaluation of the coronary fractional flow reserve in patients with left anterior descending artery myocardial bridging.

PURPOSE: To quantitatively investigate the effect of myocardial bridge (MB) in the left anterior descending artery (LAD) on the fractional flow reserve (FFR). MATERIALS AND METHODS: Three-hundred patients with LAD MB who had undergone coronary artery CT angiography (CCTA) were retrospectively enroled, and 104 normal patients were enroled as the control. The CCTA-derived fractional flow reserve (FFRCT) was measured at the LAD 10 mm proximal (FFR1) and 20-40 mm distal (FFR3) to the MB and at the MB location (FFR2). RESULTS: FFR2 and FFR3 of the MB (with BM only) and MBLA (with both MB and atherosclerosis) groups were significantly (p < 0.01) lower than those of the control. The FFR3 distal to the MB was significantly lower (p < 0.01) than that of the control. The FFRCT of the whole LAD in the MBLA group was significantly (p < 0.05) lower than that of the MB and control group (p < 0.05). MB length (OR 1.061) and MB muscle index (odds ratio or OR 1.007) were two risk factors for abnormal FFRCT, and MB length was a significant independent risk factor for abnormal FFRCT (OR = 1.077). LAD stenosis degree was a risk factor for abnormal FFRCT values (OR 3.301, 95% confidence interval [CI] 1.441-7.562, p = 0.005) and was also a significant independent risk factor (OR = 3.369, 95% CI: 1.392-8.152; p = 0.007) for abnormal FFRCT. CONCLUSION: MB significantly affects the FFRCT of distal coronary artery. For patients with MB without atherosclerosis, the MB length is a risk factor significantly affecting FFRCT, and for patients with MB accompanied by atherosclerosis, LAD stenotic severity is an independent risk factor for FFRCT.

Markers of right ventricular dysfunction predict 30-day adverse prognosis of pulmonary embolism on pulmonary computed tomographic angiography.

To investigate the value of parameters of the pulmonary artery and right ventricular function in predicting the 30-day poor prognosis of patients with acute pulmonary embolism (APE). The heart rate, respiratory rate, systolic blood pressure, Wells score for APE, history of recent operation or immobilization, history of cancer, respiratory failure, smoking were significantly (P < .05) different among the control, good prognosis, and poor prognosis groups. The maximal short diameter of the right and left ventricle (RVD/LVD) ratio (P < .001) and left pulmonary artery (LPA) (P = .01) were significantly different between the good and poor prognosis groups. Systolic blood pressure (odds ratio [OR]: 0.98, P = .045) and the RVD/LVD ratio (OR: 12.57, P = .02) were significant independent risk factors for poor prognosis. The risk for poor prognosis significantly increased when the RVD/LVD ratio was >1.11 (cutoff value) with the area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.61-0.80, P < .001). LPA (OR: 9.12, P = .01) and RVD/LVD (OR: 4.62, P = .012) were the significant independent risk factors for poor prognosis in the central pulmonary embolism. The LPA of 2.1 cm had the highest predictive value for poor prognosis in the central APE (AUC: 0.68; sensitivity 84.6%; specificity 53.1%). The RVD/LVD ratio and systolic blood pressure are significant risk factors for short-term prognosis in patients with APE. When the LPA is >2.1 cm in the central APE or the RVD/LVD is >1.11, the risk of poor prognosis increases, which can be used as important indicators for predicting the prognosis of patients with APE. Two hundred forty-three APE patients and 61 patients without APE who underwent computed tomographic pulmonary angiography (CTPA) were retrospectively enrolled as the experimental and the control group, respectively. APE patients who were followed up at the 30-day time point were divided into the good prognosis (n = 195) and poor prognosis group (n = 32). The main pulmonary artery (MPA) to the aorta (AO) ratio, maximal diameter of the LPA and right pulmonary artery (RPA), ratio of the RVD/LVD and the height and volume of the pulmonary artery (PAh and PAV, respectively) were analyzed after indexing to the body surface area.

Association of quantitative computed tomography-based right atrial appendage and right atrium parameters with postradiofrequency ablation recurrence of atrial fibrillation.

