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Vrbaski S, Bache S, Rajagopal J, Samei E. Quantitative performance of photon-counting CT at low dose: Virtual monochromatic imaging and iodine quantification. Med Phys 2023; 50:5421-5433. [PMID: 37415402 PMCID: PMC10897956 DOI: 10.1002/mp.16583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Quantitative imaging techniques, such as virtual monochromatic imaging (VMI) and iodine quantification (IQ), have proven valuable diagnostic methods in several specific clinical tasks such as tumor and tissue differentiation. Recently, a new generation of computed tomography (CT) scanners equipped with photon-counting detectors (PCD) has reached clinical status. PURPOSE This work aimed to investigate the performance of a new photon-counting CT (PC-CT) in low-dose quantitative imaging tasks, comparing it to an earlier generation CT scanner with an energy-integrating detector dual-energy CT (DE-CT). The accuracy and precision of the quantification across size, dose, material types (including low and high iodine concentrations), displacement from iso-center, and solvent (tissue background) composition were explored. METHODS Quantitative analysis was performed on two clinical scanners, Siemens SOMATOM Force and NAEOTOM Alpha using a multi-energy phantom with plastic inserts mimicking different iodine concentrations and tissue types. The tube configurations in the dual-energy scanner were 80/150Sn kVp and 100/150Sn kVp, while for PC-CT both tube voltages were set to either 120 or 140 kVp with photon-counting energy thresholds set at 20/65 or 20/70 keV. The statistical significance of patient-related parameters in quantitative measurements was examined using ANOVA and pairwise comparison with the posthoc Tukey honest significance test. Scanner bias was assessed in both quantitative tasks for relevant patient-specific parameters. RESULTS The accuracy of IQ and VMI in the PC-CT was comparable between standard and low radiation doses (p < 0.01). The patient size and tissue type significantly affect the accuracy of both quantitative imaging tasks in both scanners. The PC-CT scanner outperforms the DE-CT scanner in the IQ task in all cases. Iodine quantification bias in the PC-CT (-0.9 ± 0.15 mg/mL) at low doses in our study was comparable to that of DE-CT (range -2.6 to 1.5 mg/mL, published elsewhere) at a 1.7× higher dose, but the dose reduction severely biased DE-CT (4.72 ± 0.22 mg/mL). The accuracy in Hounsfield units (HU) estimation was comparable for 70 and 100 keV virtual imaging between scanners, but PC-CT was significantly underestimating virtual 40 keV HU values of dense materials in the phantom representing the extremely obese population. CONCLUSIONS The statistical analysis of our measurements reveals better IQ at lower radiation doses using new PC-CT. Although VMI performance was mostly comparable between the scanners, the DE-CT scanner quantitatively outperformed PC-CT when estimating HU values in the specific case of very large phantoms and dense materials, benefiting from increased X-ray tube potentials.
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Affiliation(s)
- Stevan Vrbaski
- Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
- Department of Physics, University of Trieste, Trieste, Italy
- Elettra-Sincrotrone Trieste, Basovizza, Trieste, Italy
| | - Steve Bache
- Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jayasai Rajagopal
- Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
- Radiology and Imaging Sciences,Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Ehsan Samei
- Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
- Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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2
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Wu W, Fang X, Li J, Zhang A, Zou Y, Zheng X. Application of dual-source computed tomography in the diagnosis of thyroid cancer and evaluation of biological behaviors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:195-202. [PMID: 36539919 DOI: 10.1002/jcu.23413] [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: 09/23/2022] [Revised: 11/23/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Thyroid cancer (TC) is an extremely prevailing malignant endocrine tumor. Therefore, effective diagnostic tools are necessary. This study explored the application value of dual-source computed tomography (DSCT) in TC diagnosis and biological behavior assessment. METHODS This study retrospectively selected 68 TC patients and another 74 benign patients with thyroid adenoma, nodular goiter, or adenomatous hyperplasia. All patients were confirmed by pathological examination and underwent DSCT examination. The iodine concentration (IC) obtained from plain computed tomography (CT) scanning and normalized iodine concentration (NIC) in the arterial phase and venous phase were recorded. The positive expression rates of estrogen receptor alpha (ERα), estrogen receptors beta (ERβ), and Ki67 in pathological tissues were determined by immunohistochemistry, and their correlation with IC in plain CT was assessed by Pearson correlation analysis, respectively. The diagnostic values of IC in plain CT and venous phase NIC in TC patients were evaluated using the receiver operating characteristic curve. RESULTS Malignant patients had lower IC in plain DSCT scanning, venous phase NIC, and ERβ, and higher ERα and Ki67 than benign patients. IC level in plain DSCT scanning was inversely-correlated with ERα and Ki-67 positive expression rates, but positively-related to ERβ to different degrees. For the diagnosis of TC patients, the AUC of IC level in plain DSCT was 0.771, with a cut-off value of 1.250 (97.06% sensitivity and 41.89% specificity), and the AUC of venous phase NIC was 0.738, with a cut-off value of 0.825 (100% sensitivity and 43.24% specificity). CONCLUSION The IC level obtained from DSCT scanning could assist in the differential diagnosis of malignant and benign thyroid nodules and evaluation of biological behaviors.
