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Spielberg DR, Weinman J, DeBoer EM. Advancements in imaging in ChILD. Pediatr Pulmonol 2024; 59:2276-2285. [PMID: 37222402 DOI: 10.1002/ppul.26487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
Interstitial and diffuse lung diseases in children constitute a range of congenital and acquired disorders. These disorders present with signs and symptoms of respiratory disease accompanied by diffuse radiographic changes. In many cases, radiographic findings are nonspecific, while in other disorders, chest computed tomography (CT) is diagnostic in the appropriate context. Regardless, chest imaging remains central in the evaluation of the patient with suspected childhood interstitial lung disease (chILD). Several newly described chILD entities, spanning both genetic and acquired etiologies, have imaging that aid in their diagnoses. Advances in CT scanning technology and CT analysis techniques continue to improve scan quality as well as expand use of chest CT as a research tool. Finally, ongoing research is expanding use of imaging modalities without ionizing radiation. Magnetic resonance imaging is being applied to investigate pulmonary structure and function, and ultrasound of the lung and pleura is a novel technique with an emerging role in chILD disorders. This review describes the current state of imaging in chILD including recently described diagnoses, advances in conventional imaging techniques and applications, and evolving new imaging modalities that expand the clinical and research roles for imaging in these disorders.
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Affiliation(s)
- David R Spielberg
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jason Weinman
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily M DeBoer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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2
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Horst KK, Cao JY, McCollough CH, El-Ali A, Frush DP, Siegel MJ, Ramirez-Giraldo JC, O'Donnell T, Bach S, Yu L. Multi-institutional Protocol Guidance for Pediatric Photon-counting CT. Radiology 2024; 311:e231741. [PMID: 38771176 DOI: 10.1148/radiol.231741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Performing CT in children comes with unique challenges such as greater degrees of patient motion, smaller and densely packed anatomy, and potential risks of radiation exposure. The technical advancements of photon-counting detector (PCD) CT enable decreased radiation dose and noise, as well as increased spatial and contrast resolution across all ages, compared with conventional energy-integrating detector CT. It is therefore valuable to review the relevant technical aspects and principles specific to protocol development on the new PCD CT platform to realize the potential benefits for this population. The purpose of this article, based on multi-institutional clinical and research experience from pediatric radiologists and medical physicists, is to provide protocol guidance for use of PCD CT in the imaging of pediatric patients.
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Affiliation(s)
- Kelly K Horst
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Joseph Y Cao
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Cynthia H McCollough
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Alex El-Ali
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Donald P Frush
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Marilyn J Siegel
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Juan Carlos Ramirez-Giraldo
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Tom O'Donnell
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Steve Bach
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
| | - Lifeng Yu
- From the Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (K.K.H., C.H.M., L.Y.); Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (J.Y.C., D.P.F., S.B.); Department of Radiology, Division of Pediatric Radiology, NYU Grossman School of Medicine, New York, NY (A.E.A.); Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.J.S.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., T.O.)
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3
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Peña-Trujillo V, Gallo-Bernal S, Tung EL, Gee MS. Pediatric Applications of Dual-Energy Computed Tomography. Radiol Clin North Am 2023; 61:1069-1083. [PMID: 37758357 DOI: 10.1016/j.rcl.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
There is renewed interest in novel pediatric dual-energy computed tomography (DECT) applications that can image awake patients faster and at low radiation doses. DECT enables the simultaneous acquisition of 2 data sets at different energy levels, allowing for better material characterization and unique image reconstructions that enhance image analysis and provide quantitative and qualitative information about tissue composition. Pediatric DECT reduces radiation doses further while accelerating image acquisition and improving motion robustness. Current applications include the improved evaluation of congenital and acquired cardiovascular anomalies, lung perfusion and ventilation, renal stone composition, tumor extension and treatment response, and gastrointestinal diseases.
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Affiliation(s)
- Valeria Peña-Trujillo
- Division of Pediatric Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA. https://twitter.com/valeria_pt22
| | - Sebastian Gallo-Bernal
- Division of Pediatric Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA. https://twitter.com/SebGal1230
| | - Erik L Tung
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA. https://twitter.com/ErikTungMD
| | - Michael S Gee
- Division of Pediatric Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA.
