Biomedical subjects

M Reiser

Publications and source records attributed to M Reiser.

At least 127 records · Page 7Linked to original sources

PubMed2002

[Quantitative cartilage analysis with magnetic resonance tomography (qMRI)--a new era in arthrosis diagnosis?].

Magnetic resonance imaging (MRI) is a new and very powerful method for the diagnostics and monitoring of osteoarthritis. Its advantage is that all articular tissues can be visualized directly and are accessible for three-dimensional analysis. This article reviews qualitative, semi-quantitative, and quantitative studies on articular cartilage with MRI. In particular we discuss pulse sequences and three-dimensional postprocessing methods for quantitative analysis of cartilage volume and thickness, along with their accuracy and precision in healthy volunteers and patients with osteoarthritis. It addition, we present approaches for quantitative analyses of structural/biochemical parameters and for the deformational behavior of cartilage in vivo.

Cartilage, Articular↗

PubMed2002

[Minimally invasive surgical procedures of the breast: comparison of different biopsy systems in a breast parenchymal model].

PURPOSE: The purpose of our study was to evaluate various systems for large core biopsy. First to determine the volume of specimen that can be removed with each minimal-invasive method and second to compare their consistency. With respect to the optimum of volume which can be acquired the 12-G system should be optimized by special modifications. METHODS: Examinations were performed on a phantom. We used 8 automatic, one sequential-automatic and 4 halfautomatic highspeed core biopsy systems of 16-, 14- and 12 G as well as the 11G vacuum biopsy. The weight and consistency of the specimen was determined in every case. The 12G system was optimized by enlargement of the biopsy chamber. RESULTS: The 11G vacuum biopsy exhibited best results concerning the weight of the specimen (93.7 +/- 13.5 mg). The results achieved with high speed core biopsy varied with the needle diameter as well as with the technique. Semi- and halfautomatic systems were superior to automatic systems. Best results among highspeed core biopsy systems were achieved with the modified 12G biopsy needle (41.3 +/- 4.4 mg). CONCLUSION: As expected, largest volume of specimen can be removed with vacuum biopsy. High speed core biopsy systems are inferior to vacuum biopsy. Nevertheless, the amount of volume achieved can be increased to 22.4 mg by using 14G needles and to 41.3 mg by using 12G needles. The modified 12-G needle may be considered as an less expensive alternative to 11G vacuum biopsy.

Biopsy↗

PubMed2002

[Stereotactic vacuum biopsy in prone and sitting position].

PURPOSE: The purpose of our study was to determine the accuracy of vacuum-assisted biopsy (VB) and to evaluate the side effects of this method depending on the positioning of the patient during the intervention. METHODS: Interventions were performed with the 11-G biopsy needle either in prone position (Mammotest S, Fischer Imaging, USA) on a dedicated table for breast intervention (n = 308) or in upright position with a dedicated digital stereotactic mammography system (Mammomat 3000, Optima, Siemens, Germany). VB was indicated because of indeterminate or suspicious microcalcifications (84.1%) or because of dense lesions (15.9%). All benign results found with VB have been followed up after 6 and 12 months by mammography. All malignant or histological findings discordant to imaging features have been verified by open surgery. RESULTS: Histology after VB offered 215 (64.4%) benign lesions. In neither case a carcinoma developed during follow-up. In 90 (27%) cases malignancy was found with VB. After reexcision the diagnosis of VB was confirmed in 85.6%. In 8.9% of the cases in which VB showed DCIS, histology after open surgery revealed also invasive tumor components. Technical problems occurred in 4 cases. Major side effects developed neither in prone position nor in upright, sitting position of the patient. CONCLUSION: VB is a reliable method with less side effects for the histological evaluation of breast lesions. The accuracy and complications are not depending on the type of stereotactic device or on the patients position. The accuracy of the histological diagnosis achieved with VB can be compared to that of open surgery. The relative high costs of this method may cause a problem. But compared to the costs resulting by open diagnostic surgery this disadvantage is only a relative one.

Adult↗

PubMed2002

Current treatment of follicular non-Hodgkin's lymphoma.

