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Lennartz S, Cao J, Pisuchpen N, Srinivas-Rao S, Locascio JJ, Parakh A, Hahn PF, Mileto A, Sahani D, Kambadakone A. Intra-patient variability of iodine quantification across different dual-energy CT platforms: assessment of normalization techniques. Eur Radiol 2024; 34:5131-5141. [PMID: 38189979 DOI: 10.1007/s00330-023-10560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/18/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To investigate intra-patient variability of iodine concentration (IC) between three different dual-energy CT (DECT) platforms and to test different normalization approaches. METHODS Forty-four patients who underwent portal venous phase abdominal DECT on a dual-source (dsDECT), a rapid kVp switching (rsDECT), and a dual-layer detector platform (dlDECT) during cancer follow-up were retrospectively included. IC in the liver, pancreas, and kidneys and different normalized ICs (NICPV:portal vein; NICAA:abdominal aorta; NICALL:overall iodine load) were compared between the three DECT scanners for each patient. A longitudinal mixed effects analysis was conducted to elucidate the effect of the scanner type, scan order, inter-scan time, and contrast media amount on normalized iodine concentration. RESULTS Variability of IC was highest in the liver (dsDECT vs. dlDECT 28.96 (14.28-46.87) %, dsDECT vs. rsDECT 29.08 (16.59-62.55) %, rsDECT vs. dlDECT 22.85 (7.52-33.49) %), and lowest in the kidneys (dsDECT vs. dlDECT 15.76 (7.03-26.1) %, dsDECT vs. rsDECT 15.67 (8.86-25.56) %, rsDECT vs. dlDECT 10.92 (4.92-22.79) %). NICALL yielded the best reduction of IC variability throughout all tissues and inter-scanner comparisons, yet did not reduce the variability between dsDECT vs. dlDECT and rsDECT, respectively, in the liver. The scanner type remained a significant determinant for NICALL in the pancreas and the liver (F-values, 12.26 and 23.78; both, p < 0.0001). CONCLUSIONS We found tissue-specific intra-patient variability of IC across different DECT scanner types. Normalization mitigated variability by reducing physiological fluctuations in iodine distribution. After normalization, the scanner type still had a significant effect on iodine variability in the pancreas and liver. CLINICAL RELEVANCE STATEMENT Differences in iodine quantification between dual-energy CT scanners can partly be mitigated by normalization, yet remain relevant for specific tissues and inter-scanner comparisons, which should be taken into account at clinical routine imaging. KEY POINTS • Iodine concentration showed the least variability between scanner types in the kidneys (range 10.92-15.76%) and highest variability in the liver (range 22.85-29.08%). • Normalizing tissue-specific iodine concentrations against the overall iodine load yielded the greatest reduction of variability between scanner types for 2/3 inter-scanner comparisons in the liver and for all (3/3) inter-scanner comparisons in the kidneys and pancreas, respectively. • However, even after normalization, the dual-energy CT scanner type was found to be the factor significantly influencing variability of iodine concentration in the liver and pancreas.
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Affiliation(s)
- Simon Lennartz
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jinjin Cao
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Nisanard Pisuchpen
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Shravya Srinivas-Rao
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Joseph J Locascio
- Harvard Catalyst Biostatistical Unit, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Anushri Parakh
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Peter F Hahn
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, UWMC Radiology RR218, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Avinash Kambadakone
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA.
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Foti G, Ascenti G, Agostini A, Longo C, Lombardo F, Inno A, Modena A, Gori S. Dual-Energy CT in Oncologic Imaging. Tomography 2024; 10:299-319. [PMID: 38535766 PMCID: PMC10975567 DOI: 10.3390/tomography10030024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 08/25/2024] Open
Abstract
Dual-energy CT (DECT) is an innovative technology that is increasingly widespread in clinical practice. DECT allows for tissue characterization beyond that of conventional CT as imaging is performed using different energy spectra that can help differentiate tissues based on their specific attenuation properties at different X-ray energies. The most employed post-processing applications of DECT include virtual monoenergetic images (VMIs), iodine density maps, virtual non-contrast images (VNC), and virtual non-calcium (VNCa) for bone marrow edema (BME) detection. The diverse array of images obtained through DECT acquisitions offers numerous benefits, including enhanced lesion detection and characterization, precise determination of material composition, decreased iodine dose, and reduced artifacts. These versatile applications play an increasingly significant role in tumor assessment and oncologic imaging, encompassing the diagnosis of primary tumors, local and metastatic staging, post-therapy evaluation, and complication management. This article provides a comprehensive review of the principal applications and post-processing techniques of DECT, with a specific focus on its utility in managing oncologic patients.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (C.L.); (F.L.)
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98122 Messina, Italy;
| | - Andrea Agostini
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
| | - Chiara Longo
- Department of Radiology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (C.L.); (F.L.)
| | - Fabio Lombardo
- Department of Radiology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (C.L.); (F.L.)
| | - Alessandro Inno
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (A.I.); (A.M.); (S.G.)
| | - Alessandra Modena
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (A.I.); (A.M.); (S.G.)
| | - Stefania Gori
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Italy; (A.I.); (A.M.); (S.G.)
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Zhou Y, Xu YK, Geng D, Wang JW, Chen XB, Si Y, Shen MP, Su GY, Xu XQ, Wu FY. Added value of arterial enhancement fraction derived from dual-energy computed tomography for preoperative diagnosis of cervical lymph node metastasis in papillary thyroid cancer: initial results. Eur Radiol 2024; 34:1292-1301. [PMID: 37589903 DOI: 10.1007/s00330-023-10109-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To explore the added value of arterial enhancement fraction (AEF) derived from dual-energy computed tomography CT (DECT) to conventional image features for diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC). METHODS A total of 273 cervical LNs (153 non-metastatic and 120 metastatic) were recruited from 92 patients with PTC. Qualitative image features of LNs were assessed. Both single-energy CT (SECT)-derived AEF (AEFS) and DECT-derived AEF (AEFD) were calculated. Correlation between AEFD and AEFS was determined using Pearson's correlation coefficient. Multivariate logistic regression analysis with the forward variable selection method was used to build three models (conventional features, conventional features + AEFS, and conventional features + AEFD). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses. RESULTS Abnormal enhancement, calcification, and cystic change were chosen to build model 1 and the model provided moderate diagnostic performance with an area under the ROC curve (AUC) of 0.675. Metastatic LNs demonstrated both significantly higher AEFD (1.14 vs 0.48; p < 0.001) and AEFS (1.08 vs 0.38; p < 0.001) than non-metastatic LNs. AEFD correlated well with AEFS (r = 0.802; p < 0.001), and exhibited comparable performance with AEFS (AUC, 0.867 vs 0.852; p = 0.628). Combining CT image features with AEFS (model 2) and AEFD (model 3) could significantly improve diagnostic performances (AUC, 0.865 vs 0.675; AUC, 0.883 vs 0.675; both p < 0.001). CONCLUSIONS AEFD correlated well with AEFS, and exhibited comparable performance with AEFS. Integrating qualitative CT image features with both AEFS and AEFD could further improve the ability in diagnosing cervical LN metastasis in PTC. CLINICAL RELEVANCE STATEMENT Arterial enhancement fraction (AEF) values, especially AEF derived from dual-energy computed tomography, can help to diagnose cervical lymph node metastasis in patients with papillary thyroid cancer, and complement conventional CT image features for improved clinical decision making. KEY POINTS • Metastatic cervical lymph nodes (LNs) demonstrated significantly higher arterial enhancement fraction (AEF) derived from dual-energy computed tomography (DECT) and single-energy CT (SECT)-derived AEF (AEFS) than non-metastatic LNs in patients with papillary thyroid cancer. • DECT-derived AEF (AEFD) correlated significantly with AEFS, and exhibited comparable performance with AEFS. • Integrating qualitative CT images features with both AEFS and AEFD could further improve the differential ability.