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4
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Samuels C, Marsh J, Leggett R. An age- and sex-specific biokinetic model for radon . JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041502. [PMID: 37725955 DOI: 10.1088/1361-6498/acfb19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/19/2023] [Indexed: 09/21/2023]
Abstract
Publication 137 of the International Commission on Radiological Protection (ICRP) describes a biokinetic model for radon used to derive dose coefficients for occupational intake of radon isotopes. The model depicts transfer of inhaled or ingested radon to blood, exchange of radon between blood and tissues, and gradual loss of radon from the body based on physical laws governing transfer of a non-reactive and soluble gas between materials. This paper describes an age- and sex-specific variation of that model developed for use in an upcoming ICRP series of reports on environmental intake of radionuclides by members of the public titled 'Dose Coefficients for Intakes of Radionuclides by Members of the Public'. The proposed model modifies the model structure and transfer coefficients presented in Publication 137 to allow more realistic dosimetric treatment of bone marrow and breast and expands the model to address pre-adult ages, based on the physical principles used in the development of the model of Publication 137 together with anatomical and physiological changes occurring during human development.
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Affiliation(s)
- Caleigh Samuels
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, United States of America
| | - James Marsh
- UK Health Security Agency, London, United Kingdom
| | - Rich Leggett
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, United States of America
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5
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Abstract
Dual-energy CT has expanded the potential of thoracic imaging in both children and adults. Data processing allows material- and energy-specific reconstructions, which improve material differentiation and tissue characterization compared with single-energy CT. Material-specific reconstructions include iodine, virtual unenhanced, perfusion blood volume, and lung vessel images, which can improve assessment of vascular, mediastinal, and parenchymal abnormalities. The energy-specific reconstruction algorithm allows virtual monoenergetic reconstructions, including low-energy images to increase iodine conspicuity and high-energy images to reduce beam-hardening and metal artifacts. This review highlights dual-energy CT principles, hardware, and postprocessing algorithms; the clinical applications of dual-energy CT; and the potential benefits of photon counting (the most recently introduced iteration of spectral imaging) in pediatric thoracic imaging.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marilyn J Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110
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6
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Alizadeh LS, Vogl TJ, Waldeck SS, Overhoff D, D'Angelo T, Martin SS, Yel I, Gruenewald LD, Koch V, Fulisch F, Booz C. Dual-Energy CT in Cardiothoracic Imaging: Current Developments. Diagnostics (Basel) 2023; 13:2116. [PMID: 37371011 DOI: 10.3390/diagnostics13122116] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This article describes the technical principles and clinical applications of dual-energy computed tomography (DECT) in the context of cardiothoracic imaging with a focus on current developments and techniques. Since the introduction of DECT, different vendors developed distinct hard and software approaches for generating multi-energy datasets and multiple DECT applications that were developed and clinically investigated for different fields of interest. Benefits for various clinical settings, such as oncology, trauma and emergency radiology, as well as musculoskeletal and cardiovascular imaging, were recently reported in the literature. State-of-the-art applications, such as virtual monoenergetic imaging (VMI), material decomposition, perfused blood volume imaging, virtual non-contrast imaging (VNC), plaque removal, and virtual non-calcium (VNCa) imaging, can significantly improve cardiothoracic CT image workflows and have a high potential for improvement of diagnostic accuracy and patient safety.
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Affiliation(s)
- Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Stephan S Waldeck
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mannheim, 68167 Mannheim, Germany
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, 98124 Messina, Italy
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Florian Fulisch
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
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7
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Spectral imaging in the pediatric chest: past, present and future. Pediatr Radiol 2022; 52:1910-1920. [PMID: 35726069 DOI: 10.1007/s00247-022-05404-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 05/14/2022] [Indexed: 12/14/2022]
Abstract
Computed tomography technology continues to undergo evolution and improvement with each passing decade. From its inception in 1971, to the advent of commercially available dual-energy CT just over a decade ago, and now to the latest innovation, photon-counting detector CT, CT's utility for resolving and discriminating tissue types improves. In this review we discuss the impact of spectral imaging, including dual-energy CT and the recently available photon-counting detector CT, on the imaging of the pediatric chest. We describe the current capabilities and future directions of CT imaging, encompassing both the lungs and the surrounding tissues.