Background: The significance of the right atrial appendage (RAA) and right atrium (RA) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA) remains uncertain. This retrospective case-control study aimed to quantitatively evaluate the role of morphological parameters of the RAA and RA in the recurrence of AF after RFA based on 256-slice spiral computed tomography (CT). Methods: A total of 297 patients with AF who underwent RFA for the first time between January 1 and October 31, 2020, were enrolled in the study, and they were divided into a nonrecurrence group (n=214) and a recurrence group (n=83). The volume of the RA, RAA and left atrium (LA); height of the RAA; long and short diameter, perimeter, and area of the RAA base; right atrial anteroposterior diameter; tricuspid annulus diameter; crista terminalis thickness; and cavotricuspid isthmus (CVTI) were measured, and the clinical data of patients were collected. Results: (I) Multivariable logistic regression analysis followed by univariable logistic regression analysis showed that the height of the RAA [odds ratio (OR) =1.124; 95% confidence interval (CI): 1.024-1.233; P=0.014], short diameter of the RAA base (OR =1.247; 95% CI: 1.118-1.391; P=0.001), crista terminalis thickness (OR =1.594; 95% CI: 1.052-2.415; P=0.028) and duration of AF (OR =1.009; 95% CI: 1.003-1.016; P=0.006) were independent predictors of postradiofrequency ablation AF recurrence. (II) Receiver operating characteristic (ROC) curve analysis showed that the prediction model constructed according to the multivariate logistic regression analysis presented good accuracy [area under the curve (AUC) =0.840; P=0.001]. A short diameter of the RAA base >26.95 mm had the highest predictive value for AF recurrence, with a sensitivity of 0.614 and a specificity of 0.822 (AUC =0.786, P=0.001). Pearson correlation analysis showed that there was a significant correlation between right atrial volume and left atrial volume (r=0.720, P<0.001). Conclusions: A significant increase in diameter and volume of the RAA and RA and tricuspid annulus diameter may correlate with postradiofrequency ablation AF recurrence. The height of the RAA, short diameter of the RAA base, crista terminalis thickness, and AF duration were independent predictors of recurrence. Among them, the short diameter of the RAA base had the highest predictive value for recurrence.

Association of pericoronary adipose tissue with atrial fibrillation recurrence after ablation based on computed tomographic angiography.

PURPOSE: Quantitative measurement of pericoronary adipose tissue volume (PCATV) and fat attenuation index (FAI) has mostly been used in the study of coronary artery related diseases but rarely in the relationship with atrial fibrillation (AF). This study was conducted to investigate the correlation of PCATV and FAI with the AF recurrence after ablation and the clinical significance. MATERIALS AND METHODS: Patients with continuous AF who underwent radiofrequency ablation and computed tomographic angiography (CTA) were retrospectively enrolled. The PCATV, FAI, epicardial adipose tissue volume (EATV) and EAT density (EATD) arround the three main branches of the coronary arteries (LAD, LCX, and RCA) were measured quantitatively with cardiac function software and analyzed. RESULTS: 189 patients with continuous AF who underwent radiofrequency ablation for the first time were enrolled. After 12-month follow-up with a mean follow-up time of 10.93 ± 0.16 months, 47 (24.9%) patients were confirmed to have AF recurrence. The 3 V-FAI (- 81.17 ± 4.27 vs. - 83.31 ± 4.59 HU, P = 0.005), LCX-FAI (median - 77 vs. median - 81HU, P < 0.001), EATV (median 141.14vs. median 125.39 ml, P = 0.010), and EATVI (median 70.77 vs. 66.73 ml/m2, P = 0.008) were significantly increased in the recurrence group. EATVI (OR 1.043, 95% CI 1.020-1.066) and LCX-FAI (OR 1.254, 95% CI 1.145-1.374) were two significant independent risk factors for AF recurrence. In the comparison of ROC, the predictive value of LCX-FAI (cut-off value of >- 81.5 HU, area under the curve (AUC) of 0.722) was higher than that of EATVI (cut-off value > 81.07 ml/m2, AUC of 0.630). CONCLUSION: EATVI and LCX-FAI were related to recurrence of AF after ablation and have important clinical value in predicting the AF recurrence.

Three-Tesla magnetic resonance imaging of left ventricular volume and function in comparison with computed tomography and echocardiography.

