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Singh R, Nie RZ, Homayounieh F, Schmidt B, Flohr T, Kalra MK. Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism. Eur Radiol 2020; 30:2535-2542. [DOI: 10.1007/s00330-019-06607-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
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Kamada H, Ota H, Terui Y, Sugimura K, Fukui S, Shimokawa H, Takase K. Three cases of pulmonary tumor thrombotic microangiopathy (PTTM): Challenge in antemortem diagnosis using lung perfusion blood volume images by dual-energy computed tomography. Eur J Radiol Open 2020; 7:100212. [PMID: 33102634 PMCID: PMC7569404 DOI: 10.1016/j.ejro.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/14/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a specific type of tumor embolism in the small and medium pulmonary arteries, leading to rapid progressive pulmonary hypertension. Antemortem diagnosis of PTTM is extremely difficult. We encountered three patients who were histopathologically or clinically diagnosed with PTTM. In all cases, lung perfused blood volume (PBV) images on dual-energy computed tomography (CT) demonstrated multiple subpleural wedge-shaped defects with no evidence of pulmonary embolism on CT pulmonary angiography. The lung PBV images demonstrated small pulmonary arterial obstruction reflecting the pathology of PTTM. Therefore, lung PBV imaging would be useful for antemortem diagnosis of PTTM.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Yosuke Terui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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Shahin Y, Johns C, Karunasaagarar K, Kiely DG, Swift AJ. IodiNe Subtraction mapping in the diagnosis of Pulmonary chronIc thRomboEmbolic disease (INSPIRE): Rationale and methodology of a cross-sectional observational diagnostic study. Contemp Clin Trials Commun 2019; 15:100417. [PMID: 31388600 PMCID: PMC6667787 DOI: 10.1016/j.conctc.2019.100417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/17/2019] [Accepted: 07/18/2019] [Indexed: 10/27/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe but treatable disease that is commonly underdiagnosed. Computed tomography lung subtraction iodine mapping (CT-LSIM) in addition to standard CT pulmonary angiography (CTPA) may improve the evaluation of suspected chronic pulmonary embolism and improve the diagnostic pick up rate. We aim to recruit 100 patients suspected of having CTEPH and perform CT-LSIM scans in addition to the current gold standard test of nuclear medicine test (lung single photon emission computed tomography (SPECT) imaging) as a pilot study which will contribute to and inform the definitive trial. The diagnostic accuracy of CT-LSIM and lung SPECT will be compared. The primary outcome of the full definitive study is non-inferiority of CT-LSIM versus lung SPECT imaging.
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Affiliation(s)
- Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
| | - Christopher Johns
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
| | - Andy J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.,INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
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54
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Grob D, Smit E, Prince J, Kist J, Stöger L, Geurts B, Snoeren MM, van Dijk R, Oostveen LJ, Prokop M, Schaefer-Prokop CM, Sechopoulos I, Brink M. Iodine Maps from Subtraction CT or Dual-Energy CT to Detect Pulmonary Emboli with CT Angiography: A Multiple-Observer Study. Radiology 2019; 292:197-205. [DOI: 10.1148/radiol.2019182666] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dagmar Grob
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Ewoud Smit
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Jip Prince
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Jakob Kist
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Lauran Stöger
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Bram Geurts
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Miranda M. Snoeren
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Rogier van Dijk
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Luuk J. Oostveen
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Mathias Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Cornelia M. Schaefer-Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Ioannis Sechopoulos
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
| | - Monique Brink
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (D.G., E.S., B.G., M.M.S., L.L.O., M.P., I.S., M.B.); and Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (J.P., J.K., L.S., R.v.D., C.M.S.P.)
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Kay FU, Oz OK, Abbara S, Mortani Barbosa EJ, Agarwal PP, Rajiah P. Translation of Quantitative Imaging Biomarkers into Clinical Chest CT. Radiographics 2019; 39:957-976. [PMID: 31199712 DOI: 10.1148/rg.2019180168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Quantitative imaging has been proposed as the next frontier in radiology as part of an effort to improve patient care through precision medicine. In 2007, the Radiological Society of North America launched the Quantitative Imaging Biomarkers Alliance (QIBA), an initiative aimed at improving the value and practicality of quantitative imaging biomarkers by reducing variability across devices, sites, patients, and time. Chest CT occupies a strategic position in this initiative because it is one of the most frequently used imaging modalities, anatomically encompassing the leading causes of mortality worldwide. To date, QIBA has worked on profiles focused on the accurate, reproducible, and meaningful use of volumetric measurements of lung lesions in chest CT. However, other quantitative methods are on the verge of translation from research grounds into clinical practice, including (a) assessment of parenchymal and airway changes in patients with chronic obstructive pulmonary disease, (b) analysis of perfusion with dual-energy CT biomarkers, and (c) opportunistic screening for coronary atherosclerosis and low bone mass by using chest CT examinations performed for other indications. The rationale for and the key facts related to the application of these quantitative imaging biomarkers in cardiothoracic chest CT are presented. ©RSNA, 2019 See discussion on this article by Buckler (pp 977-980).
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Orhan K Oz
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Eduardo J Mortani Barbosa
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prachi P Agarwal
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
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Abdou AM, Badr MS, Helal KF, Rafeek ME, Abdelrhman AA, Kotb M. Diagnostic accuracy of lamellar body count as a predictor of fetal lung maturity: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2019; 5:100059. [PMID: 32021970 PMCID: PMC6994392 DOI: 10.1016/j.eurox.2019.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/30/2019] [Indexed: 01/01/2023] Open
Abstract
Objective This study aimed to synthesize evidence from published studies about the diagnostic accuracy of lamellar body count (LBC) as a predictor of fetal lung maturity. Study design We searched Medline (via PubMed), EBSCO, Web of Science, Scopus and the Cochrane Library for relevant published studies assessing the accuracy of LBC as a predictor of fetal lung maturity. Studies were classified according to the counting essays, centrifugation protocols, and the reported optimum cut off values. Data of the true positive, true negative, false positive, and false negative were extracted and analyzed to calculate the overall sensitivity and specificity of the LBC. Results Thirty-one studies were included in the final analysis. Fourteen studies reported data for centrifuged amniotic fluid (AF) samples, 13 studies reported data for uncentrifuged samples, and four studies did not have enough information about whether centrifugation was done. LBC showed an area under the curve >80% in diagnosing lung immaturity with variable cut off values. Pooled analysis showed that LBC a 100% specificity to exclude respiratory distress syndrome (RDS) at a cut off value of 15,000 and 100% sensitivity to diagnose RDS at a cut off value of 55,000. Conclusion Cases with LBC < 15,000 are considered to have lung immaturity while cases with LBC > 45,000 in centrifuged AF samples or >55,000 in uncentrifuged AF samples are likely to have mature lungs. Cases with LBC ranging between these maturity and immaturity limits should be considered for further evaluation by other lung maturity tests.
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Rajiah P, Tanabe Y, Partovi S, Moore A. State of the art: utility of multi-energy CT in the evaluation of pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1509-1524. [PMID: 31049753 DOI: 10.1007/s10554-019-01615-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022]
Abstract
Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA.
| | - Yuki Tanabe
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA
- Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alastair Moore
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
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Zucker EJ, Kino A, Schmiedeskamp H, Hinostroza V, Fleischmann D, Chan FP. Feasibility and utility of dual-energy chest CTA for preoperative planning in pediatric pulmonary artery reconstruction. Int J Cardiovasc Imaging 2019; 35:1473-1481. [PMID: 31016501 DOI: 10.1007/s10554-019-01602-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/09/2019] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to assess in pediatric pulmonary artery (PA) reconstruction candidates the feasibility and added utility of preoperative chest computed tomography angiography (CTA) using dual-energy technique, from which perfused blood volume (PBV)/iodine maps can be generated as a surrogate of pulmonary perfusion. Pediatric PA reconstruction patients were prospectively recruited for a new dose-neutral dual-energy CTA protocol. For each case, the severity of anatomic PA obstruction was graded by two pediatric cardiovascular radiologists in consensus using a modified Qanadli index. PBV maps were qualitatively reviewed and auto-segmented using Siemens syngo.via software. Associations between Qanadli scores and PBV were assessed with Spearman correlation (r) and ROC analysis. Effective radiation doses were estimated from dose-length product and ICRP 103 k-factors, using cubic Hermite spline interpolation. 19 patients were recruited with mean (SD) age of 6.0 (5.1), 11 (57.9%) female, 11 (73.7%) anesthetized. Higher QS correlated with lower PBV, both on a whole lung (r = - 0.54, p < 0.001) and lobar (r = - 0.50, p < 0.001) basis. The lung with lowest absolute PBV was predictive of the lung with highest Qanadli score, with AUC of 0.70 (95% CI 0.47-0.93). Qualitatively, PBV maps were heterogeneous, corresponding to multifocal PA stenoses, with decreased iodine content in areas of most severe obstruction. In conclusion, dual-energy chest CTA is feasible for pediatric PA reconstruction candidates. PBV maps show deficits in regions of more severe anatomic obstruction and may serve as a novel biomarker in this population.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA.
