SCCT guidelines for performance of coronary computed tomographic angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee

Journal of Cardiovascular Computed Tomography

Volumn 3, Issue 3, 2009, Pages 190-204

  Abbara, Suhny ^a   Arbab Zadeh, Armin ^a   Callister, Tracy Q ^a   Desai, Milind Y ^a   Mamuya, Wilfred ^a   Thomson, Louise ^a   Weigold, Wm Guy ^a  

^a Society of Cardiovascular Computed Tomography   (United States)

Author keywords

Cardiovascular computed tomography; Computed tomography; Coronary angiography; Coronary artery disease; Guidelines; Spiral computed tomography; X ray computed tomography

Indexed keywords

AMIODARONE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM; CALCIUM CHANNEL BLOCKING AGENT; DIGOXIN; DIPHENHYDRAMINE; GLYCERYL TRINITRATE; IVABRADINE; METFORMIN; METOPROLOL; PREDNISONE; SILDENAFIL; TADALAFIL; VARDENAFIL;

ANAMNESIS; ARTICLE; ARTIFACT REDUCTION; BODY WEIGHT; BREATH HOLDING; CLINICAL COMPETENCE; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CONTRAST INDUCED NEPHROPATHY; DIGITAL IMAGING; DOSE RESPONSE; ELECTRIC POTENTIAL; ELECTROCARDIOGRAPHY; ERECTILE DYSFUNCTION; GLOMERULUS FILTRATION RATE; HEART RATE; HUMAN; IMAGE ANALYSIS; IMAGE QUALITY; INFORMED CONSENT; KIDNEY FUNCTION; MEDICAL INSTRUMENTATION; MEDICAL SOCIETY; NEPHROTOXICITY; PATIENT POSITIONING; PHYSICIAN; PRACTICE GUIDELINE; PREMEDICATION; PRIORITY JOURNAL; PULMONARY HYPERTENSION; RADIATION DOSE; RADIATION EXPOSURE; RADIATION MONITORING; RADIATION SHIELD; RADIOSENSITIVITY; RISK BENEFIT ANALYSIS; SCORING SYSTEM; SPIRAL COMPUTER ASSISTED TOMOGRAPHY; STANDARDIZATION; TREATMENT CONTRAINDICATION; VASCULAR ACCESS;

AMERICAN MEDICAL ASSOCIATION; CORONARY ANGIOGRAPHY; GUIDELINES AS TOPIC; TOMOGRAPHY, X-RAY COMPUTED; UNITED STATES;

EID: 67349168167     PISSN: 19345925     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jcct.2009.03.004     Document Type: Article

References (75)