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Affiliation(s)
- Wenhui Wu
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Xuewen Fang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Jianming Li
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - An Zhang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Yujian Zou
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Xiaolin Zheng
- Department of Radiology, Kanghua Hospital, Dongguan, China
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Guimarães LS. Editorial Comment: Toward Precise and Reproducible Iodine Quantification With Dual-Energy CT-Getting Closer, but Not There Yet. AJR Am J Roentgenol 2022; 219:840. [PMID: 35766537 DOI: 10.2214/ajr.22.28159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhao M, Nie P, Guo Y, Chen H. Pulmonary artery intimal sarcoma: A rare cause of filling defects in pulmonary arteries. Am J Med Sci 2022; 364:655-660. [PMID: 35588894 DOI: 10.1016/j.amjms.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/07/2021] [Accepted: 05/11/2022] [Indexed: 01/25/2023]
Abstract
Pulmonary artery intimal sarcomas are very rare and arise from primitive pluripotent mesenchymal cells. They are often misdiagnosed as pulmonary thromboembolism, leading to futile anticoagulation treatment and delayed diagnosis. We present a case of a patient who showed nonspecific pulmonary symptoms and characteristic imaging manifestation. Progressive symptoms and additional imaging led to the suspicion of a pulmonary artery intimal sarcoma, which was finally confirmed by pathological biopsy. This case serves as a reminder to consider pulmonary artery intimal sarcomas in the differential diagnosis of patients with dyspnea and filling defects on computed tomography pulmonary angiography or contrast-enhanced computed tomography.
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Affiliation(s)
- Mimi Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Yonghua Guo
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China, 266003.
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Murphy CG, Goldstein JM, Besharati S, Kobsa S, Salvatore MM, Rosenzweig EB, Ingham M, Del Portillo A, Takeda K, Chandra S, Furfaro D. A 52-Year-Old Man With Chest Pain and Dyspnea. Chest 2022; 162:e259-e264. [PMID: 36344135 PMCID: PMC9808716 DOI: 10.1016/j.chest.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/14/2022] [Indexed: 11/06/2022] Open
Abstract
CASE PRESENTATION A 52-year-old man came to the cardiac surgery clinic for pulmonary thromboendarterectomy (PTE) evaluation. He had initially appeared at an outside hospital 1 year earlier, with chest pain and shortness of breath. He had no known chronic conditions. A CT pulmonary angiogram (CTPA) at that time showed a filling defect at the bifurcation of the main pulmonary artery. A transthoracic echocardiogram revealed mild mitral valve regurgitation, but otherwise the results were normal. As he was hemodynamically stable and not hypoxemic, he was treated solely by anticoagulation. Despite adhering to prescribed apixaban, he developed progressive dyspnea and reduced exercise tolerance over the subsequent year. A repeat CTPA performed 12 months after the initial presentation showed a persistent filling defect at the level of the pulmonary artery bifurcation, with a new extension now completely occluding the right main pulmonary artery. A pulmonary angiogram confirmed this complete occlusion, and right heart catheterization revealed precapillary pulmonary hypertension, with a mean pulmonary artery pressure of 50 mm Hg. His anticoagulation was transitioned to enoxaparin for presumed apixaban treatment failure, and an investigation for hypercoagulable conditions was initiated. His lupus anticoagulant test result was positive, but he did not meet the criteria for antiphospholipid syndrome because he was negative for anticardiolipin and β2-glycoprotein antibodies. Assays for antithrombin III, protein C, prothrombin gene, and factor V Leiden mutations produced normal results.
