by Poon Mei Yu. / Thesis submitted in: Dec. 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 127-132). / Abstract also in Chinese. / Declaration --- p.i / Acknowledgement --- p.ii / Table of Contents --- p.iii / Abbreviations --- p.xi / List of Figures --- p.xiv / List of Tables --- p.xvii / Abstract --- p.xxi / Introduction --- p.1 / Chapter Chapter 1: --- Obesity & related abnormalities --- p.2 / Chapter Chapter 2: --- Measurement of body fat --- p.11 / Objective --- p.18 / Chapter Chapter 3: --- Purpose of study --- p.19 / Method --- p.24 / Chapter Chapter 4: --- Technical considerations on CT technique --- p.25 / Chapter Chapter 5: --- Data Collection --- p.32 / Chapter Chapter 6: --- Data Analysis --- p.44 / Results --- p.49 / Chapter Chapter 7: --- Amount of adipose tissue --- p.50 / Chapter Chapter 8: --- "Adipose tissue distribution, VSR & VTR" --- p.81 / Discussion --- p.105 / Chapter Chapter 9: --- Discussion --- p.106 / Conclusions --- p.122 / Chapter Chapter 10: --- Conclusions --- p.123 / References --- p.127 / Appendix I --- p.133 / Appendix II --- p.136 / Appendix III --- p.139 / DECLARATION --- p.i / ACKNOWLEDGEMENT --- p.ii / TABLE OF CONTENTS --- p.iii / Brief Contents --- p.iii / Detailed Contents --- p.v / ABBREVIATIONS --- p.xi / LIST OF FIGURES --- p.xiv / LIST OF TABLES --- p.xvii / ABSTRACT --- p.xxi / INTRODUCTION --- p.1 / Chapter Chapter 1: --- OBESITY & RELATED ABNORMALITIES --- p.2 / Chapter 1.1 --- Adipose Tissue --- p.2 / Chapter 1.2 --- Classification of Adiposity --- p.3 / Chapter 1.3 --- Obesity --- p.5 / Chapter Chapter 2: --- MEASUREMENT OF BODY FAT --- p.11 / Chapter 2.1 --- Methods of Measuring Body Fat --- p.11 / Chapter 2.1.1 --- Non-imaging Methods --- p.12 / Chapter 2.1.2 --- Imaging Methods --- p.13 / Chapter 2.1.2.1 --- Plain radiograph --- p.13 / Chapter 2.1.2.2 --- Ultrasound --- p.13 / Chapter 2.1.2.3 --- Computed tomography --- p.14 / Chapter 2.1.2.4 --- Magnetic resonance imaging --- p.16 / OBJECTIVE --- p.18 / Chapter Chapter 3: --- PURPOSE OF STUDY --- p.19 / Chapter 3.1 --- Objectives --- p.19 / Chapter 3.2 --- Explanation --- p.20 / Chapter 3.2.1 --- Best level of AT area measurement --- p.21 / Chapter 3.2.2 --- Linear AT dimension --- p.22 / Chapter 3.2.3 --- Sex and age differences --- p.22 / Chapter 3.2.4 --- Difference in attenuation interval of fat --- p.23 / METHOD --- p.24 / Chapter Chapter 4: --- TECHNICAL CONSIDERATIONS ON CT TECHNIQUE --- p.25 / Chapter 4.1 --- Defining Anatomy --- p.25 / Chapter 4.1.1 --- Abdominal visceral cavity --- p.26 / Chapter 4.1.1.1 --- Diaphragm --- p.26 / Chapter 4.1.1.2 --- Pelvis --- p.26 / Chapter 4.1.1.3 --- Boundary at mid-potion --- p.27 / Chapter 4.1.2 --- Intra- and retro- peritoneal compartments --- p.28 / Chapter 4.2 --- Attenuation interval of fat --- p.29 / Chapter 4.2.1 --- Distinctive pixel value vs. attenuation interval --- p.30 / Chapter 4.2.2 --- Choice of interval --- p.30 / Chapter Chapter 5: --- DATA COLLECTION --- p.32 / Chapter 5.1 --- Subjects --- p.32 / Chapter 5.2 --- Acquisition --- p.33 / Chapter 5.3 --- Measurement --- p.34 / Chapter 5.3.1 --- AT area measurement --- p.35 / Chapter 5.3.2 --- Linear AT measurement --- p.38 / Chapter 5.3.2.1 --- Subcutaneous AT thickness --- p.38 / Chapter 5.3.2.2 --- Visceral AT thickness --- p.39 / Chapter Chapter 6: --- DATA ANALYSIS --- p.44 / Chapter 6.1 --- Tools --- p.44 / Chapter 6.2 --- Mathematical Assumptions --- p.45 / RESULTS --- p.49 / Chapter Chapter 7: --- AMOUNT OF ADIPOSE TISSUE --- p.50 / Chapter 7.1 --- AT Volumes --- p.50 / Chapter 7.1.1 --- In male and female subgroups --- p.50 / Chapter 7.1.2 --- VAT and SAT increase with TAT --- p.52 / Chapter 7.1.3 --- A VAT volume vs. VAT volume --- p.54 / Chapter 7.2 --- AT Areas at Various Anatomical Levels --- p.55 / Chapter 7.2.1 --- In male and female subgroups --- p.56 / Chapter 7.2.2 --- Correlation between AT volumes and areas --- p.62 / Chapter 7.2.3 --- Prediction of abdominal AT volumes from AT areas --- p.63 / Chapter 7.3 --- Linear AT Dimensions --- p.66 / Chapter 7.3.1 --- Linear SAT dimensions correlated to AT volumes --- p.66 / Chapter 7.3.2 --- Linear VAT dimensions correlated to AT volumes --- p.68 / Chapter 7.3.3 --- Prediction of abdominal SAT volume --- p.70 / Chapter 7.3.4 --- Prediction of abdominal A VAT volume --- p.71 / Chapter 7.3.5 --- Prediction of abdominal TAT volume --- p.72 / Chapter 7.4 --- "AT Measurements, Sex and Age" --- p.73 / Chapter 7.4.1 --- In whole study population --- p.73 / Chapter 7.4.2 --- In male and female subgroups --- p.75 / Chapter 7.5 --- Difference in Attenuation Interval --- p.79 / Chapter Chapter 8: --- DISTRIBUTION OF ADIPOSE TISSUE: VSR & VTR --- p.81 / Chapter 8.1 --- VSR --- p.81 / Chapter 8.1.1 --- Correlation --- p.82 / Chapter 8.1.2 --- Prediction --- p.83 / Chapter 8.1.3 --- Effect of attenuation interval --- p.84 / Chapter 8.1.3.1 --- On VSR value --- p.84 / Chapter 8.1.3.2 --- On correlation and prediction results --- p.86 / Chapter 8.2 --- VTR --- p.88 / Chapter 8.2.1 --- Correlation --- p.88 / Chapter 8.2.2 --- Prediction --- p.89 / Chapter 8.2.3 --- Effect of attenuation interval --- p.91 / Chapter 8.2.3.1 --- On VTR value --- p.91 / Chapter 8.2.3.2 --- On correlation and prediction results --- p.93 / Chapter 8.3 --- VSR vs. VTR --- p.95 / Chapter 8.4 --- "VSR, VTR, Sex and Age" --- p.96 / Chapter 8.4.1 --- Correlation --- p.99 / Chapter 8.4.2 --- Prediction --- p.100 / Chapter 8.4.3 --- VSR and VTR increase with age --- p.101 / DISCUSSION --- p.105 / Chapter Chapter 9: --- DISCUSSION --- p.106 / Chapter 9.1 --- Absolute AT Content (Amount) --- p.106 / Chapter 9.1.1 --- AT areas of various anatomical levels --- p.106 / Chapter 9.1.1.1 --- Correlated to AT volume --- p.107 / Chapter 9.1.1.2 --- Prediction of abdominal A T volume: best level --- p.107 / Chapter 9.1.2 --- Linear AT dimensions --- p.109 / Chapter 9.1.2.1 --- Correlated to AT volume --- p.109 / Chapter 9.1.2.2 --- Prediction of abdominal AT volume --- p.111 / Chapter 9.2 --- AT Distribution Indices: VSR and VTR --- p.112 / Chapter 9.2.1 --- The best level --- p.114 / Chapter 9.3 --- Sex and Age Difference --- p.114 / Chapter 9.3.1 --- absolute AT content --- p.114 / Chapter 9.3.2 --- VSR and VTR --- p.116 / Chapter 9.4 --- Difference in Attenuation Interval --- p.118 / Chapter 9.4.1 --- Absolute AT content --- p.118 / Chapter 9.4.2 --- VSR and VTR --- p.119 / Chapter 9.5 --- Limitations --- p.120 / Chapter 9.5.1 --- Study population --- p.120 / Chapter 9.5.2 --- Differentiation of compartments --- p.121 / CONCLUSIONS --- p.122 / Chapter Chapter 10: --- CONCLUSIONS --- p.123 / Chapter 10.1 --- Absolute AT Content in Abdomen --- p.123 / Chapter 10.2 --- Abdominal AT Distribution --- p.125 / Chapter 10.3 --- Effect of Attenuation Interval --- p.126 / REFERENCES --- p.127 / APPENDIX I: Comparison of study populations & scanning techniques --- p.133 / APPENDIX II: Comparison of definitions of attenuation interval of fat and anatomical compartments --- p.136 / APPENDIX III: Statistical summary of the adipose tissue measurements in this study --- p.139