This study investigated the correlation between 3-Tesla magnetic resonance imaging (MRI) and 256 multiple-slice computed tomography (MSCT) or 2-dimensional echocardiography (ECHO) in evaluating left ventricle. Forty patients were retrospectively enrolled to undergo cardiac MSCT, 3-Tesla MRI and 2-dimensional ECHO within 1 week. The end-diastolic (EDV) and end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were analyzed and compared. MSCT was highly significantly correlated with MRI. Compared with MRI, MSCT slightly overestimated ESV for about 8.7 mL, but slightly underestimated EF and SV for about 6.8% and 5.8 mL, respectively. A high consistency existed between MSCT and MRI, with the 95% limit of agreement (-19.6, 25.4) mL for EDV, (-2.6,20.1) mL for ESV, (-28.3,16.6) mL for SV, and (-18.8%,5.1) % for EF. ECHO was also significantly correlated with MRI. The ECHO slightly underestimated the left ventricular function compared with MRI, with an underestimation of 9.4 mL for EDV, 3.5 mL for ESV, 5.8 mL for SV and 1.0% for EF. A wider agreement limit existed between MRI and ECHO. MSCT has a better correlation and agreement relationship with MRI parameters than 2-dimensional ECHO in assessing the left ventricle and may serve as a possible alternative to MRI.

Left atrial appendage filling defects restricted to the early phase of cardiac computed tomography is significantly associated with ischemic stroke.

PURPOSE: To investigate the relationship between filling defects in the left atrial appendage restricted to the early phase of cardiac computed tomography (CCT), and ischemic stroke in patients with atrial fibrillation (AF). MATERIALS AND METHODS: A total of 152 patients with non-valvular AF were retrospectively enrolled and divided into two groups according to the stroke history, as confirmed by brain computed tomography (CT) or magnetic resonance imaging (MRI), as the non-stroke group (n = 89) and stroke group (n = 63), respectively. The numbers of patients with filling defects in the early phase of CCT images without thrombi were recorded. Morphological parameters of the LAA were measured for all participants. All patients with early-phase filling defects (n = 44) were assigned to two groups according to ischemic stroke history: the filling defects with stroke group (n = 28) and the filling defects without stroke group (n = 16). The clinical characteristics and LAA morphological parameters were compared. RESULTS: Univariate analysis showed that compared with the non-stroke group，LAA volume index and age were higher in the stroke group, and the ratio of early phase filling defect in LAA, hypertension and diabetes were also higher, in the meanwhile the LVEF and BMI were lower (P < 0.05).After adjusting confounding factors by the multivariate logistic regression analysis, filling defect was significantly related with stroke [odds ratio (OR): 4.339, 95% confidence interval (CI): 1.951-9.653, P = 0.000]. LAA morphological parameters were not significantly different between the filling defects with stroke group and the group without stroke. CONCLUSION: AF patients with LAA non-thrombotic filling defects in the early-phase of CCT had an increased risk of ischemic stroke compared to those without filling defects. This finding may help to optimize stroke risk stratification in patients with AF.

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study.

Background: The significance of left atrial appendage (LAA) filling defects on early-phase cardiac computed tomography (CCT) remains uncertain. This study retrospectively investigated predictive factors of LAA filling defects on early-phase CCT. Methods: A total of 68 patients with nonvalvular atrial fibrillation (AF) and early filling defect on CCT who underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were enrolled [48 males, 20 females; mean ± standard deviation (SD) age 62.72±8.13 years]. Additionally 68 sex- and age-matched patients with normal LAA filling were included as the control group. CCT, ultrasound, clinical and laboratory data were analyzed. Baseline data between groups were analyzed using t-, Mann-Whitney, and chi-squared tests. Multivariable logistic regression analysis was used to adjust for confounders. Pearson correlation analysis was used to confirm correlations between variables. Results: Decreased LAA flow velocity [LAAFV; odds ratio (OR) =0.918; 95% confidence interval (CI): 0.883-0.954; P<0.001] and increased left atrial volume index (LAVI; OR =1.055; 95% CI: 1.012-1.099; P=0.011) were significantly associated with early-phase CCT LAA filling defects. The LAAFV threshold for predicting early LAA filling defects was 40.5 cm/s, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.905 (sensitivity 82.4%, specificity 91.2%); the LAVI predictive threshold was 58.77 mL/m2 (AUC =0.840, sensitivity 85.3%, specificity 72.1%). A significant positive correlation was detected between LAAFV and the Hounsfield unit (HU) ratio of the LAA to ascending aorta on early-phase CCT (r=0.614; P<0.001), as well as the HU difference in LAA between early and delayed phase CCT (r=0.591; P<0.001). There were significant (P<0.05) differences in LAAFV between different filling defects. Conclusions: Decreased LAAFV and increased LAVI are independent factors associated with LAA filling defects only on early-phase CCT. Early-phase CCT LAA filling defect is associated with LAA emptying dysfunction. These findings contribute to thrombosis risk stratification in patients with AF.

