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Koch V, Weitzer N, Dos Santos DP, Gruenewald LD, Mahmoudi S, Martin SS, Eichler K, Bernatz S, Gruber-Rouh T, Booz C, Hammerstingl RM, Biciusca T, Rosbach N, Gökduman A, D'Angelo T, Finkelmeier F, Yel I, Alizadeh LS, Sommer CM, Cengiz D, Vogl TJ, Albrecht MH. Multiparametric detection and outcome prediction of pancreatic cancer involving dual-energy CT, diffusion-weighted MRI, and radiomics. Cancer Imaging 2023; 23:38. [PMID: 37072856 PMCID: PMC10114410 DOI: 10.1186/s40644-023-00549-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The advent of next-generation computed tomography (CT)- and magnetic resonance imaging (MRI) opened many new perspectives in the evaluation of tumor characteristics. An increasing body of evidence suggests the incorporation of quantitative imaging biomarkers into clinical decision-making to provide mineable tissue information. The present study sought to evaluate the diagnostic and predictive value of a multiparametric approach involving radiomics texture analysis, dual-energy CT-derived iodine concentration (DECT-IC), and diffusion-weighted MRI (DWI) in participants with histologically proven pancreatic cancer. METHODS In this study, a total of 143 participants (63 years ± 13, 48 females) who underwent third-generation dual-source DECT and DWI between November 2014 and October 2022 were included. Among these, 83 received a final diagnosis of pancreatic cancer, 20 had pancreatitis, and 40 had no evidence of pancreatic pathologies. Data comparisons were performed using chi-square statistic tests, one-way ANOVA, or two-tailed Student's t-test. For the assessment of the association of texture features with overall survival, receiver operating characteristics analysis and Cox regression tests were used. RESULTS Malignant pancreatic tissue differed significantly from normal or inflamed tissue regarding radiomics features (overall P < .001, respectively) and iodine uptake (overall P < .001, respectively). The performance for the distinction of malignant from normal or inflamed pancreatic tissue ranged between an AUC of ≥ 0.995 (95% CI, 0.955-1.0; P < .001) for radiomics features, ≥ 0.852 (95% CI, 0.767-0.914; P < .001) for DECT-IC, and ≥ 0.690 (95% CI, 0.587-0.780; P = .01) for DWI, respectively. During a follow-up of 14 ± 12 months (range, 10-44 months), the multiparametric approach showed a moderate prognostic power to predict all-cause mortality (c-index = 0.778 [95% CI, 0.697-0.864], P = .01). CONCLUSIONS Our reported multiparametric approach allowed for accurate discrimination of pancreatic cancer and revealed great potential to provide independent prognostic information on all-cause mortality.
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Koch V, Martin SS, Gruber-Rouh T, Eichler K, Mahmoudi S, Leistner DM, Scholtz JE, Bernatz S, Puntmann VO, Nagel E, Booz C, D'Angelo T, Alizadeh LS, Yel I, Ziegengeist NS, Torgashov K, Geyer T, Hardt SE, Vogl TJ, Gruenewald LD, Giannitsis E. Cancer patients with venous thromboembolism: Diagnostic and prognostic value of elevated D-dimers. Eur J Clin Invest 2023; 53:e13914. [PMID: 36444723 DOI: 10.1111/eci.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND D-dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions. METHODS This retrospective study sought to assess diagnostic and prognostic features of D-dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE (n = 83) and DVT (n = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded. RESULTS For the identification of VTE, D-dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85-99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97-100). At the established rule-out cut-off level of .5 mg/L, D-dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut-off value of 4.9 mg/L increased the specificity to 95% for the detection of life-threatening VTE at the cost of moderate sensitivities (64%). During a median follow-up of 30 months, D-dimers positively correlated with the reoccurrence of VTE (p = .0299) and mortality in both cancer patients with VTE (p < .0001) and without VTE (p = .0008). CONCLUSIONS Although D-dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10-fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.
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Kinzler MN, Bankov K, Bein J, Döring C, Schulze F, Reis H, Mahmoudi S, Koch V, Grünewald LD, Stehle A, Walter D, Finkelmeier F, Zeuzem S, Wild PJ, Vogl TJ, Bernatz S. CXCL1 and CXCL6 Are Potential Predictors for HCC Response to TACE. Curr Oncol 2023; 30:3516-3528. [PMID: 36975480 PMCID: PMC10046993 DOI: 10.3390/curroncol30030267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Distinct immune patterns of hepatocellular carcinoma (HCC) may have prognostic implications in the response to transarterial chemoembolization (TACE). Thus, we aimed to exploratively analyze tumor tissue of HCC patients who do or do not respond to TACE, and to identify novel prognostic biomarkers predictive of response to TACE. We retrospectively included 15 HCC patients who had three consecutive TACE between January 2019 and November 2019. Eight patients had a response while seven patients had no response to TACE. All patients had measurable disease according to mRECIST. Corresponding tumor tissue samples were processed for differential expression profiling using NanoString nCounter® PanCancer immune profiling panel. Immune-related pathways were broadly upregulated in TACE responders. The top differentially regulated genes were the upregulated CXCL1 (log2fc 4.98, Benjamini-Hochberg (BH)-p < 0.001), CXCL6 (log2fc 4.43, BH-p = 0.016) and the downregulated MME (log2fc -4.33, BH-p 0.001). CD8/T-regs was highly increased in responders, whereas the relative number of T-regs to tumor-infiltrating lymphocytes (TIL) was highly decreased. We preliminary identified CXCL1 and CXCL6 as candidate genes that might have the potential to serve as therapeutically relevant biomarkers in HCC patients. This might pave the way to improve patient selection for TACE in HCC patients beyond expert consensus.