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Dual-source computed tomography protocols for the pediatric chest - scan optimization techniques. Pediatr Radiol 2022:10.1007/s00247-022-05468-7. [PMID: 35948645 PMCID: PMC9365683 DOI: 10.1007/s00247-022-05468-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
The gold standard for pediatric chest imaging remains the CT scan. An ideal pediatric chest CT has the lowest radiation dose with the least motion degradation possible in a diagnostic scan. Because of the known inherent risks and costs of anesthesia, non-sedate options are preferred. Dual-source CTs are currently the fastest, lowest-dose CT scanners available, utilizing an ultra-high-pitch mode resulting in sub-second CTs. The dual-energy technique, available on dual-source CT scanners, gathers additional information such as pulmonary blood volume and includes relative contrast enhancement and metallic artifact reduction, features that are not available in high-pitch flash mode. In this article we discuss the benefits and tradeoffs of dual-source CT scan modes and tips on image optimization.
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Jungblut L, Sartoretti T, Kronenberg D, Mergen V, Euler A, Schmidt B, Alkadhi H, Frauenfelder T, Martini K. Performance of virtual non-contrast images generated on clinical photon-counting detector CT for emphysema quantification: proof of concept. Br J Radiol 2022; 95:20211367. [PMID: 35357902 PMCID: PMC10996315 DOI: 10.1259/bjr.20211367] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the performance of virtual non-contrast images (VNC) compared to true non-contrast (TNC) images in photon-counting detector computed tomography (PCD-CT) for the evaluation of lung parenchyma and emphysema quantification. METHODS 65 (mean age 73 years; 48 male) consecutive patients who underwent a three-phase (non-contrast, arterial and venous) chest/abdomen CT on a first-generation dual-source PCD-CT were retrospectively included. Scans were performed in the multienergy (QuantumPlus) mode at 120 kV with 70 ml intravenous contrast agent at an injection rate of 4 ml s-1. VNC were reconstructed from the arterial (VNCart) and venous phase (VNCven). TNC and VNC images of the lung were assessed quantitatively by calculating the global noise index (GNI) and qualitatively by two independent, blinded readers (overall image quality and emphysema assessment). Emphysema quantification was performed using a commercially available software tool at a threshold of -950 HU for all data sets. TNC images served as reference standard for emphysema quantification. Low attenuation values (LAV) were compared in a Bland-Altman plot. RESULTS GNI was similar in VNCart (103.0 ± 30.1) and VNCven (98.2 ± 22.2) as compared to TNC (100.9 ± 19.0, p = 0.546 and p = 0.272, respectively). Subjective image quality (emphysema assessment and overall image quality) was highest for TNC (p = 0.001), followed by VNCven and VNCart. Both, VNCart and VNCven showed no significant difference in emphysema quantification as compared to TNC (p = 0.409 vs. p = 0.093; respectively). CONCLUSION Emphysema evaluation is feasible using virtual non-contrast images from PCD-CT. ADVANCES IN KNOWLEDGE Emphysema quantification is feasible and accurate using VNC images in PCD-CT. Based on these findings, additional TNC scans for emphysema quantification could be omitted in the future.
