Addition of FFRct in the diagnostic pathway of patients with stable chest pain to reduce unnecessary invasive coronary angiography (FUSION): Rationale and design for the multicentre,randomised, controlled FUSION trial

BackgroundCoronary computed tomography angiography (CCTA) is widely used in the diagnostic work-up of patients with stable chest pain. CCTA has an excellent negative predictive value, but a moderate positive predictive value for detecting coronary stenosis. Computed tomography-derived fractional flow reserve (FFRct) is a non-invasive, well-validated technique that provides functional assessment of coronary stenosis, improving the positive predictive value of CCTA. However, to determine the value of FFRct in routine clinical practice, a pragmatic randomised, controlled trial (RCT) is required. We will conduct an RCT to investigate the impact of adding FFRct analysis in the diagnostic pathway of patients with a coronary stenosis on CCTA on the rate of unnecessary invasive coronary angiography, cost-effectiveness, quality of life and clinical outcome.MethodsThe FUSION trial is a prospective, multicentre RCT that will randomise 528 patients with stable chest pain and anatomical stenosis of ≥ 50% but < 90% in at least one coronary artery of ≥ 2 mm on CCTA, to FFRct-guided care or usual care in a 1:1 ratio. Follow-up will be 1 year. The primary endpoint is the rate of unnecessary invasive coronary angiography within 90 days.ConclusionThe FUSION trial will evaluate the use of FFRct in stable chest pain patients from the Dutch perspective. The trial is funded by the Dutch National Health Care Institute as part of the research programme ‘Potentially Promising Care’ and the results will be used to assess if FFRct reimbursement should be included in the standard health care package.Supplementary InformationThe online version of this article (10.1007/s12471-022-01711-w) contains supplementary material, which is available to authorized users.     

Enhancement of optical coherence microscopy in turbid media by an optical parametric amplifier

We report the enhancement in imaging performance of a spectral‐domain optical coherence microscope (OCM) in turbid media by incorporating an optical parametric amplifier (OPA). The OPA provides a high level of optical gain to the sample arm, thereby improving the signal‐to‐noise ratio of the OCM by a factor of up to 15 dB. A unique nonlinear confocal gate is automatically formed in the OPA, which enables selective amplification of singly scattered (ballistic) photons against the multiply‐scattered light background. Simultaneous enhancement in both imaging depth and spatial resolution in imaging microstructures in highly light‐scattering media are demonstrated with the combined OPA‐OCM setup.

Typical OCM inteferograms (left) and images (right) without and with OPA.     

Electron microscopy holdings of the Protein Data Bank: the impact of the resolution revolution,new validation tools,and implications for the future

As a discipline, structural biology has been transformed by the three-dimensional electron microscopy (3DEM) “Resolution Revolution” made possible by convergence of robust cryo-preservation of vitrified biological materials, sample handling systems, and measurement stages operating a liquid nitrogen temperature, improvements in electron optics that preserve phase information at the atomic level, direct electron detectors (DEDs), high-speed computing with graphics processing units, and rapid advances in data acquisition and processing software. 3DEM structure information (atomic coordinates and related metadata) are archived in the open-access Protein Data Bank (PDB), which currently holds more than 11,000 3DEM structures of proteins and nucleic acids, and their complexes with one another and small-molecule ligands (~ 6% of the archive). Underlying experimental data (3DEM density maps and related metadata) are stored in the Electron Microscopy Data Bank (EMDB), which currently holds more than 21,000 3DEM density maps. After describing the history of the PDB and the Worldwide Protein Data Bank (wwPDB) partnership, which jointly manages both the PDB and EMDB archives, this review examines the origins of the resolution revolution and analyzes its impact on structural biology viewed through the lens of PDB holdings. Six areas of focus exemplifying the impact of 3DEM across the biosciences are discussed in detail (icosahedral viruses, ribosomes, integral membrane proteins, SARS-CoV-2 spike proteins, cryogenic electron tomography, and integrative structure determination combining 3DEM with complementary biophysical measurement techniques), followed by a review of 3DEM structure validation by the wwPDB that underscores the importance of community engagement.     

Method for determining the half-value layer in computed tomography scans using a real-time dosimeter: Application to dual-source dual-energy acquisition

PurposeWe have proposed a method for determining the half-value layers (HVL) in dual-source dual-energy computed tomography (DS-DECT) scans without the need for the X-ray tubes to be fixed.MethodsA custom-made lead-covered case and an ionizing chamber connected with a multi-function digitizer module (a real-time dosimeter) were used. The chamber was placed in the center of the case, and aluminum or copper filters were placed in front of the aperture. The HVL was measured using aperture widths of 1.0, 2.0, and 3.0 cm for tube potentials of 80, 120, and 150 kV in single-source single-energy CT (SS-SECT) scans and was calculated from the peak air kerma rate (peak method) and the integrated air kerma rate (integrating method); the obtained values were compared with those from a conventional non-rotating method performed using the same procedure. The HVL was then measured using an aperture width of 1.0 cm for tube potential combinations of 70/Sn150 kV and 100/Sn150 kV in DS-DECT scans using the peak method.ResultsIn the SS-SECT scans, the combination of a 1.0-cm aperture and the peak method was adequate due to the small differences in the HVL values obtained for the conventional non-rotating method. The method was also found to be applicable for the DS-DECT scans.ConclusionsOur proposed method can determine the HVL in SS-SE and DS-DECT scans to a good level of accuracy without the need for the X-ray tubes to be fixed. The combination of a 1.0-cm aperture and the peak method was adequate.     