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Gruenewald LD, Koch V, Gruber-Rouh T, Thalhammer A, Frank J, Marzi I, Booz C, Yel I, Mahmoudi S, Bernatz S, Laudenberger I, Lingwal N, Vogl TJ, Eichler K. MR angiography facilitates the differentiation of aneurysmal from unicameral bone cysts. Br J Radiol 2023; 96:20220849. [PMID: 36745072 PMCID: PMC10078881 DOI: 10.1259/bjr.20220849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The objective of this work was to evaluate the incremental value of MR angiography over plain radiographs and MRI for the differentiation of aneurysmal bone cysts (ABCs) from unicameral bone cysts (UBCs). METHODS Thirty-six juvenile patients with histologically secured primary ABCs or UBCs were included in this retrospective study. Two radiologists assessed all obtained images in a blinded fashion using a catalog of previously suggested imaging findings. A second readout with supplementary MR angiography images was performed after 8 weeks to prevent observer recall bias. Diagnostic accuracy parameters were calculated for individual imaging findings, and overall diagnostic accuracy and diagnostic confidence were assessed for all readouts. Receiver operating characteristic (ROC) curve comparison was used to determine the incremental value of MR angiography. RESULTS Of 16 imaging features, only abnormal vascularization in MR angiography provided sufficient diagnostic accuracy for the identification of ABCs. Other imaging features such as fluid-fluid levels and internal septations were insufficient for the differentiation of UBCs from ABCs. Availability of MR angiography images significantly increased diagnostic accuracy (94.4 vs 75.0% and 83.3 vs 69.4%, respectively, p < 0.05) and diagnostic confidence (4.5 vs 3.7, p < 0.05) of reading radiologists. CONCLUSION The presence of arterial feeders in MR angiography can accurately discriminate primary ABCs from UBCs and increases the diagnostic accuracy and diagnostic confidence of reporting radiologists. ADVANCES IN KNOWLEDGE Radiographic differentiation of cystic bone lesions such as ABCs and UBCs remains challenging. We demonstrate that MR angiography provides incremental value and suggest inclusion in standard examination protocols.
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Koch V, Merklein D, Zangos S, Eichler K, Gruenewald LD, Mahmoudi S, Booz C, Yel I, D'Angelo T, Martin SS, Bernatz S, Hammerstingl RM, Albrecht MH, Scholtz JE, Kaltenbach B, Vogl TJ, Langenbach M, Gruber-Rouh T. Free-breathing accelerated whole-body MRI using an automated workflow: Comparison with conventional breath-hold sequences. NMR IN BIOMEDICINE 2023; 36:e4828. [PMID: 36082477 DOI: 10.1002/nbm.4828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
Whole-body magnetic resonance imaging (MRI) has become increasingly popular in oncology. However, the long acquisition time might hamper its widespread application. We sought to assess and compare free-breathing sequences with conventional breath-hold examinations in whole-body MRI using an automated workflow process. This prospective study consisted of 20 volunteers and six patients with a variety of pathologies who had undergone whole-body 1.5-T MRI that included T1-weighted radial and Dixon volumetric interpolated breath-hold examination sequences. Free-breathing sequences were operated by using an automated user interface. Image quality, diagnostic confidence, and image noise were evaluated by two experienced radiologists. Additionally, signal-to-noise ratio was measured. Diagnostic performance for the overall detection of pathologies was assessed using the area under the receiver operating characteristics curve (AUC). Study participants were asked to rate their examination experiences in a satisfaction survey. MR free-breathing scans were rated as at least equivalent to conventional MR scans in more than 92% of cases, showing high overall diagnostic accuracy (95% [95% CI 92-100]) and performance (AUC 0.971, 95% CI 0.942-0.988; p < 0.0001) for the assessment of pathologies at simultaneously reduced examination times (25 ± 2 vs. 32 ± 3 min; p < 0.0001). Interrater agreement was excellent for both free-breathing (ϰ = 0.96 [95% CI 0.88-1.00]) and conventional scans (ϰ = 0.93 [95% CI 0.84-1.00]). Qualitative and quantitative assessment for image quality, image noise, and diagnostic confidence did not differ between the two types of MR image acquisition (all p > 0.05). Scores for patient satisfaction were significantly better for free-breathing compared with breath-hold examinations (p = 0.0145), including significant correlations for the grade of noise (r = 0.79, p < 0.0001), tightness (r = 0.71, p < 0.0001), and physical fatigue (r = 0.52, p = 0.0065). In summary, free-breathing whole-body MRI in tandem with an automated user interface yielded similar diagnostic performance at equivalent image quality and shorter acquisition times compared to conventional breath-hold sequences.
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Mahmoudi S, Bernatz S, Ackermann J, Koch V, Dos Santos DP, Grünewald LD, Yel I, Martin SS, Scholtz JE, Stehle A, Walter D, Zeuzem S, Wild PJ, Vogl TJ, Kinzler MN. Computed Tomography Radiomics to Differentiate Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma. Clin Oncol (R Coll Radiol) 2023; 35:e312-e318. [PMID: 36804153 DOI: 10.1016/j.clon.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
AIMS Intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) differ in prognosis and treatment. We aimed to non-invasively differentiate iCCA and HCC by means of radiomics extracted from contrast-enhanced standard-of-care computed tomography (CT). MATERIALS AND METHODS In total, 94 patients (male, n = 68, mean age 63.3 ± 12.4 years) with histologically confirmed iCCA (n = 47) or HCC (n = 47) who underwent contrast-enhanced abdominal CT between August 2014 and November 2021 were retrospectively included. The enhancing tumour border was manually segmented in a clinically feasible way by defining three three-dimensional volumes of interest per tumour. Radiomics features were extracted. Intraclass correlation analysis and Pearson metrics were used to stratify robust and non-redundant features with further feature reduction by LASSO (least absolute shrinkage and selection operator). Independent training and testing datasets were used to build four different machine learning models. Performance metrics and feature importance values were computed to increase the models' interpretability. RESULTS The patient population was split into 65 patients for training (iCCA, n = 32) and 29 patients for testing (iCCA, n = 15). A final combined feature set of three radiomics features and the clinical features age and sex revealed a top test model performance of receiver operating characteristic (ROC) area under the curve (AUC) = 0.82 (95% confidence interval =0.66-0.98; train ROC AUC = 0.82) using a logistic regression classifier. The model was well calibrated, and the Youden J Index suggested an optimal cut-off of 0.501 to discriminate between iCCA and HCC with a sensitivity of 0.733 and a specificity of 0.857. CONCLUSIONS Radiomics-based imaging biomarkers can potentially help to non-invasively discriminate between iCCA and HCC.