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Affiliation(s)
- Lisa Jungblut
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Thomas Sartoretti
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Daniel Kronenberg
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Victor Mergen
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Andre Euler
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Bernhard Schmidt
- Siemens Healthcare GmbH, Computed Tomography,
Forchheim, Germany
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
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10
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Ramirez-Suarez KI, Barrera CA, Otero HJ, Biko DM, States LJ, Servaes S, Zhu X, Davis JC, Piccione J, Rapp JB. Pilot study for comparative assessment of dual-energy computed tomography and single-photon emission computed tomography V/Q scanning for lung perfusion evaluation in infants. Pediatr Pulmonol 2022; 57:702-710. [PMID: 34914194 DOI: 10.1002/ppul.25788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate clinical applications of dual-energy computed tomography (DECT) in pediatric-specific lung diseases and compare ventilation and perfusion findings with those from single-photon emission computed tomography (SPECT-CT) V/Q. METHODS All patients at our institution who underwent exams using both techniques within a 3-month period were included in this study. Two readers independently described findings for DECT, and two other readers independently analyzed the SPECT-CT V/Q scan data. All findings were compared between readers and disagreements were reassessed and resolved by consensus. Inter-modality agreements are described throughout this study. RESULTS Eight patients were included for evaluation. The median age for DECT scanning was 3.5 months (IQR = 2). Five of these patients were scanned for both DECT and SPECT-CT V/Q studies the same day, and three had a time gap of 7, 65, and 94 days between studies. The most common indications were chronic lung disease (5/8; 63%) and pulmonary hypertension (6/8; 75%). DECT and SPECT-CT V/Q identified perfusion abnormalities in concordant lobes in most patients (7/8; 88%). In one case, atelectasis limited DECT perfusion assessment. Three patients ultimately underwent lobectomy with corresponding perfusion abnormalities identified by all reviewers on both DECT and SPECT-CT V/Q in all resected lobes. CONCLUSION DECT is a feasible technique that could be considered as an alternative for SPECT-CT V/Q for lung perfusion evaluation in infants.
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Affiliation(s)
- Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Xiaowei Zhu
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James C Davis
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Piccione
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Impact of Contrast Enhancement and Virtual Monoenergetic Image Energy Levels on Emphysema Quantification. Invest Radiol 2022; 57:359-365. [DOI: 10.1097/rli.0000000000000848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Degerstedt SG, Winant AJ, Lee EY. Pediatric Pulmonary Embolism: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:69-82. [PMID: 34836567 DOI: 10.1016/j.rcl.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In contrast with the algorithms and screening criteria available for adults with suspected pulmonary embolism, there is a paucity of guidance on the diagnostic approach for children. The incidence of pulmonary embolism in the pediatric population and young adults is higher than thought, and there is an urgent need for updated guidelines for the imaging approach to diagnosis in the pediatric population. This article presents an up-to-date review of imaging techniques, characteristic radiologic findings, and an evidence-based algorithm for the detection of pediatric pulmonary embolism to improve the care of pediatric patients with suspected pulmonary embolism.
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Affiliation(s)
- Spencer G Degerstedt
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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13
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Siegel MJ, Bhalla S, Cullinane M. Dual-Energy CT Material Decomposition in Pediatric Thoracic Oncology. Radiol Imaging Cancer 2021; 3:e200097. [PMID: 33778757 DOI: 10.1148/rycan.2021200097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022]
Abstract
Technical advances in CT have enabled implementation of dual-energy CT into routine clinical practice. By acquiring images at two different energy spectra, dual-energy CT enables material decomposition, allowing generation of material- and energy-specific images. Material-specific images include virtual nonenhanced images and iodine-specific images (iodine maps). Energy-specific images include virtual monoenergetic images. The reconstructed images can provide unique qualitative and quantitative information about tissue composition and contrast media distribution. In thoracic oncologic imaging, dual-energy CT provides advantages in characterization of thoracic malignancies and lung nodules, determination of extent of disease, and assessment of response to therapy. An especially important feature in children is that dual-energy CT does not come at a higher radiation exposure. Keywords: CT, CT-Quantitative, Lung, Mediastinum, Neoplasms-Primary, Pediatrics, Thorax, Treatment Effects © RSNA, 2021.
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (M.J.S., S.B.); and Siemens Healthineers, Malvern, Pa (M.C.)
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (M.J.S., S.B.); and Siemens Healthineers, Malvern, Pa (M.C.)
| | - Mike Cullinane
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (M.J.S., S.B.); and Siemens Healthineers, Malvern, Pa (M.C.)