Respiratory motion causes artifacts and blurring of cardiac structures in reconstructed images of SPECT and PET cardiac studies. Hysteresis in respiratory motion causes the organs to move in distinct paths during inspiration and expiration. Current respiratory motion correction methods use a signal generated by tracking the motion of the abdomen during respiration to bin list- mode data as a function of the magnitude of this respiratory signal. They thereby fail to account for hysteretic motion. The goal of this research was to demonstrate the effects of hysteretic respiratory motion and the importance of its correction for different medical imaging techniques particularly SPECT and PET. This study describes a novel approach for detecting and correcting hysteresis in clinical SPECT and PET studies. From the combined use of MRI and a synchronized Visual Tracking System (VTS) in volunteers we developed hysteretic modeling using the Bouc-Wen model with inputs from measurements of both chest and abdomen respiratory motion. With the MRI determined heart motion as the truth in the volunteer studies we determined the Bouc Wen model could match the behavior over a range of hysteretic cycles. The proposed approach was validated through phantom simulations and applied to clinical SPECT studies.

Optical Coherence Tomography (OCT) is an imaging technique that uses near infra-red light to non-invasively form cross-sectional images of specimens, in a similar way to ultrasound and RADAR. A number of research groups have used OCT to study natural and artificial carious lesions and to some extent erosive lesions. For this, a variety of in vitro models have been used. However, the exact mechanism by which these demineralised enamel lesions affect the OCT measurements is not fully understood. This remains a barrier to its adoption as both an analytical laboratory tool and a widespread technique in clinical dentistry. Therefore, the aim of this thesis was to develop an understanding of how different demineralised enamel lesions manifest in OCT measurements. This is necessary for the technique to become useful as an in vivo clinical measurement and imaging system. Consequently, this study was carried out in a controlled laboratory environment for which a novel specimen holder was designed. This mitigated against specimen movement and maintained specimen hydration, which can be a source of uncertainty in the measurements. A custom-built OCT microscope was used for this work, which enabled automation of experiments and continuous time-lapse OCT imaging over time periods of hours to several days. This enabled bovine enamel demineralisation dynamics to be captured during in vitro caries and erosion formation. The stability of the system also enabled direct comparison between the OCT measurements of the optical properties of different demineralisation models. To achieve these measurements, the OCT system was carefully characterised and compared to established profilometry measurements. Interestingly, this revealed that the experimental protocol used to obtain lesions for profilometry was not to be representative of the lesions formed and measured by OCT. This is an important point when interpreting OCT data in light of other techniques. A novel method of analysis was developed that uses longitudinal OCT image correlation to quantify early stage surface softening during erosion. By using OCT volumetric data, this technique was able to measure sub-resolution changes at the specimen surface. Early results also indicate sensitivity to remineralisation. This thesis shows that OCT is sensitive to different demineralisation models produced and measured under controlled conditions. New method of handling the data can observe changes not previously seen in OCT. However, further work is still required to understand the underlying physical changes that lead to this sensitivity in OCT.