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Bernatz S, Elenberger O, Ackermann J, Lenga L, Martin SS, Scholtz JE, Koch V, Grünewald LD, Herrmann Y, Kinzler MN, Stehle A, Koch I, Zeuzem S, Bankov K, Doering C, Reis H, Flinner N, Schulze F, Wild PJ, Hammerstingl R, Eichler K, Gruber-Rouh T, Vogl TJ, dos Santos DP, Mahmoudi S. CT-radiomics and clinical risk scores for response and overall survival prognostication in TACE HCC patients. Sci Rep 2023; 13:533. [PMID: 36631548 PMCID: PMC9834236 DOI: 10.1038/s41598-023-27714-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
We aimed to identify hepatocellular carcinoma (HCC) patients who will respond to repetitive transarterial chemoembolization (TACE) to improve the treatment algorithm. Retrospectively, 61 patients (mean age, 65.3 years ± 10.0 [SD]; 49 men) with 94 HCC mRECIST target-lesions who had three consecutive TACE between 01/2012 and 01/2020 were included. Robust and non-redundant radiomics features were extracted from the 24 h post-embolization CT. Five different clinical TACE-scores were assessed. Seven different feature selection methods and machine learning models were used. Radiomics, clinical and combined models were built to predict response to TACE on a lesion-wise and patient-wise level as well as its impact on overall-survival prognostication. 29 target-lesions of 19 patients were evaluated in the test set. Response rates were 37.9% (11/29) on the lesion-level and 42.1% (8/19) on the patient-level. Radiomics top lesion-wise response prognostications was AUC 0.55-0.67. Clinical scores revealed top AUCs of 0.65-0.69. The best working model combined the radiomic feature LargeDependenceHighGrayLevelEmphasis and the clinical score mHAP_II_score_group with AUC = 0.70, accuracy = 0.72. We transferred this model on a patient-level to achieve AUC = 0.62, CI = 0.41-0.83. The two radiomics-clinical features revealed overall-survival prognostication of C-index = 0.67. In conclusion, a random forest model using the radiomic feature LargeDependenceHighGrayLevelEmphasis and the clinical mHAP-II-score-group seems promising for TACE response prognostication.
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Koch V, Conrades LM, Gruenewald LD, Eichler K, Martin SS, Booz C, D'Angelo T, Yel I, Bernatz S, Mahmoudi S, Albrecht MH, Scholtz J, Thalhammer A, Zangos S, Vogl TJ, Gruber‐Rouh T. Reduction of radiation dose using real-time visual feedback dosimetry during angiographic interventions. J Appl Clin Med Phys 2022; 24:e13860. [PMID: 36565180 PMCID: PMC9924107 DOI: 10.1002/acm2.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022] Open
Abstract
This prospective study sought to evaluate potential savings of radiation dose to medical staff using real-time dosimetry coupled with visual radiation dose feedback during angiographic interventions. For this purpose, we analyzed a total of 214 angiographic examinations that consisted of chemoembolizations and several other types of therapeutic interventions. The Unfors RaySafe i2 dosimeter was worn by the interventionalist at chest height over the lead protection. A total of 110 interventions were performed with real-time radiation dosimetry allowing the interventionalist to react upon higher x-ray exposure and 104 examinations served as the comparative group without real-time radiation monitoring. By using the real-time display during interventions, the overall mean operator radiation dose decreased from 3.67 (IQR, 0.95-23.01) to 2.36 μSv (IQR, 0.52-12.66) (-36%; p = 0.032) at simultaneously reduced operator exposure time by 4.5 min (p = 0.071). Dividing interventions into chemoembolizations and other types of therapeutic interventions, radiation dose decreased from 1.31 (IQR, 0.46-3.62) to 0.95 μSv (IQR, 0.53-3.11) and from 24.39 (IQR, 12.14-63.0) to 10.37 μSv (IQR, 0.85-36.84), respectively, using live-screen dosimetry (p ≤ 0.005). Radiation dose reductions were also observed for the participating assistants, indicating that they could also benefit from real-time visual feedback dosimetry during interventions (-30%; p = 0.039). Integration of real-time dosimetry into clinical processes might be useful in reducing occupational radiation exposure time during angiographic interventions. The real-time visual feedback raised the awareness of interventionalists and their assistants to the potential danger of prolonged radiation exposure leading to the adoption of radiation-sparing practices. Therefore, it might create a safer environment for the medical staff by keeping the applied radiation exposure as low as possible.
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Koch V, Gruenewald LD, Gruber-Rouh T, Eichler K, Leistner DM, Mahmoudi S, Booz C, Bernatz S, D'Angelo T, Albrecht MH, Alizadeh LS, Nour-Eldin NEA, Scholtz JE, Yel I, Vogl TJ, März W, Hardt SE, Martin SS. Homoarginine in the cardiovascular system: Pathophysiology and recent developments. Fundam Clin Pharmacol 2022; 37:519-529. [PMID: 36509694 DOI: 10.1111/fcp.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Upcoming experimental and epidemiological data have identified the endogenous non-proteinogenic amino acid L-homoarginine (L-hArg) not only as a novel biomarker for cardiovascular disease but also as being directly involved in the pathogenesis of cardiac dysfunction. The association of low L-hArg levels with adverse cardiovascular events and mortality has proposed the idea of nutritional supplementation to rescue pathways inversely associated with cardiovascular health. Subsequent clinical and experimental studies contributed significantly to our knowledge of potential effects on the cardiorenal axis, acting either as a biomarker or a cardiovascular active agent. In this review article, we provide a comprehensive summary of the L-hArg metabolism, pathophysiological aspects, and current developments in the field of experimental and clinical evidence in favor of protective cardiovascular effects. Establishing a reliable biomarker to identify patients at high risk to die of cardiovascular disease represents one of the main goals for tackling this disease and providing individual therapeutic guidance.
