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Hu M, Wei W, Zhang J, Wang S, Tong X, Fan Y, Cheng Q, Liu Y, Li J, Liu L. Impact of virtual monochromatic images of different low-energy levels in dual-energy CT on radiomics models for predicting muscle invasion in bladder cancer. Abdom Radiol (NY) 2024:10.1007/s00261-024-04459-6. [PMID: 38937340 DOI: 10.1007/s00261-024-04459-6] [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: 04/15/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the impact of different low-energy virtual monochromatic images (VMIs) in dual-energy CT on the performance of radiomics models for predicting muscle invasive status in bladder cancer (BCa). MATERIALS AND METHODS A total of 127 patients with pathologically proven muscle-invasive BCa (n = 49) and non-muscle-invasive BCa (n = 78) were randomly allocated into the training and test cohorts at a ratio of 7:3. Feature extraction was performed on the venous phase images reconstructed at 40, 50, 60 and 70-keV (single-energy analysis) or in combination (multi-energy analysis). Recursive feature elimination (RFE) and the least absolute shrinkage and selection operator (LASSO) were employed to select the most relevant features associated with BCa. Models were built using a support vector machine (SVM) classifier. Diagnostic performance was assessed through receiver operating characteristic curves, evaluating sensitivity, specificity, accuracy, precision, and the area-under-the curve (AUC) values. RESULTS In the test cohort, the multi-energy model achieved the best diagnostic performance with AUC, sensitivity, specificity, accuracy, and precision of 0.917, 0.800, 0.833, 0.821, and 0.750, respectively. Conversely, the single-energy model exhibited lower AUC and sensitivity in predicting the muscle invasion status. CONCLUSIONS By combining information from VMIs of various energies, the multi-energy model displays superior performance in preoperatively predicting the muscle invasion status of bladder cancer.
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Affiliation(s)
- Mengting Hu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Wei
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jingyi Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shigeng Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoyu Tong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong Fan
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiye Cheng
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yijun Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Lei Liu
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Xigang District, Lianhe Road, No.193, Dalian, China.
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Ascenti G, Cicero G, Cardone G, Bertelli E, Papa M, Ciccone V, Manetta R, Gentili F, Francioso AP, Mazzei MA, Floridi C, Di Cesare E, Gandolfo N, De Filippo M, Miele V, Giovagnoni A. Cornerstones of CT urography: a shared document by the Italian board of urogenital radiology. LA RADIOLOGIA MEDICA 2023; 128:601-611. [PMID: 37027091 DOI: 10.1007/s11547-023-01623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023]
Abstract
CT urography is a single term used to refer to different scanning protocols that can be applied for a number of clinical indications. If, on the one hand, this highlights the role of the radiologist in deciding the most suitable technique to perform according to the patient's needs, on the other hand, a certain confusion may arise due to the different technical and clinical variables that have to be taken into account. This has been well demonstrated by a previous work based on an online questionnaire administered to a population of Italian radiologists that brought out similarities as well as differences across the national country. Defining precise guidelines for each clinical scenario, although desirable, is a difficult task to accomplish, if not even unfeasible. According to the prementioned survey, five relevant topics concerning CT urography have been identified: definition and clinical indications, opacification of the excretory system, techniques, post-processing reconstructions, and radiation dose and utility of dual-energy CT. The aim of this work is to deepen and share knowledge about these main points in order to assist the radiology in the daily practice. Moreover, a synopsis of recommendations agreed by the Italian board of genitourinary imaging is provided.
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Affiliation(s)
- Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy
| | - Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy.
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Papa
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Vincenzo Ciccone
- Radiology Department, San Giovanni Di Dio E Ruggi D'Aragona Hospital, Salerno, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, "Santa Maria Alle Scotte" General Hospital, Viale Mario Bracci, 16, Siena, 53100, Italy
| | - Antonio Pio Francioso
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Chiara Floridi
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Massimo De Filippo
- University of Parma, Parma Hospital, Via Gramsci 14, 43126, Parma, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
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Abstract
Computed tomography (CT) of the abdomen is usually appropriate for the initial imaging of many urinary tract diseases, due to its wide availability, fast scanning and acquisition of thin slices and isotropic data, that allow the creation of multiplanar reformatted and three-dimensional reconstructed images of excellent anatomic details. Non-enhanced CT remains the standard imaging modality for assessing renal colic. The technique allows the detection of nearly all types of urinary calculi and the estimation of stone burden. CT is the primary diagnostic tool for the characterization of an indeterminate renal mass, including both cystic and solid tumors. It is also the modality of choice for staging a primary renal tumor. Urolithiasis and urinary tract malignancies represent the main urogenic causes of hematuria. CT urography (CTU) improves the visualization of both the upper and lower urinary tract and is recommended for the investigation of gross hematuria and microscopic hematuria, in patients with predisposing factors for urologic malignancies. CTU is highly accurate in the detection and staging of upper tract urothelial malignancies. CT represents the most commonly used technique for the detection and staging of bladder carcinoma and the diagnostic efficacy of CT staging improves with more advanced disease. Nevertheless, it has limited accuracy in differentiating non-muscle invasive bladder carcinoma from muscle-invasive bladder carcinoma. In this review, clinical indications and the optimal imaging technique for CT of the urinary tract is reviewed. The CT features of common urologic diseases, including ureterolithiasis, renal tumors and urothelial carcinomas are discussed.
