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Engvall, Jan
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Publications (10 of 129) Show all publications
Bustamante, M., Gupta, V., Forsberg, D., Carlhäll, C., Engvall, J. & Ebbers, T. (2018). Automated multi-atlas segmentation of cardiac 4D flow MRI. Medical Image Analysis, 49, 128-140
Open this publication in new window or tab >>Automated multi-atlas segmentation of cardiac 4D flow MRI
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2018 (English)In: Medical Image Analysis, ISSN 1361-8415, E-ISSN 1361-8423, Vol. 49, p. 128-140Article in journal (Refereed) Published
Abstract [en]

Four-dimensional (4D) flow magnetic resonance imaging (4D Flow MRI) enables acquisition of time-resolved three-directional velocity data in the entire heart and all major thoracic vessels. The segmentation of these tissues is typically performed using semi-automatic methods. Some of which primarily rely on the velocity data and result in a segmentation of the vessels only during the systolic phases. Other methods, mostly applied on the heart, rely on separately acquired balanced Steady State Free Precession (b-SSFP) MR images, after which the segmentations are superimposed on the 4D Flow MRI. While b-SSFP images typically cover the whole cardiac cycle and have good contrast, they suffer from a number of problems, such as large slice thickness, limited coverage of the cardiac anatomy, and being prone to displacement errors caused by respiratory motion. To address these limitations we propose a multi-atlas segmentation method, which relies only on 4D Flow MRI data, to automatically generate four-dimensional segmentations that include the entire thoracic cardiovascular system present in these datasets. The approach was evaluated on 4D Flow MR datasets from a cohort of 27 healthy volunteers and 83 patients with mildly impaired systolic left-ventricular function. Comparison of manual and automatic segmentations of the cardiac chambers at end-systolic and end-diastolic timeframes showed agreements comparable to those previously reported for automatic segmentation methods of b-SSFP MR images. Furthermore, automatic segmentation of the entire thoracic cardiovascular system improves visualization of 4D Flow MRI and facilitates computation of hemodynamic parameters.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
4D Flow MRI, Cardiac segmentation, Multi-atlas segmentation, Heart, Magnetic resonance imaging, Automatic segmentations, Directional velocities, Hemodynamic parameters, Left ventricular function, Segmentation methods, Semiautomatic methods, Steady state free precessions, Image segmentation, adult, anatomy, article, cohort analysis, controlled study, error, female, heart cycle, heart left ventricle function, human, human tissue, major clinical study, male, motion, nuclear magnetic resonance imaging, steady state, thickness, volunteer
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-150788 (URN)10.1016/j.media.2018.08.003 (DOI)000446286600011 ()30144652 (PubMedID)2-s2.0-85051830661 (Scopus ID)
Note

Funding details: 310612; Funding details: FP7, Seventh Framework Programme; Funding details: 621-2014-6191, VR, Vetenskapsrådet; Funding details: 223615; Funding details: 20140398; Funding text: This work was partially funded by the FP7-funded project DOPPLER-CIP [grant number 223615]; the European Union’s Seventh Framework Programme ( FP7/2007-2013 ) [grant number 310612 ]; the Swedish Research Council [grant number 621-2014-6191 ]; and the Swedish Heart and Lung Foundation [grant number 20140398 ]. 

Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-10-17Bibliographically approved
Gupta, V., Lantz, J., Henriksson, L., Engvall, J., Karlsson, M., Persson, A. & Ebbers, T. (2018). Automated three-dimensional tracking of the left ventricular myocardium in time-resolved and dose-modulated cardiac CT images using deformable image registration. Journal of Cardiovascular Computed Tomography, 12(2), 139-148
Open this publication in new window or tab >>Automated three-dimensional tracking of the left ventricular myocardium in time-resolved and dose-modulated cardiac CT images using deformable image registration
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2018 (English)In: Journal of Cardiovascular Computed Tomography, ISSN 1934-5925, Vol. 12, no 2, p. 139-148Article in journal (Refereed) Published
Abstract [en]

Background Assessment of myocardial deformation from time-resolved cardiac computed tomography (4D CT) would augment the already available functional information from such an examination without incurring any additional costs. A deformable image registration (DIR) based approach is proposed to allow fast and automatic myocardial tracking in clinical 4D CT images.

