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The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.

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Estimating sex is a fundamental task in biological and forensic anthropology. This study aimed to develop new methods for sex estimation based on femoral cross-sectional geometry (CSG) variables and to test their applicability in recent and ancient assemblages. The sample was divided into a study group (living individuals, N = 124) for creating sex prediction equations and two test groups: living individuals (N = 31) and prehistoric individuals (N = 34). The prehistoric sample was divided into three subgroups according to subsistence strategy (hunter-gatherers, early farmers that also hunted, and farmers and herders). Femoral CSG variables (size, strength, and shape) were measured from CT images using dedicated software. Discriminant functions for sex estimation were calculated for various bone completeness scenarios and validated using the test groups. Size and strength parameters were sexually dimorphic, while shape was not. Discriminant functions for sex estimation produced success rates in the living sample between 83.9 and 93.5%; the distal shaft yielded the highest results. Success rates were lower among the prehistoric test sample, with better results (83.3%) for the mid-Holocene population (farmers and herders) than for earlier groups (e.g., hunter-gatherers; < 60%). These results were compared with those obtained using other methods for sex estimation based on various skeletal elements. This study provides new, reliable, and simple methods with high success rates for sex estimation based on femoral CSG variables obtained automatically from CT images. Discriminant functions were created for various conditions of femoral completeness. However, these functions should be used carefully in past populations from different settings.

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Sex estimation of skeletal parts is of great value even in the DNA era. When computed tomography (CT) facilities were introduced to forensic institutes, new possibilities for sex estimation emerged. The aim of this study was to develop a CT-based method for sex estimation using the mandible. Twenty-five CT-based measurements of the mandible were developed and carried out on 3D reconstructions (volume rendering) and cross sections of the lower jaw of 438 adult individuals (214 males and 224 females). Intraobserver and interobserver variances of the measurements were examined using intraclass correlation coefficient (ICC) analysis. Five discriminant functions were developed using different states of completeness of the mandible. The success rates of these equations were cross validated twice. The measurements were found to be highly reliable (for intraobserver 0.838 < ICC < 0.995 and for interobserver 0.71 < ICC < 0.996). For a complete mandible, the correct classification rate was 90.8%. For incomplete mandibles, the correct classification rates varied from 72.9 to 85.6%. Cross-validation tests yielded similar success rates, for the complete mandible 89% and for the incomplete mandible 67.5 to 89%. We concluded that CT techniques are appropriate for estimating sex based on the mandible size and shape characteristics. Suggested discriminant functions for sex estimation are given with data on the correct classification rates.

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BACKGROUND: The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS. METHODS: Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40-99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS. RESULTS: Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS. CONCLUSIONS: Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.

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STUDY DESIGN: This cross-sectional study was carried out on 196 adults (98 men and 98 women), aged between 18 and 91 years. OBJECTIVE: To examine whether vertebral hemangiomas (VHs) are associated with other spinal pathologies, metabolic diseases, cardiovascular diseases, cancer and past trauma, to shed light on their possible pathophysiology. SUMMARY OF BACKGROUND DATA: VHs are the most common form of benign tumors in the spine. Their association with spinal and systemic pathologies has not yet been systematically studied. METHODS: Clinical data were gathered from full spine CT scans and medical records. RESULTS: VHs were significantly associated with disc lesions (P = 0.004), past trauma (P = 0.037), diabetes (χ = 5.179, P = 0.023), cardio-vascular diseases (χ = 8.625, P = 0.003), and cancer (χ = 5.820, P = 0.016), but not with obesity. Only medium-large size VHs were significantly associated with osteoporosis (χ = 6.695, P = 0.010). CONCLUSION: The pattern of diseases related to VHs suggests a common cause for VH, namely, a disruption of vascular flow in the microvessels (accompanied by endothelium damage) within the vertebral body, eventually resulting in hypervascularization. LEVEL OF EVIDENCE: 4.

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A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.