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Affiliation(s)
- Charles G Murphy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY.
| | - Jonathan M Goldstein
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Sepideh Besharati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Serge Kobsa
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Matthew Ingham
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Armando Del Portillo
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Subani Chandra
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Furfaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Vulasala SSR, Wynn GC, Hernandez M, Kadambi I, Gopireddy DR, Bhosale P, Virarkar MK. Dual-Energy Imaging of the Chest. Semin Ultrasound CT MR 2022; 43:311-319. [PMID: 35738816 DOI: 10.1053/j.sult.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy computed tomography (DECT) is a contemporary development by which the tissue can be characterized beyond conventional computed tomography. It improves tissue differentiation by exploiting the X-ray absorptive property of the tissues. Although still in its early stages, DECT utilization in pulmonary and cardiovascular pathologies is emerging. It includes applications such as pulmonary embolism, pulmonary hypertension, myocardial perfusion, and coronary artery assessment. This article discusses DECT principles and their current and emerging applications in thoracic imaging.
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Affiliation(s)
- Sai Swarupa R Vulasala
- Research Assistant, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Gregory Carl Wynn
- Associate Professor, Division of Cardiovascular and Thoracic Imaging, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Mauricio Hernandez
- Radiology Research Manager II, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States.
| | - Isiri Kadambi
- Observer, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Dheeraj Reddy Gopireddy
- Associate Professor & Associate Chair, Clinical Operations, and Quality Assurance., Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Priya Bhosale
- Professor, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, United States
| | - Mayur K Virarkar
- Assistant Professor, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
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Mendoza Ferradas FJ, Ezponda A, Juan-Aracil GR, Bastarrika G. Pulmonary Artery Sarcoma: Value of Dual-Energy CT (DECT)-Based Iodine Quantification on Multimodality Workup. Arch Bronconeumol 2022; 58:565. [PMID: 35312566 DOI: 10.1016/j.arbres.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/02/2022]
Affiliation(s)
| | - Ana Ezponda
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Gorka Bastarrika
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Spain
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Uetani T, Inaba S, Higashi H, Irita J, Aono J, Nishiyama H, Tanabe Y, Kitazawa R, Kido T, Ikeda S, Yamaguchi O. Visualization of pulmonary artery intimal sarcoma by color-coded iodine map using dual-energy computed tomography. J Cardiol Cases 2022; 26:111-113. [DOI: 10.1016/j.jccase.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022] Open
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Jiang L, Liu D, Long L, Chen J, Lan X, Zhang J. Dual-source dual-energy computed tomography-derived quantitative parameters combined with machine learning for the differential diagnosis of benign and malignant thyroid nodules. Quant Imaging Med Surg 2022; 12:967-978. [PMID: 35111598 DOI: 10.21037/qims-21-501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023]
Abstract
Background This study aimed to investigate the ability of quantitative parameter-derived dual-source dual-energy computed tomography (DS-DECT) combined with machine learning to distinguish between benign and malignant thyroid nodules. Methods Patients with thyroid nodules and pathological surgical results who underwent preoperative DS-DECT were selected. Quantitative parameter-derived DS-DECT was applied to classify benign and malignant nodules. Then, machine learning and binary logistic regression analysis models were constructed using the DS-DECT quantitative parameters to distinguish between benign and malignant nodules. The receiver operating characteristic curve was used to assess the diagnostic performance. The DeLong test was used to compare the diagnostic efficacy. Results One hundred and thirty patients with 139 confirmed thyroid nodules were involved in the study. The malignant group had a significantly higher iodine concentrationnodule (arterial phase) (P=0.001), normalized iodine concentration (arterial phase) (P=0.002), iodine concentration difference (P<0.001), spectral curve slope (nonenhancement) (P=0.007), spectral curve slope (arterial phase) (P=0.001), effective atomic number (nonenhancement) (P<0.001), and effective atomic number (arterial phase) (P=0.039) than the benign group. The binary logistic regression analysis model had an AUC (area under the curve) of 0.76, a sensitivity of 0.821, and a specificity of 0.667. The machine learning model had an AUC of 0.86, a sensitivity of 0.822, specificity of 0.791 in the training cohort, an AUC of 0.84, a sensitivity of 0.727, and specificity of 0.750 in the testing cohort. Conclusions Multiple quantitative parameters of DS-DECT combined with machine learning could differentiate between benign and malignant thyroid nodules.