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Affiliation(s)
- Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - Yong-Kang Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - Di Geng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - Jing-Wei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - Xing-Biao Chen
- Section of Clinical Research, Philips Healthcare Ltd, Shanghai, China
| | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China.
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China.
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Chen H, Fang Y, Gu J, Sun P, Yang L, Pan F, Wu H, Ye T. Dual-Layer Spectral Detector Computed Tomography Quantitative Parameters: A Potential Tool for Lymph Node Activity Determination in Lymphoma Patients. Diagnostics (Basel) 2024; 14:149. [PMID: 38248026 PMCID: PMC10814325 DOI: 10.3390/diagnostics14020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Dual-energy CT has shown promising results in determining tumor characteristics and treatment effectiveness through spectral data by assessing normalized iodine concentration (nIC), normalized effective atomic number (nZeff), normalized electron density (nED), and extracellular volume (ECV). This study explores the value of quantitative parameters in contrast-enhanced dual-layer spectral detector CT (SDCT) as a potential tool for detecting lymph node activity in lymphoma patients. A retrospective analysis of 55 lymphoma patients with 289 lymph nodes, assessed through 18FDG-PET/CT and the Deauville five-point scale, revealed significantly higher values of nIC, nZeff, nED, and ECV in active lymph nodes compared to inactive ones (p < 0.001). Generalized linear mixed models showed statistically significant fixed-effect parameters for nIC, nZeff, and ECV (p < 0.05). The area under the receiver operating characteristic curve (AUROC) values of nIC, nZeff, and ECV reached 0.822, 0.845, and 0.811 for diagnosing lymph node activity. In conclusion, the use of g nIC, nZeff, and ECV as alternative imaging biomarkers to PET/CT for identifying lymph node activity in lymphoma holds potential as a reliable diagnostic tool that can guide treatment decisions.
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Affiliation(s)
- Hebing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Yuxiang Fang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Jin Gu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Peng Sun
- Clinical & Technical Support, Philips Healthcare, Floor 7, Building 2, World Profit Center, Beijing 100000, China;
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Hongying Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Tianhe Ye
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
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Virarkar MK, Mileto A, Vulasala SSR, Ananthakrishnan L, Bhosale P. Dual-Energy Computed Tomography Applications in the Genitourinary Tract. Radiol Clin North Am 2023; 61:1051-1068. [PMID: 37758356 DOI: 10.1016/j.rcl.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
By virtue of material differentiation capabilities afforded through dedicated postprocessing algorithms, dual-energy CT (DECT) has been shown to provide benefit in the evaluation of various diseases. In this article, we review the diagnostic use of DECT in the assessment of genitourinary diseases, with emphasis on its role in renal stone characterization, incidental renal and adrenal lesion characterization, retroperitoneal trauma, reduction of radiation, and contrast dose and cost-effectiveness potential. We also discuss future perspectives of the DECT scanning mode, including the use of novel contrast injection strategies and photon-counting detector computed tomography.
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Affiliation(s)
- Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Clinical Center, C90, 2nd Floor, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, Mayo Building West, 2nd Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sai Swarupa R Vulasala
- Department of radiology, University of Florida College of Medicine, Clinical Center, C90, 2nd Floor, 655 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Lakshmi Ananthakrishnan
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1479, Houston, TX 77030, USA
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Li S, Yuan L, Yue M, Xu Y, Liu S, Wang F, Liu X, Wang F, Deng J, Sun Q, Liu X, Xue C, Lu T, Zhang W, Zhou J. Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab. Cancer Imaging 2023; 23:30. [PMID: 36964617 PMCID: PMC10039512 DOI: 10.1186/s40644-023-00547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
PURPOSE Early evaluation of the efficacy of first-line chemotherapy combined with bevacizumab in patients with colorectal cancer liver metastasis (CRLM) remains challenging. This study used 2-month post-chemotherapy spectral computed tomography (CT) to predict the overall survival (OS) and response of CRLM patients with bevacizumab-containing therapy. METHOD This retrospective analysis was performed in 104 patients with pathologically confirmed CRLM between April 2017 and October 2021. Patients were treated with 5-fluorouracil, leucovorin, oxaliplatin or irinotecan with bevacizumab. Portal venous phase spectral CT was performed on the target liver lesion within 2 months of commencing chemotherapy to demonstrate the iodine concentration (IoD) of the target liver lesion. The patients were classified as responders (R +) or non-responders (R -) according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 at 6 months. Multivariate analysis was performed to determine the relationships of the spectral CT parameters, tumor markers, morphology of target lesions with OS and response. The differences in portal venous phase spectral CT parameters between the R + and R - groups were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive power of spectral CT parameters. RESULTS Of the 104 patients (mean age ± standard deviation: 57.73 years ± 12.56; 60 men) evaluated, 28 (26.9%) were classified as R + . Cox multivariate analysis identified the iodine concentration (hazard ratio [HR]: 1.238; 95% confidence interval [95% CI]: 1.089-1.408; P < 0.001), baseline tumor longest diameter (BLD) (HR: 1.022; 95% CI: 1.005-1.038, P = 0.010), higher baseline CEA (HR: 1.670; 95% CI: 1.016-2.745, P = 0.043), K-RAS mutation (HR: 2.027; 95% CI: 1.192-3.449; P = 0.009), and metachronous liver metastasis (HR: 1.877; 95% CI: 1.179-2.988; P = 0.008) as independent risk factors for patient OS. Logistic multivariate analysis identified the IoD (Odds Ratio [OR]: 2.243; 95% CI: 1.405-4.098; P = 0.002) and clinical N stage of the primary tumor (OR: 4.998; 95% CI: 1.210-25.345; P = 0.035) as independent predictor of R + . Using IoD cutoff values of 4.75 (100ug/cm3) the area under the ROC curve was 0.916, sensitivity and specificity were 80.3% and 96.4%, respectively. CONCLUSIONS Spectral CT IoD can predict the OS and response of patients with CRLM after 2 months of treatment with bevacizumab-containing therapy.
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Affiliation(s)
- Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Long Yuan
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Mengying Yue
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
| | - Yuan Xu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Suwei Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Feng Wang
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
| | - Xiaoqin Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
| | - Fengyan Wang
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Qiu Sun
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Ting Lu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Wenjuan Zhang
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.
