Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction

AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.

美国放射科住院医师分阶段目标胜任力评价系统解读与思考(五):儿科放射学分阶段目标胜任力评价系统

儿科放射学分阶段目标胜任力评价系统(Pediatric Radiology Milestone Project,PRMP)由美国毕业后医学教育认证委员会(Accreditation Council for Graduate Medical Education,ACGME)与美国放射学会(American Board of Radiology,ABR)联合发布,是放射学住院医师儿科亚专业方向培训考核系统的一部分,该考核评价体系考核并记录放射学住院医师在儿科亚专业方向培训过程中所必须具备的六项胜任力,包括病患关切(Patient Care,PC)、医学知识(Medical Knowledge,MK)、基于系统的实践(Systems-based Practice,SBP)、基于实践的学习(Practice-based Learning,PBL)、职业素养(Professionalism,PROF)以及人际关系和沟通技巧(Interpersonal and Communication Skills,ICS)。考核内容全方位展示了美国放射学住院医师儿科亚专业方向胜任力培训的要点,值得国内住院医师培训机构学习和借鉴,对于完善国内培训机构考核方式及内容具有重要的指导价值。

动脉瘤性蛛网膜下腔出血患者出血后脑血管痉挛的介入治疗

本临床实践标准述及动脉瘤性蛛网膜下腔出血患者出血后脑血管痉挛（post—hemorrhagiccerebralvasospasm,PHCV）的介入治疗。这些结论基于神经介入外科学学会的标准委员会的评估，包括使用由美国心脏协会卒中委员会和牛津大学循证医学中心提出的循证医学指南进行的文献回顾。特别关注现有介入治疗方法的安全性和有效性，包括腔内球囊血管成形术（transluminalballoonangioplasty，TBA）和动脉内血管扩张药物输注治疗（intra-arterialvasodilatorinfusiontherapy，IAVT）。评估结果显示，这些侵袭性介入治疗可能有益，并可考虑用于PHCV，如伴有脑缺血症状和最佳的药物治疗无效的患者的治疗。概括起来，IAVT对累及近端和（或）远端颅内脑循环的PHCV可能有益，而TBA则可能对累及近端颅内脑循环的PHCV有益。评估结果显示，对于上述适应证，根据美国心脏协会指南可将TBA和IAVT归为IIb级推荐和B级证据，根据牛津大学循证医学中心指南则可归为4级推荐和C级证据。

脑动静脉畸形血管造影评估和血管内治疗的报道标准

本指南根据一个致力于中枢神经系统动静脉畸形（arteriovenousmalformation，AVM）患者评估和治疗的多学科专家组共识制定。该报道标准为临床试验设计以及那些希望报道脑AVM血管内治疗的临床研究人员提供了一个样板。不同治疗方案的直接比较对于医疗诊治的标准化、良好治疗转归的最大化以及新方法和新技术的评估至关重要。