1. Hendel R.C., Patel M.R., Kramer C.M., Poon M., Hendel R.C., Carr J.C., Gerstad N.A., Gillam L.D., Hodgson J.M., Kim R.J., Kramer C.M., Lesser J.R., Martin E.T., Messer J.V., Redberg R.F., Rubin G.D., Rumsfeld J.S., Taylor A.J., Weigold W.G., Woodard P.K., Brindis R.G., Hendel R.C., Douglas P.S., Peterson E.D., Wolk M.J., Allen J.M., Patel M.R., and ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group. American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48 (2006) 1475-1497
2. Budoff M.J., Cohen M.C., Garcia M.J., Hodgson J.M., Hundley W.G., Lima A.C., Manning W.J., Pohost G.M., Raggi P.M., Rodgers G.P., Rumberger J.A., and Taylor A.J. ACC/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA Committee on CV Tomography). J Am Coll Cardiol 46 (2005) 383-402
3. Rubin G.D., Bluemke D.A., Duerinckx A.J., Flamm S.D., Grist T.M., Jacobs J.E., Lavelle M.T., Schoepf J., Stillman A.E., and Woodard P.K. ACR Committee on Cardiac Imaging. Practice guideline for the performance and interpretation of cardiac computed tomography (CT). (Res. 10, 16g, 17, 34, 35, 36-2006). Practice guidelines and technical standards (2008), American College of Radiology, Reston, VA 421-430
4. Valentin J. Pregnancy and medical radiation: ICRP publication 84. Ann ICRP 30 (2000) 1-39
5. Webb J.A., Thomsen H.S., and Morcos S.K. Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15 (2005) 1234-1240
6. Greenberger P., and Patterson R. Prednisone-diphenhydramine regimen prior to use of radiographic contrast media. J Allergy Clinical Immunol 63 (1979) 295
7. licker BM, Cypel Y.S., and Weinreb J.C. IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. AJR Am J Roentgenol 186 (2006) 1651-1658
8. Lee J.K., Warshauer D.M., Bush Jr. W.H., McClennan B.L., and Choyke P.L. Determination of serum creatinine level before intravenous administration of iodinated contrast medium: a survey. Invest Radiol 30 (1995) 700-705
9. Briguori C., Airoldi F., D'Andrea D., Bonizzoni E., Morici N., Focaccio A., Michev I., Montorfano M., Carlino M., Cosgrave J., Ricciardelli B., and Colombo A. Renal insufficiency following contrast media administration trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation 115 (2007) 1211-1217
10. Briguori C., Columbo A., Violante A., Balestrieri P., Manganelli F., Paolo Elia P., Golia B., Lepore S., Riviezzo G., Scarpato P., Focaccio A., Librera M., Bonizzoni E., and Ricciardelli B. Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J 25 (2004) 206-211
11. Lee P.T., Chou K.J., Liu C.P., Mar G.Y., Chen C.L., Hsu C.Y., Fang H.C., and Chung H.M. Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis: a randomized controlled trial. J Am Coll Cardiol 50 (2007) 1015-1020
12. Marenzi G., Assanelli E., Marana I., Lauri G., Campodonico J., Grazi M., De Metrio M., Galli S., Fabbiocchi F., Montorsi P., Veglia F., and Bartorelli A.L. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 354 (2006) 2773-2782
13. Barrett B.J., Katzberg R.W., Thomsen H.S., Chen N., Sahani D., Soulez G., Heiken J.P., Lepanto L., Ni Z.H., and Nelson R. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: a double-blind comparison of iodixanol and iopamidol. Invest Radiol 41 (2006) 815-821
14. El-Hajjar M., Bashir I., Khan M., Min J., Torosoff M., and DeLago A. Incidence of contrast-induced nephropathy in patients with chronic renal insufficiency undergoing multidetector computed tomographic angiography treated with preventive measures. Am J Cardiol 102 (2008) 353-356
15. Ahuja T.S., Niaz N., and Agraharkar M. Contrast-induced nephrotoxicity in renal allograft recipients. Clin Nephrol 54 (2000) 11-14
16. Poletti P.A., Saudan P., Platon A., Mermillod B., Sautter A.M., Vermeulen B., Sarasin F.P., Becker C.D., and Martin P.Y. N-acetylcysteine and emergency CT: use of serum creatinine and cystatin C as markers of radiocontrast nephrotoxicity. AJR Am J Roentgenol 189 (2007) 687-692
17. Schmidt P., Pang D., Nykamp D., Knowlton G., and Jia H. N-acetylcysteine and sodium bicarbonate versus n-acetylcysteine and standard hydration for the prevention of radiocontrast-induced nephropathy following coronary angiography. Ann Pharmacother 41 (2007) 46-50
18. Solomon R. Contrast media nephropathy: how to diagnose and how to prevent?. Nephrol Dial Transplant 22 (2007) 1812-1815