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Heiko Schmiedeskamp
- Siemens Medical Solutions USA, 40 Liberty Boulevard, Malvern, PA, 19355, USA
| | - Virginia Hinostroza
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
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Siegel MJ, Ramirez-Giraldo JC. Dual-Energy CT in Children: Imaging Algorithms and Clinical Applications. Radiology 2019; 291:286-297. [PMID: 30912717 DOI: 10.1148/radiol.2019182289] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dual-energy CT enables the simultaneous acquisition of CT images at two different x-ray energy spectra. By acquiring high- and low-energy spectral data, dual-energy CT can provide unique qualitative and quantitative information about tissue composition, allowing differentiation of multiple materials including iodinated contrast agents. The two dual-energy CT postprocessing techniques that best exploit the advantages of dual-energy CT in children are the material-decomposition images (which include virtual nonenhanced, iodine, perfused lung blood volume, lung vessel, automated bone removal, and renal stone characterization images) and virtual monoenergetic images. Clinical applications include assessment of the arterial system, lung perfusion, neoplasm, bowel diseases, renal calculi, tumor response to treatment, and metal implants. Of importance, the radiation exposure level of dual-energy CT is equivalent to or less than that of conventional single-energy CT. In this review, the authors discuss the basic principles of the dual-energy CT technologies and postprocessing techniques and review current clinical applications in the pediatric chest and abdomen.
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Affiliation(s)
- Marilyn J Siegel
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, Mo 63110 (M.J.S.); and Siemens Healthineers, Malvern, Pa (J.C.R.G.)
| | - Juan Carlos Ramirez-Giraldo
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, Mo 63110 (M.J.S.); and Siemens Healthineers, Malvern, Pa (J.C.R.G.)
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Kröger JR, Gerhardt F, Dumitrescu D, Rosenkranz S, Schmidt M, Maintz D, Bunck AC. Diagnosis of pulmonary hypertension using spectral-detector CT. Int J Cardiol 2019; 285:80-85. [PMID: 30905521 DOI: 10.1016/j.ijcard.2019.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/04/2019] [Accepted: 03/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the value of spectral-detector CT (SDCT) in the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), its differentiation against other etiologies of pulmonary hypertension (PH) and in the prediction of disease severity. MATERIALS AND METHODS 60 patients with suspected PH underwent SDCT. Additional diagnostic tests in accordance with the ESC guidelines including right heart catherization and VQ-SPECT were performed. After full diagnostic work-up patients were classified as: 21 precapillary PH, 5 postcapillary PH, 6 combined pre- and postcapillary PH, 19 CTEPH, 9 no PH. SDCT examinations were analyzed by two blinded readers deciding on the diagnosis of CTEPH and scoring the extent of perfusion abnormalities on iodine density images. An additional reading was performed using conventional CTPA images only. RESULTS With access to SDCT data, both readers reached a sensitivity of 100% for the diagnosis of CTEPH with a specificity of 95.1% and 87.8%. On analysis of conventional CTPA images alone, specificity and diagnostic confidence decreased for both readers (Specificity 90.2 and 85.3%) while sensitivity dropped for the less experienced reader only (Sensitivity 78.9%). Patients with PH showed significantly more perfusion abnormalities than patients without PH (16.6 ± 8.4 vs. 9.5 ± 8.9 p < 0.001) and the extent of perfusion abnormalities correlated with the mean pulmonary artery pressure (r = 0.37 p = 0.008). CONCLUSIONS SDCT offers confident identification of patients with CTEPH and enables a comprehensive analysis of pulmonary vasculature, pulmonary perfusion and the lung parenchyma in a single examination for patients with suspected PH.
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Affiliation(s)
- Jan Robert Kröger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Radiology, Germany.
| | - Felix Gerhardt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiology, Germany
| | - Daniel Dumitrescu
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiology, Germany
| | - Stephan Rosenkranz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiology, Germany
| | - Matthias Schmidt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear-Medicine, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Radiology, Germany
| | - Alexander C Bunck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Radiology, Germany
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Quantitative Dual-Energy Computed Tomography Predicts Regional Perfusion Heterogeneity in a Model of Acute Lung Injury. J Comput Assist Tomogr 2018; 42:866-872. [PMID: 30371620 PMCID: PMC6250290 DOI: 10.1097/rct.0000000000000815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The aims of this study were to investigate the ability of contrast-enhanced dual-energy computed tomography (DECT) for assessing regional perfusion in a model of acute lung injury, using dynamic first-pass perfusion CT (DynCT) as the criterion standard and to evaluate if changes in lung perfusion caused by prone ventilation are similarly demonstrated by DECT and DynCT. Methods This was an institutional review board–approved study, compliant with guidelines for humane care of laboratory animals. A ventilator-induced lung injury protocol was applied to 6 landrace pigs. Perfused blood volume (PBV) and pulmonary blood flow (PBF) were respectively quantified by DECT and DynCT, in supine and prone positions. The lungs were segmented in equally sized regions of interest, namely, dorsal, middle, and ventral. Perfused blood volume and PBF values were normalized by lung density. Regional air fraction (AF) was assessed by triple-material decomposition DECT. Per-animal correlation between PBV and PBF was assessed with Pearson R. Regional differences in PBV, PBF, and AF were evaluated with 1-way analysis of variance and post hoc linear trend analysis (α = 5%). Results Mean correlation coefficient between PBV and PBF was 0.70 (range, 0.55–0.98). Higher PBV and PBF values were observed in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were −10.24 mL/100 g per zone for PBV (P < 0.001) and −223.0 mL/100 g per minute per zone for PBF (P < 0.001). Prone ventilation also revealed higher PBV and PBF in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were −16.16 mL/100 g per zone for PBV (P < 0.001) and −108.2 mL/100 g per minute per zone for PBF (P < 0.001). By contrast, AF was lower in dorsal versus ventral regions in supine position, with dorsal-to-ventral linear trend slope of +5.77%/zone (P < 0.05). Prone ventilation was associated with homogenization of AF distribution among different regions (P = 0.74). Conclusions Dual-energy computed tomography PBV is correlated with DynCT-PBF in a model of acute lung injury, and able to demonstrate regional differences in pulmonary perfusion. Perfusion was higher in the dorsal regions, irrespectively to decubitus, with more homogeneous lung aeration in prone position.
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Braig E, Böhm J, Dierolf M, Jud C, Günther B, Mechlem K, Allner S, Sellerer T, Achterhold K, Gleich B, Noël P, Pfeiffer D, Rummeny E, Herzen J, Pfeiffer F. Direct quantitative material decomposition employing grating-based X-ray phase-contrast CT. Sci Rep 2018; 8:16394. [PMID: 30401876 PMCID: PMC6219573 DOI: 10.1038/s41598-018-34809-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/24/2018] [Indexed: 11/09/2022] Open
Abstract
Dual-energy CT has opened up a new level of quantitative X-ray imaging for many diagnostic applications. The energy dependence of the X-ray attenuation is the key to quantitative material decomposition of the volume under investigation. This material decomposition allows the calculation of virtual native images in contrast enhanced angiography, virtual monoenergetic images for beam-hardening artifact reduction and quantitative material maps, among others. These visualizations have been proven beneficial for various diagnostic questions. Here, we demonstrate a new method of 'virtual dual-energy CT' employing grating-based phase-contrast for quantitative material decomposition. Analogue to the measurement at two different energies, the applied phase-contrast measurement approach yields dual information in form of a phase-shift and an attenuation image. Based on these two image channels, all known dual-energy applications can be demonstrated with our technique. While still in a preclinical state, the method features the important advantages of direct access to the electron density via the phase image, simultaneous availability of the conventional attenuation image at the full energy spectrum and therefore inherently registered image channels. The transfer of this signal extraction approach to phase-contrast data multiplies the diagnostic information gained within a single CT acquisition. The method is demonstrated with a phantom consisting of exemplary solid and fluid materials as well as a chicken heart with an iodine filled tube simulating a vessel. For this first demonstration all measurements have been conducted at a compact laser-undulator synchrotron X-ray source with a tunable X-ray energy and a narrow spectral bandwidth, to validate the quantitativeness of the processing approach.