Methods Left ventricular myocardial tissue displacement through a cardiac cycle was tracked using a B-spline transformation based DIR. Gradient of such displacements allowed Lagrangian strain estimation with respect to end-diastole in clinical 4D CT data from ten subjects with suspected coronary artery disease. Dice similarity coefficient (DSC), point-to-curve error (PTC), and tracking error were used to assess the tracking accuracy. Wilcoxon signed rank test provided significance of tracking errors. Topology preservation was verified using Jacobian of the deformation. Reliability of estimated strains and torsion (normalized twist angle) was tested in subjects with normal function by comparing them with normal strain in the literature.

Results Comparison with manual tracking showed high accuracy (DSC: 0.99± 0.05; PTC: 0.56mm± 0.47 mm) and resulted in determinant(Jacobian) > 0 for all subjects, indicating preservation of topology. Average radial (0.13 mm), angular (0.64) and longitudinal (0.10 mm) tracking errors for the entire cohort were not significant (p > 0.9). For patients with normal function, average strain [circumferential, radial, longitudinal] and peak torsion estimates were: [-23.5%, 31.1%, −17.2%] and 7.22°, respectively. These estimates were in conformity with the reported normal ranges in the existing literature.

Conclusions Accurate wall deformation tracking and subsequent strain estimation are feasible with the proposed method using only routine time-resolved 3D cardiac CT.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cardiac computed tomography; 4D CT; Image registration; Strain analysis; Myocardial deformation; Torsion
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-147433 (URN)10.1016/j.jcct.2018.01.005 (DOI)000428247900008 ()29402736 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation, KAW 2013.0076
Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2018-06-18Bibliographically approved
Åström Aneq, M., Maret, E., Brudin, L., Svensson, A. & Engvall, J. (2018). Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy.. Clinical Physiology and Functional Imaging, 38(5), 779-787
Open this publication in new window or tab >>Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy.
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2018 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, no 5, p. 779-787Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia.

MATERIALS AND METHODS: Twenty-seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady-state free precession cine of long-axis slices and a short-axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time-to-peak (TTP) strain were measured in the four- and two-chamber views of the RV.

RESULTS: Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (-20·6 vs -26·3%, P = 0·014) and in the basal part of the RV (-22·8 vs -31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21-74] vs 35 ms [13-66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non-sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (-19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia.

CONCLUSION: ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
Cardiac MRI, cardiomyopathy, feature tracking, prognosis, strain
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144018 (URN)10.1111/cpf.12479 (DOI)000440988100006 ()29105955 (PubMedID)2-s2.0-85032942208 (Scopus ID)
Note

Funding agencies: Swedish Heart-Lung Foundation; Medical Faculty of Linkoping University; Swedish Heart Association; Linkoping Heart Centre

Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2018-09-03Bibliographically approved
Fredriksson, A. G., Trzebiatowska-Krzynska, A., Dyverfeldt, P., Engvall, J., Ebbers, T. & Carlhäll, C. (2018). Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot. Journal of Magnetic Resonance Imaging, 47(4), 1043-1053
Open this publication in new window or tab >>Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot
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2018 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 47, no 4, p. 1043-1053Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess right ventricular (RV) turbulent kinetic energy (TKE) in patients with repaired Tetralogy of Fallot (rToF) and a spectrum of pulmonary regurgitation (PR), as well as to investigate the relationship between these 4D flow markers and RV remodeling.