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Affiliation(s)
- Liling Jiang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling Long
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.,Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
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Ma X, Xu M, Tian XJ, Liu YL, Zhang XR, Qiao Y. A Retrospectively Study: Diagnosis of Pathological Types of Malignant Lung Tumors by Dual-layer Detector Spectral Computed Tomography. Technol Cancer Res Treat 2022; 21:15330338221074498. [PMID: 35099325 PMCID: PMC8811431 DOI: 10.1177/15330338221074498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Object: By retrospectively analyzing the energy spectrum of squamous cell carcinoma, adenocarcinoma, small cell lung cancer (SCLC), and pulmonary metastases that underwent dual-layer detector spectral computed tomography (DLCT) 3-phase scan of the chest, we explored the value of a multiparameter energy spectrum in the assessment of pathological types of lung tumors. Methods: Cases of squamous cell carcinoma (n = 20), adenocarcinoma (n = 24), SCLC (n = 26), and metastases (n = 14) were collected. Then the largest cross-sectional area (LCA) of the lesion, computed tomography (CT) values in the plain scan phase, arterial and venous phases (HU, HUa, and HUv), iodine concentration, and effective atomic number in the arterial and venous phases (ICa, ICv, Zeff[a], and Zeff[v]) were measured and compared among the nonsmall cell lung cancer (NSCLC), SCLC and metastases, and other 3 groups of SCLC, squamous cell carcinoma, and adenocarcinoma. Results: Only the LCA is statistically different among SCLC, NSCLC, and metastases (P < .05). And the treated subgroup analysis did not show significant differences among the groups. However, the untreated subgroup analysis showed that there was a significant difference between NSCLC and metastases in LCA, SCLC and metastases in ICa, NSCLC and SCLC in HUv, NSCLC and SCLC in Zeff(v) (P < .05). Conclusion: The energy spectrum parameters of DLCT have a certain clinical value in distinguishing NSCLC from SCLC in the Zeff(v) and distinguishing SCLC from metastases in the ICa.
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Affiliation(s)
- Xia Ma
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Xu
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Juan Tian
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong-Li Liu
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin-Ri Zhang
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Qiao
- The First Hospital of Shanxi Medical University, Taiyuan, China
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Vlahos I, Jacobsen MC, Godoy MC, Stefanidis K, Layman RR. Dual-energy CT in pulmonary vascular disease. Br J Radiol 2022; 95:20210699. [PMID: 34538091 PMCID: PMC8722250 DOI: 10.1259/bjr.20210699] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023] Open
Abstract
Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
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Affiliation(s)
- Ioannis Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rick R Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Hong YJ, Shim J, Lee SM, Im DJ, Hur J. Dual-Energy CT for Pulmonary Embolism: Current and Evolving Clinical Applications. Korean J Radiol 2021; 22:1555-1568. [PMID: 34448383 PMCID: PMC8390816 DOI: 10.3348/kjr.2020.1512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.