Morphological changes in the orifices of the left atrial appendage and left atrium in patients with atrial fibrillation.

Background: As an integral part of the left atrium (LA), the left atrial appendage (LAA) plays an important role in atrial fibrillation (AF). However, the relationship between LAA remodeling and AF has not been clearly defined. This retrospective case-control study aimed to assess the morphological and functional features of the LA and the LAA in AF patients using images obtained by computed tomography angiography (CTA). Methods: A total of 140 AF patients and 64 patients without AF or other cardiovascular diseases who underwent CTA scans between September 2016 and August 2017 were enrolled in this observational study as the experimental and the control groups, respectively. The major and minor axes, area, and perimeter of the LAA orifice, the LAA depth, and the volume of both the LAA and LA were analyzed. The data of the AF group and the control group were compared. The t-test was used to analyze the normally distributed data, and the Wilcoxon rank-sum test was used for abnormally distributed data. The best critical value of predictors of AF was calculated using receiver operating characteristic (ROC) curve analysis. The correlation of the LAA volume change with the major and minor axes, area, and perimeter of the LAA orifice, and the LAA depth were analyzed using the Pearson correlation coefficient. Results: The LAA orifice's minor axis, LAA volume, and LA volume were significantly greater (P=0.004, P=0.010, and P<0.001, respectively) in patients with AF than in those without AF. The LAA volume [95% confidence interval (CI): 1.01 to 1.30; P=0.038] and LA volume (95% CI: 1.03 to 1.07; P<0.001) were significantly independent predictors of AF. An LAA volume of 8.75 mL had the highest predictive value for AF [area under the curve (AUC), 0.612], with a sensitivity of 76.6% and a specificity of 48.6%. In contrast, an LA volume of 97.15 mL had the highest predictive value for AF (AUC, 0.771), with a sensitivity of 90.6% and a specificity of 53.6%. The change of LAA volume was positively weakly correlated with the area and perimeter of the LAA orifice (r=0.1703 and r=0.1378, respectively). The LAA emptying fraction was negatively correlated with the major axis and the area of the LAA orifice. The major and minor axes, area, and perimeter of the LAA orifice, and LAA depth were significantly greater in female than in male patients (P=0.003, P=0.003, P=0.001, P=0.019, and P<0.001, respectively). Conclusions: The AF patients had a longer minor axis of the LAA orifice than that of the control group, resulting in a more circular LAA orifice. The LAA orifice area and perimeter were positively correlated with LAA volume change. The LAA orifice major and minor axes, area, and perimeter, and the LAA depth of the female patients were significantly greater than those of their male counterparts in AF patients.

Retrospective Analysis of the Value of Enhanced CT Radiomics Analysis in the Differential Diagnosis Between Pancreatic Cancer and Chronic Pancreatitis.