56200 new cases of NHL are expected to be diagnosed in the United States (US) per year. For reasons that are not fully understood, the number of new cases per year has nearly doubled in the past three decades. Most patients with follicular lymphoma are over 50 years of age and present with widespread disease at diagnosis. Nodal involvement is very common, often accompanied by splenic and bone marrow disease. Despite the advanced stage, the median survival ranges from 8 to 12 years. The vast majority of patients with advanced stage follicular lymphoma are not cured using the current therapeutic options. The rate of relapse is fairly consistent over time, even in patients who have achieved complete responses (CRs) to treatment. Therapeutic options in follicular NHL include watchful waiting, oral alkylating agents, purine nucleoside analogues, combination chemotherapy, interferon and monoclonal antibodies. Radiolabelled monoclonal antibodies, autologous or allogeneic bone marrow or peripheral stem cell transplantation are under current clinical evaluation. The approval of rituximab, an unconjugated chimeric antibody against the CD20 antigen for the treatment of relapsed follicular B-cell NHL marked a milestone in the development of antibody treatment. In addition, newer approaches like radioimmunoconjugates with myeloablative activity induced response rates of 80-100% in heavily pretreated patients. Various clinical trials combining monoclonal antibodies with conventional therapies are currently ongoing to determine whether these new biological agents will alter the natural history of follicular lymphoma.

Aged↗

PubMed2002

Functional adaptation of human joints to mechanical stimuli.

OBJECTIVE: This study tests the hypothesis that functional adaptation occurs in human joints, and that substantial differences in joint 'loading history' explain the phenotypic variability observed in human cartilage morphology. METHOD: We examined 18 triathletes (nine men and nine women) who had been physically active throughout life (training for >10 h per week for the last 3 years), and 18 volunteers that had never been physically active on a regular basis. The right knee joints were imaged with a previously validated fat-suppressed gradient-echo MR sequence. Cartilage volume, thickness, joint surface areas, and normalized cartilage signal intensity were determined with post-processing software, specifically designed for these applications. RESULTS: The knee joint cartilage thickness, and signal intensity were not significantly different between athletes and inactive volunteers, but male athletes displayed significantly larger knee joint surfaces (P< 0.01; +8.8%). Female athletes displayed a significantly larger medial tibia (P< 0.05; +18.9%), the difference in the total knee surface area reaching borderline significance (P=0.08; +7.0%). CONCLUSIONS: The results suggest that joint size can be modulated during growth, but that (opposite to muscle and bone) the thickness of the cartilage does not adapt to mechanical stimulation. This finding may reveal a general principle in the development and functional adaptation of diarthrodial joints, elucidating an important mechanism for reducing mechanical stress in biphasic cartilage layers.

Adaptation, Physiological↗

PubMed2002

Side differences of knee joint cartilage volume, thickness, and surface area, and correlation with lower limb dominance--an MRI-based study.

OBJECTIVE: To test the hypotheses that absolute side differences in knee joint cartilage morphology are substantially smaller than intersubject variability, and that systematic side differences are determined by (force) dominance of the lower limbs. METHODS: Fifteen healthy volunteers with definite dominance of one lower limb were studied. Knees were imaged sagittally with a validated, high-resolution MR sequence. Transverse MR images of the thigh and calf were acquired with a spin echo sequence. Knee joint cartilage volume, thickness and joint surface areas, as well as muscle cross sectional areas were determined with in house post-processing software. RESULTS: Absolute side differences amounted to 5.0+/-3.7% for the knee cartilage volume, 3.8+/-3.1% for cartilage thickness, and 3.4+/-1.7% for joint surface areas. The intersubject variability was 24.8%, 14.4%, and 14.1%, respectively. Volunteers with dominance of one of both lower limbs did not display significant side differences in cartilage morphology, but the side differences of the thigh musculature correlated positively with side differences of knee joint cartilage volume (r=+0.68; P< 0.01). CONCLUSIONS: The results advocate the use of cartilage parameters from the contra-lateral limb for retrospectively estimating cartilage loss in patients with unilateral osteoarthritis (OA), and for determining local risk factors of OA in cross-sectional epidemiological studies, which are specific to pre-morbid cartilage morphology. Functional (force) dominance of one of both lower limbs does not explain side differences of articular cartilage morphology, but side differences are positively associated with side differences in muscle cross sectional areas.

Adult↗

PubMed2002

Long-term and resegmentation precision of quantitative cartilage MR imaging (qMRI).