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Affiliation(s)
- Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jina Shim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Schmidt C, Baessler B, Nakhostin D, Das A, Eberhard M, Alkadhi H, Euler A. Dual-Energy CT-Based Iodine Quantification in Liver Tumors - Impact of Scan-, Patient-, and Position-Related Factors. Acad Radiol 2021; 28:783-789. [PMID: 32418783 DOI: 10.1016/j.acra.2020.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVES To quantify the contribution of lesion location and patient positioning, dual-energy approach, patient size, and radiation dose to the error of dual-energy CT-based iodine quantification (DECT-IQ) in liver tumors. MATERIALS AND METHODS A phantom with four liver lesions (diameter 15 mm; iodine concentration 0-5 mgI/mL) and two sizes was used. One lesion emulated a subdiaphragmatic lesion. Both sizes were imaged in dual-energy mode on (1) a dual-source DECT (DS-DE) at 100/Sn150 kV and (2) a single-source split-filter DECT (SF-DE) at AuSn120 kV at two radiation doses (8 and 12 mGy). Scans were performed at seven different vertical table positions (from -6 to + 6 cm from the gantry isocenter). Iodine concentration was repeatedly measured and absolute errors (errorabs) were calculated. Errors were compared using robust repeated-measures ANOVAs with post-hoc comparisons. A linear mixed effect model was used to determine the factors influencing the error of DECT-IQ. RESULTS The linear mixed effect models showed that errors were significantly influenced by DECT approach, phantom size, and lesion location (all p < 0.001). The impact of lesion location on the error was stronger in SF-DE compared to DS-DE. Radiation dose did not significantly influence error (p = 0.22). When averaged across all setups, errorabs was significantly higher for SF-DE (2.08 ± 1.92 mgI/mL) compared to DS-DE (0.37 ± 0.29 mgI/mL) (all p < 0.001). Artefacts were found in the subdiaphragmatic lesion for SF-DE with significantly increased errorabs compared to DS-DE (p < 0.001). Errorabs was significantly higher in the large compared to the medium phantom for DS-DE (0.30 ± 0.23 mgI/mL vs. 0.43 ± 0.33 mgI/mL) and SF-DE (1.68 ± 1.99 vs. 2.36 ± 1.81 mgI/mL) (p < 0.001). CONCLUSION The dual-energy approach, patient size, and lesion location modified by patient position significantly impacted DECT-IQ in simulated liver tumors.
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14
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A comprehensive review on the diagnosis and management of intimal sarcoma of the pulmonary artery. Crit Rev Oncol Hematol 2020; 147:102889. [PMID: 32035299 DOI: 10.1016/j.critrevonc.2020.102889] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
Only a few hundred cases of intimal sarcomas of pulmonary artery (ISPA) were reported on the literature. Diagnosis of this rare entity is a challenging dilemma with the need for a high expertise in the radiological and pathological identification of ISPA. Treatment strategies rely initially on an early aggressive surgery aiming for complete surgical resection with clear margins while no clear recommendations guiding the choice for additional drug therapy or radiotherapy exist. In this article, we perform an extensive review of the literature on ISPA with details on the clinical presentation, diagnosis and management strategies. An additional goal of this paper is to make practicing oncologists aware of this rare entity with clear idea on the initial management.
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Leitman EM, McDermott S. Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovasc Diagn Ther 2019; 9:S37-S58. [PMID: 31559153 DOI: 10.21037/cdt.2018.08.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pulmonary arteries are not just affected by thrombus. Various acquired and congenital conditions can also affect the pulmonary arteries. In this review we discuss cross sectional imaging modalities utilized for the imaging of the pulmonary arteries. Acquired pulmonary artery entities, including pulmonary artery sarcoma (PAS), vasculitis, aneurysm, and arteriovenous malformations, and congenital anomalies in adults, including proximal interruption of the pulmonary artery, pulmonary sling, pulmonary artery stenosis, and idiopathic dilatation of the pulmonary trunk, are also discussed. An awareness of these entities and their imaging findings is important for radiologists interpreting chest imaging.
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Affiliation(s)
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
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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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Riederer I, Si-Mohamed S, Ehn S, Bar-Ness D, Noël PB, Fingerle AA, Pfeiffer F, Rummeny EJ, Douek P, Pfeiffer D. Differentiation between blood and iodine in a bovine brain-Initial experience with Spectral Photon-Counting Computed Tomography (SPCCT). PLoS One 2019; 14:e0212679. [PMID: 30802258 PMCID: PMC6388929 DOI: 10.1371/journal.pone.0212679] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/07/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the accuracy of Spectral Photon-Counting Computed Tomography (SPCCT) in the quantification of iodine concentrations and its potential for the differentiation between blood and iodine. Methods Tubes with blood and a concentration series of iodine were scanned with a preclinical SPCCT system (both in vitro and in an ex vivo bovine brain tissue sample). Iodine density maps (IDM) and virtual non-contrast (VNC) images were generated using the multi-bin spectral information to perform material decomposition. Region-of-interest (ROI) analysis was performed within the tubes to quantitatively determine the absolute content of iodine (mg/ml). Results In conventional CT images, ROI analysis showed similar Hounsfield Unit (HU) values for the tubes with blood and iodine (59.9 ± 1.8 versus 59.2 ± 1.5). Iodine density maps enabled clear differentiation between blood and iodine in vitro, as well as in the bovine brain model. Quantitative measurements of the different iodine concentrations matched well with those of actual known concentrations even for very small iodine concentrations with values below 1mg/ml (RMSE = 0.19). Conclusions SPCCT providing iodine maps and virtual non-contrast images allows material decomposition, differentiation between blood and iodine in vitro and ex vivo in a bovine brain model and reliably quantifies the iodine concentration.