A especialidade de Prótese Buco-Maxilo-Facial é responsável por reconstruções complexas da face e do crânio. Entretanto, com a utilização de impressões convencionais, é difícil se alcançar uma adequada adaptação clínica para a reabilitação do paciente. Assim, algumas vêzes, faz-se necessária a obtenção de modelos tridimensionais (3D) que reproduzam a realidade clínica. O objetivo deste estudo é comparar os protótipos obtidos com diferentes protocolos de aquisição de imagem provenientes de distintos aparelhos de tomografia computadorizada com relação à rugosidade superficial, área reconstruída e dose de exposição gerada, procurando estabelecer o mais adequado para a confecção de protótipos de crânio. Para isso, nove protótipos de um fragmento craniofacial seco foram confeccionados. A comparação entre os protótipos quanto à lisura superficial e à área reconstruída foi realizada por meio da Análise de Variância (ANOVA). Nos casos em que a avaliação indicou diferença significativa, foi aplicado como complemento o Teste de Comparações Múltiplas de Tukey. O nível de significância adotado foi de 5%. Em relação à análise de rugosidade as diferenças encontradas não demonstraram correlação com a área reconstruída. Já em relação aos diferentes protocolos, diferenças significativas foram observadas nos protótipos com respeito à área reconstruída e dose de radiação gerada. Pode-se concluir, frente aos resultados encontrados, que as imagens geradas pelos tomógrafos de feixe cônico e feixe em leque, utilizando os protocolos com as resoluções máximas estudadas, estão indicadas para a confecção de protótipos. Contudo, o que deve nortear a seleção do melhor protocolo tomográfico deve ser o propósito da indicação clínica correlacionado com o princípio ALARA (As Low As Reasonably Achievable). / Oral-maxillo-facial prosthodontics is the study of complex face and skull reconstructions. In view of the insufficient degree of adjustment of conventional impression to enable proper clinical rehabilitation, among other reasons, practitioners increasingly resort to 3D models that accurately reproduce the clinical reality. The aim of this study is to determine the optimal selection of imaging device and protocol for use in skull prototyping. The surface roughness and reconstructed area of nine prototypes obtained from a dried craniofacial specimen using different image acquisition protocols and CT devices were measured, in addition to measurements of the radiation dose potentially received by the patient. ANOVA of the surface roughness, reconstructed area and radiation dose data enabled statistical comparisons among the prototypes. Where significant differences were found, Tukey’s multiple-comparison test was conducted, using a significance level of 5%. No correlation was found between surface roughness and reconstructed area. However, significant differences in reconstructed area and radiation dose were found among the different protocols. These results support the use of images generated by CBCT or fan beam CT for the construction of prototypes, using the protocols with the highest resolution. Nevertheless, the selection of the most appropriate TC protocol should be based on the particular clinical indication along with the ALARA (as low as reasonably achievable) principle.

The largest earthquakes and the majority of the seismic energy are released on megathrust faults in subduction zones. The goal of this dissertation is to characterize the seismic behavior, structural and physical properties of the megathrust fault, so that we can better understand the controls on slip behavior and large earthquakes. To address this goal, I analyzed seismicity data collected by a local seismic network deployed in southern Alaska and multi-channel seismic (MCS) data from an active-source survey offshore of the Alaska Peninsula. This dissertation work revealed seismicity patterns associated with a large asperity, downdip transitions in megathrust fault structure, and along-strike variations in the properties of subducting sediment on the shallow part of the subduction zone. All of these observations have important implications for seismic behavior of the megathrust.

Esta dissertação apresenta um estudo sobre a utilização de tomografia acústica para reconstruir a distribuição interna de temperaturas de um corpo ou escoamento. Para tanto, o problema inverso foi modelado matematicamente a partir da equação de propagação acústica e de um funcional de erro quantificando a sensibilidade dos perfis de pressão acústica externa relativamente a variações na distribuição interna de impedância acústica. Simulações numéricas foram realizadas em um modelo de um problema real, tendo sido testadas duas técnicas de excitação, a clássica tipo Dirac e uma estratégia otimizada segundo um perfil triangular. / This work presents a study about the utilization of acoustic tomography to reconstruct the internal temperature distribution of a body or a flow. To do this, the inverse problem was mathematically modeled from the acoustic propagation equation and a error functional quantifying the sensitivity of external acoustic pressure profile according to changes in the internal acoustic impedance distribution. Numerical simulations were done in a real problem model, two excitation techniques were tested, the classical Dirac type and a optimized strategy with a triangular profile.