PURPOSE: To investigate the feasibility of enhanced computed tomography (CT) radiomics analysis to differentiate between pancreatic cancer (PC) and chronic pancreatitis. METHODS AND MATERIALS: The CT images of 151 PCs and 24 chronic pancreatitis were retrospectively analyzed in the three-dimensional regions of interest on arterial phase (AP) and venous phase (VP) and segmented by MITK software. A multivariable logistic regression model was established based on the selected radiomics features. The radiomics score was calculated, and the nomogram was established. The discrimination of each model was analyzed by the receiver operating characteristic curve (ROC). Decision curve analysis (DCA) was used to evaluate clinical utility. The precision recall curve (PRC) was used to evaluate whether the model is affected by data imbalance. The Delong test was adopted to compare the diagnostic efficiency of each model. RESULTS: Significant differences were observed in the distribution of gender (P = 0.034), carbohydrate antigen 19-9 (P < 0.001), and carcinoembryonic antigen (P < 0.001) in patients with PC and chronic pancreatitis. The area under the ROC curve (AUC) value of AP multivariate regression model, VP multivariate regression model, AP combined with VP features model (Radiomics), clinical feature model, and radiomics combined with clinical feature model (COMB) was 0.905, 0.941, 0.941, 0.822, and 0.980, respectively. The sensitivity and specificity of the COMB model were 0.947 and 0.917, respectively. The results of DCA showed that the COMB model exhibited net clinical benefits and PRC shows that COMB model have good precision and recall (sensitivity). CONCLUSION: The COMB model could be a potential tool to distinguish PC from chronic pancreatitis and aid in clinical decisions.

Detection of Early Vascular Atherosclerosis in Type 2 Diabetes Mellitus Using Ultrasound Radiofrequency-Data Technique.

OBJECTIVES: To quantitatively evaluate changes in vascular elasticity and intima-media thickness (IMT) of the common carotid artery (CCA) with Ultrasound radiofrequency (RF)-data technology in asymptomatic patients with type-2 diabetes mellitus (T2DM) and controls. MATERIALS AND METHODS: Thirty-seven T2DM patients and 39 controls were enrolled. Arterial elasticity and CCA-IMT were quantitatively assessed by RF-data technology. The CCA diameters in the diastolic and systolic phases, carotid distensibility (CD), IMT, values of stiffness (ß) and local pulse wave velocity (PWVß) were measured and compared between the two groups. RESULTS: The T2DM group had significantly larger CCA diastolic and systolic diameter, lower CD values, higher IMT measurements (all p < 0.001), and higher values of ß and PWVß (all P < 0.05) than the controls. Significant differences were not revealed in the mean values of IMT, ß, PWVß and CD across both sides of the CCA (all P > 0.05). CONCLUSIONS: Higher IMT measurement and lower arterial elasticity of the CCA are significantly pronounced in asymptomatic T2DM patients and may suggest atherosclerotic changes, and the ultrasound RF-data technique may be used as a potential approach for detection of early-stage atherosclerosis.

Morphological and functional parameters of left atrial appendage play a greater role in atrial fibrillation relapse after radiofrequency ablation.

This study was to quantitatively investigate the role of morphological and functional parameters of the left atrium (LA) and left atrial appendage (LAA) with 256-slice spiral computed tomography (CT) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA). Eighty-three patients with AF who underwent RFA for the first time were divided into the recurrence (n = 27) and non-recurrence (n = 56) groups. All patients underwent a 256-slice spiral CT examination before the operation. The clinical data and quantitative measurement of the morphology and functional parameters of the LA and LAA were analyzed, including the maximal and minimal volume, ejection fraction and volume, and volume strain of LAA and LA (LAAVmax, LAAVmin, LAAEF, LAAEV, and LAA-VS, LAVmax, LAVmin, LAEF, LAEV and LA-VS, respectively). The CHA2DS2-VASc score and the proportion of patients with heart failure were significantly (P < 0.05) higher in the recurrence than non-recurrence group. The LAAVmax, LAAVmin, LAVmax, LAVmin, LAAV and LAV were all significantly greater in the recurrence than non-recurrence group (P < 0.05), and the perimeter, major and minor axes of LAA orifice and LAA depth were also significantly greater in the recurrence than non-recurrence group. The LAAEF, LAEF and LAA-VS were significantly (P < 0.05) lower in the recurrence than non-recurrence group (P < 0.05). Heart failure, CHA2DS2-VASC score, LAEF, LAV, LAAEF and LAA-VS were univariately significant (P < 0.05) risk factors for AF recurrence after ablation. Multivariate analysis revealed LAAEF (HR: 0.790, 95% CI: 0.657-0.950, P = 0.012) and LAAV (HR: 1.160, 95% CI: 1.095-1.229, P <0.001) to be two significant independent predictors of recurrence. ROC curve analysis showed that LAAEF <44.68% had the highest predictive value for recurrence after radiofrequency ablation, with the sensitivity of 90% and specificity of 67.4%, whereas LAA volume >9.25 ml had the highest predictive value for AF recurrence after RFA, with the sensitivity of 85.2% and specificity of 67.9%. In conclusion, the volume of left atrium, volume and morphology of left atrial appendage have all significantly increased while the ejection fraction and volume strain of left atrium and left atrial appendage have both significantly decreased in recurrence than in non-recurrence after radiofrequency ablation. The ejection fraction and volume of left atrial appendage are significant independent predictors of atrial fibrillation recurrence after radiofrequency ablation.