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Salim Si-Mohamed
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Sebastian Ehn
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniel Bar-Ness
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexander A. Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Philippe Douek
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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Chen M, Wang D, Cai N, Xia D, Zou J, Yu H. FBP-type CT reconstruction algorithms for triple-source circular trajectory with different scanning radii. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:665-684. [PMID: 31256110 DOI: 10.3233/xst-190494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Multi-source computed tomography (CT) imaging has unique technical advantages not only for dynamic objects, but also for large-size objects by designing its imaging scan mode. Using the triple-source fan-beam imaging scan mode under three circular trajectories with two different radii, we in this study developed and analyzed theoretically several exact reconstruction algorithms in terms of full-scan and short-scan for three sets of truncated projection data. This triple-source scan configuration in different radii cases is easier to be simulated by a single-source scan configuration in an industrial CT system. The proposed algorithms are based on the idea of filtering-back-projection (FBP) algorithm, and can reconstruct the large-size objects under the same CT devices. The developed algorithms avoid data rebinning and can provide exact and fast image reconstruction. The results of the numerical simulation based data analysis verified that new algorithms were accurate and effective.
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Affiliation(s)
- Ming Chen
- College of Mathematics and Systems Science, Shandong University of Science and Technology, Qingdao, People's Republic of China
| | - Dan Wang
- College of Mathematics and Systems Science, Shandong University of Science and Technology, Qingdao, People's Republic of China
| | - Ning Cai
- College of Mathematics and Systems Science, Shandong University of Science and Technology, Qingdao, People's Republic of China
| | - Dimeng Xia
- College of Mathematics and Systems Science, Shandong University of Science and Technology, Qingdao, People's Republic of China
| | - Jing Zou
- State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin, People's Republic of China
| | - Hengyong Yu
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Lee DH, Lee YH, Seo HS, Lee KY, Suh S, Ryoo I, You S, Kim B, Yang K. Dual‐energy CT iodine quantification for characterizing focal thyroid lesions. Head Neck 2018; 41:1024-1031. [DOI: 10.1002/hed.25524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Do Hyung Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Young Hen Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Hyung Suk Seo
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Ki Yeol Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Sang‐il Suh
- Department of RadiologyGuro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Inseon Ryoo
- Department of RadiologyGuro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Sung‐Hye You
- Department of RadiologyAnam Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Byungjun Kim
- Department of RadiologyAnam Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Kyung‐Sook Yang
- Department of BiostatisticsKorea University College of Medicine Seoul Republic of Korea
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Wu W, Zhang Y, Wang Q, Liu F, Chen P, Yu H. Low-dose spectral CT reconstruction using image gradient ℓ 0-norm and tensor dictionary. APPLIED MATHEMATICAL MODELLING 2018; 63:538-557. [PMID: 32773921 PMCID: PMC7409840 DOI: 10.1016/j.apm.2018.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Spectral computed tomography (CT) has a great superiority in lesion detection, tissue characterization and material decomposition. To further extend its potential clinical applications, in this work, we propose an improved tensor dictionary learning method for low-dose spectral CT reconstruction with a constraint of image gradient ℓ 0-norm, which is named as ℓ 0TDL. The ℓ 0TDL method inherits the advantages of tensor dictionary learning (TDL) by employing the similarity of spectral CT images. On the other hand, by introducing the ℓ 0-norm constraint in gradient image domain, the proposed method emphasizes the spatial sparsity to overcome the weakness of TDL on preserving edge information. The split-bregman method is employed to solve the proposed method. Both numerical simulations and real mouse studies are perform to evaluate the proposed method. The results show that the proposed ℓ 0TDL method outperforms other competing methods, such as total variation (TV) minimization, TV with low rank (TV+LR), and TDL methods.