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14
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Chen IC, Hsu JS, Chen YW, Liu YC, Wu YH, Hsu JH, Cheng YF, Dai ZK. Post-infectious Bronchiolitis Obliterans: HRCT, DECT, Pulmonary Scintigraphy Images, and Clinical Follow-up in Eight Children. Front Pediatr 2020; 8:622065. [PMID: 33392122 PMCID: PMC7775597 DOI: 10.3389/fped.2020.622065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Bronchiolitis obliterans (BO), first mentioned in 1901, is a severe and rare chronic lung disease in children. BO has various etiologies and the most common in children is post-infectious BO (PIBO). High resolution CT (HRCT) is an often-used image tool for the diagnosis of BO, and pulmonary scintigraphy is an alternative tool that can functionally evaluate BO. Recently, dual-energy computed tomography (DECT) have also been applied to BO for its accuracy and safety. Here we described the characteristics of HRCT, pulmonary scintigraphy, DECT, and the clinical profiles of patients with PIBO. Methods: This is a retrospective and descriptive study. Data were collected from patients diagnosed with PIBO from 2014 to 2019 in the Pediatric Cardiopulmonary Outpatient Clinics of Kaohsiung Medical University Hospital. The diagnosis was based on clinical, chest X-ray, and HRCT findings. Clinical profile, radiological characteristics, and images of pulmonary scintigraphy were documented. Results: Eight children (4 boys and 4 girls) were diagnosed with PIBO at a mean age of 25.8 months (range 15 to 41 months). Two of our patients developed pulmonary hypertension. The most common HRCT finding is mosaic pattern, where match ventilation/perfusion (V/Q) defects is a general feature in pulmonary scintigraphy. DECT pulmonary blood vasculature images revealed various degrees of decreased perfusion and is compatible with the decreased perfusion on pulmonary scintigraphy. Conclusion: The therapeutic strategy of PIBO is still lacking of standardization. HRCT and V/Q scans are important image tools in diagnosis and follow-up of BO. DECT may be used in BO patients as it has no additional radiation exposure and add value on functional information of HRCT.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Sheng Hsu
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Wen Chen
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Nuclear Medicine, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Fang Cheng
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Hong SH, Goo HW, Maeda E, Choo KS, Tsai IC. User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques. Korean J Radiol 2019; 20:190-204. [PMID: 30672159 PMCID: PMC6342752 DOI: 10.3348/kjr.2018.0571] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/30/2018] [Indexed: 12/13/2022] Open
Abstract
Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.
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Affiliation(s)
- Sun Hwa Hong
- Department of Radiology, Mediplex Sejong Hospital, Incheon, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taiwan
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16
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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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17
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Abstract
Pulmonary embolism is an uncommon but potentially life-threatening event in children. There has been increasing awareness of pulmonary embolism in children with improved survival in children with systemic disease and advancements in diagnostic modalities. However, literature regarding pulmonary embolism in children is sparse, and thus current guidelines for management of pulmonary embolism in children are extrapolated from adult literature and remain controversial. This article reviews the background and pathophysiology of venous thromboembolism, as well as current diagnostic approach and recommended management of pulmonary embolism in children.