OBJECTIVE: Follow up of osteoarthritis (OA) and evaluation of structure modifying OA drugs require longitudinal data on cartilage structure. The aim of this study was to analyse the long term and resegmentation precision of quantitative cartilage analysis with magnetic resonance imaging (qMRI) in vivo, and to relate precision errors to the estimated cartilage loss in OA. METHOD: Sagittal MR images of the knee were obtained in 14 individuals, four datasets being acquired in a first imaging session. In 12 subjects, two further datasets were acquired over the next months. Image analysis was performed in the same session for image data obtained under short-term and long-term imaging conditions, and in three different sessions (months apart) for the first data set (resegmentation precision). RESULTS: Long-term precision errors ranged from 1.4% (total knee) to 3.9% (total femur) for cartilage volume and thickness and were only marginally higher than those under short term conditions. In the medial tibia, the error was 84 mm(3) compared with an estimated loss of >1,200 mm(3) in varus OA. Precision errors for resegmentation were somewhat higher, but considerably smaller than the intersubject variability. CONCLUSIONS: Scanner drift and changes in imaging or patient conditions appear not to represent a critical problem in quantitative cartilage analysis with magnetic resonance imaging (qMRI). In longitudinal studies, image analysis of sequential data should be performed within the same post-processing session. Under these conditions, qMRI promises to be a very powerful method to assess structural change of cartilage in OA.

Adult↗

PubMed2002

[Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence].

PURPOSE: To evaluate the diagnostic accuracy of a diffusion-weighted, steady-state free precession (SSFP) sequence for the differentiation of acute benign osteoporotic and neoplastic vertebral compression fractures. METHODS: 85 patients with 102 vertebral compression fractures were examined with MR imaging using a spine array surface coil (Siemens, Vision, 1.5 Tesla). The following sequences were performed in sagittal orientation: T1-weighted spin echo (SE), short-tau inversion recovery (STIR) and a diffusion-weighted SSFP sequence (TR = 25 msec, diffusion pulse length delta = 3 msec). The SSFP images were evaluated qualitatively on a 5-grade scale from strongly hypointense to strongly hyperintense. Quantitative analysis was performed with region of interest measurements (ROI) and calculation of a bone marrow ratio. RESULTS: 60 fractures were due to osteoporosis and 42 fractures were caused by malignancy. "Hyperintensity" in a vertebral fracture on a SSFP sequence provided a sensitivity of 100 % and a specificity of 93 %. The positive predictive value was 91 %, the negative predictive value was 100 %. Quantitative analysis of the bone marrow ratio showed a statistically significant difference between the osteoporosis and the tumor group (p < 0.001). The mean value for the osteoporotic fractures was - 0.32 (SD 0.33) and + 2.07 (SD 1.37) for the tumor group. CONCLUSION: The SSFP sequence provides a high accuracy in the differentiation of benign osteoporotic and neoplastic vertebral compression fractures.

Adult↗

PubMed2002

[Detection of tibial condylar fractures using 3D imaging with a mobile image amplifier (Siemens ISO-C-3D): Comparison with plain films and spiral CT].

PURPOSE: To analyze a prototype mobile C-arm 3D image amplifier in the detection and classification of experimental tibial condylar fractures with multiplanar reconstructions (MPR). METHOD: Human knee specimens (n = 22) with tibial condylar fractures were examined with a prototype C-arm (ISO-C-3D, Siemens AG), plain films (CR) and spiral CT (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119 mm data cube. From these 3D data sets MP reconstructions were obtained. All images were evaluated by four independent readers for the detection and assessment of fracture lines. All fractures were classified according to the Müller AO classification. To confirm the results, the specimens were finally surgically dissected. RESULTS: 97 % of the tibial condylar fractures were easily seen and correctly classified according to the Müller AO classification on MP reconstruction of the ISO-C-3D. There is no significant difference between ISO-C and CT in detection and correct classification of fractures, but ISO-CD-3D is significant by better than CR. CONCLUSION: The evaluation of fractures with the ISO-C is better than with plain films alone and comparable to CT scans. The three-dimensional reconstruction of the ISO-C can provide important information which cannot be obtained from plain films. The ISO-C-3D may be useful in planning operative reconstructions and evaluating surgical results in orthopaedic surgery of the limbs.

Humans↗

PubMed2002

[Sedation analgesia in interventional radiology].