With current needs to better understand the interaction between atrial tissue microstructure and atrial fibrillation dynamics, micrometer scale imaging with optical coherence tomography has significant potential to provide further insight on arrhythmia mechanisms and improve treatment guidance. However, optical coherence tomography imaging of cardiac tissue in humans is largely unexplored, and the ability of optical coherence tomography to identify the structural substrate of atrial fibrillation has not yet been investigated. Therefore, the objective of this thesis was to develop an optical coherence tomography imaging atlas of the human heart, study the utility of optical coherence tomography in providing useful features of human left atrial tissues, and develop a framework for optical coherence tomography-informed cardiac modeling that could be used to probe dynamics between electrophysiology and tissue structure. Human left atrial tissues were comprehensively imaged by optical coherence tomography for the first time, providing an imaging atlas that can guide identification of left atrial tissue features from optical coherence tomography imaging. Optical coherence tomography image features corresponding to myofiber and collagen fiber orientation, adipose tissue, endocardial thickness and composition, and venous media were established. Varying collagen fiber distributions in the myocardial sleeves were identified within the pulmonary veins. A scheme for mapping optical coherence tomography data of dissected left atrial tissues to a three-dimensional, anatomical model of the human left atrium was also developed, enabling the mapping of distributions of imaged adipose tissue and fiber orientation to the whole left atrial geometry. These results inform future applications of structural substrate mapping in the human left atrium using optical coherence tomography-integrated catheters, as well as potential directions of ex vivo optical coherence tomography atrial imaging studies. Additionally, we developed a workflow for creating optical mapping models of atrial tissue as informed by optical coherence tomography. Tissue geometry, fiber orientation, ablation lesion geometry, and heterogeneous tissue types were extracted from optical coherence tomography images and incorporated into tissue-specific meshes. Electrophysiological propagation was simulated and combined with photon scattering simulations to evaluate the influence of tissue-specific structure on electrical and optical mapping signals. Through tissue-specific modeling of myofiber orientation, ablation lesions, and heterogeneous tissue types, the influence of myofiber orientation on transmural activation, the relationship between fluorescent signals and lesion geometry, and the blurring of optical mapping signals in the presence of heterogeneous tissue types were investigated. By providing a comprehensive optical coherence tomography image database of the human left atrium and a workflow for developing optical coherence tomography-informed cardiac tissue models, this work establishes the foundation for utilizing optical coherence tomography to improve the structural substrate characterization of atrial fibrillation. Future developments include analysis of optical coherence tomography imaged tissue structure with respect to clinical presentation, development of automated processing to better leverage the large amount of imaging data, enhancements and validation of the modeling scheme, and in vivo evaluation of the left atrial structural substrate through optical coherence tomography-integrated catheters

A instabilidade patelar é uma patologia comum dentro da especialidade da cirurgia do joelho. O principal fator estabilizador dessa articulação é o ligamento patelofemoral medial, sendo esta a principal estrutura a ser reconstruída no tratamento cirúrgico da instabilidade patelar. Apesar de sua reconstrução apresentar excelentes resultados clínicos, não se sabe ao certo o real efeito in vivo desse procedimento no movimento da patela ao redor do fêmur. A avaliação da articulação patelofemoral tradicionalmente é feita através de exames de imagem estáticos. Com a evolução dos aparelhos de tomografia computadorizada, se tornou possível realizar esse exame durante movimento ativo, técnica ainda pouco utilizada para estudo de articulações como o joelho. O objetivo deste estudo foi padronizar o uso da tomografia de 320 