Optimal Monochromatic Imaging of Spectral Computed Tomography Potentially Improves the Quality of Hepatic Vascular Imaging.

Objective: To investigate the efficiency of spectral computed tomography (CT) optimal monochromatic images in improving imaging quality of liver vessels. Materials and Methods: The imaging data of 35 patients with abdominal CT angiography were retrospectively analyzed. Hepatic arteries, portal veins, and hepatic veins were reconstructed with mixed energy (quality check, QC), 70 keV and optimal monochromatic mode. Comparative parameters were analyzed including CT value, image noise (IN), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and subjective qualitative analysis. Results: The optimal monochromatic value for assessment of the common hepatic artery, portal vein, and hepatic vein ranged between 49 keV and 53 keV, with a mean of 51 keV. There were statistically significant differences (p < 0.001) among the optimal monochromatic, 70 keV and QC images with regards to the hepatic vascular CT value, IN, CNR, SNR, and subjective qualitative score. CNR of the common hepatic artery in the optimal monochromatic, 70 keV and QC groups was 24.6 ± 10.9, 18.1 ± 8.3, and 11.6 ± 4.6, respectively (p < 0.001) with subjective scores of 4.7 ± 0.2, 4.0 ± 0.3, and 3.6 ± 0.4, respectively (p < 0.001). CNR of the hepatic portal vein was 6.9 ± 2.7, 4.3 ± 1.9, and 3.0 ± 2.1, respectively (p < 0.001) with subjective scores of 4.5 ± 0.3, 3.9 ± 0.4, and 3.3 ± 0.3, respectively (p < 0.001). CNR of the hepatic vein was 5.7 ± 2.3, 4.2 ± 1.9, and 2.7 ± 1.4, respectively with subjective scores of 4.3 ± 0.3, 3.8 ± 0.4, and 3.2 ± 0.3, respectively (p < 0.001). Conclusion: Optimal monochromatic images can lead to improvement in the imaging parameters and optimization of the image quality of the common hepatic artery, hepatic portal vein and hepatic vein compared with conventional mixed kV and with 70 keV datasets.

Automatic spectral imaging protocol selection combined with iterative reconstruction can enhance image quality and decrease radiation and contrast dosage in abdominal CT angiography.

PURPOSE: To investigate the effect of automatic spectral imaging protocol selection (ASIS) and adaptive statistical iterative reconstruction (ASIR) technology in reducing radiation and contrast dosage. METHODS: Sixty-four patients were randomly divided into two groups for abdominal computed tomography (CT): the experiment group with ASIS plus 50% ASIR and the control with 120 kVp voltage. RESULTS: The CT dose-index volume decreased by 23.68 and 23.57% and the dose-length product dropped by 25.59 and 18.45% in the arterial and portal venous phases, respectively, in the experiment than control group. The contrast dose was reduced by 16.86% in the experiment group. In the 55 keV + 50% ASIR group, the arterial contrast-to-noise ratio and scores were significantly (P < 0.05) higher than in the control group in the arterial phase while the portal contrast-to-noise ratio and scores were not significantly different between the two groups (P > 0.05). CONCLUSION: The ASIS technique plus 50% ASIR can enhance image quality of the abdominal structures while decreasing the radiation and contrast dosage compared with the conventional scan mode.

Quantitative analysis of the right auricle with 256-slice computed tomography.