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Affiliation(s)
- Eva Braig
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany.
| | - Jessica Böhm
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Christoph Jud
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Max-Planck-Institute of Quantum Optics, Hans-Kopfermann-Straße 1, 85748, Garching, Germany
| | - Korbinian Mechlem
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Sebastian Allner
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Thorsten Sellerer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Gleich
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
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Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, Moskowitz C, Ginsberg MS. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology 2018; 289:546-553. [PMID: 30204073 DOI: 10.1148/radiol.2018180594] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if there is added benefit of using iodine maps from dual-energy (DE) CT in addition to conventional CT angiography images to diagnose pulmonary embolism (PE). Materials and Methods In this retrospective analysis, 1144 consecutive dual-energy CT angiography examinations performed from January through September 2014 at an oncologic referral center to evaluate for PE were reviewed. The 1144 examinations included 1035 patients (mean age, 58.7 years; range, 15-99 years). First, the location, level, and type (occlusive vs nonocclusive) of PEs on conventional CT angiograms were recorded. Iodine maps were then reviewed for defects suggestive of PE. Last, CT angiograms were rereviewed to detect additional PEs suggested by the iodine map. Consensus reviews were performed for examinations with PEs. The confidence interval of percentages was calculated by using the Clopper-Pearson method. Results On 147 of 1144 (12.8%) CT angiograms, a total of 372 PEs were detected at initial review. After review of the DE CT iodine map, 27 additional PEs were found on 26 of 1144 CT angiograms (2.3%; 95% confidence interval [CI]: 1.5%, 3.3%). Of the 27 additional PEs, six (22.2%) were segmental, 21 (77.8%) were subsegmental, 24 (88.9%) were occlusive, and three (11.1%) were nonocclusive. Eleven of 1144 (1.0%; 95% CI: 0.5%, 1.7%) CT angiograms had a new diagnosis of PE after review of the DE CT iodine maps. Conclusion Dual-energy CT iodine maps show a small incremental benefit for the detection of occlusive segmental and subsegmental pulmonary emboli. © RSNA, 2018.
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Affiliation(s)
- Elizabeth K Weidman
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Andrew J Plodkowski
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Darragh F Halpenny
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Sara A Hayes
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Rocio Perez-Johnston
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Junting Zheng
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Chaya Moskowitz
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Michelle S Ginsberg
- From the Departments of Radiology (E.K.W., A.J.P., D.F.H., S.A.H., R.P.J., M.S.G.) and Epidemiology and Biostatistics (J.Z., C.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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De Santis D, Eid M, De Cecco CN, Jacobs BE, Albrecht MH, Varga-Szemes A, Tesche C, Caruso D, Laghi A, Schoepf UJ. Dual-Energy Computed Tomography in Cardiothoracic Vascular Imaging. Radiol Clin North Am 2018; 56:521-534. [PMID: 29936945 DOI: 10.1016/j.rcl.2018.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual energy computed tomography is becoming increasingly widespread in clinical practice. It can expand on the traditional density-based data achievable with single energy computed tomography by adding novel applications to help reach a more accurate diagnosis. The implementation of this technology in cardiothoracic vascular imaging allows for improved image contrast, metal artifact reduction, generation of virtual unenhanced images, virtual calcium subtraction techniques, cardiac and pulmonary perfusion evaluation, and plaque characterization. The improved diagnostic performance afforded by dual energy computed tomography is not associated with an increased radiation dose. This review provides an overview of dual energy computed tomography cardiothoracic vascular applications.
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Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Marwen Eid
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Lazarettstraße 36, Munich 80636, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
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Noschang J, Guimarães MD, Teixeira DFD, Braga JCD, Hochhegger B, Santana PRP, Marchiori E. Pulmonary thromboembolism: new diagnostic imaging techniques. Radiol Bras 2018; 51:178-186. [PMID: 29991840 PMCID: PMC6034731 DOI: 10.1590/0100-3984.2017.0191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The accurate diagnosis of pulmonary thromboembolism is essential to reducing the
morbidity and mortality associated with the disease. The diagnosis of pulmonary
thromboembolism is challenging because of the nonspecific nature of the clinical
profile and the risk factors. Imaging methods provide the definitive diagnosis.
Currently, the imaging method most commonly used in the evaluation of pulmonary
thromboembolism is computed tomography. The recent development of dual-energy
computed tomography has provided a promising tool for the evaluation of
pulmonary perfusion through iodine mapping. In this article, we will review the
importance of diagnosing pulmonary thromboembolism, as well as the imaging
methods employed, primarily dual-energy computed tomography.
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Affiliation(s)
- Julia Noschang
- MD, Resident in Radiology in the Department of Imaging of the A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcos Duarte Guimarães
- MD, PhD, Radiologist in the Department of Imaging of the A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Bruno Hochhegger
- PhD, Adjunct Professor of Radiology at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Edson Marchiori
- Full Professor of Radiology at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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67
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Kandathil A, Kay F, Batra K, Saboo SS, Rajiah P. Advances in Computed Tomography in Thoracic Imaging. Semin Roentgenol 2018; 53:157-170. [PMID: 29861007 DOI: 10.1053/j.ro.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Asha Kandathil
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Fernando Kay
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Kiran Batra
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Sachin S Saboo
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX.
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Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure caused by a broad spectrum of congenital and acquired disease processes, which are currently divided into five groups based on the 2013 WHO classification. Imaging plays an important role in the evaluation and management of PH, including diagnosis, establishing etiology, quantification, prognostication and assessment of response to therapy. Multiple imaging modalities are available, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, echocardiography and invasive catheter angiography (ICA), each with their own advantages and disadvantages. In this article, we review the comprehensive role of imaging in the evaluation of PH.
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Affiliation(s)
- Harold Goerne
- IMSS Centro Medico Nacional De Occidente, Guadalajara, Jalisco, Mexico.,CID Imaging and Diagnostic Center, Guadalajara, Jalisco, Mexico
| | - Kiran Batra
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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69
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Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018; 8:225-243. [PMID: 30057872 DOI: 10.21037/cdt.2017.12.01] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Imaging plays an important role in the evaluation and management of acute pulmonary embolism (PE). Computed tomography (CT) pulmonary angiography (CTPA) is the current standard of care and provides accurate diagnosis with rapid turnaround time. CT also provides information on other potential causes of acute chest pain. With dual-energy CT, lung perfusion abnormalities can also be detected and quantified. Chest radiograph has limited utility, occasionally showing findings of PE or infarction, but is useful in evaluating other potential causes of chest pain. Ventilation-perfusion (VQ) scan demonstrates ventilation-perfusion mismatches in these patients, with several classification schemes, typically ranging from normal to high. Magnetic resonance imaging (MRI) also provides accurate diagnosis, but is available in only specialized centers and requires higher levels of expertise. Catheter pulmonary angiography is no longer used for diagnosis and is used only for interventional management. Echocardiography is used for risk stratification of these patients. In this article, we review the role of imaging in the evaluation of acute PE.
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Affiliation(s)
- Alastair J E Moore
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Wachsmann
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Murthy R Chamarthy
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lloyd Panjikaran
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Yuki Tanabe
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
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Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther 2018; 8:253-271. [PMID: 30057874 DOI: 10.21037/cdt.2018.01.09] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolic disease. Differently from other causes of pulmonary hypertension, CTEPH is potentially curable with surgery (thromboendarterectomy) or balloon pulmonary angioplasty. Imaging plays a central role in CTEPH diagnosis. The combination of techniques such as lung scintigraphy, computed tomography and magnetic resonance angiography provides non-invasive anatomic and functional information. Conventional pulmonary angiography (CPA) with right heart catheterization (RHC) is considered the gold standard method for diagnosing CTEPH. In this review, we discuss the utility of these imaging techniques in the diagnosis of CTEPH.