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18
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Goo HW, Goo JM. Dual-Energy CT: New Horizon in Medical Imaging. Korean J Radiol 2017; 18:555-569. [PMID: 28670151 PMCID: PMC5447632 DOI: 10.3348/kjr.2017.18.4.555] [Citation(s) in RCA: 245] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
Dual-energy CT has remained underutilized over the past decade probably due to a cumbersome workflow issue and current technical limitations. Clinical radiologists should be made aware of the potential clinical benefits of dual-energy CT over single-energy CT. To accomplish this aim, the basic principle, current acquisition methods with advantages and disadvantages, and various material-specific imaging methods as clinical applications of dual-energy CT should be addressed in detail. Current dual-energy CT acquisition methods include dual tubes with or without beam filtration, rapid voltage switching, dual-layer detector, split filter technique, and sequential scanning. Dual-energy material-specific imaging methods include virtual monoenergetic or monochromatic imaging, effective atomic number map, virtual non-contrast or unenhanced imaging, virtual non-calcium imaging, iodine map, inhaled xenon map, uric acid imaging, automatic bone removal, and lung vessels analysis. In this review, we focus on dual-energy CT imaging including related issues of radiation exposure to patients, scanning and post-processing options, and potential clinical benefits mainly to improve the understanding of clinical radiologists and thus, expand the clinical use of dual-energy CT; in addition, we briefly describe the current technical limitations of dual-energy CT and the current developments of photon-counting detector.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
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19
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Adamson EB, Ludwig KD, Mummy DG, Fain SB. Magnetic resonance imaging with hyperpolarized agents: methods and applications. Phys Med Biol 2017; 62:R81-R123. [PMID: 28384123 DOI: 10.1088/1361-6560/aa6be8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the past decade, hyperpolarized (HP) contrast agents have been under active development for MRI applications to address the twin challenges of functional and quantitative imaging. Both HP helium (3He) and xenon (129Xe) gases have reached the stage where they are under study in clinical research. HP 129Xe, in particular, is poised for larger scale clinical research to investigate asthma, chronic obstructive pulmonary disease, and fibrotic lung diseases. With advances in polarizer technology and unique capabilities for imaging of 129Xe gas exchange into lung tissue and blood, HP 129Xe MRI is attracting new attention. In parallel, HP 13C and 15N MRI methods have steadily advanced in a wide range of pre-clinical research applications for imaging metabolism in various cancers and cardiac disease. The HP [1-13C] pyruvate MRI technique, in particular, has undergone phase I trials in prostate cancer and is poised for investigational new drug trials at multiple institutions in cancer and cardiac applications. This review treats the methodology behind both HP gases and HP 13C and 15N liquid state agents. Gas and liquid phase HP agents share similar technologies for achieving non-equilibrium polarization outside the field of the MRI scanner, strategies for image data acquisition, and translational challenges in moving from pre-clinical to clinical research. To cover the wide array of methods and applications, this review is organized by numerical section into (1) a brief introduction, (2) the physical and biological properties of the most common polarized agents with a brief summary of applications and methods of polarization, (3) methods for image acquisition and reconstruction specific to improving data acquisition efficiency for HP MRI, (4) the main physical properties that enable unique measures of physiology or metabolic pathways, followed by a more detailed review of the literature describing the use of HP agents to study: (5) metabolic pathways in cancer and cardiac disease and (6) lung function in both pre-clinical and clinical research studies, concluding with (7) some future directions and challenges, and (8) an overall summary.
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Affiliation(s)
- Erin B Adamson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States of America
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20
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Zhu X, McCullough WP, Mecca P, Servaes S, Darge K. Dual-energy compared to single-energy CT in pediatric imaging: a phantom study for DECT clinical guidance. Pediatr Radiol 2016; 46:1671-1679. [PMID: 27518078 DOI: 10.1007/s00247-016-3668-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 06/20/2016] [Accepted: 07/20/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dual-energy CT technology is available on scanners from several vendors and offers significant advantages over classic single-energy CT technology in multiple clinical applications. Many studies have detailed dual-energy CT applications in adults and several have evaluated the relative radiation dose performance of dual-energy CT in adult imaging. However, little has been published on dual-energy CT imaging in the pediatric population, and the relative dose performance of dual-energy CT imaging in the pediatric population is not well described. OBJECTIVE When evaluating dual-energy CT technology for implementation into a routine clinical pediatric imaging practice, the radiation dose implications must be considered, and when comparing relative CT dose performance, image quality must also be evaluated. Therefore the purpose of this study is to develop dual-energy CT scan protocols based on our optimized single-energy scan protocols and compare the dose. MATERIALS AND METHODS We scanned the head, chest and abdomen regions of pediatric-size anthropomorphic phantoms with contrast inserts, using our optimized single-energy clinical imaging protocols on a Siemens Flash® CT scanner. We then scanned the phantoms in dual-energy mode using matching image-quality reference settings. The effective CT dose index volume (CTDIvol) of the scans was used as a surrogate for relative dose in comparing the single- and dual-energy scans. Additionally, we evaluated image quality using visual assessment and contrast-to-noise ratio. RESULTS Dual-energy CT scans of the head and abdomen were dose-neutral for all three phantoms. Dual-energy CT scans of the chest showed a relative dose increase over the single-energy scan for 1- and 5-year-old child-based age-equivalent phantoms, ranging 11-20%. Quantitative analysis of image quality showed no statistically significant difference in image quality between the single-energy and dual-energy scans. There was no clinically significant difference in image quality by visual assessment. CONCLUSION Dual-energy CT is dose-neutral in imaging the head and abdomen in children. It is not dose-neutral in chest imaging of very small children. With a better understanding of the dose consequences of converting single-energy protocols to dual-energy protocols we can begin to implement clinical dual-energy CT and utilize its unique capabilities in pediatric imaging.