19. Zagler A., Azadpour M., Mercado C., and Hennekens C.H. N-acetylcysteine and contrast-induced nephropathy: a meta-analysis of 13 randomized trials. Am Heart J 151 (2006) 140-145
20. Brodoefel H., Reimann A., Heuschmid M., Küttner A., Beck T., Burgstahler C., Claussen C.D., Schroeder S., and Kopp A.F. Non-invasive coronary angiography with 16-slice spiral computed tomography: image quality in patients with high heart rates. Eur Radiol 16 (2006) 1434-1441
21. Cademartiri F., Mollet N.R., Runza G., Belgrano M., Malagutti P., Meijboom B.W., Midiri M., Feyter P.J., and Krestin G.P. Diagnostic accuracy of multislice computed tomography coronary angiography is improved at low heart rates. Int J Cardiovasc Imaging 22 (2006) 101-105
22. Hoffmann M.H., Shi H., Manzke R., Schmid F.T., De Vries L., Grass M., Brambs H.J., and Aschoff A.J. Noninvasive coronary angiography with 16-detector row CT: effect of heart rate. Radiology 234 (2005) 86-97
23. Le Jemtel T.H., Padeletti M., and Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. J Am Coll Cardiol 49 (2007) 171-182
24. Dewey M., Hoffmann H., and Hamm B. Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries. ROFO Fortschr Geb Rontgenstr Nuklearmed 178 (2006) 600-604
25. Decramer I., Vanhoenacker P.K., Sarno G., Van Hoe L., Bladt O., Wijns W., and Parizel P.M. Effects of sublingual nitroglycerin on coronary lumen diameter and number of visualized septal branches on 64-MDCT angiography. AJR Am J Roentgenol 190 (2008) 219-225
26. Wang G., and Vannier M.W. Spatial variation of section sensitivity profile in spiral computed tomography. Med Phys 21 (1994) 1491-1497
27. Ohnesorge B., Flohr T., Becker C., Kopp A.F., Schoepf U.J., Baum U., Knez A., Klingenbeck-Regn K., and Reiser M.F. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 217 (2000) 564-571
28. Halliburton S.S., and Abbara S. Practical tips and tricks in cardiovascular computed tomography: patient preparation for optimization of cardiovascular CT data acquisition. J Cardiovasc Comput Tomogr 1 (2007) 62-65
29. Bae K.T., Tran H.Q., and Heiken J.P. Multiphasic injection method for uniform prolonged vascular enhancement at CT angiography: pharmacokinetic analysis and experimental porcine model. Radiology 216 (2000) 872-880
30. Fleischmann D., Rubin G.D., Bankier A.A., and Hittmair K. Improved uniformity of aortic enhancement with customized contrast medium injection protocols at CT angiography. Radiology 214 (2000) 363-371
31. Haage P., Schmitz-Rode T., Hubner D., Piroth W., and Gunther R.W. Reduction of contrast material dose and artifacts by a saline flush using a double power injector in helical CT of the thorax. AJR Am J Roentgenol 174 (2000) 1049-1053
32. Hopper K.D., Mosher T.J., Kasales C.J., TenHave T.R., Tully D.A., and Weaver J.S. Thoracic spiral CT: delivery of contrast material pushed with injectable saline solution in a power injector. Radiology 205 (1997) 269-271
33. Segal A.J., Ellis J.H., Baumgartner B.R., Choyke P.L., Cohan R.H., Costouros N.G., Feinstein K.A., Fielding J.R., Jenkins R., Krecke K.N., Sandler C.M., Spinosa D.J., Spring D.B., and Wasserman N.F. ACR Committee on Drugs and Contrast Media. Practice guideline for the use of intravascular contrast media. (Res. 38 - 2007). Practice guidelines and technical standards (2008), American College of Radiology, Reston, VA 73-78
34. Segal A.J., Ellis J.H., Baumgartner B.R., Choyke P.L., Cohan R.H., Cohen M., Feinstein K.A., Fielding J.R., Jenkins R., Krecke K.N., Sandler C.M., Spinosa D.J., Spring D.B., and Wasserman N.F. ACR Committee on Drugs and Contrast Media: Manual on contrast media. Version 6 (2008), American College of Radiology, Reston, VA
35. Brenner D.J., and Hall E.J. Computed tomography: an increasing source of radiation exposure. New Engl J Med 357 (2007) 2277-2284
36. Overbeek F.J., Pauwels E.K., Bloem J.L., Camps J.A., Geleijns J., and Broerse J.J. Somatic effects in nuclear medicine and radiology. Appl Radiat Isot 50 (1999) 63-72
37. Brenner D.J., Doll R., Goodhead D.T., Hall E.J., Land C.E., Little J.B., Lubin J.H., Preston D.L., Preston R.J., Puskin J.S., Ron E., Sachs R.K., Samet J.M., Setlow R.B., and Zaider M. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 100 (2003) 13761-13766
38. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Nuclear and Radiation Studies Board. Division on Earth and Life Studies, National Research Council of the National Academies: Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2 (2006), The National Academies Press, Washington, DC
39. Don S. Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Ped Radiol 34 Suppl 3 (2004) S167-S172
40. Nickoloff E.L., and Alderson P.O. A comparative study of thoracic radiation doses from 64-slice cardiac CT. Br J Radiol 80 (2007) 537-544
41. Einstein A.J., Henzlova M.J., and Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298 (2007) 317-323
42. Rybicki F.J., Otero H.J., Steigner M.L., Vorobiof G., Nallamshetty L., Mitsouras D., Ersoy H., Mather R.T., Judy P.F., Cai T., Coyner K., Schultz K., Whitmore A.G., and Di Carli M.F. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 24 (2008) 535-546
43. Rehani M.M., Bongartz G., Kalender W., Golding S.J., Gordon L., Murakami T., and Shrimpton P. Managing patient dose in computed tomography. Ann ICRP 30 (2000) 7-45
44. Hausleiter J., Meyer T., Hadamitzky M., Huber E., Zankl M., Martinoff S., Kastrati A., and Schomig A. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113 (2006) 1305-1310
45. Siegel M.J., Schmidt B., Bradley D., Suess C., and Hildebolt C. Radiation dose and image quality in pediatric CT: effect of technical factors and phantom size and shape. Radiology 233 (2004) 515-522
46. Hermann F., Martinoff S., Meyer T., Hadamitzky M., Jiang C., Hendrich E., and Hausleiter J. Reduction of radiation dose estimates in cardiac 64-slice CT angiography in patients after coronary artery bypass graft surgery. Invest Radiol 43 (2008) 253-260
47. Shuman W.P., Branch K.R., May J.M., Mitsumori L.M., Lockhart D.W., Dubinsky T.J., Warren B.H., and Caldwell J.H. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 248 (2008) 431-437
48. Husmann L., Valenta I., Gaemperli O., Adda O., Treyer V., Wyss C.A., Veit-Haibach P., Tatsugami F., von Schulthess G.K., and Kaufmann P.A. Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29 (2008) 191-197
49. Scheffel H., Alkadhi H., Leschka S., Plass A., Desbiolles L., Guber I., Krauss T., Gruenenfelder J., Genoni M., Luescher T.F., Marincek B., and Stolzmann P. Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 94 (2008) 1132-1137
50. Geleijns J., Salvado Artells M., Veldkamp W.J., Lopez Tortosa M., and Calzado Cantera A. Quantitative assessment of selective in-plane shielding of tissues in computed tomography through evaluation of absorbed dose and image quality. Eur Radiol 16 (2006) 2334-2340
51. Donadieu J., Roudier C., Saguintaah M., Maccia C., and Chiron R. Estimation of the radiation dose from thoracic CT scans in a cystic fibrosis population. Chest 132 (2007) 1233-1238
52. Bae K.T. Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model. Radiology 227 (2003) 809-816
53. McCollough C., Cody D., Edyvean S., Geise R., Gould B., Keat N., Huda W., Judy P., Kalender W., McNitt-Gray M., Morin R., Payne T., Stern S., Rothenberg L., and AAPM Task Group 23: CT dosimetry. Diagnostic Imaging Council CT Committee. The Measurement, reporting, and management of radiation dose in CT (2008), American Association of Physicists in Medicine, College Park, MD AAPM Report No. 96
54. Hunold P., Vogt F.M., Schmermund A., Debatin J.F., Kerkhoff G., Budde T., Erbel R., Ewen K., and Barkhausen J. Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT. Radiology 226 (2003) 145-152
55. Pundziute G., Schuijf J.D., Jukema J.W., Lamb H.J., de Roos A., van der Wall E.E., and Bax J.J. Impact of coronary calcium score on diagnostic accuracy of multislice computed tomography coronary angiography for detection of coronary artery disease. J Nucl Cardiol 14 (2007) 36-43
56. Cordeiro M.A., Miller J.M., Schmidt A., Lardo A.C., Rosen B.D., Bush D.E., Brinker J.A., Bluemke D.A., Shapiro E.P., and Lima J.A. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores. Heart 92 (2006) 589-597
57. Rumberger J.A., Simons D.B., Fitzpatrick L.A., Sheedy P.F., and Schwartz R.S. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92 (1995) 2157-2162
58. Oncel D., Oncel G., and Tastan A. Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experience. Radiology 245 (2007) 703-711