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Affiliation(s)
- Katia Hidemi Nishiyama
- Department of Thoracic Imaging, Hospital do Coração and DASA (Diagnósticos da América), São Paulo, Brazil
| | - Sachin S Saboo
- Department of Radiology, UT Southwestern Medical Center, Florence Building, Dallas, TX, USA
| | - Yuki Tanabe
- Department of Radiology, UT Southwestern Medical Center, Florence Building, Dallas, TX, USA
| | | | - Michael J Landay
- Department of Radiology, UT Southwestern Medical Center, Florence Building, Dallas, TX, USA
| | - Fernando Uliana Kay
- Department of Radiology, UT Southwestern Medical Center, Florence Building, Dallas, TX, USA
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Comparative clinical and predictive value of lung perfusion blood volume CT, lung perfusion SPECT and catheter pulmonary angiography images in patients with chronic thromboembolic pulmonary hypertension before and after balloon pulmonary angioplasty. Eur Radiol 2018; 28:5091-5099. [PMID: 29802574 DOI: 10.1007/s00330-018-5501-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/26/2018] [Accepted: 04/18/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Lung perfusion blood volume (PBV) using dual-energy computed tomography has recently become an accepted technique for diagnosing pulmonary thromboembolism. We evaluated the correlation among lung PBV, single-photon emission computed tomography (SPECT) and catheter pulmonary angiography images in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after balloon pulmonary angioplasty (BPA). METHODS In total, 17 patients and 57 sessions were evaluated with the three modalities. Segmental lung perfusion and its improvement in lung PBV and SPECT were compared with catheter pulmonary angiography as the reference standard before and after BPA. RESULTS The sensitivity for detecting segmental perfusion defects using SPECT and lung PBV was 85% and 92%, the specificity was 99% and 99%, the accuracy was 92% and 95%, the positive predictive value was 99% and 99%, and the negative predictive value was 88% and 93%. The sensitivity for detecting segmental perfusion improvement using SPECT and lung PBV was 61% and 69%, the specificity was 75% and 83%, the accuracy was 62% and 70%, the positive predictive value was 97% and 98%, and the negative predictive value was 12% and 16%. CONCLUSIONS Lung PBV is a useful technique for evaluation of segmental lung perfusion and its improvement in patients with CTEPH. KEY POINTS • BPA is a new treatment for patients with CTEPH. • Lung PBV images may be more sensitive for pulmonary blood flow. • The current work demonstrates that Lung PBV images are useful in evaluating patients with CTEPH. • The current work demonstrates that Lung PBV is useful in gauging the treatment effect of BPA.
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Lapointe A, Lalonde A, Bahig H, Carrier J, Bedwani S, Bouchard H. Robust quantitative contrast‐enhanced dual‐energy CT for radiotherapy applications. Med Phys 2018; 45:3086-3096. [DOI: 10.1002/mp.12934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 02/27/2018] [Accepted: 04/11/2018] [Indexed: 01/07/2023] Open
Affiliation(s)
- Andréanne Lapointe
- Département de physique Université de Montréal 2900 boulevard Édouard‐Montpetit Montréal QC H3T 1J4Canada
| | - Arthur Lalonde
- Département de physique Université de Montréal 2900 boulevard Édouard‐Montpetit Montréal QC H3T 1J4Canada
| | - Houda Bahig
- Département de radio‐oncologie Centre hospitalier de l’Université de Montréal (CHUM) 1000 rue Saint‐Denis Montréal Québec H2X 0C1Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal QC H2X 0A9Canada
| | - Jean‐François Carrier
- Département de physique Université de Montréal 2900 boulevard Édouard‐Montpetit Montréal QC H3T 1J4Canada
- Département de radio‐oncologie Centre hospitalier de l’Université de Montréal (CHUM) 1000 rue Saint‐Denis Montréal Québec H2X 0C1Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal QC H2X 0A9Canada
| | - Stéphane Bedwani
- Département de physique Université de Montréal 2900 boulevard Édouard‐Montpetit Montréal QC H3T 1J4Canada
- Département de radio‐oncologie Centre hospitalier de l’Université de Montréal (CHUM) 1000 rue Saint‐Denis Montréal Québec H2X 0C1Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal QC H2X 0A9Canada
| | - Hugo Bouchard
- Département de physique Université de Montréal 2900 boulevard Édouard‐Montpetit Montréal QC H3T 1J4Canada
- Département de radio‐oncologie Centre hospitalier de l’Université de Montréal (CHUM) 1000 rue Saint‐Denis Montréal Québec H2X 0C1Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal QC H2X 0A9Canada
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Koike H, Sueyoshi E, Sakamoto I, Uetani M, Nakata T, Maemura K. Correlation between lung perfusion blood volume and SPECT images in patients with chronic thromboembolic pulmonary hypertension by balloon pulmonary angioplasty. Clin Imaging 2018; 49:80-86. [DOI: 10.1016/j.clinimag.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 12/31/2022]
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Chen B, Zhang Z, Xia D, Sidky EY, Pan X. Algorithm-enabled partial-angular-scan configurations for dual-energy CT. Med Phys 2018. [PMID: 29516523 DOI: 10.1002/mp.12848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We seek to investigate an optimization-based one-step method for image reconstruction that explicitly compensates for nonlinear spectral response (i.e., the beam-hardening effect) in dual-energy CT, to investigate the feasibility of the one-step method for enabling two dual-energy partial-angular-scan configurations, referred to as the short- and half-scan configurations, on standard CT scanners without involving additional hardware, and to investigate the potential of the short- and half-scan configurations in reducing imaging dose and scan time in a single-kVp-switch full-scan configuration in which two full rotations are made for collection of dual-energy data. METHODS We use the one-step method to reconstruct images directly from dual-energy data through solving a nonconvex optimization program that specifies the images to be reconstructed in dual-energy CT. Dual-energy full-scan data are generated from numerical phantoms and collected from physical phantoms with the standard single-kVp-switch full-scan configuration, whereas dual-energy short- and half-scan data are extracted from the corresponding full-scan data. Besides visual inspection and profile-plot comparison, the reconstructed images are analyzed also in quantitative studies based upon tasks of linear-attenuation-coefficient and material-concentration estimation and of material differentiation. RESULTS Following the performance of a computer-simulation study to verify that the one-step method can reconstruct numerically accurately basis and monochromatic images of numerical phantoms, we reconstruct basis and monochromatic images by using the one-step method from real data of physical phantoms collected with the full-, short-, and half-scan configurations. Subjective inspection based upon visualization and profile-plot comparison reveals that monochromatic images, which are used often in practical applications, reconstructed from the full-, short-, and half-scan data are largely visually comparable except for some differences in texture details. Moreover, quantitative studies based upon tasks of linear-attenuation-coefficient and material-concentration estimation and of material differentiation indicate that the short- and half-scan configurations yield results in close agreement with the ground-truth information and that of the full-scan configuration. CONCLUSIONS The one-step method considered can compensate effectively for the nonlinear spectral response in full- and partial-angular-scan dual-energy CT. It can be exploited for enabling partial-angular-scan configurations on standard CT scanner without involving additional hardware. Visual inspection and quantitative studies reveal that, with the one-step method, partial-angular-scan configurations considered can perform at a level comparable to that of the full-scan configuration, thus suggesting the potential of the two partial-angular-scan configurations in reducing imaging dose and scan time in the standard single-kVp-switch full-scan CT in which two full rotations are performed. The work also yields insights into the investigation and design of other nonstandard scan configurations of potential practical significance in dual-energy CT.
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Affiliation(s)
- Buxin Chen
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Zheng Zhang
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Dan Xia
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Emil Y Sidky
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Xiaochuan Pan
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.,Department of Radiation Oncology, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
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Abstract
Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 25 mm Hg. Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as pulmonary hypertension in the presence of an organized thrombus within the pulmonary vascular bed that persists at least 3 months after the onset of anticoagulant therapy. Because CTEPH is potentially curable by surgical endarterectomy, correct identification of patients with this form of pulmonary hypertension and an accurate assessment of surgical candidacy are essential to provide optimal care. Patients most commonly present with symptoms of exertional dyspnea and otherwise unexplained decline in exercise capacity. Atypical chest pain, a nonproductive cough, and episodic hemoptysis are observed less frequently. With more advanced disease, patients often develop symptoms suggestive of right ventricular compromise. Physical examination findings are minimal early in the course of this disease, but as pulmonary hypertension progresses, may include nonspecific finding of right ventricular failure, such as a tricuspid regurgitation murmur, pedal edema, and jugular venous distention. Chest radiographs may suggest pulmonary hypertension, but are neither sensitive nor specific for the diagnosis. Radioisotopic ventilation-perfusion scanning is sensitive for detecting CTEPH, making it a valuable screening study. Conventional catheter-based pulmonary angiography retains an important role in establishing the presence and extent of chronic thromboembolic disease. However, computed tomographic and magnetic resonance imaging are playing a growing diagnostic role. Innovative technologies such as dual-energy computed tomography, dynamic contrast-enhanced magnetic resonance imaging, and optical coherence tomography show promise for contributing diagnostic information and assisting in the preoperative characterization of patients with CTEPH.
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77
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Chen B, Zhang Z, Sidky EY, Xia D, Pan X. Image reconstruction and scan configurations enabled by optimization-based algorithms in multispectral CT. Phys Med Biol 2017; 62:8763-8793. [PMID: 29094680 DOI: 10.1088/1361-6560/aa8a4b] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Optimization-based algorithms for image reconstruction in multispectral (or photon-counting) computed tomography (MCT) remains a topic of active research. The challenge of optimization-based image reconstruction in MCT stems from the inherently non-linear data model that can lead to a non-convex optimization program for which no mathematically exact solver seems to exist for achieving globally optimal solutions. In this work, based upon a non-linear data model, we design a non-convex optimization program, derive its first-order-optimality conditions, and propose an algorithm to solve the program for image reconstruction in MCT. In addition to consideration of image reconstruction for the standard scan configuration, the emphasis is on investigating the algorithm's potential for enabling non-standard scan configurations with no or minimum hardware modification to existing CT systems, which has potential practical implications for lowered hardware cost, enhanced scanning flexibility, and reduced imaging dose/time in MCT. Numerical studies are carried out for verification of the algorithm and its implementation, and for a preliminary demonstration and characterization of the algorithm in reconstructing images and in enabling non-standard configurations with varying scanning angular range and/or x-ray illumination coverage in MCT.