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Mahmoudi S, Koch V, Santos DPD, Ackermann J, Grünewald LD, Weitkamp I, Yel I, Martin SS, Albrecht MH, Scholtz JE, Vogl TJ, Bernatz S. Imaging biomarkers to stratify lymph node metastases in abdominal CT - Is radiomics superior to dual-energy material decomposition? Eur J Radiol Open 2022; 10:100459. [PMID: 36561422 PMCID: PMC9763741 DOI: 10.1016/j.ejro.2022.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess the potential of radiomic features in comparison to dual-energy CT (DECT) material decomposition to objectively stratify abdominal lymph node metastases. Materials and methods In this retrospective study, we included 81 patients (m, 57; median age, 65 (interquartile range, 58.7-73.3) years) with either lymph node metastases (n = 36) or benign lymph nodes (n = 45) who underwent contrast-enhanced abdominal DECT between 06/2015-07/2019. All malignant lymph nodes were classified as unequivocal according to RECIST criteria and confirmed by histopathology, PET-CT or follow-up imaging. Three investigators segmented lymph nodes to extract DECT and radiomics features. Intra-class correlation analysis was applied to stratify a robust feature subset with further feature reduction by Pearson correlation analysis and LASSO. Independent training and testing datasets were applied on four different machine learning models. We calculated the performance metrics and permutation-based feature importance values to increase interpretability of the models. DeLong test was used to compare the top performing models. Results Distance matrices and t-SNE plots revealed clearer clusters using a combination of DECT and radiomic features compared to DECT features only. Feature reduction by LASSO excluded all DECT features of the combined feature cohort. The top performing radiomic features model (AUC = 1.000; F1 = 1.000; precision = 1.000; Random Forest) was significantly superior to the top performing DECT features model (AUC = 0.942; F1 = 0.762; precision = 0.800; Stochastic Gradient Boosting) (DeLong < 0.001). Conclusion Imaging biomarkers have the potential to stratify unequivocal lymph node metastases. Radiomics models were superior to DECT material decomposition and may serve as a support tool to facilitate stratification of abdominal lymph node metastases.
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Key Words
- ADB, AdaBoost
- AUC, Area under the curve
- Abdominal imaging
- CT, Computed tomography
- CTDI, Computed tomography dose index
- DECT, Dual-energy computed tomography
- DICOM, Digital Imaging and Communications in Medicine
- DLP, Dose-length product
- Dual-energy computed tomography
- GLCM, Gray Level Co-occurrence Matrix
- GLDM, Gray Level Dependence Matrix
- GLRLM, Gray Level Run Length Matrix
- GLSZM, Gray Level Size Zone Matrix
- HU, Hounsfield Units
- ICC, Intra-class correlation coefficient
- ID%, Normalized iodine uptake
- ID, Iodine density
- LR, Logistic Regression
- Lymph node metastasis
- Machine Learning
- NGTDM, Neighboring Gray Tone Difference Matrix
- Oncology
- PET, Positron emission tomography
- RF, Random Forest
- ROC, Receiver operating characteristics
- ROI, Region of interest
- Radiomics
- SGB, Stochastic Gradient Boosting
- VOI, Volume of interest
- mGy, Milligray
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Mahmoudi S, Bernatz S, Althoff FC, Koch V, Grünewald LD, Scholtz JE, Walter D, Zeuzem S, Wild PJ, Vogl TJ, Kinzler MN. Dual-energy CT based material decomposition to differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Eur J Radiol 2022; 156:110556. [PMID: 36270195 DOI: 10.1016/j.ejrad.2022.110556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the potential of material decomposition in dual-energy CT (DECT) to differentiate intrahepatic cholangiocarcinoma (iCCA) from hepatocellular carcinoma (HCC). METHOD In this retrospective study, we included 94 patients (26 female (27.7 %), median age 64.5 (interquartile range 55.5-74.5) years) with either iCCA or HCC who underwent abdominal contrast-enhanced DECT in arterial phase. To test for differences between iCCA (n = 47) and HCC (n = 47), we evaluated mean attenuation and DECT material density values including iodine density (ID), normalized iodine uptake (NIU), fat fraction, and lesion-to-liver parenchyma ratio. Histopathology served as reference standard for all lesions. We used univariate logistic regression models for the outcome iCCA versus HCC. ROC curve analysis was applied to assess discriminative ability of the model. Model accuracy was evaluated by calculating the Brier score. Youden index was applied to establish thresholds to differentiate between iCCA and HCC. RESULTS Comparison of quantitative image parameters revealed significant differences between iCCA and HCC for ID (1.6 ± 0.5 mg/ml vs 2.8 ± 0.8 mg/ml, p < 0.001), NIU (14.5 ± 4.8 vs 24.8 ± 10.3, p < 0.001), attenuation (41.9 ± 10.1 HU vs 47.9 ± 8.9 HU, p = 0.003), and fat fraction (12.0 ± 7.8 % vs 9.0 ± 6.4 %, p = 0.045). ROC curve analysis revealed highest ability to differentiate iCCA from HCC for ID (AUC = 0.93, 95 % CI 0.89-0.98). For ID, an optimal threshold of 2.33 mg/dl was determined to discriminate between iCCA and HCC (sensitivity 89.4 %, specificity 76.6 %). CONCLUSIONS DECT-based iodine quantification can serve as a tool for the differentiation of iCCA and HCC in contrast-enhanced CT. ID yielded the highest diagnostic performance and may assist in clinical routine CT diagnostics.