- Second Clinical School, Lanzhou University, Lanzhou, China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Drljevic-Nielsen A, Mains JR, Thorup K, Andersen MB, Rasmussen F, Donskov F. Early reduction in spectral dual-layer detector CT parameters as favorable imaging biomarkers in patients with metastatic renal cell carcinoma. Eur Radiol 2022; 32:7323-7334. [PMID: 35511260 DOI: 10.1007/s00330-022-08793-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To associate the early change in DL-CT parameters and HU with survival outcomes and treatment response in patients with metastatic renal cell carcinoma (mRCC). METHODS DL-CT scans were performed at baseline and after 1 month of checkpoint immunotherapy or tyrosine kinase inhibitor therapy. Scans were reconstructed to conventional CT and DL-CT series, and used for assessment of HU, iodine concentration (IC), and the effective atomic number (Zeffective) in the combined RECISTv.1.1 target lesions. The relative changes, defined as ΔIC(combined), ΔZeffective(combined), and ΔHU(combined), were associated with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The reduction in the sum of diameters of target lesions ≥ 30% after 1 month was associated with OS, PFS, and ORR. RESULTS Overall, 115 and 104 mRCC patients were included at baseline and 1 month, respectively. Median IC(combined) decreased from 2.3 to 1.2 mg/ml (p < 0.001), Zeffective(combined) from 8.5 to 8.0 (p < 0.001), and HU(combined) from 86.0 to 64.00 HU (p < 0.001). After multivariate adjustments, the largest reductions in ΔIC(combined) (HR 0.47, 95% CI: 0.24-0.94, p = 0.033) and ΔZeffective(combined) (HR = 0.43, 95% CI: 0.21-0.87, p = 0.019) were associated with favorable OS; the largest reduction in ΔZeffective(combined) was associated with higher response (OR = 2.79, 95% CI: 1.12-6.94, p = 0.027). The largest reduction in ΔHU(combined) was solely associated with OS in univariate analysis (HR 0.45, 95% CI: 0.23-0.91). Reduction in SOD ≥ 30% at 1 month was not associated with outcomes (p > 0.075). CONCLUSIONS Early reductions at 1 month in ΔIC(combined) and ΔZeffective(combined) are associated with favorable outcomes in patients with mRCC. This information may reassure physicians and patients about treatment strategy. KEY POINTS • Early reductions following 1 month of therapy in spectral dual-layer detector CT-derived iodine concentration and the effective atomic number (Zeffective) are independent biomarkers for better overall survival in patients with metastatic renal cell carcinoma. • Early reduction after 1 month of therapy in the effective atomic number (Zeffective) is an independent imaging biomarker for better treatment response metastatic renal cell carcinoma.
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Affiliation(s)
- Aska Drljevic-Nielsen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.
| | - Jill R Mains
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Kennet Thorup
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Michael Brun Andersen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
- Department of Radiology, Herlev/Gentofte, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
- Department of Oncology, University Hospital of Southern Denmark, Esbjerg, Denmark
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Ersahin D, Rasla J, Singh A. Dual energy CT applications in oncological imaging. Semin Ultrasound CT MR 2022; 43:344-351. [PMID: 35738819 DOI: 10.1053/j.sult.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer is the second leading cause of death in the United States, killing more than 600.000 people each year.1 Despite several screening programs available, cancer diagnosis is often made incidentally during imaging studies performed for other reasons. Once the diagnosis is made, treatment assessment and surveillance of these patients heavily rely on radiological tools. Computed tomography (CT) in particular is one of the most commonly ordered modalities due to wide availability even in the most remote locations, and fast results. However, conventional CT often cannot definitively characterize a neoplastic lesion unless it was tailored toward answering a specific question. Furthermore, characterizing small lesions can be difficult with CT. An innovative technique called dual-energy CT (DECT) offers solutions to some of the challenges of conventional CT in oncological imaging.
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Zhou Y, Geng D, Su GY, Chen XB, Si Y, Shen MP, Xu XQ, Wu FY. Extracellular Volume Fraction Derived From Dual-Layer Spectral Detector Computed Tomography for Diagnosing Cervical Lymph Nodes Metastasis in Patients With Papillary Thyroid Cancer: A Preliminary Study. Front Oncol 2022; 12:851244. [PMID: 35756662 PMCID: PMC9213667 DOI: 10.3389/fonc.2022.851244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The current study evaluates the performance of dual-energy computed tomography (DECT) derived extracellular volume (ECV) fraction based on dual-layer spectral detector CT for diagnosing cervical lymph nodes (LNs) metastasis from papillary thyroid cancer (PTC) and compares it with the value of ECV derived from conventional single-energy CT (SECT). Methods One hundred and fifty-seven cervical LNs (81 non-metastatic and 76 metastatic) were recruited. Among them, 59 cervical LNs (27 non-metastatic and 32 metastatic) were affected by cervical root artifact on the contrast-enhanced CT images in the arterial phase. Both the SECT-derived ECV fraction (ECVS) and the DECT-derived ECV fraction (ECVD) were calculated. A Pearson correlation coefficient and a Bland–Altman analysis were performed to evaluate the correlations between ECVD and ECVS. Receiver operator characteristic curves analysis and the Delong method were performed to assess and compare the diagnostic performance. Results ECVD correlated significantly with ECVS (r = 0.925; p <0.001) with a small bias (−0.6). Metastatic LNs showed significantly higher ECVD (42.41% vs 22.53%, p <0.001) and ECVS (39.18% vs 25.45%, p <0.001) than non-metastatic LNs. By setting an ECVD of 36.45% as the cut-off value, optimal diagnostic performance could be achieved (AUC = 0.813), which was comparable with that of ECVS (cut-off value = 34.99%; AUC = 0.793) (p = 0.265). For LNs affected by cervical root artifact, ECVD also showed favorable efficiency (AUC = 0.756), which was also comparable with that of ECVS (AUC = 0.716) (p = 0.244). Conclusions ECVD showed a significant correlation with ECVS. Compared with ECVS, ECVD showed comparable performance in diagnosing metastatic cervical LNs in PTC patients, even though the LNs were affected by cervical root artifacts on arterial phase CT.
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Affiliation(s)
- Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Geng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing-Biao Chen
- Section of Clinical Research, Philips Healthcare Ltd, Shanghai, China
| | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Gehling K, Mokry T, Do TD, Giesel FL, Dietrich S, Haberkorn U, Kauczor HU, Weber TF. Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity. ROFO-FORTSCHR RONTG 2022; 194:747-754. [PMID: 35211927 DOI: 10.1055/a-1735-3477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In patients with malignant lymphoma, disease activity is recommended to be assessed by FDG-PET/CT and the Deauville five-point scale (5-PS). The purpose of this study was to explore the potential of iodine concentration measured in contrast-enhanced dual-layer spectral detector CT (SDCT) as an alternative surrogate parameter for lymphoma disease activity by investigating its correlation with maximum standardized uptake values (SUVmax) and 5-PS. MATERIALS AND METHODS 25 patients were retrospectively analyzed. Contrast-enhanced SDCT and FDG-PET/CT were performed in the same treatment interval within at most 3 months. CT attenuation values (AV), absolute iodine concentrations (aIC), and normalized iodine concentrations (nIC) of lymphoma lesions were correlated with SUVmax using Spearman's rank correlation coefficient. The performance of aIC and nIC to detect lymphoma activity (defined as 5-PS > 3) was determined using ROC curves. RESULTS 60 lesions were analyzed, and 31 lesions were considered active. AV, aIC, and nIC all correlated significantly with SUVmax. The strongest correlation (Spearman ρ = 0.71; p < 0.001) and highest area under the ROC curve (AUROC) for detecting lymphoma activity were observed for nIC normalized to inferior vena cava enhancement (AUROC = 0.866). The latter provided sensitivity, specificity, and diagnostic accuracy of 87 %, 75 %, and 80 %, respectively, at a threshold of 0.20. ROC analysis for AV (AUROC = 0.834) and aIC (AUROC = 0.853) yielded similar results. CONCLUSION In malignant lymphomas, there is a significant correlation between metabolic activity as assessed by FDG-PET/CT and iodine concentration as assessed by SDCT. Iodine concentration shows promising diagnostic performance for detecting lymphoma activity and may represent a potential imaging biomarker. KEY POINTS · Iodine concentration correlates significantly with SUVmax in lymphoma patients. · Iodine concentration may represent a potential imaging biomarker for detecting lymphoma activity. · Normalization of iodine concentration improves diagnostic performance of iodine concentration. CITATION FORMAT · Gehling K, Mokry T, Do TD et al. Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1735-3477.