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BACKGROUND: Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. METHODS: Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. PRINCIPAL FINDINGS: Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). CONCLUSIONS: Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

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Cherubism is a benign fibro-osseous disease of childhood limited specifically to the maxilla and mandible. The progressive replacement of the jaw bones with expansile multilocular cystic lesions causes eventual prominence of the lower face, and hence the classic "cherubic" phenotype reflecting variable extents of jaw hypertrophy. Histologically, this condition has been characterized as replacement of the normal bone matrix with multicystic pockets of fibrous stroma and osteoclastic giant cells. Because of radiographic features common to both, primarily the presence of multiloculated lucencies with heterogeneous "ground-glass" sclerosis on CT imaging, cherubism was long mistaken for a craniofacial subtype of fibrous dysplasia. In 1999, however, the distinct genetic basis for cherubism was mapped to chromosome 4p16.3 and the SH-3 binding protein SH3BP2. But while there are already three suspected cases of fibrous dysplasia amongst archaeological populations, no definitive cases of cherubism have yet been reported in historical populations. In the current study we describe micro- and macro-structural changes in the face of a 17th century Joseon Dynasty Korean mummy which may coincide with the clinic-pathologic and radiologic features of cherubism.

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The role of transitional vertebra in spondylolisthesis is still an enigma. Theoretically, obstruction of movements in the L5-S1 joint should provoke hypermobility at the L4-L5 vertebrae, thus leading to the development of spondylolisthesis. The aim of this study was to inquire whether a positive association exists between sacralization and spondylolisthesis. For this purpose, CT images of 436 consecutive patients were examined for the presence of sacralization and spondylolisthesis. The sample was divided into two groups: a sacralization group and non-sacralization group. Independent variables considered were age, sex and degree of lordosis. Sacralization was found in 13.1% of the individuals examined. It was found to be gender- and age-independent (P>0.05), Spondylolisthesis was identified in 7.3% of the individuals examined and found to be gender independent (P>0.05), and age dependent (P<0.05). No association between the presence of sacralization and spondylolisthesis was found. The mean lordosis angle in the spondylolisthesis group was 60.41° compared with 50.84° in patients without spondylolisthesis. No association was found between sacralization and the angle of lordosis (P>0.05). The current study did not reveal an association between sacralization and spondylolisthesis and as such sacralization should not be considered an etiology for the development of degenerative spondylolisthesis.

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The coronary artery calcium score (CS), an independent predictor of cardiovascular events, can be obtained from a stand-alone nonenhanced computed tomography (CT) scan (CSCT) or as an additional nonenhanced procedure before contrast-enhanced coronary CT angiography (CCTA). We evaluated the accuracy of a novel fully automatic tool for computing CS from the CCTA examination. One hundred thirty-six consecutive symptomatic patients (aged 59 ± 11 years, 40% female) without known coronary artery disease who underwent both 256-row CSCT and CCTA were studied. Original scan reconstruction (slice thickness) was maintained (3 mm for CSCT and 0.67 mm for CCTA). CS was computed from CCTA by an automatic tool (COR Analyzer, rcadia Medical Imaging, Haifa, Israel) and compared with CS results obtained by standard assessment of nonenhanced CSCT (HeartBeat CS, Philips, Cleveland, Ohio). We also compared both methods for classification into 5 commonly used CS categories (0, 1 to 10, 11 to 100, 101 to 400, >400 Agatston units). All scans were of diagnostic quality. CS obtained by the COR Analyzer from CCTA classified 111 of 136 (82%) of patients into identical categories as CS by CSCT and 24 of remaining 25 into an adjacent category. Overall, CS values from CCTA showed high correlation with CS values from CSCT (Spearman rank correlation = 0.95, p <0.0001). In conclusion, CS values automatically computed from 256-row CCTA correlated highly with standard CS values obtained from nonenhanced CSCT. CS obtained directly from CCTA may obviate the need for an additional scan and attendant radiation.

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Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors.