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Affiliation(s)
- Buxin Chen
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America
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78
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Virtual Monoenergetic Imaging and Iodine Perfusion Maps Improve Diagnostic Accuracy of Dual-Energy Computed Tomography Pulmonary Angiography With Suboptimal Contrast Attenuation. Invest Radiol 2017; 52:659-665. [DOI: 10.1097/rli.0000000000000387] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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79
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Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT. AJR Am J Roentgenol 2017; 209:1015-1022. [DOI: 10.2214/ajr.17.17815] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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80
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Felloni P, Duhamel A, Faivre JB, Giordano J, Khung S, Deken V, Remy J, Remy-Jardin M. Regional Distribution of Pulmonary Blood Volume with Dual-Energy Computed Tomography: Results in 42 Subjects. Acad Radiol 2017; 24:1412-1421. [PMID: 28711443 DOI: 10.1016/j.acra.2017.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES The noninvasive approach of lung perfusion generated from dual-energy computed tomography acquisitions has entered clinical practice. The purpose of this study was to analyze the regional distribution of iodine within distal portions of the pulmonary arterial bed on dual-source, dual-energy computed tomography examinations in a cohort of subjects without cardiopulmonary pathologies. MATERIALS AND METHODS The study population included 42 patients without cardiorespiratory disease, enabling quantitative and qualitative analysis of pulmonary blood volume after administration of a 40% contrast agent. Qualitative analysis was based on visual assessment. Quantitative analysis was obtained after semiautomatic division of each lung into 18 areas. RESULTS The iodine concentration did not significantly differ between the right (R) and left (L) lungs (P = .49), with a mean attenuation of 41.35 Hounsfield units (HU) and 41.14 HU, respectively. Three regional gradients of attenuation were observed between: (a) lung bases and apices (P < .001), linked to the conditions of examination (mean Δ: 6.23 in the R lung; 5.96 in the L lung); (b) posterior and anterior parts of the lung (P < .001) due to gravity (mean Δ: 11.92 in the R lung ; 15.93 in the L lung); and (c) medullary and cortical lung zones (P < .001) (mean Δ: 9.35 in the R lung ; 8.37 in the L lung). The intensity of dependent-nondependent (r = 0.42; P < .001) and corticomedullary (r = 0.58; P < .0001) gradients was correlated to the overall iodine concentration. CONCLUSION Distribution of pulmonary blood volume is influenced by physiological gradients and scanning conditions.
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81
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Kalisz K, Halliburton S, Abbara S, Leipsic JA, Albrecht MH, Schoepf UJ, Rajiah P. Update on Cardiovascular Applications of Multienergy CT. Radiographics 2017; 37:1955-1974. [DOI: 10.1148/rg.2017170100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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82
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Advanced virtual monochromatic reconstruction of dual-energy unenhanced brain computed tomography in children: comparison of image quality against standard mono-energetic images and conventional polychromatic computed tomography. Pediatr Radiol 2017; 47:1648-1658. [PMID: 28656326 DOI: 10.1007/s00247-017-3908-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/01/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Advanced virtual monochromatic reconstruction from dual-energy brain CT has not been evaluated in children. OBJECTIVE To determine the most effective advanced virtual monochromatic imaging energy level for maximizing pediatric brain parenchymal image quality in dual-energy unenhanced brain CT and to compare this technique with conventional monochromatic reconstruction and polychromatic scanning. MATERIALS AND METHODS Using both conventional (Mono) and advanced monochromatic reconstruction (Mono+) techniques, we retrospectively reconstructed 13 virtual monochromatic imaging energy levels from 40 keV to 100 keV in 5-keV increments from dual-source, dual-energy unenhanced brain CT scans obtained in 23 children. We analyzed gray and white matter noise ratios, signal-to-noise ratios and contrast-to-noise ratio, and posterior fossa artifact. We chose the optimal mono-energetic levels and compared them with conventional CT. RESULTS For Mono+maximum optima were observed at 60 keV, and minimum posterior fossa artifact at 70 keV. For Mono, optima were at 65-70 keV, with minimum posterior fossa artifact at 75 keV. Mono+ was superior to Mono and to polychromatic CT for image-quality measures. Subjective analysis rated Mono+superior to other image sets. CONCLUSION Optimal virtual monochromatic imaging using Mono+ algorithm demonstrated better image quality for gray-white matter differentiation and reduction of the artifact in the posterior fossa.
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83
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Lapointe A, Bahig H, Blais D, Bouchard H, Filion É, Carrier JF, Bedwani S. Assessing lung function using contrast-enhanced dual-energy computed tomography for potential applications in radiation therapy. Med Phys 2017; 44:5260-5269. [PMID: 28718888 DOI: 10.1002/mp.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/15/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE There is an increasing interest in the evaluation of lung function from physiological images in radiation therapy treatment planning to reduce the extent of postradiation toxicities. The purpose of this work was to retrieve reliable functional information from contrast-enhanced dual-energy computed tomography (DECT) for new applications in radiation therapy. The functional information obtained by DECT is also compared with other methods using single-energy CT (SECT) and single-photon emission computed tomography (SPECT) with CT. The differential function between left and right lung, as well as between lobes is computed for all methods. METHODS Five lung cancer patients were retrospectively selected for this study; each underwent a SPECT/CT scan and a contrast-injected DECT scan, using 100 and 140 Sn kVp. The DECT images are postprocessed into iodine concentration maps, which are further used to determine the perfused blood volume. These maps are calculated in two steps: (a) a DECT stoichiometric calibration adapted to the presence of iodine and followed by (b) a two-material decomposition technique. The functional information from SECT is assumed proportional to the HU numbers from a mixed CT image. The functional data from SPECT/CT are considered proportional to the number of counts. A radiation oncologist segmented the entire lung volume into five lobes on both mixed CT images and low-dose CT images from SPECT/CT to allow a regional comparison. The differential function for each subvolume is computed relative to the entire lung volume. RESULTS The differential function per lobe derived from SPECT/CT correlates strongly with DECT (Pearson's coefficient r = 0.91) and moderately with SECT (r = 0.46). The differential function for the left lung shows a mean difference of 7% between SPECT/CT and DECT; and 17% between SPECT/CT and SECT. The presence of nonfunctional areas, such as localized emphysema or a lung tumor, is reflected by an intensity drop in the iodine concentration maps. Functional dose volume histograms (fDVH) are also generated for two patients as a proof of concept. CONCLUSION The extraction of iodine concentration maps from a contrast-enhanced DECT scan is achieved to compute the differential function for each lung subvolume and good agreement is found in respect to SPECT/CT. One promising avenue in radiation therapy is to include such functional information during treatment planning dose optimization to spare functional lung tissues.
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Affiliation(s)
- Andréanne Lapointe
- Département de physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Houda Bahig
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada
| | - Danis Blais
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada
| | - Hugo Bouchard
- Département de physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.,Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Édith Filion
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada
| | - Jean-François Carrier
- Département de physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.,Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Stéphane Bedwani
- Département de physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.,Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1560 rue Sherbrooke est, Montréal, Québec, H2L 4M1, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
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84
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Kunihiro Y, Okada M, Matsunaga N. Evaluation of a proper cutoff value on quantitative dual-energy perfusion CT for the assessment of acute pulmonary thromboembolism. Acta Radiol 2017; 58:1061-1067. [PMID: 28142251 DOI: 10.1177/0284185116683577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The cutoff value for assessing the severity of acute pulmonary thromboembolism (PTE) using relative volumetric evaluations of dual-energy perfusion computed tomography (DEpCT) is unclear. Purpose To determine the proper cutoff value for determining the severity of PTE using DEpCT volumetry. Material and Methods A total of 185 patients with venous thromboembolism were included in this study, of whom 61 were diagnosed with acute PTE. DEpCT images were three-dimensionally reconstructed at the following attenuation ranges: 1-2 HU (V2), 1-10 HU (V10), and 1-120 HU (V120). The ratios of low perfusion areas associated with each threshold range per V120 were also calculated, and the relative ratios were expressed as %V2 to %V10. These values were compared with factors indicating the severity of PTE, including the pulmonary arterial pressure, heart rate, CT angiographic obstruction index (CTOI), and right/left ventricular diameter ratio (RV/LV). Results The area under the curve (AUC) of %V2 was highest (0.783) among these values (95% confidence interval, 0.710-0.856) based on the presence of IPCs. The %V2 showed moderate correlations with CTOI (r = 0.36, P = 0.005) and RV/LV (r = 0.36, P = 0.004) in the patients with acute PTE. Conclusion Volumetric evaluations of DEpCT images using the lowest attenuation threshold range (1-2 HU) exhibit the best correlation with factors suggesting the severity of acute PTE.