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Affiliation(s)
- Kim Gehling
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,German Cancer Research Center (DKFZ) Division of Radiology, Heidelberg, Germany
| | - Thuy Duong Do
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany.,Department of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Sascha Dietrich
- Clinic for Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Hoover KB, Starks AO, Robila V, Riddle DL. Quantitative contrast enhanced dual energy CT to predict avascular necrosis: a feasibility study of proximal humerus fractures. BMC Med Imaging 2021; 21:191. [PMID: 34895190 PMCID: PMC8666015 DOI: 10.1186/s12880-021-00717-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/25/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Avascular necrosis is a delayed complication of proximal humerus fractures that increases the likelihood of poor clinical outcomes. CT scans are routinely performed to guide proximal humerus fracture management. We hypothesized iodine concentration on post-contrast dual energy CT scans identifies subjects who develop avascular necrosis and ischemia due to compromised blood flow. MATERIALS AND METHODS 55 patients with proximal humerus fractures enrolled between 2014 and 2017 underwent clinical, radiographic and contrast enhanced dual energy CT assessment. Iodine densities of the humeral head and the glenoid (control) were measured on CT. Subjects managed with open reduction internal fixation or conservatively (non-surgical) were followed for up to two years for radiographic evidence of avascular necrosis. Arthroplasty subjects underwent histopathologic evaluation for ischemia of the resected humeral head. RESULTS 17 of 55 subjects (30.9%) were treated conservatively, 21 (38.2%) underwent open reduction internal fixation and 17 of 55 (30.9%) underwent arthroplasty. Of the 38 subjects treated conservatively or with ORIF, 20 (52.6%) completed 12 months of follow up and 14 (36.8%) 24 months of follow up. At 12 months follow up, two of 20 subjects (10%) and at 24 months 3 of 14 subjects (21.4%) developed avascular necrosis. At 12 months, the mean humerus/glenoid iodine ratio was 1.05 (standard deviation 0.24) in subjects with AVN compared to 0.91 (0.24) in those who did not. At 24 months, subjects with avascular necrosis had a mean humerus/glenoid iodine concentration ratio of 1.06 (0.17) compared to 0.924 (0.21) in those who did not. Of 17 arthroplasty subjects, 2 had severe ischemia and an iodine ratio of 1.08 (0.30); 5 had focal ischemia and a ratio of 1.00 (0.36); and 8 no ischemia and a ratio of 0.83 (0.08). CONCLUSIONS Quantifying iodine using dual energy CT in subjects with proximal humerus fractures is technically feasible. Preliminary data suggest higher humeral head iodine concentration may increase risk of avascular necrosis; however, future studies must enroll and follow enough subjects managed with open reduction internal fixation or conservatively for two or more years to provide statistically significant results. Trial Registrations NCT02170545 registered June 23, 2014, ClinicalTrials.gov.
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Affiliation(s)
- Kevin B. Hoover
- Mink Radiology, Cedars-Sinai Health System, 8670 Wilshire Blvd Suite 101, Beverly Hills, CA 90211 USA
| | - Alexandria O. Starks
- Orthopedic Associates of Lancaster, 170 North Pointe Blvd, Lancaster, PA 17601 USA
| | - Valentina Robila
- Department of Pathology, Virginia Commonwealth University/VCU Health, 1101 East Marshall St, P.O. Box 980662, Richmond, VA 23298-0662 USA
| | - Daniel L. Riddle
- Otto D. Payton Professor of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Room B-100, West Hospital, 1200 East Broad Street, Richmond, VA 23298 USA
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A Method for Reducing Variability Across Dual-Energy CT Manufacturers in Quantification of Low Iodine Content Levels. AJR Am J Roentgenol 2021; 218:746-755. [PMID: 34668387 DOI: 10.2214/ajr.21.26714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Clinical use of the dual-energy CT (DECT) iodine quantification technique is hindered by between-platform (i.e., across different manufacturers) variability in iodine concentration (IC), particularly at low iodine levels. Objective: To develop in an anthropomorphic phantom a method for reducing between-platform variability in quantification of low iodine content levels using DECT and to evaluate the method's performance in patients undergoing serial clinical DECT examinations on different platforms. Methods: An anthropomorphic phantom in three body sizes, incorporating varied lesion types and scanning conditions, was imaged with three distinct DECT implementations from different manufacturers at varying radiation exposures. A cross-platform iodine quantification model for correcting between-platform variability at low iodine content was developed using the phantom data. The model was tested in a retrospective series of 30 patients (20 men, 10 women; median age, 62 years) who each underwent three serial contrast-enhanced DECT examinations of the abdomen and pelvis (90 scans total) for routine oncology surveillance, using the same three DECT platforms as in the phantom. Estimated accuracy of phantom IC values was summarized using rootmean-squared error (RMSE) relative to known IC. Between-platform variability in patients was summarized using root-mean-square-deviation (RMSD). RMSE and RMSD were compared between platform-based IC (ICPB) and cross-platform IC (ICCP). ICPB was normalized to aorta and portal vein. Results: In the phantom study, mean RMSE of ICPB across platforms and other experimental conditions was 0.65 ± 0.18 mgI/mL compared with 0.40 ± 0.075 mgI/mL for ICCP (38% decrease in mean RMSE; P<.05). Intra-patient between-platform variability across serial DECT examinations was lower for ICPB than ICCP (RMSD: 97% vs 88%; P<.001). Between-platform variability was not reduced by normalization of ICPB to aorta (RMSD: 97% vs 101%; P=.12) or portal vein (RMSD: 97% vs 97%; P=.81). Conclusion: The developed cross-platform method significantly decreased between-platform variability occurring at low iodine content with platform-based DECT iodine quantification. Clinical Impact: With further validation, the cross-platform method, which has been implemented as a webbased app, may expand clinical use of DECT iodine quantification, yielding meaningful IC values that reflect tissue biologic viability or treatment response in patients who undergo serial examinations on different platforms.