fileiras de detectores para estudo dinâmico da articulação patelofemoral em pacientes com instabilidade patelar recidivante pré e pós-reconstrução do ligamento patelofemoral medial, analisando o efeito da cirurgia no trajeto da patela ao longo do arco de movimento. Foram selecionados 10 pacientes com instabilidade patelar e indicação de reconstrução do ligamento patelofemoral medial isolada, que foram submetidos à tomografia antes e após um mínimo de 6 meses da cirurgia. Os parâmetros anatômicos avaliados foram os ângulos de inclinação da patela e distância da patela ao eixo da tróclea através de um programa de computador desenvolvido especificamente para esse fim. Foram aplicados os escores clínicos de Kujala e Tegner e calculada a radiação dos exames. O protocolo escolhido para aquisição de imagens na tomografia foi: potencial do tubo de 80 kV, carga transportável de 50 mA, espessura de corte de 0,5 mm e tempo de aquisição de 10 segundos, o que gerou um DLP (dose length product) de 254 mGycm e uma dose efetiva estimada de radiação de 0,2032 mSv. O paciente realizava uma extensão ativa do joelho contra a gravidade. Os resultados não mostraram mudança do trajeto da patela após a reconstrução do ligamento patelofemoral medial, apesar de não ter havido nenhuma recidiva da instabilidade e os escores clínicos apresentarem melhora média de 22,33 pontos no Kujala (p=0,011) e de 2 níveis no Tegner (p=0,017) / Patellar instability is a common pathology in the practice of knee surgeons. The most important stabilizing structure in the patellofemoral joint is the medial patellofemoral ligament. This ligament is the main structure to be reconstructed during surgery for patellofemoral instability. Although clinical results for this procedure are excellent, the real in vivo effect of medial patellofemoral ligament reconstruction on patellar tracking is unknown. The study of this joint is usually made with static imaging. With the recent evolution of tomographers, it is now possible to analyze anatomical structures moving during active range of motion. This technique (dynamic computerized tomography) has not been routinely used to study joints as the knee. This study had the purpose of standardizing the use of 320-detector row computerized tomography for the patellofemoral joint, analyzing patients before and after surgical reconstruction of medial patellofemoral ligament. We selected 10 patients with patellofemoral instability referred to isolated medial patellofemoral ligament reconstruction surgery, and submitted them to a dynamic computerized tomography before and at a minimum of 6 months after surgery. Patellar tilt angles and shift distance were analyzed using a computer software specifically designed for this purpose. Kujala and Tegner scores were applied and the radiation of the exams was recorded. The protocol for imaging acquisition was: tube potential of 80 kV, 50 mA, slice thickness of 0.5 mm and 10 seconds of acquisition duration. This produced a DLP (dose length product) of 254 mGycm and a radiation effective estimated dose of 0.2032 mSv. There were no changes in patellar tracking after medial patellofemoral ligament reconstruction. There was no instability relapse. Clinical scores showed an average improvement of 22.33 points for Kujala (p=0.011) and of 2 levels for Tegner (p=0.017)

INTRODUÇÃO: A angiotomografia computadorizada com múltiplos detectores (ATCMD) apresenta alta acurácia para a detecção de estenose luminal significativa das artérias coronárias ( 50%) quando comparada à angiografia coronária invasiva (ACI). Recentemente, esse método vem sendo investigado na avaliação de pacientes com dor torácica aguda de baixo risco. No entanto, poucos estudos investigaram a capacidade da ATCMD na avaliação de pacientes com maior risco para síndrome coronária aguda (SCA). OBJETIVOS: Investigar a acurácia diagnóstica da ATCMD com 64 colunas de detectores para a detecção de estenose luminal coronária 50% definida pela ACI em indivíduos com suspeita de SCA sem supradesnível do segmento ST e comparar estes resultados com a acurácia encontrada em pacientes com suspeita de doença coronária crônica; avaliar a capacidade da ATCMD em predizer revascularização miocárdica nos 30 primeiros dias de seguimento. Adicionalmente objetivamos verificar a prevalência e a acurácia da presença de calcificação coronária para detecção de estenose luminal coronária significativa. MÉTODOS: Pacientes