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BACKGROUND: Small case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA). METHODS AND RESULTS: Three hundred and thirty-four consecutive patients (age 57 ± 13 years, 43% female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥ 50% coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35%) patients on CCTA and 80% of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1%) patients with, and 7 out of 217 (3.2%) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events. CONCLUSION: MB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI.

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Hyperbaric oxygen-induced seizures are classified as generalized, tonic-clonic seizures. They are believed to cause no residual neurologic damage, although this has not been investigated in depth. We used different MRI sequences to determine whether hyperbaric oxygen-induced seizures in mice caused brain structural changes. Experimental animals were exposed to a pressure of 6 atmospheres absolute breathing oxygen, and were randomly assigned to two groups in which MRI was performed immediately after the appearance of seizures or 7 days later. Control groups were not exposed to hyperbaric oxygen. Our MRI protocols included T2*-weighted images, T2 maps, diffusion-weighted echo-planar pulse sequence, and contrast-enhanced T1-weighted images. Both the cortex and the hippocampus were analyzed. T2 values of the hippocampus and the cortex in the hyperbaric oxygen-exposed groups showed a small but statistically significant decrease compared with the control groups immediately after seizures (p<0.01). One week after seizures, enhancement following contrast injection was significantly higher both in the cortex and the hippocampus in the hyperbaric oxygen-exposed groups compared with the control groups (p<0.01). Hippocampal and cortex T2 values 7 days after seizures were similar to control group values. No differences were found among the other sequences. We conclude that hyperbaric oxygen-induced seizures result in delayed injury to the blood-brain barrier. Elucidation of the mechanisms and significance of this injury will necessitate further investigation.

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STUDY DESIGN: A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). OBJECTIVE: To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. METHODS: Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ tests were used to determine the association between parametric and nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. RESULTS: Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. CONCLUSION: Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS.

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BACKGROUND: Visceral abdominal adipose tissue (VAT) may play an active role in the progression of coronary atherosclerosis. We examined the relation between VAT, non-alcoholic fatty liver disease and extent of coronary atheroma in patients with type 2 diabetes mellitus but no known coronary artery disease. METHODS: Coronary artery calcium and area, distribution and thickness of upper abdominal fat were measured in selected axial cross-sections from non-enhanced computed tomography (CT) scans of the chest. Coronary atheroma was assessed visually on a per vessel basis from 64 slice CT angiography using axial views and multi-format reconstructions. Fatty liver was diagnosed when liver density was <40 Hounsfield units (HU) or ≥10 HU below spleen density. RESULTS: The area of VAT was increased in patients with versus without multi-vessel coronary artery plaque (237.0 ± 101.4 vs 179.2 ± 79.4 mm(2), p<0.001). Waist circumference (101.6 ± 12.3 versus 95.3 ± 13.8 cm) and internal abdominal diameter (218.7 ± 33.0 vs 194.6 ± 25.7 mm) (both p<0.001) were increased in patients with multi-vessel plaque whereas subcutaneous fat was unrelated to coronary plaque. Presence of fatty liver (93/318 patients, 29.2%) did not correlate with presence or extent of coronary plaque. The correlation of VAT with multi-vessel plaque although nominally independent of the metabolic syndrome (p=0.04) was not independent of waist circumference. CONCLUSION: In asymptomatic subjects with DM and no history of CAD area of VAT correlated with the presence and extent of coronary atheroma but as a risk predictor added little independent information to that obtained by more readily obtainable measures of adiposity-waist circumference and internal abdominal diameter.