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Affiliation(s)
- Weiwen Wu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Yanbo Zhang
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Qian Wang
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Fenglin Liu
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
- Engineering Research Center of Industrial Computed Tomography Nondestructive Testing, Ministry of Education, Chongqing University, Chongqing 400044, China
- Corresponding author at: Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China. (F. Liu)
| | - Peijun Chen
- Key Lab of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing 400044, China
| | - Hengyong Yu
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA
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How accurate and precise are CT based measurements of iodine concentration? A comparison of the minimum detectable concentration difference among single source and dual source dual energy CT in a phantom study. Eur Radiol 2018; 29:2069-2078. [DOI: 10.1007/s00330-018-5736-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/09/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
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Rahaghi FN, Minhas JK, Heresi GA. Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism: New Imaging Tools and Modalities. Clin Chest Med 2018; 39:493-504. [PMID: 30122174 PMCID: PMC6317734 DOI: 10.1016/j.ccm.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Imaging continues to be the modality of choice for the diagnosis of venous thromboembolic disease, particularly when incorporated into diagnostic algorithms. Improvement in imaging techniques as well as new imaging modalities and processing methods have improved diagnostic accuracy and additionally are being leveraged in prognostication and decision making for choice of intervention. In this article, we review the role of imaging in diagnosis and prognostication of venous thromboembolism. We also discuss emerging imaging approaches that may in the near future find clinical usefulness in improving diagnosis and prognostication as well as differentiating disease phenotypes.
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Affiliation(s)
- Farbod N. Rahaghi
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School. 15 Francis Street, Boston MA 02115, ; Phone: 617-632-6770
| | - Jasleen K. Minhas
- Department of Medicine, North Shore Medical Center, 81 highland Ave Salem MA 10970, Phone: 978-354-4801
| | - Gustavo A. Heresi
- Respiratory Institute, Cleveland Clinic, Mail code A90, 9500 Euclid Ave, OH 44195, Phone: 216-636-5327
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Kim C, Kim MY, Kang JW, Song JS, Lee KY, Kim SS. Pulmonary Artery Intimal Sarcoma versus Pulmonary Artery Thromboembolism: CT and Clinical Findings. Korean J Radiol 2018; 19:792-802. [PMID: 29962886 PMCID: PMC6005959 DOI: 10.3348/kjr.2018.19.4.792] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To describe CT and clinical findings of pulmonary artery intimal sarcoma (PAIS) compared with those of pulmonary thromboembolism (PTE), to investigate MRI and positron emission tomography (PET)-CT findings of PAIS, and to evaluate the effect of delayed diagnosis of PAIS on survival outcomes. Materials and Methods Twenty-six patients with PAIS were retrospectively identified and matched for sex, with patients with PTE at a ratio of 1:2. CT and clinical findings of the two groups were compared using Student's t test or chi-square test. The effect of delayed diagnosis on survival was investigated using Kaplan-Meier analysis. Results The most common tumor pattern in PAIS was tumoral impaction. Heterogeneous attenuation, wall eclipse signs, intratumoral vessels, acute interphase angles, single location, presence of lung ischemia, and central location were significantly more common in PAIS than in PTE (all p < 0.01). Levels of D-dimers and brain natriuretic peptide were lower in PAIS than in PTE (p < 0.05). In three patients of PAIS, long inversion time sequence MRI showed intermingled dark signal intensity foci suggestive of intermingled thrombi. All nine patients who had undergone PET-CT displayed hypermetabolism. Diagnosis was delayed in 42.3% of the PAIS patients and those patients had a significantly shorter overall survival than patients whose diagnosis was not delayed (p < 0.05). Conclusion The characteristic CT and clinical findings of PAIS may help achieve early diagnosis of PAIS and make better survival outcomes of patients. MRI and PET-CT can be used as second-line imaging modalities and could help distinguish PAIS from PTE and to plan clinical management.