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Dane B, Sarkar S, Nazarian M, Galitzer H, O'Donnell T, Remzi F, Chang S, Megibow A. Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis. Radiology 2021; 301:144-151. [PMID: 34342502 DOI: 10.1148/radiol.2021204405] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Dual-energy CT enterography (DECTE) has been shown to be useful in characterizing Crohn disease activity compared with clinical markers of inflammation but, to the knowledge of the authors, comparison has not been made with histopathologic specimens. Purpose To compare mucosal iodine density obtained at DECTE from Crohn disease-affected bowel with histopathologic specimens from surgically resected ileocolectomy bowel segments or terminal ileum colonoscopic biopsies in the same patients. Materials and Methods This was a retrospective study. Bowel segments in adults with Crohn disease who underwent DECTE from January 2017 to April 2019 within 90 days of ileocolectomy or colonoscopy were retrospectively evaluated with prototype software allowing the semiautomatic determination of inner hyperdense bowel wall (mucosal) mean iodine density, normalized to the aorta. Mean normalized iodine density and clinical activity indexes (Crohn Disease Activity Index [CDAI] and Harvey-Bradshaw Index [HBI]) were compared with histologic active inflammation grades by using two-tailed t tests. Receiver operating characteristic curves were generated for mean normalized iodine density, CDAI, and HBI to determine sensitivity, specificity, and accuracy. A P value less than .05 was considered to indicate statistical significance. Results The following 16 patients were evaluated (mean age, 41 years ± 14 [standard deviation]): 10 patients (five men, five women; mean age, 41 years ± 15) with 19 surgical resection specimens and six patients with terminal ileum colonoscopic mucosal biopsies (four men, two women; mean age, 43 years ± 14). Mean normalized iodine density was 16.5% ± 5.7 for bowel segments with no active inflammation (n = 8) and 34.7% ± 9.7 for segments with any active inflammation (n = 17; P < .001). A 20% mean normalized iodine density threshold had sensitivity, specificity, and accuracy of 17 of 17 (100%; 95% CI: 80.5, 100), six of eight (75%; 95% CI: 35, 97), and 23 of 25 (92%; 95% CI: 74, 99), respectively, for active inflammation. Clinical indexes were similar for patients with and without active inflammation at histopathologic analysis (CDAI score, 261 vs 251, respectively [P = .77]; HBI score, 7.8 vs 6.4, respectively [P = .36]). Conclusion Iodine density from dual-energy CT enterography may be used as a radiologic marker of Crohn disease activity as correlated with histopathologic analysis. © RSNA, 2021 See also the editorial by Ohliger in this issue.
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Affiliation(s)
- Bari Dane
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Suparna Sarkar
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Matthew Nazarian
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Hayley Galitzer
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Thomas O'Donnell
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Feza Remzi
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Shannon Chang
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Alec Megibow
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
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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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Artificial Intelligence and Machine Learning in Radiology: Current State and Considerations for Routine Clinical Implementation. Invest Radiol 2021; 55:619-627. [PMID: 32776769 DOI: 10.1097/rli.0000000000000673] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although artificial intelligence (AI) has been a focus of medical research for decades, in the last decade, the field of radiology has seen tremendous innovation and also public focus due to development and application of machine-learning techniques to develop new algorithms. Interestingly, this innovation is driven simultaneously by academia, existing global medical device vendors, and-fueled by venture capital-recently founded startups. Radiologists find themselves once again in the position to lead this innovation to improve clinical workflows and ultimately patient outcome. However, although the end of today's radiologists' profession has been proclaimed multiple times, routine clinical application of such AI algorithms in 2020 remains rare. The goal of this review article is to describe in detail the relevance of appropriate imaging data as a bottleneck for innovation, provide insights into the many obstacles for technical implementation, and give additional perspectives to radiologists who often view AI solely from their clinical role. As regulatory approval processes for such medical devices are currently under public discussion and the relevance of imaging data is transforming, radiologists need to establish themselves as the leading gatekeepers for evolution of their field and be aware of the many stakeholders and sometimes conflicting interests.
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Crohn Disease Prognostication With Semiautomatic Dual-Energy Computed Tomography Enterography-Derived Iodine Density. J Comput Assist Tomogr 2021; 45:171-176. [PMID: 33661155 DOI: 10.1097/rct.0000000000001135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine if dual-energy computed tomography enterography (DECTE)-obtained iodine density can predict medical management change or surgery in Crohn disease patients. METHODS The most active-appearing bowel segment on DECTE in 21 Crohn disease patients was retrospectively interrogated with prototype software determining the percentage of bowel wall (I) in specified ranges. Patients were categorized into 3 groups after DECTE: (1) no management change, (2) outpatient medication change, and (3) inpatient admission or surgery. Crohn's disease activity index was calculated. Group 3's percentage iodine density of >3 mg/mL and Crohn's disease activity index were compared with group 1/2. Crohn's disease activity index and percentage iodine density of >2 mg/mL were compared for groups 2/3 versus group 1 patients. RESULTS There were 5 group 1, 6 group 2, and 10 group 3 patients. Group 3 patients had higher frequency of iodine density >3 mg/mL (27%) compared with groups 1/2 patients (12.6%) (P < 0.05). Crohn's disease activity index was similar (P = 0.98). Groups 2/3 patients had 60.5% iodine density of >2 mg/mL, whereas group 1 patients had 31.7% iodine density of >2 mg/mL (P < 0.05). Crohn's disease activity index was similar (P = 0.12). CONCLUSIONS Iodine density from DECTE may predict medical or surgical Crohn disease management.
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Lennartz S, Parakh A, Cao J, Zopfs D, Große Hokamp N, Kambadakone A. Inter-scan and inter-scanner variation of quantitative dual-energy CT: evaluation with three different scanner types. Eur Radiol 2021; 31:4438-4451. [PMID: 33443600 DOI: 10.1007/s00330-020-07611-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To investigate inter-scan and inter-scanner variation of iodine concentration (IC) and attenuation in virtual monoenergetic images at 65 keV (HU65keV) in patients with repeated abdominal examinations on dual-source (dsDECT), rapid kV switching (rsDECT), and dual-layer detector DECT (dlDECT). METHODS We retrospectively included 131 patients who underwent two abdominal DECT examinations on the same scanner (dsDECT: n = 46, rsDECT: n = 45, dlDECT: n = 40). IC and HU65keV were measured by placing regions of interest in the liver, spleen, kidneys, aorta, portal vein, and inferior vena cava. Overall IC and HU65keV for each scanner, their inter-scan differences and proportional variation were calculated and compared between scanner types. RESULTS The three scanner-specific cohorts showed similar weight, body diameter, age, sex, and contrast media injection parameters as well as inter-scan differences hereof (p range: 0.23-0.99). Absolute inter-scan differences of HU65keV and IC were comparable between scanners (p range: 0.08-1.0). Overall inter-scan variation was significantly higher in IC than HU65keV (p < 0.05). For the liver, rsDECT showed significantly lower inter-scan variation of IC compared to dsDECT/dlDECT (p = 0.005/0.01), while for the spleen, this difference was only significant compared to dsDECT (p = 0.015). Normalizing IC of the liver to the portal vein and of the spleen to the aorta did not significantly reduce inter-scan variation (p = 0.97 and 0.50). CONCLUSIONS Iodine measurements across different DECT scanners show inter-scan variation which is higher compared to variation of attenuation values. Inter-scanner differences in longitudinal variation and overall iodine concentration depend on the scanner pairs and organs assessed and should be acknowledged in clinical and scientific DECT applications. KEY POINTS • All scanner types showed comparable inter-scan variation of attenuation, while for iodine, the rapid kV switching DECT showed lower variability in the liver and spleen. • Iodine concentration showed higher inter-scan variation than attenuation measurements; normalization to vessels did not significantly improve inter-scan reproducibility of iodine concentration in parenchymal organs. • Differences between the three scanner types regarding overall iodine concentration and attenuation obtained from both timepoints were within the range of average intra-patient, inter-scan differences for most assessed organs and vessels.