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We assessed the performance of a new-generation, 256-row computed tomography (CT) scanner for detection of obstructive coronary artery disease (CAD) compared to invasive quantitative coronary angiography. A total 121 consecutive symptomatic patients without known CAD referred for invasive coronary angiography (age 59 ± 12 years, 37% women) underwent clinically driven 256-row coronary computed tomographic angiography (CCTA) before the invasive procedure. Obstructive CAD (>50% diameter stenosis) was assessed visually on CCTA by 2 independent observers using the 18-segment society of cardiovascular CT model and on invasive angiograms using quantitative coronary angiography (the reference standard). Observers were unaware of the findings from the alternate modality. Nonassessable coronary computed tomographic angiographic segments were considered obstructive for the purpose of analysis. Quantitative coronary angiography demonstrated obstructive CAD in 145 segments in 82 of 121 patients (68%). Overall, 1,677 coronary segments were available for comparative analysis, of which 39 (2.3%) were nonassessable by CCTA, mostly because of heavy calcification. Patient-based and segment-based analysis showed a sensitivity of 100% and 97% (95% confidence interval 95% to 100%) and specificity of 69% (95% confidence interval 55% to 84%) and 97% (confidence interval 96% to 98%), respectively. Four segments with obstructive CAD in 4 patients were not detected by CCTA. All 4 patients had additional coronary obstructions identified by CCTA. The predictive accuracy was 90% (range 85% to 95%) for patient based and 97% (96% to 98%) for segment based analysis. In conclusion, 256-row CCTA showed high sensitivity and high predictive accuracy for detection of obstructive CAD in patients without previously known disease. Although coronary calcification might still interfere with analysis, the rate of nonassessable segments was low.

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OBJECTIVES: According to the "brain reserve hypothesis," a larger premorbid brain protects against the development of dementia. The aim of this study was to reveal a possible pathophysiology of brain degenerative diseases by studying intracranial bone lesions that act to reduce intracranial volume (ICV), such as hyperostosis frontalis interna (HFI). METHODS: Three hundred and eighty postmenopausal females (aged 60+) who had undergone a head computerized tomography scan (Brilliance 64, Philips Healthcare, Cleveland, OH) at the Carmel Medical Center, Haifa, Israel, before the study were included. The subjects were divided into four groups according to their degree of HFI. Six measurements of the skull and brain were taken. RESULTS: As HFI becomes more severe, the cranial bone thickness and cranial bone volume increase. This process is accompanied by a decrease in ICV. In none of the HFI groups studied there was a significant association between ICV and cranial bone thickness. The inter-relationships between the various thickness parameters are not disturbed by the degree of HFI. CONCLUSION: HFI is accompanied by an increase in thickness of all calvarial bones and reduced ICV. In addition, the thickening process initiated by HFI is synchronized among the calvarial bones. Presence of HFI suggests a decrease in brain volume and has a major clinical significance as it may indicate the beginning of degenerative processes of the brain. In addition, as females age, their skulls tend to develop more robust characteristics.

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PURPOSE: Following a recent introduction of computer-aided simple triage (CAST) as a new subclass of computer-aided detection/diagnosis (CAD), we present a CAST software system for a fully automatic initial interpretation of coronary CT angiography (CCTA). We show how the system design and diagnostic performance make it CAST-compliant and suitable for chest pain patient triage in emergency room (ER). METHODS: The processing performed by the system consists of three major steps: segmentation of coronary artery tree, labeling of major coronary arteries, and detection of significant stenotic lesions (causing > 50% stenosis). In addition, the system performs an automatic image quality assessment to discards low-quality studies. For multiphase studies, the system automatically chooses the best phase for each coronary artery. Clinical evaluation results were collected in 14 independent trials that included more than 2000 CCTA studies. Automatic diagnosis results were compared with human interpretation of the CCTA and to cath lab results. RESULTS: The presented system performs a fully automatic initial interpretation of CCTA without any human interaction and detects studies with significant coronary artery disease. The system demonstrated higher than 90% per patient sensitivity and 40-70% per patient specificity. For the chest pain, ER population, the specificity was 60-70%, yielding higher than 98% NPV. CONCLUSIONS: The diagnostic performance of the presented CCTA CAD system meets the CAST requirements, thus enabling efficient, 24/7 utilization of CCTA for chest pain patient triage in ER. This is the first fully operational, clinically validated, CAST-compliant CAD system for a fully automatic analysis of CCTA and detection of significant stenosis.

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