Dynamic Four-dimensional Computed Tomography (4D CT) Imaging for Re-entry Risk Assessment in Re-do Sternotomy - First experience

Narayanan, Harish; Viana, Fabiano; Smith, Julian Anderson; Roumeliotis, Nicholas K; Troupis, Christopher J; Crossett, Marcus; Troupis, John

doi:10.1016/j.hlc.2015.02.027

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…Adhesions were confirmed by detecting deformation and tethering of mediastinal structures on cine CT imaging. Dynamic 4D CT imaging is a relatively new technique that assesses differential mobility to identify tethering between sternum and underlying structures during breathing [13]. Image acquisition occurs while patient is spontaneously breathing for two respiratory cycles over few seconds.…”

Section: Discussionmentioning

confidence: 99%

“…Image acquisition occurs while patient is spontaneously breathing for two respiratory cycles over few seconds. Using this modality, Narayanan et al demonstrated excellent correlation with intraoperative findings without false negative cases [13]. Similar to the CMR RTC technique, the 4D CT incorporates cardiac and respiratory motion to determine tethering; however, it involves a significantly higher radiation dose than coronary CT angiogram [13].…”

Section: Discussionmentioning

confidence: 99%

“…Using this modality, Narayanan et al demonstrated excellent correlation with intraoperative findings without false negative cases [13]. Similar to the CMR RTC technique, the 4D CT incorporates cardiac and respiratory motion to determine tethering; however, it involves a significantly higher radiation dose than coronary CT angiogram [13]. CMR has been used to detect and grade the severity of retrosternal adhesions using tagged cine imaging with aid of a finite element model [8].…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy

Zahr

Gooty

Tandon

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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BackgroundInjury to vital structures posterior to the sternum is a complication associated with redo sternotomy in congenital cardiac surgery. The goal of our study was a novel evaluation of real-time cine cardiovascular magnetic resonance (CMR) to predict the presence of significant retrosternal adhesions of cardiac and vascular structures prior to redo sternotomy in patients with congenital heart disease.MethodsTwenty-three patients who had prior congenital heart surgery via median sternotomy had comprehensive CMR studies prior to redo sternotomy. The real time cine (RTC) sequence that was used is an ungated balanced steady-state free precession (bSSFP) sequence using SENSitivity Encoding for acceleration with real-time reconstruction. Spontaneously breathing patients were instructed to take deep breaths during the acquisition whilst increased tidal volumes were delivered to mechanically ventilated patients. All patients underwent redo cardiac surgery subsequently and the presence and severity of retrosternal adhesions were noted at the time of the redo sternotomies.ResultsMedian age at the time of CMR and operation were 5.5 years (range, 0.2–18.4y) and 6.1 years (range, 0.3–18.8y) respectively. There were 15 males and 8 females in the study group. Preoperative retrosternal adhesions were identified on RTC in 13 patients and confirmed in 11 (85%) at the time of surgery. In only 2 patients, no adhesions were identified on CMR but were found to have significant retrosternal adhesions at surgery; false positive rate 15% (CI 0.4–29.6%), false negative rate 20% (CI 3.7–36.4%). The total classification error of the real time cine sequence was 17% (CI 1.7–32.4%) with an overall accuracy of 83% (CI 67.7–98.4%). Standard breath-hold cine images correlated poorly with surgical findings and did not increase the diagnostic yield.ConclusionsRTC imaging can predict the presence of significant retrosternal adhesions and thus help in risk assessment prior to redo sternotomy. These findings complement the surgical planning and potentially reduce surgical complications .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy

Zahr

Gooty

Tandon

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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“…The visualization of cardiac and vascular structure in close proximity to the sternum, particularly with evidence of tethering, can facilitate decisions for use of special precautions for sternotomy or change to a non-sternotomy approach. [13][14][15] In the setting of anomalous coronary arteries, virtual CCTA provides visualization of the origin, course and termination important to identification of high risk coronary anatomy and planning of approaches to intervention. 16,17 Coronary anatomy characterization beyond the luminogram provided by cardiac catheterization provides vascular wall plaque tissue characteristics and architecture of vascular remodeling.…”

Section: Coronary Artery Interventionsmentioning

confidence: 99%

Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation

Shinbane

Saxon

2018

Journal of Cardiovascular Computed Tomography

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Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.

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Divergence-Free Fitting-Based Incompressible Deformation Quantification of Liver

Fan

Liu

et al. 2021

IEEE J. Biomed. Health Inform.

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Dynamic Four-dimensional Computed Tomography (4D CT) Imaging for Re-entry Risk Assessment in Re-do Sternotomy - First experience

Cited by 3 publications

References 15 publications

Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy

Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy

Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation

Divergence-Free Fitting-Based Incompressible Deformation Quantification of Liver

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