Materials and Methods: Seventeen patients with rToF and 10 healthy controls were included in the study. Patients were divided into two groups based on PR fraction: one lower PR fraction group (11%) and one higher PR fraction group (>11%). Field strength/sequences: 3D cine phase contrast (4D flow), 2D cine phase contrast (2D flow), and balanced steady-state free precession (bSSFP) at 1.5T. Assessment: The RV volume was segmented in the morphologic short-axis images and TKE parameters were computed inside the segmented RV volume throughout diastole. Statistical tests: One-way analysis of variance with Bonferroni post-hoc test; unpaired t-test; Pearson correlation coefficients; simple and stepwise multiple regression models; intraclass correlation coefficient (ICC).

Results: The higher PR fraction group had more remodeled RVs (140 6 25 vs. 107 6 22 [lower PR fraction, P < 0.01] and 93 6 15 ml/m2[healthy, P < 0.001] for RV end-diastolic volume index [RVEDVI]) and higher TKE values (5.95 6 3.15 vs. 2.23 6 0.81 [lower PR fraction, P < 0.01] and 1.91 6 0.78 mJ [healthy, P < 0.001] for Peak Total RV TKE). Multiple regression analysis between RVEDVI and 4D/2D flow parameters showed that Peak Total RV TKE was the strongest predictor of RVEDVI (R25 0.47, P 5 0.002).

Conclusion: The 4D flow-specific TKE markers showed a slightly stronger association with RV remodeling than conventional 2D flow PR parameters. These results suggest novel hemodynamic aspects of PR in the development of late complications after ToF repair.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
4D flow, MRI, Turbulence, Tetralogy of Fallot, Turbulent kinetic energy
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies Anesthesiology and Intensive Care Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-143780 (URN)10.1002/jmri.25830 (DOI)000427125300016 ()28766919 (PubMedID)2-s2.0-85026745981 (Scopus ID)
Note

Funding agencies:  European Research Council [310612]; Swedish Heart and Lung Foundation [20140398]; County Council of Ostergotland; Medical Research Council of Southeast Sweden (FORSS); Swedish Research Council [2013-6077, 2014-6191]

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2018-04-12Bibliographically approved
Ahlander, B.-M., Maret, E., Brudin, L., Starck, S.-Å. & Engvall, J. (2017). An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion. Clinical Physiology and Functional Imaging, 37(1), 52-61
Open this publication in new window or tab >>An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
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2017 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 1, p. 52-61Article in journal (Refereed) Published
Abstract [en]

Background To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference. Methods Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study. Results Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI). Conclusion GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
cardiac imaging techniques, coronary heart disease, Magnetic Resonance Imaging, nuclear medicine, perfusion
National Category
Radiology, Nuclear Medicine and Medical Imaging Medical Laboratory and Measurements Technologies Medical Image Processing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-130795 (URN)10.1111/cpf.12267 (DOI)000390688200008 ()26147785 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden [12437]; Futurum, the County council of Jonkoping [12440, 81851, 217261]; Linkoping University; County Council of Ostergotland [281281]; Swedish Heart-Lung Foundation [20120449]

Available from: 2016-08-24 Created: 2016-08-24 Last updated: 2017-11-28Bibliographically approved
Davidsson, A., Olsson, E., Engvall, J. & Gustafsson, A. (2017). Influence of reconstruction algorithms on image quality in SPECT myocardial perfusion imaging. Clinical Physiology and Functional Imaging, 37(6), 655-662
Open this publication in new window or tab >>Influence of reconstruction algorithms on image quality in SPECT myocardial perfusion imaging
2017 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 6, p. 655-662Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: We investigated if image- and diagnostic quality in SPECT MPI could be maintained despite a reduced acquisition time adding Depth Dependent Resolution Recovery (DDRR) for image reconstruction. Images were compared with filtered back projection (FBP) and iterative reconstruction using Ordered Subsets Expectation Maximization with (IRAC) and without (IRNC) attenuation correction (AC).

MATERIALS AND METHODS: Stress- and rest imaging for 15 min was performed on 21 subjects with a dual head gamma camera (Infinia Hawkeye; GE Healthcare), ECG-gating with 8 frames/cardiac cycle and a low-dose CT-scan. A 9 min acquisition was generated using five instead of eight gated frames and was reconstructed with DDRR, with (IRACRR) and without AC (IRNCRR) as well as with FBP. Three experienced nuclear medicine specialists visually assessed anonymized images according to eight criteria on a four point scale, three related to image quality and five to diagnostic confidence. Statistical analysis was performed using Visual Grading Regression (VGR).