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Affiliation(s)
- Yoshie Kunihiro
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Munemasa Okada
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Naofumi Matsunaga
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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85
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Ohno Y, Koyama H, Lee HY, Miura S, Yoshikawa T, Sugimura K. Contrast-enhanced CT- and MRI-based perfusion assessment for pulmonary diseases: basics and clinical applications. Diagn Interv Radiol 2017; 22:407-21. [PMID: 27523813 DOI: 10.5152/dir.2016.16123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Assessment of regional pulmonary perfusion as well as nodule and tumor perfusions in various pulmonary diseases are currently performed by means of nuclear medicine studies requiring radioactive macroaggregates, dual-energy computed tomography (CT), and dynamic first-pass contrast-enhanced perfusion CT techniques and unenhanced and dynamic first-pass contrast enhanced perfusion magnetic resonance imaging (MRI), as well as time-resolved three-dimensional or four-dimensional contrast-enhanced magnetic resonance angiography (MRA). Perfusion scintigraphy, single-photon emission tomography (SPECT) and SPECT fused with CT have been established as clinically available scintigraphic methods; however, they are limited by perfusion information with poor spatial resolution and other shortcomings. Although positron emission tomography with 15O water can measure absolute pulmonary perfusion, it requires a cyclotron for generation of a tracer with an extremely short half-life (2 min), and can only be performed for academic purposes. Therefore, clinicians are concentrating their efforts on the application of CT-based and MRI-based quantitative and qualitative perfusion assessment to various pulmonary diseases. This review article covers 1) the basics of dual-energy CT and dynamic first-pass contrast-enhanced perfusion CT techniques, 2) the basics of time-resolved contrast-enhanced MRA and dynamic first-pass contrast-enhanced perfusion MRI, and 3) clinical applications of contrast-enhanced CT- and MRI-based perfusion assessment for patients with pulmonary nodule, lung cancer, and pulmonary vascular diseases. We believe that these new techniques can be useful in routine clinical practice for not only thoracic oncology patients, but also patients with different pulmonary vascular diseases.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology and Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
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Lee SW, Lee SM, Shin SY, Park TS, Oh SY, Kim N, Hong Y, Lee JS, Oh YM, Lee SD, Seo JB. Improvement in Ventilation-Perfusion Mismatch after Bronchoscopic Lung Volume Reduction: Quantitative Image Analysis. Radiology 2017; 285:250-260. [PMID: 28510483 DOI: 10.1148/radiol.2017162148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate whether bronchoscopic lung volume reduction (BLVR) increases ventilation and therefore improves ventilation-perfusion (V/Q) mismatch. Materials and Methods All patients provided written informed consent to be included in this study, which was approved by the Institutional Review Board (2013-0368) of Asan Medical Center. The physiologic changes that occurred after BLVR were measured by using xenon-enhanced ventilation and iodine-enhanced perfusion dual-energy computed tomography (CT). Patients with severe emphysema plus hyperinflation who did not respond to usual treatments were eligible. Pulmonary function tests, the 6-minute walking distance (6MWD) test, quality of life assessment, and dual-energy CT were performed at baseline and 3 months after BLVR. The effect of BLVR was assessed with repeated-measures analysis of variance. Results Twenty-one patients were enrolled in this study (median age, 68 years; mean forced expiratory volume in 1 second [FEV1], 0.75 L ± 0.29). After BLVR, FEV1 (P < .001) and 6MWD (P = .002) improved significantly. Despite the reduction in lung volume (-0.39 L ± 0.44), both ventilation per voxel (P < .001) and total ventilation (P = .01) improved after BLVR. However, neither perfusion per voxel (P = .16) nor total perfusion changed significantly (P = .49). Patients with lung volume reduction of 50% or greater had significantly better improvement in FEV1 (P = .02) and ventilation per voxel (P = .03) than patients with lung volume reduction of less than 50%. V/Q mismatch also improved after BLVR (P = .005), mainly owing to the improvement in ventilation. Conclusion The dual-energy CT analyses showed that BLVR improved ventilation and V/Q mismatch. This increased lung efficiency may be the primary mechanism of improvement after BLVR, despite the reduction in lung volume. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Sei Won Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang Min Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - So Youn Shin
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Tai Sun Park
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang Young Oh
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Namkug Kim
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Yoonki Hong
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Jae Seung Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Yeon-Mok Oh
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang-Do Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Joon Beom Seo
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
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87
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Takx RAP, Henzler T, Schoepf UJ, Germann T, Schoenberg SO, Shirinova A, Bauer RW, Frellesen C, Zhang LJ, Nance JW, Fink C, Apfaltrer P. Predictive value of perfusion defects on dual energy CTA in the absence of thromboembolic clots. J Cardiovasc Comput Tomogr 2017; 11:183-187. [PMID: 28431860 DOI: 10.1016/j.jcct.2017.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. METHODS 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA. Diagnostic performance for identifying patients at risk of dying was evaluated using ROC analysis. All-cause mortality was assessed via the hospital electronic medical records and/or consultation of the patient or the patient's primary care physician via phone call interviews. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve (AUC) were determined for PDvol (volume of perfusion defects/total lung volume), transverse right ventricular to left ventricular diameter ratios (RV/LV) and for the combination of both tests. RESULTS Mortality was 38% within the investigated time period of 6 months. Patients who died had significantly higher PDvol (PDvol 28 ± 13% vs. 19 ± 12%, p < 0.001) and a non-significant difference in transverse RV/LV ratio (1.14 ± 0.37 vs. 1.06 ± 0.22, p = 0.159). The AUC was 0.71 for PDvol, 0.53 for RV/LV ratio, and 0.67 for the combination of PDvol and RV/LV ratio. PDvol remained a significant predictor after correcting for age. CONCLUSIONS In the absence of thromboembolic clots, PDvol at DE-CTA appears to be predictive for all cause mortality.
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Affiliation(s)
- Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Henzler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
| | - Thomas Germann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Aysel Shirinova
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany; Clinic of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Radiology, General Hospital Celle, Celle, Germany
| | - Paul Apfaltrer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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88
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Abdulazim A, Rubbert C, Reichelt D, Mathys C, Turowski B, Steiger HJ, Hänggi D, Etminan N. Dual- versus Single-Energy CT-Angiography Imaging for Patients Undergoing Intracranial Aneurysm Repair. Cerebrovasc Dis 2017; 43:272-282. [PMID: 28319953 DOI: 10.1159/000464356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The invasiveness and risk of thromboembolic complications of catheter angiography underline the need for alternative imaging modalities in patients following intracranial aneurysm (IA) repair. However, the overall image quality of existing noninvasive imaging modalities, such as single-energy CT angiography (SE-CTA), compromises its value in this respect. OBJECTIVE We prospectively investigated the value of a novel dual-energy CTA (DE-CTA) scanner and algorithm for assessing the degree of occlusion and parent vessel patency in patients following IA repair. METHODS A prospective cohort of 17 patients underwent DE-CTA imaging following surgical or endovascular IA repair. This dataset was matched with an identical historical cohort of 17 patients, who underwent IA repair and SE-CTA imaging. Beam-hardening artifacts, as a measure for objective imaging quality were analyzed based on the volume of a prolate ellipsoid, whereas subjective imaging quality at the IA site and corresponding parent vessels was rated by 2 independent neuroradiologists on a scale from 4 (excellent, no artifacts) to 1 (poor, severe artifacts). RESULTS Objective DE-CTA image quality was markedly higher, compared to SE-CTA in patients undergoing surgical (0.77 ± 0.23 vs. 10.91 ± 1.88 mL, respectively; p < 0.001) or endovascular (32.36 ± 10.62 vs. 107.63 ± 24.51 mL, respectively; p = 0.026) IA repair. Subjective image quality for DE-CTA was significantly improved compared to SE-CTA in the surgical group but not in the endovascular group. The calculated dose values for DE-CTA in our study remain markedly below the legally required radiation dose limits. CONCLUSION The imaging quality of DE-CTA, especially for patients undergoing surgical IA repair, is distinctly superior, compared to SE-CTA imaging. Therefore, DE-CTA may serve as a noninvasive alternative for assessing the IA occlusion rate and parent vessel patency.