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Koch V, Abt J, Gruenewald LD, Eichler K, D’Angelo T, Martin SS, Albrecht MH, Thalhammer A, Booz C, Yel I, Bernatz S, Mahmoudi S, Harth M, Derwich W, Vogl TJ, Gray D, Gruber-Rouh T, Jung G. Systematic evaluation of imaging techniques and baseline characteristics in patients with suspected vasculitis. Eur J Radiol Open 2022; 9:100445. [PMID: 36262692 PMCID: PMC9574707 DOI: 10.1016/j.ejro.2022.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To assess the diagnostic value of different imaging modalities in distinguishing systemic vasculitis from other internal and immunological diseases. Methods This retrospective study included 134 patients with suspected vasculitis who underwent ultrasound, magnetic resonance imaging (MRI), or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) between 01/2010 and 01/2019, finally consisting of 70 individuals with vasculitis. The main study parameter was the confirmation of the diagnosis using one of the three different imaging modalities, with the adjudicated clinical and histopathological diagnosis as the gold standard. A secondary parameter was the morphological appearance of the vessel affected by vasculitis. Results Patients with systemic vasculitis had myriad clinical manifestations with joint pain as the most common symptom. We found significant correlations between different imaging findings suggestive of vasculitis and the final adjudicated clinical diagnosis. In this context, on MRI, vessel wall thickening, edema, and diameter differed significantly between vasculitis and non-vasculitis groups (p < 0.05). Ultrasound revealed different findings that may serve as red flags in identifying patients with vasculitis, such as vascular occlusion or halo sign (p = 0.02 vs. non-vasculitis group). Interestingly, comparing maximal standardized uptake values from PET/CT examinations with vessel wall thickening or vessel diameter did not result in significant differences (p > 0.05). Conclusions We observed significant correlations between different imaging findings suggestive of vasculitis on ultrasound or MRI and the final adjudicated diagnosis. While ultrasound and MRI were considered suitable imaging methods for detecting and discriminating typical vascular changes, 18F-FDG PET/CT requires careful timing and patient selection given its moderate diagnostic accuracy.
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Koch V, Loos G, Gruenewald LD, Eichler K, Booz C, D'Angelo T, Yel I, Mahmoudi S, Martin SS, Harth M, Albrecht MH, Zangos S, Bernatz S, Thalhammer A, Scholtz JE, Vogl TJ, Gruber-Rouh T. Comprehensive comparison of three different workstations for accurate planning of endovascular stent implantation in patients with thoracic aortic aneurysms. Eur J Radiol Open 2022; 9:100427. [PMID: 35757233 PMCID: PMC9213697 DOI: 10.1016/j.ejro.2022.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the diagnostic precision of three different workstations for measuring thoracic aortic aneurysms (TAAs) in vivo and ex vivo using either pre-interventional computed tomography angiography scans (CTA) or a specifically designed phantom model. Methods This retrospective study included 23 patients with confirmed TAA on routinely performed CTAs. In addition to phantom tube diameters, one experienced blinded radiologist evaluated the dimensions of TAAs on three different workstations in two separate rounds. Precision was assessed by calculating measurement errors. In addition, correlation analysis was performed using Pearson correlation. Results Measurements acquired at the Siemens workstation deviated by 3.54% (range, 2.78–4.03%; p = 0.14) from the true size, those at General Electric by 4.05% (range, 1.46–7.09%; p < 0.0001), and at TeraRecon by 4.86% (range, 3.22–6.45%; p < 0.0001). Accordingly, Siemens provided the most precise workstation at simultaneously most fluctuating values (scattering of 4.46%). TeraRecon had the smallest fluctuation (scattering of 2.83%), but the largest deviation from the true size of the phantom. The workstation from General Electric showed a scattering of 2.94%. The highest overall correlation between the 1st and 2nd rounds was observed with measurements from Siemens (r = 0.898), followed by TeraRecon (r = 0.799), and General Electric (r = 0.703). Repetition of measurements reduced processing times by 40% when using General Electric, by 20% with Siemens, and by 18% with TeraRecon. Conclusions In conclusion, all three workstations facilitated precise assessment of dimensions in the majority of cases at simultaneously high reproducibility, ensuring accurate pre-interventional planning of thoracic endovascular aortic repair. Pre-interventional planning of TEVAR in patients with TAAs using CTA is feasible. All three workstations facilitated accurate measurements in vivo and ex vivo. Repetition of measurements resulted in faster processing due to learning effects.
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Koch V, Gruenewald LD, Albrecht MH, Eichler K, Gruber-Rouh T, Yel I, Alizadeh LS, Mahmoudi S, Scholtz JE, Martin SS, Lenga L, Vogl TJ, Nour-Eldin NEA, Bienenfeld F, Hammerstingl RM, Graf C, Sommer CM, Hardt SE, Mazziotti S, Ascenti G, Versace GA, D'Angelo T, Booz C. Lung Opacity and Coronary Artery Calcium Score: A Combined Tool for Risk Stratification and Outcome Prediction in COVID-19 Patients. Acad Radiol 2022; 29:861-870. [PMID: 35346565 PMCID: PMC8882413 DOI: 10.1016/j.acra.2022.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System). METHODS This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score. RESULTS CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis. CONCLUSIONS Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.
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Mahmoudi S, Lange M, Lenga L, Yel I, Koch V, Booz C, Martin S, Bernatz S, Vogl T, Albrecht M, Scholtz JE. Salvaging low contrast abdominal CT studies using noise-optimised virtual monoenergetic image reconstruction. BJR Open 2022; 4:20220006. [PMID: 36105416 PMCID: PMC9446156 DOI: 10.1259/bjro.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess the impact of noise-optimised virtual monoenergetic imaging (VMI+) on image quality and diagnostic evaluation in abdominal dual-energy CT scans with impaired portal-venous contrast. Methods We screened 11,746 patients who underwent portal-venous abdominal dual-energy CT for cancer staging between 08/2014 and 11/2019 and identified those with poor portal-venous contrast.Standard linearly-blended image series and VMI+ image series at 40, 50, and 60 keV were reconstructed. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of abdominal organs and vascular structures were calculated. Image noise, image contrast and overall image quality were rated by three radiologists using 5-point Likert scale. Results 452 of 11,746 (4%) exams were poorly opacified. We excluded 190 cases due to incomplete datasets or multiple exams of the same patient with a final study group of 262. Highest CNR values in all abdominal organs (liver, 6.4 ± 3.0; kidney, 17.4 ± 7.5; spleen, 8.0 ± 3.5) and vascular structures (aorta, 16.0 ± 7.3; intrahepatic vein, 11.3 ± 4.7; portal vein, 15.5 ± 6.7) were measured at 40 keV VMI+ with significantly superior values compared to all other series. In subjective analysis, highest image contrast was seen at 40 keV VMI+ (4.8 ± 0.4), whereas overall image quality peaked at 50 keV VMI+ (4.2 ± 0.5) with significantly superior results compared to all other series (p < 0.001). Conclusions Image reconstruction using VMI+ algorithm at 50 keV significantly improves image contrast and image quality of originally poorly opacified abdominal CT scans and reduces the number of non-diagnostic scans. Advances in knowledge We validated the impact of VMI+ reconstructions in poorly attenuated DECT studies of the abdomen in a big data cohort.
