I-chen Tsai | National Yang Ming Chiao Tung University (original) (raw)

Papers by I-chen Tsai

Korean Journal of Radiology, 2019

Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challengi... more Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.

Cardiovascular Imaging Asia, 2021

A previous 1999 to 2010 analysis showed that Asia is the only continent publishing more congenita... more A previous 1999 to 2010 analysis showed that Asia is the only continent publishing more congenital heart CT articles than those concerning MR imaging. A 1999 to 2020 follow-up, 21-year analysis shows the same trend. Among the 16 countries that published more than 21 congenital heart CT and 21 congenital heart MR articles in this period, South Korea, Taiwan, Japan, and China were the only four countries with CT/MR ratios of at least 1. As compared with 12 countries with CT/MR publication ratios of less than 1, these four countries have significantly lower health expenditures per capita (2395 USD vs. 5225 USD; p=0.029). On the citation map of congenital heart CT, South Korea, Taiwan, and Japan pioneered this field, but recent growth in the prominence of this imaging modality has been observed in China. Several researchers are at the center of the citation map, indicating the key roles they play in the accumulation and growth of the literature.

Korean Journal of Radiology, 2021

The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limit... more The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.

Europace, 2009

A 77-year-old man with dilated cardiomyopathy, atrial fibrillation, QRS duration of 140 ms, and N... more A 77-year-old man with dilated cardiomyopathy, atrial fibrillation, QRS duration of 140 ms, and NYHA functional class III was referred for cardiac resynchronization therapy device implantation. Coronary sinus (CS) contrast venography by balloon catheter showed no evidence of tributary veins, mimicking total occlusion of the CS. It was found to be due to superselection of a side branch with the balloon catheter.

… International Journal of …, 2010

The use of contrast media for cardiac imaging becomes increasing as the widespread of cardiac CT ... more The use of contrast media for cardiac imaging becomes increasing as the widespread of cardiac CT and cardiac MR. A radiologist needs to carefully consider the indication and the injection protocol of contrast media to be used as well as the possibility of adverse effect. There are several guidelines for contrast media in western countries. However, these are focusing the adverse effect of contrast media. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and created a guideline, which summarizes the integrated knowledge of contrast media for cardiac imaging. In cardiac imaging, coronary artery evaluation is feasible by non-contrast MR angiography, which can be an alternative examination in high risk patients for the use of iodine contrast media. Furthermore, the body habitus of Asian patients is usually smaller than that of their western counterparts. This necessitates modifications in the injection protocol and in the formula for calculation of estimated glomerular filtration rate. This guideline provided fundamental information for the use of contrast media for Asian patients in cardiac imaging.

The International Journal of Cardiovascular Imaging, 2010

These practice guidelines are recommended by the Asian Society of Cardiovascular Imaging (ASCI), ... more These practice guidelines are recommended by the Asian Society of Cardiovascular Imaging (ASCI), the sole society in Asia designated for cardiovascular imaging, to provide a framework to healthcare providers for suggested essential elements in cardiac magnetic resonance (CMR) examinations of different disease spectra. The guideline is composed of recommendations on the general technique, acquisition of some basic modules, and protocols on stress tests. The protocols for specific diseases are provided in a table format for quick reference to be easily utilized for everyday clinical CMR.

PURPOSE/AIM CT technologists should be able to perform an MDCT scan, with proper patient position... more PURPOSE/AIM CT technologists should be able to perform an MDCT scan, with proper patient positioning, contrast injection and scan parameters, to evaluate a patient suspected with catheter-related thrombosis (CRT). Radiologists should be able to interpret the MDCT scan to make a correct diagnosis and facilitate the clinical care for patients suspected with CRT. CONTENT ORGANIZATION Introduction Techniques Catheter-related thrombosis and associated conditions/complications Acute catheter-related thrombosis Chronic catheter-related thrombosis Postthrombotic syndrome Venous thromboembolism in other location Alternative diagnosis Cancer-related superior vena cava syndrome Compression of brachiocephalic vein by native anatomy or other disease Infection Lymphedema Conclusion SUMMARY MDCT could serve as a useful imaging modality for evaluating patients with suspected with catheter-related thrombosis (CRT). When evaluating patients with CRT, the common conditions are acute CRT, chronic CRT, ...

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2011

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2010

Intramyocardial hematoma is a rare sequela of percutaneous coronary intervention after acute myoc... more Intramyocardial hematoma is a rare sequela of percutaneous coronary intervention after acute myocardial infarction. Clinical outcomes of intramyocardial hematoma vary from asymptomatic remission to cardiac death. Close follow-up is imperative. Herein, we report the case of a 69-year-old man who had sustained an acute inferior myocardial infarction. During primary percutaneous coronary intervention to the occluded right coronary artery, an intramyocardial hematoma developed and immediately ruptured into the right ventricle. Because the patient remained hemodynamically stable, a conservative approach was taken. Follow-up with serial multidetector computed tomographic imaging elucidated the course and extent of the hematoma and clearly revealed the healing process. After 1 year, this method of imaging showed complete remission of the hematoma. To the best of our knowledge, this is the 1st use of serial multidetector computed tomography to document the remission of an intramyocardial he...