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Affiliation(s)
- Amr Abdulazim
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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89
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Ruggiero A, Screaton NJ. Imaging of acute and chronic thromboembolic disease: state of the art. Clin Radiol 2017; 72:375-388. [PMID: 28330686 DOI: 10.1016/j.crad.2017.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/23/2017] [Accepted: 02/07/2017] [Indexed: 01/31/2023]
Abstract
Acute pulmonary embolism (PE) is a life-threatening condition that requires prompt diagnosis and treatment. Recent advances in imaging allow acute and rapid recognition even by the non-specialist radiologist. Most acute emboli resolve on anticoagulation without sequelae; however, some emboli fail to fully resolve becoming endothelialised with the development of chronic thromboembolic disease (CTED). Increased pulmonary vascular resistance arising from CTED may lead to chronic thromboembolic pulmonary hypertension (CTEPH) a debilitating disease affecting up to 5% of survivors of acute PE. Diagnostic evaluation is more complex in CTEPH/CTED than acute PE with subtle imaging features often being overlooked or misinterpreted. Differentiation of acute from chronic PE and from other forms of pulmonary hypertension has profound therapeutic implications. Diverse imaging techniques are available to diagnose and monitor PEs both in the acute and chronic setting. Broadly they include techniques that provide data on lung parenchymal perfusion (ventilation-perfusion [VQ] scintigraphy), angiographic techniques (computed tomography [CT], magnetic resonance imaging [MRI], and invasive angiography) or a combination of both (MR angiography and time-resolved angiography or dual-energy CT angiography). This review aims to describe state of the art imaging highlighting the strength and weaknesses of individual techniques in the diagnosis of acute and chronic PE.
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Affiliation(s)
- A Ruggiero
- Department of Radiology, Papworth Hospital, Cambridge, UK
| | - N J Screaton
- Department of Radiology, Papworth Hospital, Cambridge, UK.
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90
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Ohana M, Labani A, Severac F, Jeung MY, Gaertner S, Caspar T, Roy C. Single source dual energy CT: What is the optimal monochromatic energy level for the analysis of the lung parenchyma? Eur J Radiol 2017; 88:163-170. [PMID: 28189203 DOI: 10.1016/j.ejrad.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the optimal monochromatic energy level for lung parenchyma analysis in spectral CT. METHODS All 50 examinations (58% men, 64.8±16yo) from an IRB-approved prospective study on single-source dual energy chest CT were retrospectively included and analyzed. Monochromatic images in lung window reconstructed every 5keV from 40 to 140keV were independently assessed by two chest radiologists. Based on the overall image quality and the depiction/conspicuity of parenchymal lesions, each reader had to designate for every patient the keV level providing the best diagnostic and image quality. RESULTS 72% of the examinations exhibited parenchymal lesions. Reader 1 picked the 55keV monochromatic reconstruction in 52% of cases, 50 in 30% and 60 in 18%. Reader 2 chose 50keV in 52% cases, 55 in 40%, 60 in 6% and 40 in 2%. The 50 and 55keV levels were chosen by at least one reader in 64% and 76% of all patients, respectively. Merging 50 and 55keV into one category results in an optimal setting selected by reader 1 in 82% of patients and by reader 2 in 92%, with a 74% concomitant agreement. CONCLUSION The best image quality for lung parenchyma in spectral CT is obtained with the 50-55keV monochromatic reconstructions.
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Affiliation(s)
- M Ohana
- iCube Laboratory, Université de Strasbourg/CNRS, UMR 7357, 67400 Illkirch, France; Service de Radiologie B, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
| | - A Labani
- Service de Radiologie B, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
| | - F Severac
- Département de Biostatistiques et d'Informatique Médicale, Hôpital Civil - Hôpitaux Universitaires de Strasbourg,1 place de l'hôpital, 67000 Strasbourg, France.
| | - M Y Jeung
- Service de Radiologie B, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
| | - S Gaertner
- Service de Médecine Vasculaire, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg,1 place de l'hôpital, 67000 Strasbourg, France.
| | - T Caspar
- Service de Cardiologie, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg,1 place de l'hôpital, 67000 Strasbourg, France.
| | - C Roy
- Service de Radiologie B, Nouvel Hôpital Civil - Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
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91
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 3. J Comput Assist Tomogr 2017; 41:1-7. [DOI: 10.1097/rct.0000000000000538] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol 2016; 208:495-504. [PMID: 27897042 DOI: 10.2214/ajr.16.17202] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pulmonary CT angiography (CTA) is the imaging modality of choice in suspected acute pulmonary embolism (PE). Current pulmonary CTA techniques involve ever lower doses of contrast medium and radiation along with advanced postprocessing applications to enhance image quality, diagnostic accuracy, and provide added value in patient management. The objective of this article is to summarize these current developments and discuss the appropriate use of state-of-the-art pulmonary CTA. CONCLUSION Pulmonary CTA is well established as a fast and reliable means of excluding or diagnosing PE. Continued developments in CT system hardware and postprocessing techniques will allow incremental reductions in radiation and contrast material requirements while improving image quality. Advances in risk stratification and prognostication from pulmonary CTA examinations should further refine its clinical value while minimizing the potential harm from overutilization and overdiagnosis.
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93
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Lador F, Hachulla AL, Hohn O, Plojoux J, Ronot M, Montet X, Soccal PM. Pulmonary Perfusion Changes as Assessed by Contrast-Enhanced Dual-Energy Computed Tomography after Endoscopic Lung Volume Reduction by Coils. Respiration 2016; 92:404-413. [PMID: 27820928 DOI: 10.1159/000452477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic lung volume reduction by coils (LVRC) is a recent treatment approach for severe emphysema. Furthermore, dual-energy computed tomography (DECT) now offers a combined assessment of lung morphology and pulmonary perfusion. OBJECTIVES The aim of our study was to assess the impact of LVRC on pulmonary perfusion with DECT. METHODS Seventeen patients (64.8 ± 6.7 years) underwent LVRC. DECT was performed prior to and after LVRC. For each patient, lung volumes and emphysema quantification were automatically calculated. Then, 6 regions of interest (ROIs) on the iodine perfusion map were drawn in the anterior, mid, and posterior right and left lungs at 4 defined levels. The ROI values were averaged to obtain lung perfusion as assessed by the lung's iodine concentration (CLung, μg·cm-3). The CLung values were normalized using the left atrial iodine concentration (CLA) to take into account differences between successive DECT scans. RESULTS The 6-min walk distance (6MWD) improved significantly after the procedure (p = 0.0002). No lung volume changes were observed between successive DECT scans for any of the patients (p = 0.32), attesting the same suspended inspiration. After LVRC, the emphysema index was significantly reduced in the treated lung (p = 0.0014). Lung perfusion increased significantly adjacent to the treated areas (CLung/CLA from 3.4 ± 1.7 to 5.6 ± 2.2, p < 0.001) and in the ipsilateral untreated areas (from 4.1 ± 1.4 to 6.6 ± 1.7, p < 0.001), corresponding to a mean 65 and 61% increase in perfusion, respectively. No significant difference was observed in the contralateral upper and lower areas (from 4.4 ± 1.9 to 4.8 ± 2.1, p = 0.273, and from 4.9 ± 2.0 to 5.2 ± 1.7, p = 0.412, respectively). A significant correlation between increased 6MWD and increased perfusion was found (p = 0.0027, R2 = 0.3850). CONCLUSIONS Quantitative analysis based on DECT acquisition revealed that LVRC results in a significant increase in perfusion in the coil-free areas adjacent to the treated ones, as well as in the ipsilateral untreated areas. This suggests a possible role for LVRC in the improvement of the ventilation/perfusion relationship.
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Affiliation(s)
- Frédéric Lador
- Service of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
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Hwang HJ, Hoffman EA, Lee CH, Goo JM, Levin DL, Kauczor HU, Seo JB. The role of dual-energy computed tomography in the assessment of pulmonary function. Eur J Radiol 2016; 86:320-334. [PMID: 27865580 DOI: 10.1016/j.ejrad.2016.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 01/05/2023]
Abstract
The assessment of pulmonary function, including ventilation and perfusion status, is important in addition to the evaluation of structural changes of the lung parenchyma in various pulmonary diseases. The dual-energy computed tomography (DECT) technique can provide the pulmonary functional information and high resolution anatomic information simultaneously. The application of DECT for the evaluation of pulmonary function has been investigated in various pulmonary diseases, such as pulmonary embolism, asthma and chronic obstructive lung disease and so on. In this review article, we will present principles and technical aspects of DECT, along with clinical applications for the assessment pulmonary function in various lung diseases.