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Koch V, Booz C, Gruenewald LD, Albrecht MH, Gruber-RouhMD T, Eichler K, Yel I, Mahmoudi S, Scholtz JE, Martin SS, Graf C, Vogl TJ, Weber C, Hardt SE, Frey N, Giannitsis E. Diagnostic performance and predictive value of D-dimer testing in patients referred to the emergency department for suspected myocardial infarction. Clin Biochem 2022; 104:22-29. [PMID: 35181290 DOI: 10.1016/j.clinbiochem.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/08/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The study sought to assess the performance of D-dimer testing for the diagnosis of acute coronary syndrome (ACS) and prediction of outcomes in patients admitted for suspected myocardial infarction (MI). RESULTS A total of 3,557 patients with suspected ACS presenting to a single center with a broad range of symptoms including atypical chest pain were retrospectively recruited between 02/2012-01/2019. Of the study cohort, 435 patients had unstable angina (UA), 420 non-ST-segment elevation myocardial infarction (NSTEMI), 22 ST-segment elevation myocardial infarction (STEMI), and 2,680 non-coronary chest pain. Plasma D-dimer concentrations in patients with hs-cTnT >14 ng/L differed significantly from those with hs-cTnT <14 ng/L (1.5 ± 3.6 mg/L vs. 0.5 ± 0.8 mg/L; p<0.0001). Positive predictive value for a final diagnosis of ACS increased proportionally to rising D-dimer concentrations. The area under the curve (AUC) to discriminate STEMI from non-coronary chest pain (AUC 0.729, 95% confidence interval [CI] 0.71-0.75) was moderate and differed not significantly to UA (AUC 0.595, 95% CI 0.58-0.61; p=0.0653). During a median follow-up of 29 months, higher D-dimer was associated with a significantly increased risk of recurrent MI (quartile 4 vs. 1: hazard ratio [HR], 6.9 [95% CI 1.2-39.9]; p<0.0001) and higher all-cause mortality (HR, 17.4 [95% CI 4.3-69.9]; p<0.0001). D-dimer was an independent predictor of all-cause mortality (p<0.0001) and subsequent MI events (p=0.0333). CONCLUSIONS D-dimer testing revealed great potential to provide independent prognostic information on recurrent MI and all-cause mortality. However, D-dimers do not improve the diagnostic performance except if values exceed the 95th percentile.
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Mahmoudi S, Martin SS, Ackermann J, Zhdanovich Y, Koch I, Vogl TJ, Albrecht MH, Lenga L, Bernatz S. Potential of high dimensional radiomic features to assess blood components in intraaortic vessels in non-contrast CT scans. BMC Med Imaging 2021; 21:123. [PMID: 34384385 PMCID: PMC8359593 DOI: 10.1186/s12880-021-00654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background To assess the potential of radiomic features to quantify components of blood in intraaortic vessels to non-invasively predict moderate-to-severe anemia in non-contrast enhanced CT scans. Methods One hundred patients (median age, 69 years; range, 19–94 years) who received CT scans of the thoracolumbar spine and blood-testing for hemoglobin and hematocrit levels ± 24 h between 08/2018 and 11/2019 were retrospectively included. Intraaortic blood was segmented using a spherical volume of interest of 1 cm diameter with consecutive radiomic analysis applying PyRadiomics software. Feature selection was performed applying analysis of correlation and collinearity. The final feature set was obtained to differentiate moderate-to-severe anemia. Random forest machine learning was applied and predictive performance was assessed. A decision-tree was obtained to propose a cut-off value of CT Hounsfield units (HU). Results High correlation with hemoglobin and hematocrit levels was shown for first-order radiomic features (p < 0.001 to p = 0.032). The top 3 features showed high correlation to hemoglobin values (p) and minimal collinearity (r) to the top ranked feature Median (p < 0.001), Energy (p = 0.002, r = 0.387), Minimum (p = 0.032, r = 0.437). Median (p < 0.001) and Minimum (p = 0.003) differed in moderate-to-severe anemia compared to non-anemic state. Median yielded superiority to the combination of Median and Minimum (p(AUC) = 0.015, p(precision) = 0.017, p(accuracy) = 0.612) in the predictive performance employing random forest analysis. A Median HU value ≤ 36.5 indicated moderate-to-severe anemia (accuracy = 0.90, precision = 0.80). Conclusions First-order radiomic features correlate with hemoglobin levels and may be feasible for the prediction of moderate-to-severe anemia. High dimensional radiomic features did not aid augmenting the data in our exemplary use case of intraluminal blood component assessment. Trial registration Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00654-9.
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Mader C, Bernatz S, Michalik S, Koch V, Martin SS, Mahmoudi S, Basten L, Grünewald LD, Bucher A, Albrecht MH, Vogl TJ, Booz C. Quantification of COVID-19 Opacities on Chest CT - Evaluation of a Fully Automatic AI-approach to Noninvasively Differentiate Critical Versus Noncritical Patients. Acad Radiol 2021; 28:1048-1057. [PMID: 33741210 PMCID: PMC7936551 DOI: 10.1016/j.acra.2021.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 12/31/2022]
Abstract
Objectives To evaluate the potential of a fully automatic artificial intelligence (AI)-driven computed tomography (CT) software prototype to quantify severity of COVID-19 infection on chest CT in relationship with clinical and laboratory data. Methods We retrospectively analyzed 50 patients with laboratory confirmed COVID-19 infection who had received chest CT between March and July 2020. Pulmonary opacifications were automatically evaluated by an AI-driven software and correlated with clinical and laboratory parameters using Spearman-Rho and linear regression analysis. We divided the patients into sub cohorts with or without necessity of intensive care unit (ICU) treatment. Sub cohort differences were evaluated employing Wilcoxon-Mann-Whitney-Test. Results We included 50 CT examinations (mean age, 57.24 years), of whom 24 (48%) had an ICU stay. Extent of COVID-19 like opacities on chest CT showed correlations (all p < 0.001 if not otherwise stated) with occurrence of ICU stay (R = 0.74), length of ICU stay (R = 0.81), lethal outcome (R = 0.56) and length of hospital stay (R = 0.33, p < 0.05). The opacities extent was correlated with laboratory parameters: neutrophil count (NEU) (R = 0.60), lactate dehydrogenase (LDH) (R = 0.60), troponin (TNTHS) (R = 0.55) and c-reactive protein (CRP) (R = 0.51). Differences (p < 0.001) between ICU group and non-ICU group concerned longer length of hospital stay (24.04 vs. 10.92 days), higher opacity score (12.50 vs. 4.96) and severity of laboratory data changes such as c-reactive protein (11.64 vs. 5.07 mg/dl, p < 0.01). Conclusions Automatically AI-driven quantification of opacities on chest CT correlates with laboratory and clinical data in patients with confirmed COVID-19 infection and may serve as non-invasive predictive marker for clinical course of COVID-19.