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Affiliation(s)
- Cherry Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Mi Young Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Joon-Won Kang
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Sung-Soo Kim
- Department of Healthcare Management, Cheongju University, Cheongju 28503, Korea
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Liu MX, Ma ZH, Jiang T, Guo XJ, Yu FF, Yang YH, Zhai ZG. Differential Diagnosis of Pulmonary Artery Sarcoma and Central Chronic Pulmonary Thromboembolism Using CT and MR Images. Heart Lung Circ 2017; 27:819-827. [PMID: 29032917 DOI: 10.1016/j.hlc.2017.06.716] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinical and imaging manifestations are similar in pulmonary artery sarcomas (PAS) and thromboembolic diseases, especially central chronic pulmonary thromboembolism (CPTE). The feasibility of utilising clinical imaging tools such as computed tomography (CT) and magnetic resonance imaging (MRI) for differential diagnosis of PAS and CPTE has not been fully explored, especially MRI. METHODS Patients with PAS (n=18) and central CPTE (n=20) treated at our hospital between January 2013 and September 2016 were identified retrospectively. Computed tomography and MRI findings of pulmonary artery (PA) filling defects including the location, the involvement of pulmonary artery, morphology, signal intensities and enhancement in MRI, calcification, sizes of right atrium and ventricle, inner diameters of the pulmonary artery trunk and branches, and mediastinal collateral circulation in both groups were examined, and differences were analysed by Fisher exact test and independent sample t-test. RESULTS Compared to those of central CPTE, PAS lesions were in full shape or expansive growth (p<0.001), and the proximal end of the tumours was often bulging or lobulated (p<0.001). These lesions were aneurysm- or grape-like distally (p<0.01) with inhomogeneous enhancement (p<0.001). The MRI contrast enhancement pattern of PAS lesions were cloudy with inhomogeneous delayed enhancement and the time-density curves for some of the lesions increased gradually. CONCLUSION Computed tomographic and MR imaging manifestations may resemble PAS and central CPTE; however, some manifestations still have great value for the differential diagnosis of these two conditions, specifically the morphology and MRI enhancement patterns.
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Affiliation(s)
- Ming-Xi Liu
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Zhan-Hong Ma
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China.
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China.
| | - Xiao-Juan Guo
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Fang-Fang Yu
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Zhen-Guo Zhai
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Building, Chaoyang District, Beijing, China
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Accuracy of iodine quantification using dual energy CT in latest generation dual source and dual layer CT. Eur Radiol 2017; 27:3904-3912. [PMID: 28168368 PMCID: PMC5544802 DOI: 10.1007/s00330-017-4752-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/18/2016] [Accepted: 01/17/2017] [Indexed: 01/22/2023]
Abstract
Objective To determine the accuracy of iodine quantification with dual energy computed tomography (DECT) in two high-end CT systems with different spectral imaging techniques. Methods Five tubes with different iodine concentrations (0, 5, 10, 15, 20 mg/ml) were analysed in an anthropomorphic thoracic phantom. Adding two phantom rings simulated increased patient size. For third-generation dual source CT (DSCT), tube voltage combinations of 150Sn and 70, 80, 90, 100 kVp were analysed. For dual layer CT (DLCT), 120 and 140 kVp were used. Scans were repeated three times. Median normalized values and interquartile ranges (IQRs) were calculated for all kVp settings and phantom sizes. Results Correlation between measured and known iodine concentrations was excellent for both systems (R = 0.999–1.000, p < 0.0001). For DSCT, median measurement errors ranged from −0.5% (IQR −2.0, 2.0%) at 150Sn/70 kVp and −2.3% (IQR −4.0, −0.1%) at 150Sn/80 kVp to −4.0% (IQR −6.0, −2.8%) at 150Sn/90 kVp. For DLCT, median measurement errors ranged from −3.3% (IQR −4.9, −1.5%) at 140 kVp to −4.6% (IQR −6.0, −3.6%) at 120 kVp. Larger phantom sizes increased variability of iodine measurements (p < 0.05). Conclusion Iodine concentration can be accurately quantified with state-of-the-art DECT systems from two vendors. The lowest absolute errors were found for DSCT using the 150Sn/70 kVp or 150Sn/80 kVp combinations, which was slightly more accurate than 140 kVp in DLCT. Key Points • High-end CT scanners allow accurate iodine quantification using different DECT techniques. • Lowest measurement error was found in scans with largest photon energy separation. • Dual-source CT quantified iodine slightly more accurately than dual layer CT.
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Chang S, Hur J, Im DJ, Suh YJ, Hong YJ, Lee HJ, Kim YJ, Han K, Kim DJ, Lee CY, Shin HY, Choi BW. Volume-based quantification using dual-energy computed tomography in the differentiation of thymic epithelial tumours: an initial experience. Eur Radiol 2016; 27:1992-2001. [DOI: 10.1007/s00330-016-4542-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 06/06/2016] [Accepted: 08/04/2016] [Indexed: 12/28/2022]
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