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Affiliation(s)
- Simon Lennartz
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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18
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Thiravit S, Brunnquell C, Cai LM, Flemon M, Mileto A. Use of dual-energy CT for renal mass assessment. Eur Radiol 2020; 31:3721-3733. [PMID: 33210200 DOI: 10.1007/s00330-020-07426-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
Although dual-energy CT (DECT) may prove useful in a variety of abdominal imaging tasks, renal mass evaluation represents the area where this technology can be most impactful in abdominal imaging compared to routinely performed contrast-enhanced-only single-energy CT exams. DECT post-processing techniques, such as creation of virtual unenhanced and iodine density images, can help in the characterization of incidentally discovered renal masses that would otherwise remain indeterminate based on post-contrast imaging only. The purpose of this article is to review the use of DECT for renal mass assessment, including its benefits and existing limitations. KEY POINTS: • If DECT is selected as the scanning mode for most common abdominal protocols, many incidentally found renal masses can be fully triaged within the same exam. • Virtual unenhanced and iodine density DECT images can provide additional information when renal masses are discovered in the post-contrast-only setting. • For renal mass evaluation, virtual unenhanced and iodine density DECT images should be interpreted side-by-side to troubleshoot pitfalls that can potentially lead to erroneous interpretation.
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Affiliation(s)
- Shanigarn Thiravit
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.,Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Christina Brunnquell
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Larry M Cai
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Mena Flemon
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Achille Mileto
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.
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19
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Novel Dual-Energy Computed Tomography Enterography Iodine Density Maps Provide Unique Depiction of Crohn Disease Activity. J Comput Assist Tomogr 2020; 44:772-779. [PMID: 32936579 DOI: 10.1097/rct.0000000000001009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To create a map of iodine densities within affected segments of small-bowel Crohn disease (CD) derived from contrast-enhanced dual-energy computed tomography enterography (DECTE) studies. METHODS Twenty CD patients imaged with intravenous contrast-enhanced DECTE between June 2016 and December 2017 were retrospectively identified. Ten patients without clinical evidence of CD and 8 normal-appearing jejunal segments in CD patients were controls. Using prototype software, 8 manual contours were drawn along the mucosa of affected segments. Relatively normal-appearing bowel was included at the edges. These contours served as a basis for iodine density calculation and 3-dimensional iodine density map rendering. Color-coded iodine densities allowed detection and quantification of the most and least dense portion of each segment and also permitted relative comparison between segments. RESULTS The average iodine density per CD involved segment ranged 1.0 to 3.3 mg/mL, which differed significantly from normal ileum (P < 0.0001) and normal-appearing jejunum in patients with CD (P = 0.0009). Standard deviations ranged from 0.8 to 1.7 mg/mL, which differed significantly from normal ileum (P = 0.0039) and normal-appearing jejunum in patients with CD (P = 0.0056). The amplitude of the power spectrum ranged from 0.66 to 3.3 demonstrating patches of iodine rather than uniform distribution. This differed significantly from normal ileum (P = 0.0005) and normal-appearing jejunum in patients with CD (P = 0.0004). CONCLUSIONS Heterogeneous CD activity and distribution can be displayed as iodine density maps created from DECTE.
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21
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Takagi S, Yamazaki H, Izumi Y, Hanazono K, Hoshino Y, Hosoya K. Assessment of tumor enhancement by contrast-enhanced CT in solid tumor-bearing dogs treated with toceranib phosphate. Vet Radiol Ultrasound 2020; 61:427-434. [PMID: 32162400 DOI: 10.1111/vru.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
In humans, contrast-enhanced CT (CECT) has been used to indirectly assess the antiangiogenic effects demonstrated by a number of tyrosine kinase inhibitors. This retrospective, cross-sectional study aimed to quantitatively evaluate changes in tumor contrast-enhancement (CE) using CECT in solid tumor-bearing dogs treated with toceranib phosphate (TOC). The changes in tumor size and CE were measured using the Hounsfield unit (HU) scale in CECT images before TOC treatment and between 30 and 90 days after initiating the treatment. Among the 36 dogs treated with TOC, eight (22.2%) showed a partial response, 22 (61.1%) showed stable disease, and six (16.7%) showed progressive disease. Thirty (83.3%) of 36 dogs showed a decrease in tumor CE (median: -20%, range: -1% to -48%) after initiating the treatment. The results indicated that tumor CE and size changes were observed in tumor-bearing dogs that were treated with TOC; however, tumor CE was not significantly correlated with tumor regression. We suggest that these results could serve as pilot data to evaluate the antiangiogenic effects associated with TOC.
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Affiliation(s)
- Satoshi Takagi
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, Azabu University, Fuchinobe, Chuoku, Sagamihara, Kanagawa, Japan.,Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Hiroki Yamazaki
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Rinku-oraikita, Izumisano, Osaka, Japan
| | - Yusuke Izumi
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Kiwamu Hanazono
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan.,Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Bunkyodai-Midorimachi, Ebetsu, Hokkaido, Japan
| | - Yuki Hoshino
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan.,Division of Small Animal Surgery, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Ueda, Morioka, Iwate, Japan
| | - Kenji Hosoya
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
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22
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Crohnʼs Disease Activity Quantified by Iodine Density Obtained From Dual-Energy Computed Tomography Enterography. J Comput Assist Tomogr 2020; 44:242-247. [DOI: 10.1097/rct.0000000000000986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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23
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Marcon J, Graser A, Horst D, Casuscelli J, Spek A, Stief CG, Reiser MF, Rübenthaler J, Buchner A, Staehler M. Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density. Eur Radiol 2019; 30:1-10. [DOI: 10.1007/s00330-019-06298-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/12/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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24
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Thomas R, Qin L, Alessandrino F, Sahu SP, Guerra PJ, Krajewski KM, Shinagare A. A review of the principles of texture analysis and its role in imaging of genitourinary neoplasms. Abdom Radiol (NY) 2019; 44:2501-2510. [PMID: 30448920 DOI: 10.1007/s00261-018-1832-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in the management of genitourinary neoplasms have resulted in a trend towards providing patients with personalized care. Texture analysis of medical images, is one of the tools that is being explored to provide information such as detection and characterization of tumors, determining their aggressiveness including grade and metastatic potential and for prediction of survival rates and risk of recurrence. In this article we review the basic principles of texture analysis and then detail its current role in imaging of individual neoplasms of the genitourinary system.
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25
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Lennartz S, Abdullayev N, Zopfs D, Borggrefe J, Neuhaus VF, Persigehl T, Haneder S, Große Hokamp N. Intra-individual consistency of spectral detector CT-enabled iodine quantification of the vascular and renal blood pool. Eur Radiol 2019; 29:6581-6590. [DOI: 10.1007/s00330-019-06266-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023]
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26
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Systematic Review and Meta-Analysis Investigating the Diagnostic Yield of Dual-Energy CT for Renal Mass Assessment. AJR Am J Roentgenol 2019; 212:1044-1053. [PMID: 30835518 DOI: 10.2214/ajr.18.20625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. The objective of our study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of dual-energy CT (DECT) for renal mass evaluation. MATERIALS AND METHODS. In March 2018, we searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Web of Science databases. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled estimates for sensitivity, specificity, and diagnostic odds ratios were calculated for DECT-based virtual monochromatic imaging (VMI) and iodine quantification techniques as well as for conventional attenuation measurements from renal mass CT protocols. I2 was used to evaluate heterogeneity. The methodologic quality of the included studies and potential bias were assessed using items from the Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2). RESULTS. Of the 1043 articles initially identified, 13 were selected for inclusion (969 patients, 1193 renal masses). Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for VMI were 87% (95% CI, 80-92%; I2, 92.0%), 93% (95% CI, 90-96%; I2, 18.0%), and 183.4 (95% CI, 30.7-1093.4; I2, 61.6%), respectively. Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for iodine quantification were 99% (95% CI, 97-100%; I2, 17.6%), 91% (95% CI, 89-94%; I2, 84.2%), and 511.5 (95% CI, 217-1201; I2, 0%). No significant differences in AUCs were found when comparing iodine quantification to conventional attenuation measurements (p = 0.79). CONCLUSION. DECT yields high accuracy for renal mass evaluation. Determination of iodine content with the iodine quantification technique shows diagnostic accuracy similar to conventional attenuation measurements from renal mass CT protocols. The iodine quantification technique may be used to characterize incidental renal masses when a dedicated renal mass protocol is not available.