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Bernatz S, Mahmoudi S, Martin SS, Burck I, Vogl TJ, Ackermann J, Stöver T, Balster S, Gröger M. Differences in mastoid and middle-ear cavity opacification in CT between intensive care patients and patients with acute mastoiditis requiring surgical treatment. Eur J Radiol Open 2021; 8:100365. [PMID: 34195304 PMCID: PMC8227832 DOI: 10.1016/j.ejro.2021.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To stratify differences in visual semantic and quantitative imaging features in intensive care patients with nonspecific mastoid effusions versus patients with acute mastoiditis (AM) requiring surgical treatment. Methods We included 48 patients (male, 28; female, 20; mean age, 59.5 ± 18.1 years) with mastoid opacification (AM, n = 24; control, n = 24) who underwent clinically indicated cerebral CT between 12/2007 and 07/2018 in this retrospective study. Semantic features described the extend and asymmetry of mastoid and middle-ear cavity opacification and complications like erosive changes. Minimum, maximum and mean Hounsfield unit (HU) values were obtained as quantitative features. We analyzed the features employing univariate testing. Results Compared to intensive care patients, AM patients revealed asymmetric mastoid or middle-ear cavity opacification (likelihood-ratio (LR) < 0.001). Applying a dedicated threshold of the extent of opacification, AM patients reached significance levels of LR = 0.042 and 0.002 for mastoid and middle-ear cavity opacification. AM cases showed higher maximum and mean HU values (p = 0.009, p = 0.024). Conclusions We revealed that the extent and asymmetry of mastoid and middle-ear cavity opacification differs significantly between AM patients and intensive care patients. Multicenter research is needed to expand our cohort and possibly pave the way to build a non-invasive predictive model for AM in the future.
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Toutaoui A, Baroudi T, Mahmoudi S, Louelh R. PO-0906: MRI contrast clearance analysis for follow-up of brain tumors treated with VMAT and SRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haji Esmaeil Memar E, Mamishi S, Sharifzadeh Ekbatani M, Alimadadi H, Yaghmaei B, Chegini V, Janani S, Mahmoudi S. Fulminant hepatic failure: A rare and devastating manifestation of Coronavirus disease 2019 in an 11-year-old boy. Arch Pediatr 2020; 27:502-505. [PMID: 33069564 PMCID: PMC7522641 DOI: 10.1016/j.arcped.2020.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/13/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Abstract
Although several typical manifestation of novel coronavirus disease 2019 (COVID-19) including respiratory symptoms, weakness, fever, and fatigue have been reported, some rare and novel manifestations have also been observed, particularly in children. We report a pediatric case of fulminant hepatic failure associated with COVID-19. Although the patient was treated for acute fulminant hepatic failure in the context of COVID-19, he died following the progression of the disease to stage 4 hepatic failure with encephalopathy and brain death.
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Pourakbari B, Mamishi S, Banar M, Keshtkar AA, Mahmoudi S. Prevalence of TB/ HIV co-infection in Iran: a systematic review and meta-analysis. ANNALI DI IGIENE : MEDICINA PREVENTIVA E DI COMUNITA 2020; 31:333-348. [PMID: 31268118 DOI: 10.7416/ai.2019.2295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Co-infection of TB/ HIV is an emerging threat to a global public health. Although several studies have investigated the prevalence of TB/HIV co-infection in Iran, the results are inconsistent. The current systematic review and meta-analysis was planned to estimate the overall prevalence of TB/HIV co-infection in Iran. METHODS Electronic databases, including MEDLINE (via PubMed), SCOPUS, SID and Mag Iran (two Persian scientific search engines) were searched up to 27 Apr 2017. The random effect model was used for estimating the prevalence of TB/ HIV co-infection. Heterogeneity was assessed by subgroup analysis. RESULTS Forty-eight articles met our inclusion criteria, with a total of 21,388 individuals. The meta-analysis demonstrates that the prevalence of TB/ HIV co-infection in Iran was 14% [95% confidence interval CI:12-15%]. According to the meta-analysis of 5 subgroups, the prevalence of TB/ HIV co-infection in the subgroup with high intravenous drug users (IVDU) [27%, 95% CI: 20-35%], in border provinces of Iran [17%, 95% CI: 13-21%], in the subgroup with pulmonary tuberculosis (PTB) ≥ 20% [22%, 95% CI: 17-27%], in patients <40 years of age [25%, 95 CI: 19-31%] was significantly higher. There were no significant differences between the prevalence of co-infection among low and high-quality studies. Pulmonary TB was the predominant type of TB among co-infected patients [77%, 95% CI: 71 to 84%]. CONCLUSIONS Our study demonstrates that the overall prevalence of TB/HIV co-infection in Iran was 14% [95% CI: 12-15%], which was a high rate. Some factors such as using intravenous drugs, living in border provinces of Iran, having PTB, and age <40 years had an impact on the prevalence of co-infection. Results revealed the need of HIV surveillance program among TB patients and screening of HIV-positive patients for diagnosis and treatment of TB. Further large-scale studies about the prevalence of this infection in all provinces of Iran are needed.