Thorax, 2011

A 47-year-old woman with a past history of pulmonary tuberculosis presented to our institution wi... more A 47-year-old woman with a past history of pulmonary tuberculosis presented to our institution with out-of-hospital cardiac arrest because of massive haemoptysis after severe coughing. On arrival, immediate cardiopulmonary resuscitation with chest compression, endotracheal intubation and intravenous epinephrine 1 mg with an interval of 3 min for asystole was performed. Twelve minutes later she was defibrillated twice with 150 joules and intravenous epinephrine of 1 mg with an interval of 3 min for ventricular fibrillation was given. Return of spontaneous circulation with a blood pressure of 181/98 mm Hg and a pulse rate of 80 beats/min was achieved 4 min later. Fluid replacement, blood transfusion, tranexamic acid and pitressin were given for persistent gushing of fresh blood from the endotracheal tube. It was suspected that the bleeding originated from the pulmonary or bronchial vessels. Laboratory evaluation revealed a white blood cell count of 13 100/mm 3 with 43.2% segmented neutrophils and 50.4% lymphocytes, haemoglobin 8.5 g/dl and platelet counts of 134310 3 /mm 3 . Thoracic contrastenhanced 64-slice multidetector computed tomographic angiography (MDCTA) demonstrated a vascular lesion 29 mm in diameter originating from a branch of the pulmonary artery (PA) with contrast media extravasations indicating a ruptured Rasmussen's aneurysm (figures 1 and 2). Pulmonary angiography with embolisation was attempted and a thoracic surgeon was consulted. However, cardiopulmonary resuscitation, defibrillation, fluid replacement, epinephrine and pitressin were prescribed for pulseless electrical activity and recurrent ventricular fibrillation. Four hours later the patient died after return of spontaneous circulation. Sputum culture 1 month later confirmed tuberculosis.

American Journal of Roentgenology, 2009

... Letter. Penumbra Imaging as a Prognostic Indicator for Acute Myocardial Infarction Using MDCT... more ... Letter. Penumbra Imaging as a Prognostic Indicator for Acute Myocardial Infarction Using MDCT. I-Chen Tsai, Kae-Woei Liang and Wen-Lieng Lee ... For complete MDCT and catheter coronary angiography images of this patient, see reference 1 of this letter. ...

American Journal of Roentgenology, 2008

Recently MDCT has become widely used for the evaluation of ischemic heart disease, but clinically... more Recently MDCT has become widely used for the evaluation of ischemic heart disease, but clinically the evaluation is primarily focused on the coronary artery only. We describe why and how to comprehensively evaluate the cardiac CT scan, including myocardium, motion, viability, valve, and perfusion aspects related to ischemic heart disease. Radiologists should be familiar with the protocol design and comprehensive interpretation of cardiac MDCT to provide comprehensive treatment suggestions for the patients.

American Journal of Roentgenology, 2007

The essay describes the protocol for and interpretation of MDCT scans in the evaluation of patien... more The essay describes the protocol for and interpretation of MDCT scans in the evaluation of patients after insertion of an Amplatzer septal occluder. In anatomic regions that cannot be confidently evaluated with transthoracic echocardiography, MDCT is useful for evaluating Amplatzer septal occluders for protrusion, migration, and residual shunt. Radiologists should be familiar with the imaging protocol and interpretation.

The American Journal of Emergency Medicine, 2005

Tzu Chi Medical Journal, 2010

Neck arteriovenous malformation (AVM) is an uncommon high flow vascular lesion. In the past, beca... more Neck arteriovenous malformation (AVM) is an uncommon high flow vascular lesion. In the past, because of limitations in magnetic resonance imaging and sonography, invasive angiography was usually necessary for diagnosis and surgical planning. Here, we present a 33-year-old woman with neck AVM. Multidetector row computed tomography (MDCT) provided comprehensive preoperative information, including the anatomic location, feeding artery and draining veins of the lesion. This report demonstrates that MDCT has evolved into a mature technology that can be an alternative tool and probably a new paradigm in the diagnosis of and surgical planning for AVMs. [Tzu Chi Med J 2010;22(3):157-159]

Journal of The Chinese Medical Association, 2010

Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) is a rare... more Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) is a rare congenital heart defect that affects approximately 1 in 300,000 live births and accounts for 0.5% of all congenital heart disease. Without surgical intervention, most patients with this anomaly die in infancy. The diagnosis of ALCAPA syndrome is sometimes difficult, especially in children, because it often presents with atypical symptoms and signs. Echocardiography can yield some findings that are highly indicative of this syndrome. Cardiac catheterization usually establishes the diagnosis, but it is invasive and painful. Multidetector-row computed tomography (MDCT) is a valuable alternative tool to confirm the diagnosis of ALCAPA syndrome. In this report, we describe a 24-year-old woman with a dilated right coronary artery detected by transthoracic echocardiography, showing an interventricular abnormal flow over the diastolic phase of the cardiac cycle and the left main coronary artery not merging with the ascending aorta. The diagnosis of ALCAPA syndrome was confirmed by MDCT.

Interventional Neuroradiology

Carotid-ophthalmic fistula is a rare disease, which can be treated by transvenous endovascular em... more Carotid-ophthalmic fistula is a rare disease, which can be treated by transvenous endovascular embolization. Here, we report a unique case with draining vein thrombosed, making a transvenous approach impossible. An old but valuable technique, direct transcutaneous puncture of the superior ophthalmic vein, was used to save the patient's right eye. The old technique, direct puncture of the superior ophthalmic vein, retains its irreplaceable usefulness in this special situation. Thus, interventional neuroradiologists should equip themselves with this essential technique.