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Affiliation(s)
- Xiaowei Zhu
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William P McCullough
- Department of Radiology and Medical Imaging, University of Virginia Health System, P.O. Box 800170, Charlottesville, VA, 22908-0170, USA.
| | - Patricia Mecca
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sabah Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kassa Darge
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Effects of Dual-Energy Technique on Radiation Exposure and Image Quality in Pediatric Body CT. AJR Am J Roentgenol 2016; 207:826-835. [DOI: 10.2214/ajr.15.15994] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Ebner L, Kammerman J, Driehuys B, Schiebler ML, Cadman RV, Fain SB. The role of hyperpolarized 129xenon in MR imaging of pulmonary function. Eur J Radiol 2016; 86:343-352. [PMID: 27707585 DOI: 10.1016/j.ejrad.2016.09.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 01/29/2023]
Abstract
In the last two decades, functional imaging of the lungs using hyperpolarized noble gases has entered the clinical stage. Both helium (3He) and xenon (129Xe) gas have been thoroughly investigated for their ability to assess both the global and regional patterns of lung ventilation. With advances in polarizer technology and the current transition towards the widely available 129Xe gas, this method is ready for translation to the clinic. Currently, hyperpolarized (HP) noble gas lung MRI is limited to selected academic institutions; yet, the promising results from initial clinical trials have drawn the attention of the pulmonary medicine community. HP 129Xe MRI provides not only 3-dimensional ventilation imaging, but also unique capabilities for probing regional lung physiology. In this review article, we aim to (1) provide a brief overview of current ventilation MR imaging techniques, (2) emphasize the role of HP 129Xe MRI within the array of different imaging strategies, (3) discuss the unique imaging possibilities with HP 129Xe MRI, and (4) propose clinical applications.
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Affiliation(s)
- Lukas Ebner
- Cardiothoracic Imaging, Duke University Medical Center, Department of Radiology, Duke University, Durham, NC, USA
| | - Jeff Kammerman
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | - Mark L Schiebler
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Robert V Cadman
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
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23
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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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24
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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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25
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Kruger SJ, Nagle SK, Couch MJ, Ohno Y, Albert M, Fain SB. Functional imaging of the lungs with gas agents. J Magn Reson Imaging 2016; 43:295-315. [PMID: 26218920 PMCID: PMC4733870 DOI: 10.1002/jmri.25002] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/26/2015] [Indexed: 12/22/2022] Open
Abstract
This review focuses on the state-of-the-art of the three major classes of gas contrast agents used in magnetic resonance imaging (MRI)-hyperpolarized (HP) gas, molecular oxygen, and fluorinated gas--and their application to clinical pulmonary research. During the past several years there has been accelerated development of pulmonary MRI. This has been driven in part by concerns regarding ionizing radiation using multidetector computed tomography (CT). However, MRI also offers capabilities for fast multispectral and functional imaging using gas agents that are not technically feasible with CT. Recent improvements in gradient performance and radial acquisition methods using ultrashort echo time (UTE) have contributed to advances in these functional pulmonary MRI techniques. The relative strengths and weaknesses of the main functional imaging methods and gas agents are compared and applications to measures of ventilation, diffusion, and gas exchange are presented. Functional lung MRI methods using these gas agents are improving our understanding of a wide range of chronic lung diseases, including chronic obstructive pulmonary disease, asthma, and cystic fibrosis in both adults and children.
