Cardiothoracic Surgery |

Dual Energy Subtraction Chest Radiography as Applied to the Evaluation of Cardiac Calcium and Disease FREE TO VIEW

Calen Frolkis, BA; Dr. Robert Gilkeson, BA; Dr. Alan Markowitz, BA
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Case Western Reserve University-University Hospitals, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):90A. doi:10.1378/chest.1967307
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: This abstract describes a retrospective study investigating the diagnostic implications of Dual Energy Subtraction Radiography (DES) when used with Cardiac Computed Tomography (CT) in the work up of cardiovascular disease.

METHODS: All patients who underwent Aortic and/or Mitral valve replacement and/or repair from February 2010 to November 2012 at our institution were identified. Of 400, 222 patients met inclusion criteria: record of both pre-operative DES chest radiography, and Chest CT or CT Angiography. Dual Energy Subtraction protocol included an initial 60kV acquisition, 150msec delay, followed by 140kV acquisition. The subtracted low energy bone algorithm was evaluated, and compared to standard 140kV CXR for visualization of cardiovascular calcification. Those cases where cardiovascular disease was better visualized on bone window were then further screened, and disease confirmed with correlative CT images. Primary findings were coronary artery calcification (CAC), valvular calcification (both mitral and aortic), Mitral annual calcification (MAC), and aortic arch or descending aorta disease.

RESULTS: 47 patients were included (29 women, 61.7%, 18 men, 38.2%). Ages ranged from 38-92 (average 74.4). Of theses patients, 21 underwent subsequent AVR. 12 underwent Aortic root reconstruction with valve conduit enlargement. 8 underwent both MVR and AVR. 3 had subsequent MVR, 2 had aortic valve repair with MVR. Of the 47 patients with significant findings on DES radiography, the most common finding was Mitral Annular Calcification (31, 65.9%). Coronary Artery Calcification was the next most common finding (23,48.9%). Calcific aortic valve (CAV) was seen in 22 patients (46.8%). MV disease was seen in 8 cases, and aortic disease in 5 patients.

CONCLUSIONS: Dual Energy Subtraction improves visualization of calcified cardiovascular structures. In our study, correlative CT imaging was used to confirm that DES can optimize visualization of calcified aortic valve disease in 22 of 30 patients undergoing subsequent AVR compared to standard CXR. This correlative imaging also optimized visualization of MAC in 31 cases, 18 of which were asymptomatic. The use of both CT and DES offers an intriguing clinical correlation in the evaluation of cardiovascular calcification. Further prospective studies are warranted.

CLINICAL IMPLICATIONS: Dual Energy Radiography enables an enhanced detection of cardiovascular disease compared to standard radiographic techniques.

DISCLOSURE: The following authors have nothing to disclose: Calen Frolkis, Dr. Robert Gilkeson, Dr. Alan Markowitz

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