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Affiliation(s)
- Hye Jeon Hwang
- Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 431-796, Republic of Korea
| | - Eric A Hoffman
- Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa, 200 Hawkins Dr, CC 701 GH, Iowa City, IA 52241, United States
| | - Chang Hyun Lee
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - David L Levin
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, United States
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul, 05505, Republic of Korea.
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Uhrig M, Simons D, Kachelrieß M, Pisana F, Kuchenbecker S, Schlemmer HP. Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose. Cancer Imaging 2016; 16:15. [PMID: 27329159 PMCID: PMC4915171 DOI: 10.1186/s40644-016-0073-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/14/2016] [Indexed: 01/28/2023] Open
Abstract
Background Dual energy CT (DECT) has proven its potential in oncological imaging. Considering the repeated follow-up examinations, radiation dose should not exceed conventional single energy CT (SECT). Comparison studies on the same scanner with a large number of patients, considering patient geometries and image quality, and exploiting full potential of SECT dose reduction are rare. Purpose of this retrospective study was to compare dose of dual source DECT versus dose-optimized SECT abdominal imaging in clinical routine. Methods One hundred patients (62y (±14)) had either contrast-enhanced SECT including automatic voltage control (44) or DECT (56). CT dose index (CTDIvol), size-specific dose-estimate (SSDE) and dose-length product (DLP) were reported. Image noise (SD) was recorded as mean of three ROIs placed in subcutaneous fat and normalized to dose by \documentclass[12pt]{minimal}
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\begin{document}$$ SDn=SD\times \sqrt{CDTIvol} $$\end{document}SDn=SD×CDTIvol. For dose-normalized contrast-to-noise ratio (CNRD), mean attenuation of psoas muscle (CTmuscle) and subcutaneous fat (CTfat) were compared by CNRD = (CTmuscle − CTfat)/SDn. Statistical significance was tested with two-sided t-test (α = 0.05). Results There was no significant difference (p < 0.05) between DECT and SECT: Mean CTDIvol was 14.2 mGy (±3.9) (DECT) and 14.3 mGy (±4.5) (SECT). Mean DLP was 680 mGy*cm (±220) (DECT) and 665 mGy*cm (±231) (SECT). Mean SSDE was 15.7 mGy (±1.9) (DECT) and 16.1 mGy (±2.5) (SECT). Mean SDn was 42.2 (±13.9) HU \documentclass[12pt]{minimal}
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\begin{document}$$ *\sqrt{\mathrm{mGy}} $$\end{document}*mGy (DECT) and 47.8 (±14.9) HU \documentclass[12pt]{minimal}
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\begin{document}$$ *\sqrt{\mathrm{mGy}} $$\end{document}*mGy (SECT). Mean CNRD was 3.9 (±1.3) \documentclass[12pt]{minimal}
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\begin{document}$$ {\mathrm{mGy}}^{-\frac{1}{2}} $$\end{document}mGy−12. (DECT) and 4.0 (±1.3) \documentclass[12pt]{minimal}
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\begin{document}$$ {\mathrm{mGy}}^{-\frac{1}{2}} $$\end{document}mGy−12 (SECT). Conclusion Abdominal DECT is feasible without increasing radiation dose or deteriorating image quality, even compared to dose-optimized SECT including automatic voltage control. Thus DECT can contribute to sophisticated oncological imaging without dose penalty.
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Affiliation(s)
- Monika Uhrig
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
| | - David Simons
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Marc Kachelrieß
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Francesco Pisana
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Stefan Kuchenbecker
- Department of Medical Physics in Oncology, Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
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Hong SR, Chang S, Im DJ, Suh YJ, Hong YJ, Hur J, Kim YJ, Choi BW, Lee HJ. Feasibility of Single Scan for Simultaneous Evaluation of Regional Krypton and Iodine Concentrations with Dual-Energy CT: An Experimental Study. Radiology 2016; 281:597-605. [PMID: 27203543 DOI: 10.1148/radiol.16152429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the feasibility of a simultaneous single scan of regional krypton and iodine concentrations by using dual-energy computed tomography (CT). Materials and Methods The study was approved by the institutional animal experimental committee. An airway obstruction model was first made in 10 beagle dogs, and a pulmonary arterial occlusion was induced in each animal after 1 week. For each model, three sessions of dual-energy CT (80% krypton ventilation [krypton CT], 80% krypton ventilation with iodine enhancement [mixed-contrast agent CT], and iodine enhancement [iodine CT]) were performed. Krypton maps were made from krypton and mixed-contrast agent CT, and iodine maps were made from iodine and mixed-contrast agent CT. Observers measured overlay Hounsfield units of the diseased and contralateral segments on each map. Values were compared by using the Wilcoxon signed-rank test. Results In krypton maps of airway obstruction, overlay Hounsfield units of diseased segments were significantly decreased compared with those of contralateral segments in both krypton and mixed-contrast agent CT (P = .005 for both). However, the values of mixed-contrast agent CT were significantly higher than those of krypton CT for both segments (P = .005 and .007, respectively). In iodine maps of pulmonary arterial occlusion, values were significantly lower in diseased segments than in contralateral segments for both iodine and mixed-contrast agent CT (P = .005 for both), without significant difference between iodine and mixed-contrast agent CT for both segments (P = .126 and .307, respectively). Conclusion Although some limitations may exist, it might be feasible to analyze regional krypton and iodine concentrations simultaneously by using dual-energy CT. © RSNA, 2016.
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Affiliation(s)
- Sae Rom Hong
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Suyon Chang
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Dong Jin Im
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Young Joo Suh
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Yoo Jin Hong
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Jin Hur
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Young Jin Kim
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Byoung Wook Choi
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Hye-Jeong Lee
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
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Yazdani M, Lau CT, Lempel JK, Yadav R, El-Sherief AH, Azok JT, Renapurkar RD. Historical Evolution of Imaging Techniques for the Evaluation of Pulmonary Embolism. Radiographics 2016; 35:1245-62. [PMID: 26172362 DOI: 10.1148/rg.2015140280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As we celebrate the 100th anniversary of the founding of the Radiological Society of North America (RSNA), it seems fitting to look back at the major accomplishments of the radiology community in the diagnosis of pulmonary embolism. Few diseases have so consistently captured the attention of the medical community. Since the first description of pulmonary embolism by Virchow in the 1850s, clinicians have struggled to reach a timely diagnosis of this common condition because of its nonspecific and often confusing clinical picture. As imaging tests started to gain importance in the 1900s, the approach to diagnosing pulmonary embolism also began to change. Rapid improvements in angiography, ventilation-perfusion imaging, and cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging have constantly forced health care professionals to rethink how they diagnose pulmonary embolism. Needless to say, the way pulmonary embolism is diagnosed today is distinctly different from how it was diagnosed in Virchow's era; and imaging, particularly CT, now forms the cornerstone of diagnostic evaluation. Currently, radiology offers a variety of tests that are fast and accurate and can provide anatomic and functional information, thus allowing early diagnosis and triage of cases. This review provides a historical journey into the evolution of these imaging tests and highlights some of the major breakthroughs achieved by the radiology community and RSNA in this process. Also highlighted are areas of ongoing research and development in this field of imaging as radiologists seek to combat some of the newer challenges faced by modern medicine, such as rising health care costs and radiation dose hazards.
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Affiliation(s)
- Milad Yazdani
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruchi Yadav
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ahmed H El-Sherief
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Rahul D Renapurkar
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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Thacker PG, Lee EY. Advances in Multidetector CT Diagnosis of Pediatric Pulmonary Thromboembolism. Korean J Radiol 2016; 17:198-208. [PMID: 26957904 PMCID: PMC4781758 DOI: 10.3348/kjr.2016.17.2.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/18/2015] [Indexed: 11/19/2022] Open
Abstract
Although pediatric pulmonary thromboembolism is historically believed to be rare with relatively little information available in the medical literature regarding its imaging evaluation, it is more common than previously thought. Thus, it is imperative for radiologists to be aware of the most recent advances in its imaging information, particularly multidetector computed tomography (MDCT), the imaging modality of choice in the pediatric population. The overarching goal of this article is to review the most recent updates on MDCT diagnosis of pediatric pulmonary thromboembolism.
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Affiliation(s)
- Paul G Thacker
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology and Medicine, Pulmonary Division Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Qualitative Comparison of Noncontrast Head Dual-Energy Computed Tomography Using Rapid Voltage Switching Technique and Conventional Computed Tomography. J Comput Assist Tomogr 2016; 40:320-5. [DOI: 10.1097/rct.0000000000000350] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Where do we stand? Functional imaging in acute and chronic pulmonary embolism with state-of-the-art CT. Eur J Radiol 2015; 84:2432-7. [DOI: 10.1016/j.ejrad.2015.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023]
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