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Affiliation(s)
- Stanley J. Kruger
- Department of Medical Physics, University of Wisconsin – Madison, WI, U.S.A
| | - Scott K. Nagle
- Department of Medical Physics, University of Wisconsin – Madison, WI, U.S.A
- Department of Radiology, University of Wisconsin – Madison, WI, U.S.A
- Department of Pediatrics, University of Wisconsin – Madison, WI, U.S.A
| | - Marcus J. Couch
- Thunder Bay Regional Research Institute, Thunder Bay, ON, Canada
- Biotechnology Program, Lakehead University, Thunder Bay, ON, Canada
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitchell Albert
- Thunder Bay Regional Research Institute, Thunder Bay, ON, Canada
- Department of Chemistry, Lakehead University, Thunder Bay, ON, Canada
| | - Sean B. Fain
- Department of Medical Physics, University of Wisconsin – Madison, WI, U.S.A
- Department of Radiology, University of Wisconsin – Madison, WI, U.S.A
- Department of Biomedical Engineering, University of Wisconsin – Madison, WI, U.S.A
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26
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Tang CX, Schoepf UJ, Chowdhury SM, Fox MA, Zhang LJ, Lu GM. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol 2015; 45:1431-9. [PMID: 25846076 PMCID: PMC4553120 DOI: 10.1007/s00247-015-3336-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U. Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mary A. Fox
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
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Lee E, Goo HW, Lee JY. Age- and gender-specific estimates of cumulative CT dose over 5 years using real radiation dose tracking data in children. Pediatr Radiol 2015; 45:1282-92. [PMID: 25801905 DOI: 10.1007/s00247-015-3331-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/23/2015] [Accepted: 02/24/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is necessary to develop a mechanism to estimate and analyze cumulative radiation risks from multiple CT exams in various clinical scenarios in children. OBJECTIVE To identify major contributors to high cumulative CT dose estimates using actual dose-length product values collected for 5 years in children. MATERIALS AND METHODS Between August 2006 and July 2011 we reviewed 26,937 CT exams in 13,803 children. Among them, we included 931 children (median age 3.5 years, age range 0 days-15 years; M:F = 533:398) who had 5,339 CT exams. Each child underwent at least three CT scans and had accessible radiation dose reports. Dose-length product values were automatically extracted from DICOM files and we used recently updated conversion factors for age, gender, anatomical region and tube voltage to estimate CT radiation dose. We tracked the calculated CT dose estimates to obtain a 5-year cumulative value for each child. The study population was divided into three groups according to the cumulative CT dose estimates: high, ≥30 mSv; moderate, 10-30 mSv; and low, <10 mSv. We reviewed clinical data and CT protocols to identify major contributors to high and moderate cumulative CT dose estimates. RESULTS Median cumulative CT dose estimate was 5.4 mSv (range 0.5-71.1 mSv), and median number of CT scans was 4 (range 3-36). High cumulative CT dose estimates were most common in children with malignant tumors (57.9%, 11/19). High frequency of CT scans was attributed to high cumulative CT dose estimates in children with ventriculoperitoneal shunt (35 in 1 child) and malignant tumors (range 18-49). Moreover, high-dose CT protocols, such as multiphase abdomen CT (median 4.7 mSv) contributed to high cumulative CT dose estimates even in children with a low number of CT scans. CONCLUSION Disease group, number of CT scans, and high-dose CT protocols are major contributors to higher cumulative CT dose estimates in children.
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Affiliation(s)
- Eunsol Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Xenon-Enhanced Dual-Energy CT Lung Ventilation Imaging: Techniques and Clinical Applications. AJR Am J Roentgenol 2014; 202:309-17. [PMID: 24450670 DOI: 10.2214/ajr.13.11191] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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