que participaram do estudo multicêntrico internacional CorE64 foram classificados nos grupos SCA e não-SCA de acordo com critérios clínicos, incluindo a presença de angina ao repouso, alterações isquêmicas ao ECG e elevação de marcadores de necrose miocárdica. Todos os pacientes foram submetidos à ATCMD e posteriormente à ACI e para a análise primária foram considerados apenas aqueles com escore de cálcio (EC) 600. RESULTADOS: Dos 291 pacientes incluídos, 80 (27%) foram classificados no grupo SCA. A prevalência de estenose coronária 50% foi de 68% neste grupo e de 52% no grupo não-SCA (p=0,015). A acurácia diagnóstica da ATCMD, em análise por paciente, para detecção de estenose coronária significativa demonstrada pela análise da área sob a Curva de Características Operacionais (AUC) foi de 0,95 (IC 95%: 0,90-0,99) e 0,92 (IC 95%: 0,89-0,96) nos grupos SCA e não-SCA, respectivamente (p=0,44). Nos 30 dias de seguimento, 98 pacientes foram submetidos à revascularização miocárdica (48 do grupo SCA e 50 do grupo não-SCA). A AUC da ATCMD e da ACI para predição de revascularização foi de 0,91 (95% IC: 0,83-0,99) e 0,89 (95% IC: 0,80-0,98), respectivamente, no grupo SCA (p=0,61) e 0,80 (95% IC: 0,74-0,86) e 0,79 (95% IC: 0,73-0,85) no grupo não-SCA, p=0,75. Comparando os dois grupos estudados, a ATCMD foi melhor preditora de revascularização no grupo SCA (p=0,035). No grupo SCA, 6 pacientes (7,5%) tinham EC zero e estenose coronária significativa, comparado a 8 indivíduos (3,8%) do grupo não-SCA (p=0,22). Considerando pacientes com EC baixo (0 a 9), 12 (15%) do grupo SCA e 11 (5,2%) do não- SCA apresentaram estenose coronária 50% (p=0,012). A acurácia do EC para detecção de estenose coronária significativa nos grupos SCA e não- SCA foi de 0,73 (IC 95%: 0,63-0,82) e 0,70 (IC 95%: 0,64-0,76), respectivamente (p=0,75), sendo que o valor preditivo negativo no grupo SCA foi estatisticamente menor que no grupo não-SCA [0,63 (IC95%: 0,39- 0,86) e 0,86 (IC 95%: 0,77-0,95), respectivamente, p=0,038]. CONCLUSÕES: A ATCMD apresentou alta acurácia diagnóstica para detecção de estenose coronária significativa nos grupos SCA e não-SCA, não havendo diferença significativa entre ambos. A ATCMD obteve acurácia semelhante à ACI na predição de revascularização, sendo maior no grupo SCA que no não-SCA. A acurácia do EC para a detecção de estenose coronária 50% foi moderada em ambos os grupos, sendo que um EC zero ou baixo não excluiu a ocorrência de estenose significativa, especialmente no grupo SCA / BACKGROUND: Multi-detector computed tomography angiography (MDCTA) has shown high accuracy to detect obstructive coronary luminal stenosis ( 50%) compared to invasive coronary angiography (ICA). Recently, this technology has been investigated in the evaluation of patients with low-risk acute chest pain. However, few studies investigated its diagnostic performance in higher-risk patients with suspected acute coronary syndrome (ACS). OBJECTIVES: To estimate the diagnostic accuracy of 64- row computed tomography angiography to detect significant coronary stenosis defined by ICA in a per-patient analysis and its ability to predict coronary revascularization in patients with suspected acute coronary syndrome and in those with chronic, stable coronary artery disease; to identify the prevalence and the diagnostic accuracy of coronary calcification to detect significant luminal stenosis in both groups. METHODS: Patients included in the international multicenter trial CorE64 were categorized as suspected ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before ICA and both exams were evaluated by blinded, independent core laboratories. RESULTS: From 291 patients with coronary calcium score (CCS) 600 included in the primary analysis, 80 were categorized as suspected ACS. The prevalence of obstructive coronary disease was 68% in suspected ACS and 52% in non-ACS group (p=0.015). Patient-based analysis showed an area under the receiver-operatingcharacteristic curve (AUC) for detecting coronary stenosis 50% of 0.95 (95% CI: 0.90-0.99) in ACS and 0.92 (95% CI: 0.89-0.96) in non-ACS group (p=0.44). After 30 days of follow-up, 98 patients were submitted to coronary revascularization (48 from the ACS and 50 from the non-ACS group). MDCTA was similar to ICA to predict coronary revascularization in both groups with AUC of 0.91 (95% CI: 0.83-0.99) for MDCTA versus 0.89 (95% CI: 0.80-0.98) for ICA in the ACS group (p=0.61) and 0.80 (95% CI: 0.74- 0.86) for MDCTA versus 0.79 (95% CI: 0.73-0.85) for ICA in non-ACS group (p=0.75). MDCTA was better to predict revascularization in ACS than in non- ACS group (p=0.035). In the suspected ACS group, 6 patients (7.5%) had no coronary calcification and coronary stenosis 50%, compared with 8 patients (3.8%) in the non-ACS group (p=0.22). Considering patients with zero or low (0 to 9) CCS, 12 (15%) in the ACS and 11 (5.2%) in the non-ACS group had significant coronary stenosis (p=0.012). The accuracy of CCS to detect obstructive coronary stenosis in the ACS and non-ACS groups were 0.73 (95% CI: 0.63-0.82) e 0.70 (95% CI: 0.64-0.76), p=0.75, and its negative predictive value in the suspected ACS group was lower than in non-ACS patients [0.63 (95% CI: 0.39-0.86) and 0.86 (95% CI: 0.77-0.95), respectively, p=0.038]. CONCLUSIONS: Coronary MDCTA diagnostic accuracy was high and comparable for both ACS and non-ACS patients. MDCTA predicted revascularization similarly to ICA and its prediction ability was significantly better in the ACS than in non-ACS group. The diagnostic accuracy of a positive CCS to detect luminal stenosis 50% was moderate in both groups and a zero or low CCS could not exclude reliably significant coronary stenosis, particularly in suspected ACS patients

This research focuses on developing optical sensing systems for 2D and 3D spatial monitoring of temperature and concentration distribution profiles of complex or reacting gas flows. Non-invasive, species specific and sensitive nature of monitoring allows spatial information to be extracted from harsh environments with poor physical access, allowing validation of computational models or process monitoring. This is suitable for processes like combustion engines or sealed atmospheric cloud chambers. A novel line-of-sight (LOS) Tunable Diode Laser Absorption Spectroscopy(TDLAS) system using a preselected laser diode centred at 7212.88 cm-1 was first designed to monitor the change of relative humidity (water vapour concentration) during an expansion process within the Manchester Ice Cloud Chamber (MICC), operating from atmospheric pressure, down to 0.7 atm. The experimental results were validated with an Aerosol Cloud Precipitation Interaction Model (ACPIM) simulation, feasible for tomography applications. The MICC shares similar combustion monitoring challenges such as minimal optical access or reactive gas flows. The TDLAS system developed for the MICC was then used as a foundation design for a TDLAS tomography setup capable of conducting temporal two-dimensional (2D) and three-dimensional (3D) concentration and temperature imaging. This system uses the principle of two-line thermometry, centred within the near infrared (NIR) region of 7181.93cm-1 and 7179.8 cm-1. The laser was divided into 4 simultaneous parallel beams using a 1 × 4 fiber coupler (4 LOS). Using a motorised platform, the beams were projected at 0.5° interval, from 0° to 179° angle within 3.6 s, around the exhaust of two asymmetrical shaped flame burners. A total of 360 projection slices comprised of 1440 integrated absorbance data were used per tomogram reconstruction. By solving for the spatial distribution of temperature first, the concentration distribution of water vapour could be then calculated. Reconstruction algorithms (Filtered Back Projection, Fourier Slice Reconstruction and Direct Fourier Reconstruction (DFR)) were compared using a range of criteria. The DFR method was selected as the best method at 700 zero padding, with a spatial in-plane resolution of 1-2 lp/cm, pixel resolution of 128 by 128, thermocouple temperature validations of ±5°C and a relative mean error performance of 8.12%. The concentration could not be validated due to the lack of a mass spectrometer.3D volumetric monitoring results took 36 seconds to complete, and was constructed using 10 interpolated parallel, 1 cm height interval spaced tomograms. Independent vertical slices along the x-axis and y-axis could also be extracted. The temporal results were also successfully conducted and consisted of a quick succession of 16 experiments at a temporal resolution of 0.28 frames per second. A tomographic system that performs 3D and 2D temporal sensing was successfully developed and validated. Although 3D work was conducted using planar imaging or hyperspectral tomography, no work has been conducted so far using NIR TDLAS systems to date.