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27
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Fan AC, Sundaram V, Kino A, Schmiedeskamp H, Metzner TJ, Kamaya A. Early Changes in CT Perfusion Parameters: Primary Renal Carcinoma Versus Metastases After Treatment with Targeted Therapy. Cancers (Basel) 2019; 11:cancers11050608. [PMID: 31052289 PMCID: PMC6562747 DOI: 10.3390/cancers11050608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/28/2022] Open
Abstract
Computed tomography (CT) perfusion is a novel imaging method to determine tumor perfusion using a low-dose CT technique to measure iodine concentration at multiple time points. We determined if early changes in perfusion differ between primary renal tumors and metastatic tumor sites in patients with renal cell carcinoma (RCC) receiving targeted anti-angiogenic therapy. A total of 10 patients with advanced RCC underwent a CT perfusion scan at treatment baseline and at one week after initiating treatment. Perfusion measurements included blood volume (BV), blood flow (BF), and flow extraction product (FEP) in a total of 13 lesions (six primary RCC tumors, seven RCC metastases). Changes between baseline and week 1 were compared between tumor locations: primary kidney tumors vs metastases. Metastatic lesions had a greater decrease in BF (average BF difference ± standard deviation (SD): −75.0 mL/100 mL/min ± 81) compared to primary kidney masses (−25.5 mL/100 mL/min ± 35). Metastatic tumors had a wider variation of change in BF, BV and FEP measures compared to primary renal tumors. Tumor diameters showed little change after one week, but early perfusion changes are evident, especially in metastatic lesions compared to primary lesions. Future studies are needed to determine if these changes can predict which patients are benefiting from targeted therapy.
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Affiliation(s)
- Alice C Fan
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Thomas J Metzner
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Aya Kamaya
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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28
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Carotti M, Salaffi F, Beci G, Giovagnoni A. The application of dual-energy computed tomography in the diagnosis of musculoskeletal disorders: a review of current concepts and applications. Radiol Med 2019; 124:1175-1183. [DOI: 10.1007/s11547-019-01015-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
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Deniffel D, Sauter A, Dangelmaier J, Fingerle A, Rummeny EJ, Pfeiffer D. Differentiating intrapulmonary metastases from different primary tumors via quantitative dual-energy CT based iodine concentration and conventional CT attenuation. Eur J Radiol 2019; 111:6-13. [DOI: 10.1016/j.ejrad.2018.12.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022]
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30
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Nagayama Y, Nakaura T, Oda S, Taguchi N, Utsunomiya D, Funama Y, Kidoh M, Namimoto T, Sakabe D, Hatemura M, Yamashita Y. Dual-layer detector CT of chest, abdomen, and pelvis with a one-third iodine dose: image quality, radiation dose, and optimal monoenergetic settings. Clin Radiol 2018; 73:1058.e21-1058.e29. [DOI: 10.1016/j.crad.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/24/2018] [Indexed: 12/12/2022]
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31
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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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32
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Frellesen C, Azadegan M, Martin SS, Otani K, D'Angelo T, Booz C, Eichler K, Panahi B, Kaup M, Bauer RW, Vogl TJ, Wichmann JL. Dual-Energy Computed Tomography–Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures. Invest Radiol 2018; 53:409-416. [DOI: 10.1097/rli.0000000000000458] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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33
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Martin SS, Czwikla R, Wichmann JL, Albrecht MH, Lenga L, Savage RH, Arendt C, Hammerstingl R, Vogl TJ, Kaltenbach B. Dual-energy CT-based iodine quantification to differentiate abdominal malignant lymphoma from lymph node metastasis. Eur J Radiol 2018; 105:255-260. [PMID: 30017291 DOI: 10.1016/j.ejrad.2018.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/10/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the value of dual-energy computed tomography (DECT)-derived iodine and fat quantification in differentiating malignant abdominal lymphoma from lymph node metastasis. MATERIALS AND METHODS In this retrospective study, 59 patients (39 men; mean age, 62.7 years) with histopathologically-confirmed diagnosis of either malignant lymphoma or lymph node metastasis were included. For each lesion, contrast-enhanced attenuation, as well as DECT-derived iodine density and fat fraction measurements were recorded. Mean attenuation and material density values were compared between malignant lymphomas and lymph node metastases. The receiver operating characteristic (ROC) curve analysis was adopted to estimate the optimal threshold for discriminating between both entities. A control group (n = 60) was analyzed for comparison of attenuation and material density values of normal abdominal lymph nodes. RESULTS Assessment of DECT-derived iodine density and fat fraction values revealed significant differences between lymph node metastases (1.7 ± 0.4 mg/ml and 15.5 ± 7.3%) and malignant lymphomas (2.5 ± 0.5 mg/ml and 26.7 ± 12.2%) as well as normal lymph nodes (2.4 ± 0.8 mg/ml and 24.1 ± 10.8%) (P ≤ 0.013). An iodine concentration of 2.0 mg/ml represented the optimal threshold to discriminate between lymphoma and lymph node metastasis (sensitivity, 87%; specificity, 89%). Moreover, a significant correlation was found between iodine concentration and fat fraction for both lymphomas and lymph node metastases (P = 0.001). CONCLUSION DECT enables characterization of abdominal masses as derived iodine and fat fraction values differ significantly between malignant abdominal lymphomas and lymph node metastases.
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Affiliation(s)
- Simon S Martin
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rouben Czwikla
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Julian L Wichmann
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Moritz H Albrecht
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lukas Lenga
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Rock H Savage
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Christophe Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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Vernuccio F, Meyer M, Mileto A, Marin D. Use of Dual-Energy Computed Tomography for Evaluation of Genitourinary Diseases. Urol Clin North Am 2018; 45:297-310. [PMID: 30031456 DOI: 10.1016/j.ucl.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Since its clinical inception a decade ago, dual-energy computed tomography has expanded the array of computed tomography imaging tools available to the practicing abdominal radiologist. Of note, diagnostic solutions for imaging-based evaluation of genitourinary diseases, foremost kidney calculi and renal tumors characterization, represent the apogee applications of dual-energy computed tomography in abdominal imaging. This article reviews clinical applications of dual-energy computed tomography for the assessment of genitourinary diseases.
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Affiliation(s)
- Federica Vernuccio
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC 27710, USA; Section of Radiology -Di.Bi.Med., University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Mathias Meyer
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC 27710, USA
| | - Achille Mileto
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC 27710, USA.