59. Scheffel H., Alkadhi H., Plass A., Vachenauer R., Desbiolles L., Gaemperli O., Schepis T., Frauenfelder T., Schertler T., Husmann L., Grunenfelder J., Genoni M., Kaufmann P.A., Marincek B., and Leschka S. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control. Eur Radiol 16 (2006) 2739-2747
60. Cademartiri F., Runza G., Mollet N.R., Luccichent G., Belgrano M., Somers P., Knaapen M., Verheye S., Bruining N., Hamers R., Midiri M., DeFeyter P.J., and Krestin G.P. Influence of increasing convolution kernel filtering on plaque imaging with multislice CT using an ex-vivo model of coronary angiography. Radiol Med (Torino) 110 (2005) 234-240
61. Birnbaum B.A., Hindman N., Lee J., and Babb J.S. Multi-detector row CT attenuation measurements: Assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 242 (2007) 109-119
62. Dewey M., Teige F., Rutsch W., Schink T., and Hamm B. CT coronary angiography: influence of different cardiac reconstruction intervals on image quality and diagnostic accuracy. Eur J Radiol 67 (2008) 92-99
63. Herzog C., Arning-Erb M., Zangos S., Eichler K., Hammerstingl R., Dogan S., Ackermann H., and Vogl T.J. Multi-detector row CT coronary angiography: influence of reconstruction technique and heart rate on image quality. Radiology 238 (2006) 75-86
64. Husmann L., Leschka S., Desbiolles L., Schepis T., Gaemperli O., Seifert B., Cattin P., Frauenfelder T., Flohr T.G., Marincek B., Kaufmann P.A., and Alkadhi H. Coronary artery motion and cardiac phases: dependency on heart rate and implications for CT image reconstruction. Radiology 245 (2007) 567-576
65. Leschka S., Wildermuth S., Boehm T., Desbiolles L., Husmann L., Plass A., Koepfli P., Schepis T., Marincek B., Kaufmann P.A., and Alkadhi H. Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. Radiology 241 (2006) 378-385
66. Vembar M., Walker M.J., and Johnson P.C. Cardiac imaging using multislice computed tomography scanners: technical considerations. Coron Artery Dis 17 (2006) 115-123
67. Wintersperger B.J., Nikolaou K., von Ziegler F., Johnson T., Rist C., Leber A., Flohr T., Knez A., Resier M.F., and Becker C.R. Image quality, motion artifacts, and reconstruction timing of 64-slice coronary computed tomography angiography with 0.33-second rotation speed. Invest Radiol 41 (2006) 436-442
68. Nagatani Y., Takahashi M., Takazakura R., Nitta N., Murata K., Ushio N., Matsuo S., Yamamoto T., and Horie M. Multidetector-row computed tomography coronary angiography: optimization of image reconstruction phase according to the heart rate. Circ J 71 (2007) 112-121
69. Seifarth H., Wienbeck S., Püsken M., Juergens K.U., Maintz D., Vahlhaus C., Heindel W., and Fischbach R. Optimal systolic and diastolic reconstruction windows for coronary CT angiography using dual-source CT. AJR Am J Roentgenol 189 (2007) 1317-1323
70. Leschka S., Husmann L., Desboilles L.M., Gaemperli O., Schepis T., Koepfli P., Boehm T., and Marincek B. Kaufmann PA Alkadhi H: Optimal image reconstruction intervals for non-invasive coronary angiography with 64-slice CT. Eur Radiol 16 (2006) 1964-1972
71. Dewey M., Teige F., Laule M., and Hamm B. Influence of heart rate on diagnostic accuracy and image quality of 16-slice CT coronary angiography: comparison of multisegment and halfscan reconstruction approaches. Eur Radiol 17 (2007) 2829-2837
72. Weininger M., Ritter C., Beer M., Hahn D., and Beissert M. Evaluation of the optimal image reconstruction interval for coronary artery imaging using 64-slice computed tomography. Acta Radiol 48 (2007) 620-627
73. Frydrychowicz A., Pache G., Saueressig U., Foll D., Kotter E., Langer M., and Bley T.A. Comparison of reconstruction intervals in routine ECG-pulsed 64-row MSCT coronary angiography in frequency controlled patients. Cardiovasc Intervent Radiol 30 (2007) 79-84
74. Herzog C., Nguyen S.A., Savino G., Zwerner P.L., Doll J., Nielsen C.D., Flohr T.G., Vogl T.J., Costello P., and Schoepf U.J. Does two segment image reconstruction at 64-section CT coronary angiography improve image quality and diagnostic accuracy?. Radiology 244 (2007) 121-129
75. Cademartiri F., Mollet N.R., Runza G., Baks T., Midiri M., McFadden E.P., Flohr T.G., Ohnesorge B., de Feyter P.J., and Krestin G.P. Improving diagnostic accuracy of MDCT coronary angiography in patients with mild heart rhythm irregularities using ECG editing. AJR Am J Roentgenol 186 (2006) 634-638