PURPOSE: Development of a save and effective protocol for analgosedation of patients undergoing painful interventional procedures. MATERIAL AND METHODS: In a prospective trial a consecutive series of 72 adult patients underwent analgosedation during painful interventions. A radiologist performed the analgosedation, the patients received a combination of a shortly effective piperidine derivative (Alfentanil [Rapifen(R)]; 7.5 - 15 microgram/kg body weight) and Benzodiazepine (midazolam [Dormicum(R)]; 20 microgram/kg body weight). After pre-procedure oxygenation patients were continuously monitored. Pain and discomfort were scored using an established visual-analog pain score (0 - 10). A control group (n = 24) had received midazolam, pentazocine or fentanyl according to the study protocol. RESULTS: All procedures could be carried out by an interventional radiologist and a nurse and/or technologist only. In 69/72 cases adequate analgosedation could be achieved. Injection of alfentanil was titrated, with a rapid onset and short acting effect of the analgesia. Patients reported an average pain score of 2.6 vs. 4.5 in the control group. Over 55 % experienced no or mild pain (score 0 - 3), in the control group only 8 % reached this level. CONCLUSION: A combination of shortly effective alfentanil and midazolam allows interventional radiologists to perform major procedures alone under effective analgosedation. This medication scheme is superior to the medication upon demand.

Adjuvants, Anesthesia↗

PubMed2002

[Studies on image quality, high contrast resolution and dose for the axial skeleton and limbs with a new, dedicated CT system (ISO-C-3 D)].

PURPOSE: Evaluation of 3D-CT imaging of the axial skeleton and different joints of the lower and upper extremities with a new dedicated CT system (ISO-C-3D) based on a mobile isocentric C-arm image amplifier. MATERIAL AND METHODS: 27 cadaveric specimes of different joints of the lower and upper extremities and of the spinal column were examined with 3D-CT imaging (ISO-C-3D). All images were evaluated by 3 radiologists for image quality using a semiquantitative score (score value 1: poor quality; score value 4: excellent quality). In addition, dose measurements and measurements of high contrast resolution were performed in comparison to conventional and low-dose spiral CT using a high contrast phantom (Catphan, Phantom Laboratories). RESULTS: Adequate image quality (mean score values 3 - 4) could be achieved with an applied dose comparable to low-dose CT in smaller joints such as wrist, elbow, ankle and knee. A remarkably inferior image quality resulted in imaging of the hip, lumbar and thoracic spine (mean score values 2 - 3) in spite of almost doubling the dose (dose increased by 85 percent). The image quality of shoulder examinations was insufficient (mean score value 1). Phantom studies showed a high-contrast resolution comparable to helical CT in the xy-axis (9 lp/cm). CONCLUSION: Preliminary results show, that image quality of C-arm-based CT-imaging (ISO-C-3D) seems to be adequate in smaller joints. ISO-C-3D images of the hip and axial skeleton show a decreased image quality, which does not seem to be sufficient for diagnosing subtle fractures.

Arm↗

PubMed2002

Transjugular intrahepatic portosystemic shunting is not superior to endoscopic variceal band ligation for prevention of variceal rebleeding in cirrhotic patients: a randomized, controlled trial.

BACKGROUND: The aim of the present study was to compare the transjugular intrahepatic portosystemic shunt (TIPS) with variceal band ligation (VBL) in the prophylaxis of variceal rebleeding in patients with cirrhosis of the liver. METHODS: Fifty-four cirrhotic patients (21 Child-Pugh class A, 27 class B, 6 class C) were randomized to TIPS (n = 28) or VBL (n = 26) within 2 months after control of esophageal variceal hemorrhage. Statistical analysis was performed on the intention-to-treat principle. RESULTS: Mean follow-up was 2 years. Mortality risk at 1 and 2 years of follow-up was 7.8% +/- 5.3% and 19.9% +/- 8.8% in the TIPS group and 16.5% +/- 7.6% and 16.5% +/- 7.6% in the VBL group, respectively (n.s.); actuarial probability of remaining free from rebleeding was 83.7% +/- 77.4% and 71.4% +/- 10.4% in the TIPS group and 83.9% +/- 7.3% and 78.1% +/- 8.8% in the VBL group at 1 and 2 years, respectively (n.s.). Hepatic encephalopathy within 1 month after randomization was observed in 2 patients in the TIPS group and in 1 in the VBL group. CONCLUSION: TIPS is not superior to VBL in the prevention of variceal rebleeding. Furthermore, similar mortality rates in patients treated with TIPS or VBL negate TIPS as the preferred strategy for prevention of variceal rebleeding.

Endoscopy↗

PubMed2002

T-cell non-Hodgkin's lymphoma in adults: clinicopathological characteristics, response to treatment and prognostic factors.