A four-dimensional computed tomography comparison of healthy and asthmatic human lungs

The purpose of this study was to explore new insights in non-linearity, hysteresis and ventilation heterogeneity of asthmatic human lungs using four-dimensional computed tomography (4D-CT) image data acquired during tidal breathing. Volumetric image data were acquired for 5 non-severe and one severe asthmatic volunteers. Besides 4D-CT image data, function residual capacity and total lung capacity image data during breath-hold were acquired for comparison with dynamic scans. Quantitative results were compared with the previously reported analysis of five healthy human lungs. Using an image registration technique, local variables such as regional ventilation and anisotropic deformation index (ADI) were estimated. Regional ventilation characteristics of non-severe asthmatic subjects were similar to those of healthy subjects, but different from the severe asthmatic subject. Lobar airflow fractions were also well correlated between static and dynamic scans (R² > 0.84). However, local ventilation heterogeneity significantly increased during tidal breathing in both healthy and asthmatic subjects relative to that of breath-hold perhaps because of airway resistance present only in dynamic breathing. ADI was used to quantify non-linearity and hysteresis of lung motion during tidal breathing. Non-linearity was greater on inhalation than exhalation among all subjects. However, exhalation non-linearity among asthmatic subjects was greater than healthy subjects and the difference diminished during inhalation. An increase of non-linearity during exhalation in asthmatic subjects accounted for lower hysteresis relative to that of healthy ones. Thus, assessment of non-linearity differences between healthy and asthmatic lungs during exhalation may provide quantitative metrics for subject identification and outcome assessment of new interventions.     

Imaging growth dynamics of tumour spheroids using optical coherence tomography

Optical coherence tomography (OCT) was used to monitor the dynamics of tumour spheroid formation by the hanging drop method. In contrast to microscopy, the estimates obtained using OCT for the volume of the spheroid, were consistent with the measured changes in cell number as a function of time. The OCT images also revealed heterogeneous structures in the spheroids of ∼200 μm diameter. These corresponded to the necrotic regions identified by fluorescence of propidium iodide stained cells.     

Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations

Background: The mechanical response of patient-specific bone to various load conditions is of major clinical importance in orthopedics. Herein we enhance the methods presented in Yosibash et al. [2007. A CT-based high-order finite element analysis of the human proximal femur compared to in-vitro experiments. ASME Journal of Biomechanical Engineering 129(3), 297–309.] for the reliable simulations of the human proximal femur by high-order finite elements (FEs) and validate the simulations by experimental observations.

Method of approach: A fresh-frozen human femur was scanned by quantitative computed tomography (QCT) and thereafter loaded (in vitro experiments) by a quasi-static force of up to 1250 N. QCT scans were manipulated to generate a high-order FE bone model with distinct cortical and trabecular regions having inhomogeneous isotropic elastic properties with Young's modulus represented by continuous spatial functions. Sensitivity analyses were performed to quantify parameters that mostly influence the mechanical response. FE results were compared to displacements and strains measured in the experiments.

Results: Young moduli correlated to QCT Hounsfield Units by relations in Keyak and Falkinstein [2003. Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load. Medical Engineering and Physics 25, 781–787.] were found to provide predictions that match the experimental results closely. Excellent agreement was found for both the displacements and strains. The presented study demonstrates that reliable and validated high-order patient-specific FE simulations of human femurs based on QCT data are achievable for clinical computer-aided decision making.     

急性兔脑栓塞模型的建立

目的建立稳定的兔脑栓塞模型,以期为进一步开展脑栓塞的病理生理变化及影像学研究提供可靠实用的工具。方法30只健康新西兰兔,随机分成3组,其中A组3只,为空白对照组;B组5只,为假手术对照组;C组22只,为栓塞组。分离右侧颈部血管,经颈外动脉向颈内动脉注入直径约0.5~1.0 mm的SiO2颗粒10枚左右,栓塞后30 min行CT灌注检查,利用多层螺旋CT灌注成像对各组动物的脑缺血情况进行观察。24 h处死动物取脑组织进行病理研究。结果A、B组CT灌注及病理均未见异常。C组栓塞过程中3只兔死亡。16只兔CT灌注异常,表现为右侧局部CBF降低、MTT延长、CBV无明显变化或轻度上升、下降。3只兔灌注未见异常。HE染色可见8只兔脑梗塞,7只兔脑缺血,4只兔未见明显异常。结论采用该方法和技术能够建立稳定的兔脑栓塞模型,结果可靠,具有可操作性和重复性。     

64层螺旋CT血管造影在胸部大血管成像中的临床应用

目的探讨64层螺旋CT血管造影在胸部大血管成像的临床应用价值。方法回顾分析了112例患者行64层螺旋CT胸部大血管造影资料,以临床手术或随访结果为金标准,进行图像分析。结果CT能够显示主动脉、肺动静脉的结构,可以诊断主动脉夹层、主动脉瘤、肺栓塞、先天性心脏病等多种大血管病变,诊断准确率100%。结论64层CT血管造影扫描速度快、安全、准确,是胸部大血管病变的首选方法。