PURPOSE: To quantitatively measure the morphology parameters of the right auricle with 256-slice multidetector computed tomography angiography (MDCTA) in healthy people. MATERIALS AND METHODS: A retrospective analysis of 200 patients who had undergone coronary MDCTA with negative findings was performed. The raw imaging data were reconstructed and the right auricular volume, right atrial volume, right auricle height, base long and short axes, base perimeter and area, normal angle, and distance were quantitatively measured. RESULTS: Men had significantly (P < 0.05) greater values than women in the right auricular volume (13.3 ± 4.0 vs. 11.7 ± 3.7 mL) and height (33.0 ± 5.0 vs. 30.5 ± 5.2 mm), the base long axis (34.4 ± 4.1 vs. 33.2 ± 3.9 mm), area (787.6 ± 177.6 vs. 771.0 ± 143.2 mm2) and perimeter (119.2 ± 17.5 vs. 115.0 ± 13.0), and the normal distance (22.4 ± 6.6 vs. 20.2 ± 6.7 mm). The normal 95 % reference range for the right auricular parameters was put forward. The right auricular parameters had a good correlation with the right atrium volume, aortic diameter, the body weight, height, and body surface area but a bad correlation with the vertebral body height. Significantly (P < 0.05) greater values were found in the normal angle and distance in subjects below than over 40 years of age. No other significant (P > 0.05) difference existed in the other right auricular parameters. CONCLUSION: Quantitative measurements of the right auricle can help us get a good understanding of the right auricular morphology and its relationship with surrounding structures and are helpful for cardiac interventions of electrophysiology and radiofrequency ablation.

Morphologic classification of the right auricule on 256-slice computed tomography.

PURPOSE: To investigate the shape of right auricule on 256-slice computed tomography (CT). MATERIALS AND METHODS: Five hundred people (250 men, age range 16-84 years) who had cardiac multidetector CT angiography were recruited in this study. All patients had normal sinus rhythm with normal blood pressure (<140/90 mmHg for systolic/diastolic pressure). The morphology of the right auricule was studied and compared after reconstruction of the raw images. RESULTS: All patients successfully had cardiac CT angiography (100%), and the right auricule morphology was divided into five types and nine subtypes, including Type I of triangular shape (Ia and Ib), Type II of M shape (IIa and IIb), Type III of L shape (IIIa and IIIb), Type IV of reverse L shape (IVa and IVb), and Type V of balanced shape. The most common type of right auricule is Type IV (28.4%) followed by Type II (24.0%), whereas the least common is Type V (11.0%). Type Ia was present significantly (P < 0.0001) more frequently in females than in males, whereas Type IIa significantly (P = 0.042) more frequently in males than females. No other significant (P > 0.05) sex difference existed in the constitution ratio of the types. The normal angle was greater in Type Ib than in Ia. The greater the normal angle in Type I, the greater the deviation of the right auricule tip towards the left. CONCLUSION: A good understanding of the right auricule anatomical morphology can better guide atrial pacing, radiofrequency ablation and other surgical procedures while preventing possible intra-procedural complications.

Evaluation of left gastric vein in Chinese healthy adults with multi-detector computed tomography.

OBJECTIVES: To evaluate the classification and diameter of left gastric vein (LGV) in healthy Chinese adults with multi-detector computed tomography (MDCT). METHODS: MDCT angiography was performed in 234 healthy adults for the portal venous system. CT cross-sectional thin-layer reconstruction combined with maximum intensity projection, volume rendering and multiplanar reconstruction were applied. The diameter of LGV was measured at the point within 2 cm from LGV origination. RESULTS: Of 234 subjects, 11 subjects (4.70%) who did not have clear images were excluded, and 223 subjects (95.30%) with excellent images were included. The LGV was originated from the portal vein in 46.15%, splenic vein in 30.77%, portal splenic angle in 14.53%, and the left branch of the portal vein in 3.85%. The maximal diameter of LGV was 4.74 ± 0.84 mm with a 95% confidence interval of 4.63-4.85 mm, and the LGV diameter was positively correlated with the weight of patients (R = 0.26, P = 0.006). No significant difference existed in the maximal diameter of LGV at different origination sites (P = 0.35). The diameter of LGV was significantly greater in males than in females (4.90 ± 0.85 vs. 4.56 ± 0.80 mm, P = 0.002), and the maximal diameter of LGV was significantly (P = 0.02) greater in the age range of 30-39 and 40-49 years than in the range of >70 years. No statistical significance (P = 0.36) was detected in the other groups. CONCLUSION: MDCT can clearly display the detailed anatomy and variation of LGV in healthy adults, providing a normal range of LGV diameter for clinical reference for diagnosing possible portal hypertension and for possible intervention.