T-cell NHL represent 10-15% of all malignant lymphomas making systematic prospective clinical trials difficult. Therefore, the prognostic significance of the T-cell phenotype has been a matter of controversy in recent years. In a retrospective analysis of 681 patients (pts) with NHL accrued from 1992 to 1997 at a single institution, 66 patients with T-cell NHL were identified. According to the REAL classification, histologies were as follows: 28 peripheral T-cell lymphomas (PTCL), 19 large cell anaplastic lymphoma (LCAL), 12 precursor lymphoblastic lymphoma (Lb), and seven AILD. Multiagent anthracycline containing regimens were used as initial therapy in 91% of cases. T-cell NHL represent 9.8% of all NHL patients at our institution accrued over a 6-year period. Overall response rate was 76%, 21% had progressive disease and 3% died during first line treatment. Mean overall survival (OS) was 8.22 +/- 0.94 years. There was a significant difference in OS between the four different histological subgroups (log rank P=0.0288). LCAL: mean OS 11.05 +/- 1.55 years (95% CI 8.00-14.09); LB: mean OS 7.09 +/- 1.40 years (95% CI 4.33-9.84); PTCL: mean 6.62 +/- 1.17 years (95% CI 4.33-8.90); AILD: 1.54 +/- 0.44 years (95% CI 0.67-2.40). OS was also significantly different for patients classified according to the International Prognostic Index (IPI)-score (log rank P = 0.002). Mean OS for patients with low risk, intermediate low risk, intermediate high risk and high risk was 10.46 +/- 1.02, 6.46 +/- 1.79, 4.50 +/- 1.20 and 1.15 +/- 0.46 years, respectively. Univariate analysis (log-rank test) for prognostic factors also revealed elevated LDH, B-symptoms and extranodal involvement as significant factors for OS. The presence of bulky disease (>7.5 cm), advanced stage III/IV and bone marrow involvement did not influence OS. In conclusion, it is evident that histological subtype and IPI-score have a strong prognostic impact on OS in pts with T-cell NHL. Thus, the distribution of risk factors in patients with T-cell NHL may be more important for OS than T-cell histology per se.

Aged↗

PubMed2002

Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease.

BACKGROUND: An important variable affecting outcome in relapsed and refractory Hodgkin's disease (HD) is the potential of conventional salvage chemotherapy to reduce tumor volume before high-dose chemotherapy (HDCT) and autologous stem cell transplantation. Currently, the optimal salvage chemotherapy regimen for these patients is unclear. Since dexamethasone/cisplatin/cytarabine (DHAP) given at 3-4 week intervals has been shown to be very effective in patients with relapsed aggressive non-Hodgkin's lymphoma, we evaluated this regimen given at a median of 16-day intervals in patients with relapsed and refractory HD. PATIENTS AND METHODS: Patients with relapsed or refractory HD were treated with two cycles of DHAP [dexamethasone 40 mg intravenously (i.v.) day 1-4, cisplatin 100 mg/m(2) i.v. as 24-h continuous infusion day 1, and cytarabine 2 g/m(2) i.v. 12q day 2]. Granulocyte colony-stimulating factor (G-CSF) was given at a dose of 5 micro g/kg from day 4 until day 13. Patients with partial remission (PR) or complete remission (CR) after two cycles of DHAP received sequential HDCT. RESULTS: The median age of the 102 patients included was 34 years (range 21-64 years). Forty-two percent of the patients had late relapse, 29% early relapse, 12% multiple relapse and 16% primary progressive/refractory disease. The response rate (RR) after two cycles of DHAP was 89% (21% CR, 68% PR). The RRs for patients with late, early, multiple and progressive HD were 91%, 93%, 92% and 65%, respectively. Using the chi-square test for independence, remission status (relapsed HD versus progressive HD) and stage at relapse (stage I/II versus stage III/IV) were significant factors for response to DHAP. WHO grade 4 leukocytopenia and thrombocytopenia were the main toxic- ities occurring in 43% (mean duration 1.1 days, range 0-6) and 48% (mean duration 1.4 days, range 0-11) of all courses, respectively. Neither severe infections nor treatment-related deaths occurred. Peripheral blood stem cells (PBSCs) were collected after the first cycle DHAP in eight patients. The hematopoietic progenitors showed a very rapid increase from day 10 with a synchronous and impressive peak on day 12. A mean of 6.1 x 10(6)/kg CD34(+) cells were collected per apheresis. As originally recommended in the protocol, PBSCs were routinely collected during sequential HDCT in the remaining patients. CONCLUSIONS: A brief tumor-reducing program with two cycles of DHAP given in short intervals supported by G-CSF is effective and well-tolerated in patients with relapsed and refractory HD. This regimen can be used to mobilize stem cells and select those patients with chemosensitive relapse who should subsequently be treated with HDCT.