RESULTS: Observer confidence in statements on image quality was highest for the images that were reconstructed using DDRR (P<0·01 compared to FBP). Iterative reconstruction without DDRR was not superior to FBP. Interobserver variability was significant for statements on image quality (P<0·05) but lower in the diagnostic statements on ischemia and scar. The confidence in assessing ischemia and scar was not different between the reconstruction techniques (P = n.s.).

CONCLUSION: SPECT MPI collected in 9 min, reconstructed with DDRR and AC, produced better image quality than the standard procedure. The observers expressed the highest diagnostic confidence in the DDRR reconstruction.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
image quality, MPI SPECT, noise regularization, resolution recovery, Visual Grading Regression
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-129965 (URN)10.1111/cpf.12354 (DOI)000413678400015 ()26991110 (PubMedID)
Note

Funding agencies: Region Ostergotland [285001]; Swedish Heart-Lung foundation [20120449]; Faculty of Health Sciences at Linkoping University [284731]

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2017-11-13Bibliographically approved
Fredriksson, A. G., Svalbring, E., Eriksson, J., Dyverfeldt, P., Alehagen, U., Engvall, J., . . . Carlhäll, C.-J. (2016). 4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.. Journal of Magnetic Resonance Imaging, 43(3), 558-565
Open this publication in new window or tab >>4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.
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2016 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 43, no 3, p. 558-565Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate whether 4D flow magnetic resonance imaging (MRI) can detect subtle right ventricular (RV) dysfunction in primary left ventricular (LV) disease.

MATERIALS AND METHODS: 4D flow and morphological 3T MRI data were acquired in 22 patients with mild ischemic heart disease who were stratified into two groups based on LV end-diastolic volume index (EDVI): lower-LVEDVI and higher-LVEDVI, as well as in 11 healthy controls. The RV volume was segmented at end-diastole (ED) and end-systole (ES). Pathlines were emitted from the ED volume and traced forwards and backwards in time to ES. The blood volume was separated into flow components. The Direct Flow (DF) component was defined as RV inflow passing directly to outflow. The kinetic energy (KE) of the DF component was calculated. Echocardiographic conventional RV indices were also assessed.

RESULTS: The higher-LVEDVI group had larger LVEDVI and lower LV ejection fraction (98 ± 32 ml/m(2) ; 48 ± 13%) compared to the healthy (67 ± 12, P = 0.002; 64 ± 7, P < 0.001) and lower-LVEDI groups (62 ± 10; 68 ± 7, both P < 0.001). The RV 4D flow-specific measures "DF/EDV volume-ratio" and "DF/EDV KE-ratio at ED" were lower in the higher-LVEDVI group (38 ± 5%; 52 ± 6%) compared to the healthy (44 ± 6; 65 ± 7, P = 0.018 and P < 0.001) and lower-LVEDVI groups (44 ± 6; 64 ± 7, P = 0.011 and P < 0.001). There was no difference in any of the conventional MRI and echocardiographic RV indices between the three groups.

CONCLUSION: We found that in primary LV disease mild impairment of RV function can be detected by 4D flow-specific measures, but not by the conventional MRI and echocardiographic indices. J. Magn. Reson. Imaging 2015.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
4D flow MRI; interventricular interaction; left ventricular disease; right ventricular function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124293 (URN)10.1002/jmri.25015 (DOI)000373000300003 ()26213253 (PubMedID)
Note

Funding agencies: Swedish Heart and Lung Foundation; Swedish Research Council; European Union [223615]; Medical Research Council of Southeast Sweden (FORSS); County Council of Ostergotland/Heart and Medicine Center

Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2017-05-03
Pedrosa, J., Heyde, B., Heeren, L., Engvall, J., Zamorano, J., Papachristidis, A., . . . Dhooge, J. (2016). Automatic Short Axis Orientation of the Left Ventricle in 3D Ultrasound Recordings. In: MEDICAL IMAGING 2016: ULTRASONIC IMAGING AND TOMOGRAPHY: . Paper presented at Conference on Medical Imaging - Ultrasonic Imaging and Tomography. SPIE-INT SOC OPTICAL ENGINEERING, 9790(97900E)
Open this publication in new window or tab >>Automatic Short Axis Orientation of the Left Ventricle in 3D Ultrasound Recordings
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2016 (English)In: MEDICAL IMAGING 2016: ULTRASONIC IMAGING AND TOMOGRAPHY, SPIE-INT SOC OPTICAL ENGINEERING , 2016, Vol. 9790, no 97900EConference paper, Published paper (Refereed)
Abstract [en]

The recent advent of three-dimensional echocardiography has led to an increased interest from the scientific community in left ventricle segmentation frameworks for cardiac volume and function assessment. An automatic orientation of the segmented left ventricular mesh is an important step to obtain a point-to-point correspondence between the mesh and the cardiac anatomy. Furthermore, this would allow for an automatic division of the left ventricle into the standard 17 segments and, thus, fully automatic per-segment analysis, e.g. regional strain assessment. In this work, a method for fully automatic short axis orientation of the segmented left ventricle is presented. The proposed framework aims at detecting the inferior right ventricular insertion point. 211 three-dimensional echocardiographic images were used to validate this framework by comparison to manual annotation of the inferior right ventricular insertion point. A mean unsigned error of 8, 05 degrees +/- 18, 50 degrees was found, whereas the mean signed error was 1, 09 degrees. Large deviations between the manual and automatic annotations (amp;gt; 30 degrees) only occurred in 3, 79% of cases. The average computation time was 666ms in a non-optimized MATLAB environment, which potentiates real-time application. In conclusion, a successful automatic real-time method for orientation of the segmented left ventricle is proposed.

Place, publisher, year, edition, pages
SPIE-INT SOC OPTICAL ENGINEERING, 2016
Series
Proceedings of SPIE, ISSN 0277-786X ; 9790
Keywords
Left ventricle; short axis; orientation; 3D echocardiography
National Category
Computer Vision and Robotics (Autonomous Systems)
Identifiers
urn:nbn:se:liu:diva-130315 (URN)10.1117/12.2214106 (DOI)000378539900013 ()978-1-5106-0025-6 (ISBN)
Conference
Conference on Medical Imaging - Ultrasonic Imaging and Tomography
Available from: 2016-07-31 Created: 2016-07-28 Last updated: 2018-01-10
Panayi, G., Wieringa, W. G., Alfredsson, J., Carlsson, J., Karlsson, J.-E., Persson, A., . . . Swahn, E. (2016). Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography. BMC Cardiovascular Disorders, 16(78)
Open this publication in new window or tab >>Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 78Article in journal (Refereed) Published
Abstract [en]

Background: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI).

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Acute myocardial infarction; Normal coronary arteries; Computed tomography coronary angiography; MINCA
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-129496 (URN)10.1186/s12872-016-0254-y (DOI)000376723200001 ()27142217 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation [20120449]; Region of Ostergotland [437491]; European Union FP 7 [223615]; Medical Research Council of Southeast Sweden [157921]

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-03-23
Ahlander, B.-M., Årestedt, K., Engvall, J., Maret, E. & Ericsson, E. (2016). Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ). Journal of Advanced Nursing, 72(6), 1368-1380
Open this publication in new window or tab >>Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)
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2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 6, p. 1368-1380Article in journal (Refereed) Published
Abstract [en]

Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbachs alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbachs alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
anxiety; instrument development; magnetic resonance imaging; nurse; nursing; reliability; validity
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-129145 (URN)10.1111/jan.12917 (DOI)000376007400014 ()26893007 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation; Futurum County Council of Jonkoping

Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2017-11-28
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