Quantitative evaluation of left ventricular volume and function in middle-aged healthy chinese people with 3 Tesla MRI.

PURPOSE: To quantitatively investigate left ventricular volume and function in middle-aged healthy subjects. MATERIALS AND METHODS: Ninety healthy volunteers underwent cardiac 3 Tesla MRI. The left ventricular end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), myocardial mass (MM), and their normalized indices (EDVI, ESVI, SVI, CI, and MI, respectively) after corrected with the body surface area (BSA) were analyzed and compared at different ages. RESULTS: All subjects had successfully completed the 3-Tesla cardiac MR. Females had significantly smaller EDV (110.5 ± 9.2 versus 125.7 ± 8.3 mL), ESV (36.1 ± 3.5 versus 41.5 ± 3.8 mL), SV (74.3 ± 6.3 versus 84.2 ± 6.7 mL), CO (5.4 ± 0.8 versus 5.8 ± 0.9 l/min) and MM (73.0 ± 10.5 versus 94.8 ± 10.6 g) than males (P < 0.05). The EF had no significant (P = 0.47) difference between genders (67.3 ± 1.7 percent in females versus 66.9 ± 2.4 percent in males). After normalization with BSA, no significant (P > 0.05) difference was detected between the genders in EDVI (71.2 ± 4.3 versus 71.1 ± 4.2 mL/m2 , P = 0.882), ESVI (23.3 ± 1.9 versus 23.5 ± 1.9 mL/m2 , P = 0.733) and SVI (47.9 ± 2.9 versus 47.7 ± 3.7 mL/m2 , P = 0.698) except for CI and MI. Females had significantly (P < 0.05) greater CI (3.5 ± 0.4 versus 3.3 ± 0.4) but smaller MI (46.9 ± 5.3 versus 53.6 ± 7.6) than males. EDV, EDVI, ESV, ESVI, SV, and SVI significantly (P < 0.05) decreased with age increase. BSA was positively correlated with EDV, ESV, SV, MM, and CO. No significance (P > 0.05) was detected in other parameters. CONCLUSION: The left ventricular volume and function differs in women compared with men in the middle-aged population, and these parameters have a tendency of decrease with ageing. J. Magn. Reson. Imaging 2016;44:1143-1150.

Quantitative Evaluation of the Substantially Variable Morphology and Function of the Left Atrial Appendage and Its Relation with Adjacent Structures.

OBJECTIVE: To investigate quantitatively the morphology, anatomy and function of the left atrial appendage (LAA) and its relation with adjacent structures. MATERIALS AND METHODS: A total of 860 patients (533 men, 62.0%, age 55.9±10.4 year) who had cardiac multidetector computed tomography angiography from May to October 2012 were enrolled for analysis. RESULTS: Seven types and 6 subtypes of LAA morphology were found with Type 2 being the most prevalent. Type 5 was more significantly (P<0.05) present in women (8.0%) than in men (4.2%). LAA orifice was oval in 81.5%, triangular in 7.3%, semicircular in 4%, water drop-like in 3.2%, round in 2.4% and foot-like in 1.6%. The LAA orifice had a significantly greater (P<0.01) major axis in men (24.79±3.81) than in women (22.68±4.07). The LAA orifice long axis was significantly (P<0.05) positively correlated with the height, weight and surface area of the patient. The LAA morphology parameters displayed strong positive correlation with the left atrium volume, aortic cross area long axis or LSPV long axis but poor correlation with the height, weight, surface area and vertebral body height of the patients. Four types of LAA ridge were identified: AI, AII, B and C with the distribution of 17.6%, 69.9%, 5.9% and 6.6%, respectively. The LAA had a significantly (P<0.05) greater distance from its orifice to the mitral ring in women than in men. The LAA had two filling and two emptying processes with the greatest volume at 45% phase but the least volume at 5% phase. The LAA maximal, minimal and emptying volumes were all significantly (P<0.05) positively correlated with the body height, weight and surface area, whereas the LAA ejection fraction had an inverse correlation with the LAA minimal volume but no correlation with the maximal volume. CONCLUSION: The LAA has substantially variable morphologies and relation with the adjacent structures, which may be helpful in guiding the LAA trans-catheter occlusion or catheter ablation procedures.