Adolescent↗

PubMed2002

Quantitative image analysis of the cartilage in Virtual Reality.

The objective of this work is to develop image processing methods for analysing the morphology of the joint cartilage with magnetic resonance imaging. Quantitative data on the morphological distribution of the joint cartilage are of great interest for both research as well as for diagnosis. The cartilage thickness provides information on the local cartilage occurance and may therefore be helpful in early and objective diagnosing degenerative cartilage changes, monitoring the pathogenesis of osteoarthritis, and controlling the success of chondroprotective treatment. In biomechanics, the thickness distribution serves to analyse the functional adaptation or the compression of the cartilage under loading and may be used for numerical simulation of load transmission in the joint.

Biomechanical Phenomena↗

PubMed2001

[Virtual large intestine imaging with multi-level CT. Pain free coloscopy--that works!].

Provided that the bowel is carefully cleansed, virtual colonoscopy permits a safe, reliable and painfree diagnosis of the large bowel. It requires distension of the bowel with ambient air. Contraindications include pregnancy, acute inflammation of the bowel and recent surgery. Tumors and large polyps (10 mm and more) can be diagnosed with certainty, while polyps measuring 5 mm and more are detected with a high degree of sensitivity. It goes without saying that virtual colonoscopy does not allow for the taking of biopsy material or the performance of therapeutic measures, so that positive or suspicious findings must be clarified by conventional colonoscopy. In principle, virtual colonoscopy is also suitable for use as a screening procedure. Whether the radiation exposure associated with the conventional examination protocol can be considered acceptable for screening purposes is questionable. However, using mathematical means, the radiation dose can be reduced to one-tenth of the usual dose.

Colon↗

PubMed2001

Case-oriented computer-based-training in radiology: concept, implementation and evaluation.

BACKGROUND: Providing high-quality clinical cases is important for teaching radiology. We developed, implemented and evaluated a program for a university hospital to support this task. METHODS: The system was built with Intranet technology and connected to the Picture Archiving and Communications System (PACS). It contains cases for every user group from students to attendants and is structured according to the ACR-code (American College of Radiology) 2. Each department member was given an individual account, could gather his teaching cases and put the completed cases into the common database. RESULTS: During 18 months 583 cases containing 4136 images involving all radiological techniques were compiled and 350 cases put into the common case repository. Workflow integration as well as individual interest influenced the personal efforts to participate but an increasing number of cases and minor modifications of the program improved user acceptance continuously. 101 students went through an evaluation which showed a high level of acceptance and a special interest in elaborate documentation. CONCLUSION: Electronic access to reference cases for all department members anytime anywhere is feasible. Critical success factors are workflow integration, reliability, efficient retrieval strategies and incentives for case authoring.

Computer Communication Networks↗

PubMed2001

Usefulness of calcium scoring using electron beam computed tomography and noninvasive coronary angiography in patients with suspected coronary artery disease.

The aim of this study was to investigate the reliability of calcium scoring (CS) and electron beam computed tomographic angiography (EBCTA) as a noninvasive tool in the diagnosis of coronary artery disease (CAD): 93 consecutive patients (aged 59 +/- 9 years) with symptoms suspicious for CAD underwent CS. In 87 of these subjects, an additional EBCTA investigation was performed. Using receiver-operating characteristic curve analysis, we determined a calcium score cut point providing an overall sensitivity of 80% and a specificity of 72% in detecting patients with CAD. For clinical purposes the use of cut points is difficult. We therefore determined score ranges providing >80% specificity (high score range) and >85% sensitivity (low score range) and determined the scores between these ranges as equivocal borderline scores. Calculated on a per-segment basis in assessable proximal and midcoronary segments, the sensitivity for detecting coronary stenoses >50% was 78%, and the specificity was 93%. Thus, 32 of 44 patients with significant CAD and 24 of 49 patients without CAD were correctly classified. The combination of CS and EBCTA predicted CAD in 77% (72 of 93) of patients. No or low calcium scores provided high specificity for ruling out CAD. The addition of EBCTA in those patients improved sensitivity. In patients with high calcium scores, accuracy of EBCTA was not significantly different from CS alone (72% vs 83%), whereas in patients with borderline scores it was significantly superior (80% vs 58%, p <0.03). Thus, the complementary use of CS and EBCTA appears beneficial, particularly in patients with borderline scores, and could improve sensitivity in the low score range. In the presence of high scores, no major diagnostic gain from an additional EBCTA versus CS alone could be observed.

Calcinosis↗