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Mamishi S, Arab Yazdi Z, Mahmoudi S, Moradzadeh M, Taghi Haghi Ashtiani M, Pourakbari B. Antimicrobial-resistance pattern of Shigella species in children: a six-year study in an Iranian referral Hospital. ANNALI DI IGIENE : MEDICINA PREVENTIVA E DI COMUNITA 2020; 31:356-364. [PMID: 31268120 DOI: 10.7416/ai.2019.2297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Shigella species are a frequent cause of shigellosis and shigellosis is considered as one of the most common causes of diarrhea in children. This disease is endemic in many developing countries such as Iran. This study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among pediatric patients with acute diarrhea in Children Medical Center (CMC) Hospital, with a diagnosis of acute diarrhea to CMC Hospital from March 2011 through March 2016. Isolation and identification techniques, as well as the susceptibility tests are described in detail. RESULTS Of the 46,795 stool specimens that were sent to the microbiology laboratory of the CMC Hospital for culture and susceptibility testing, 573 (1.2%) were positive for Shigella species. The most common species of Shigella were S. sonnei (n= 335, 58.4%) and S. flexneri (n=229, 40%), followed by S. boydii (n=8, 1.4%) and S. dysenteriae (n=1, 0.2%). S. flexneri was most sensitive to gentamicin (n=17/19, 89%) and amikacin (n=15/18, 83%), while high frequency of resistance to trimethoprim- sulfamethoxazole (n=204/224, 91%) and ampicillin (n=216/228, 95%) was seen. S. boydii was most sensitive to ampicillin (n=5 out of 7, 71%) and cefotaxime (n=6/7, 86%) and the high frequency of resistance was seen against trimethoprim-sulfamethoxazole (n=5/7, 71%). For S. sonnei, the highest sensitivity was reported against amikacin and gentamicin (87% and 80%, respectively), while the highest resistance to trimethoprim- sulfamethoxazole (n=325/331, 98%) and ciprofloxacin (n= 66 out of 76, 87%) was reported. Ciprofloxacin was examined on 115 out of 573 isolates and 84 isolates were resistant (73%). Multidrug-resistance (MDR), (i.e. resistance to three or more classes of antimicrobial agents) was classified into 11 distinct patterns. CONCLUSIONS In this study, S. sonnei was the predominant Shigella species. High frequency of resistance to common antimicrobials such as trimethoprim-sulfamethoxazole and ampicillin limits the empirical therapy for the management of shigellosis in Iran. On the other hand, it should be noted that third-generation cephalosporins can be convenient replacing drugs.
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Ekbatani MS, Hassani SA, Tahernia L, Yaghmaei B, Mahmoudi S, Navaeian A, Rostamyan M, Zamani F, Mamishi S. Atypical and novel presentations of Coronavirus Disease 2019: a case series of three children. Br J Biomed Sci 2020; 78:47-52. [PMID: 32552415 DOI: 10.1080/09674845.2020.1785102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Typical presentations of Coronavirus Disease 2019 (Covid-19) including respiratory symptoms (cough, respiratory distress and hypoxia), fever and dyspnoea are considered main symptoms in adults, but atypical presentation in children could be a diagnostic challenge. We report three children whose initial presentation was gastrointestinal, and in whom Covid-19 infection was found, concluding that cases of acute appendicitis, mesenteric adenitis and flank tenderness may mask an infection with this virus, and should therefore be investigated.
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Pourakbari B, Mamishi S, Shokrollahi MR, Heydari H, Mahmoudi S, Banar M, Sadeghi RH, Movahedi Z. Molecular characteristics and antibiotic resistance profiles of Escherichia coli strains isolated from urinary tract infections in children admitted to children's referral hospital of Qom, Iran. ANNALI DI IGIENE : MEDICINA PREVENTIVA E DI COMUNITA 2020; 31:252-262. [PMID: 31069370 DOI: 10.7416/ai.2019.2288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are a highly prevalent infection among children and Escherichia coli is one of the most important pathogens causing pediatric UTIs. Production of extended spectrum b-lactamase (ESBL) enzymes is an important factor in the emergence of antibiotic resistance among these bacteria. This study aimed to determine the resistance patterns, the frequency of ESBL-encoding genes and the genetic diversity of E. coli strains isolated from children with UTIs who were admitted to children's referral hospital of Hazrat Masoumeh, Qom, Iran. METHODS A total of 102 consecutive non-duplicative strains of E.coli that were isolated from children with UTIs were included into the study. Antibiotic susceptibility of the isolates was determined by disk diffusion method according to the CLSI guidelines. The ability of the isolates to produce ESBLs was phenotypically determined by both combined disk test and double disk synergy test. The ESBL encoding genes (bla CTX-M, bla SHV, and bla TEM) in phenotypically confirmed ESBL-positive isolates was detected by PCR method. The genetic relatedness of the isolates was designated by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). RESULTS Eighty-three percent (n=85) of the children were female. Most of the infected boys (88%, n=15) were less than 1 year of age and most of the infected girls (48%, n=41) aged 1 to 6 years old. The highest sensitivity was observed to nitrofurantoin (8%, n=8), followed by amikacin (12%, n=12) and piperacillin-tazobactam (17%, n=17). In contrast, the highest resistance rate was seen to ampicillin (94%, n=96) and cefazolin (93%, n=95). Eighty-eight percent (90 out of 102) of the strains were multidrug-resistant (MDR). Fifty-eight percent (n=59) of the strains were ESBL-positive and results of the combined disk test was in concordance with PCR. The blaCTX-M was the most frequent ESBL encoding gene (88%, n=52), followed by blaTEM (54%, n=32), and blaSHV (15%, n=9). Based on the ERIC-PCR technique, isolates were clustered in 13 different types. There was no relationship between different ERIC types and origin of the isolates (i.e. hospitalized or outpatients), ESBL-producing ability, and antibiotic resistance patterns. CONCLUSIONS High prevalence of ESBL-positive isolates of E. coli (58%) was found in our study and all of them were MDR. In addition, there were statistically significant differences in the resistance rates of ESBL-producers, and non-producers to some antibiotics, which result in limiting their therapeutic options. Continuous surveillance of the emergence of ESBL-producing isolates and their antibiotic resistance profiles as well as using appropriate typing methods is needed for reducing their spread, selecting appropriate treatment regimens and finding hospital outbreaks.
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