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35
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Yang L, Luo D, Yi J, Li L, Zhao Y, Lin M, Guo W, Hu L, Zhou C. Therapy Effects of Advanced Hypopharyngeal and Laryngeal Squamous Cell Carcinoma: Evaluated using Dual-Energy CT Quantitative Parameters. Sci Rep 2018; 8:9064. [PMID: 29899458 PMCID: PMC5998143 DOI: 10.1038/s41598-018-27341-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/16/2018] [Indexed: 12/11/2022] Open
Abstract
The accurate evaluation of the therapeutic effects of advanced laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) remains challenging. In this study, we determined the value of quantitative parameters derived from dual-energy computed tomography (DECT) for predicting the therapeutic effects of advanced LHSCC and to provide valuable evidence for early judgement of the tumour's response to therapy in clinical practice. We prospectively analysed 41 patients with pathologically confirmed LHSCC. All patients received a DECT scan before therapy. Nineteen of 41 patients showed complete remission (CR), and 22 showed non-complete remission (NCR). The mean of the slope of spectral Hounsfield unit curve (λHU), standardized iodine concentration and effective atomic number in the CR group were significantly lower than the NCR group (P < 0.05). There were no significant differences for T stage, treatment modality and standardized water concentration between two groups (P > 0.05). The best predictor of CR effect was λHU. The 2-year cumulative recurrence rate of patients with higher λHU values was significantly higher than that of patients with lower λHU values (P < 0.05), while the 2-year survival rate of those patients was not significantly different (P > 0.05). DECT could easily identify CR patients and potentially help to choose the appropriate treatment regimen for advanced LHSCC.
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Affiliation(s)
- Liang Yang
- Department of Diagnostic Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Dehong Luo
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Junlin Yi
- Department of Radiotherapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yanfeng Zhao
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Meng Lin
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Guo
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lei Hu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chunwu Zhou
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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36
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Kandathil A, Kay F, Batra K, Saboo SS, Rajiah P. Advances in Computed Tomography in Thoracic Imaging. Semin Roentgenol 2018; 53:157-170. [PMID: 29861007 DOI: 10.1053/j.ro.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Asha Kandathil
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Fernando Kay
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Kiran Batra
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Sachin S Saboo
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX.
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37
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Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual-layer dual-energy computed tomography system. Med Phys 2018; 45:2486-2497. [DOI: 10.1002/mp.12903] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/26/2018] [Accepted: 03/09/2018] [Indexed: 01/30/2023] Open
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Iodine and Fat Quantification for Differentiation of Adrenal Gland Adenomas From Metastases Using Third-Generation Dual-Source Dual-Energy Computed Tomography. Invest Radiol 2018; 53:173-178. [DOI: 10.1097/rli.0000000000000425] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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39
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Toia GV, Kim S, Dighe MK, Mileto A. Dual-Energy Computed Tomography in Body Imaging. Semin Roentgenol 2018; 53:132-146. [PMID: 29861005 DOI: 10.1053/j.ro.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Giuseppe V Toia
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Sooah Kim
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Manjiri K Dighe
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Achille Mileto
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195.
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40
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Abstract
Renal cell carcinoma (RCC) exhibits a diverse and heterogeneous disease spectrum, but insight into its molecular biology has provided an improved understanding of potential risk factors, oncologic behavior, and imaging features. Computed tomography (CT) and MR imaging may allow the identification and preoperative subtyping of RCC and assessment of a response to various therapies. Active surveillance is a viable management option in some patients and has provided further insight into the natural history of RCC, including the favorable prognosis of cystic neoplasms. This article reviews CT and MR imaging in RCC and the role of screening in selected high-risk populations.
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Affiliation(s)
- Alberto Diaz de Leon
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, 2nd Floor, Suite 202, Dallas, TX 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, 2nd Floor, Suite 202, Dallas, TX 75390-9085, USA.
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41
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Marino MA, Silipigni S, Barbaro U, Mazziotti S, Sofia C, Mazzei MA, Ascenti G. Dual Energy CT Scanning in Evaluation of the Urinary Tract. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Matoori S, Thian Y, Koh DM, Sohaib A, Larkin J, Pickering L, Gutzeit A. Contrast-Enhanced CT Density Predicts Response to Sunitinib Therapy in Metastatic Renal Cell Carcinoma Patients. Transl Oncol 2017; 10:679-685. [PMID: 28672196 PMCID: PMC5496476 DOI: 10.1016/j.tranon.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 12/27/2022] Open
Abstract
The first-line therapy in metastatic renal cell carcinoma (mRCC), sunitinib, exhibits an objective response rate of approximately 30%. Therapeutic alternatives such as other tyrosine kinase inhibitors, VEGF inhibitors, or mTOR inhibitors emphasize the clinical need to predict the patient's response to sunitinib therapy before treatment initiation. In this study, we evaluated the prognostic value of pretreatment portal venous phase contrast-enhanced computed tomography (CECT) mean tumor density on overall survival (OS), progression-free survival (PFS), and tumor growth in 63 sunitinib-treated mRCC patients. Higher pretreatment CECT tumor density was associated with longer PFS and OS [hazard ratio (HR)=0.968, P=.002, and HR=0.956, P=.001, respectively], and CECT density was inversely correlated with tumor growth (P=.010). Receiver operating characteristic analysis identified two CECT density cut-off values (63.67 HU, sensitivity 0.704, specificity 0.694; and 68.67 HU, sensitivity 0.593, specificity 0.806) which yielded subpopulations with significantly different PFS and OS (P<.001). Pretreatment CECT is therefore a promising noninvasive strategy for response prediction in sunitinib-treated mRCC patients, identifying patients who will derive maximum therapeutic benefit.
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Affiliation(s)
- Simon Matoori
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland; Clinical Research Group, Hirslanden Clinic St. Anna, St. Anna-Strasse 32, 6006 Luzern, Switzerland.
| | - Yeeliang Thian
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - James Larkin
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Lisa Pickering
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Andreas Gutzeit
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland; Clinical Research Group, Hirslanden Clinic St. Anna, St. Anna-Strasse 32, 6006 Luzern, Switzerland; Department of Radiology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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43
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Fukuda T, Umezawa Y, Asahina A, Nakagawa H, Furuya K, Fukuda K. Dual energy CT iodine map for delineating inflammation of inflammatory arthritis. Eur Radiol 2017; 27:5034-5040. [PMID: 28674965 DOI: 10.1007/s00330-017-4931-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/10/2017] [Accepted: 06/07/2017] [Indexed: 01/08/2023]
Abstract
Iodine mapping is an image-processing technique used with dual-energy computed tomography (DECT) to improve iodine contrast resolution. CT, because of its high spatial resolution and thin slice reconstruction, is well suited to the evaluation of the peripheral joints. Recent developments in the treatment of inflammatory arthritis that require early diagnosis and precise therapeutic assessment encourage radiological evaluation. To facilitate such assessment, we describe DECT iodine mapping as a novel modality for evaluating rheumatoid arthritis and psoriatic arthritis of the hands and feet. KEY POINTS • Dual-energy CT iodine mapping can delineate inflammation of peripheral inflammatory arthritis. • DECT iodine mapping has high spatial resolution compared with MRI. • DECT iodine mapping has a high iodine contrast resolution. • DECT iodine mapping may reflect therapeutic effects.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan.
| | - Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan
| | - Kazuhiro Furuya
- Division of Rheumatology Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan
| | - Kunihiko Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 1058471, Japan
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