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Galluzzo A, Danti G, Bicci E, Mastrorosato M, Bertelli E, Miele V. The role of Dual-Energy CT in the study of urinary tract tumours: review of recent literature. Semin Ultrasound CT MR 2023; 44:136-144. [DOI: 10.1053/j.sult.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Head and neck squamous cell carcinoma: evaluation of iodine overlay maps and low-energy virtual mono-energetic images acquired with spectral detector CT. Clin Radiol 2022; 77:e425-e433. [DOI: 10.1016/j.crad.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022]
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Zhang X, Zhang G, Xu L, Bai X, Lu X, Yu S, Sun H, Jin Z. Utilisation of virtual non-contrast images and virtual mono-energetic images acquired from dual-layer spectral CT for renal cell carcinoma: image quality and radiation dose. Insights Imaging 2022; 13:12. [PMID: 35072807 PMCID: PMC8787008 DOI: 10.1186/s13244-021-01146-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Renal cell carcinoma (RCC) is the most common renal malignant tumour. We evaluated the potential value and dose reduction of virtual non-contrast (VNC) images and virtual monoenergetic images (VMIs) from dual-layer spectral CT (DL-CT) in the diagnosis of RCC. Results Sixty-two patients with pathologically confirmed RCC who underwent contrast-enhanced DL-CT were retrospectively analysed. For the comparison between true non-contrast (TNC) and VNC images of the excretory phase, the attenuation, image noise, signal-to-noise ratio (SNR) and subjective image quality of tumours and different abdominal organs and tissues were evaluated. To compare corticomedullary phase images and low keV VMIs (40 to 100 keV) from the nephrographic phase, the attenuation, image noise, SNR and subjective lesion visibility of the tumours and renal arteries were evaluated. For the tumours, significant differences were not observed in attenuation, noise or SNR between TNC and VNC images (p > 0.05). For the abdominal organs and tissues, except for fat, the difference in attenuation was 100% within 15 HU and 96.78% within 10 HU. The subjective image quality of TNC and VNC images was equivalent (p > 0.05). The attenuation of lesions in 40 keV VMIs and renal arteries in 60 keV VMIs were similar to those in the corticomedullary images (p > 0.05). The subjective lesion visibility in low keV VMIs is slightly lower than that in the corticomedullary images (p < 0.05). Using VNC and VMIs instead of TNC and corticomedullary phase images could decrease the radiation dose by 50.5%. Conclusion VNC images and VMIs acquired from DL-CT can maintain good image quality and decrease the radiation dose for diagnosis of RCC.
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Reimer RP, Gertz RJ, Pennig L, Henze J, Celik E, Lennartz S, Maintz D, Zopfs D, Große Hokamp N. Value of spectral detector computed tomography to differentiate infected from noninfected thoracoabominal fluid collections. Eur J Radiol 2021; 145:110037. [PMID: 34808580 DOI: 10.1016/j.ejrad.2021.110037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the diagnostic value of spectral detector CT (SDCT)-derived virtual non-contrast (VNC), virtual monoenergetic images (VMI) and iodine overlays (IO) for distinguishing infected from noninfected fluid collections (FC) in the chest or abdomen. METHOD This retrospective study included 58 patients with venous phase SDCT with 77 FC. For all included FC, microbiological analysis of aspirated fluid served as reference. For quantitative analysis, wall thickness was measured, and (ROI)-based analysis performed within the fluid, the FC's wall (if any) and the aorta. Two radiologists qualitatively evaluated visibility of wall enhancement, diagnostic confidence regarding infection of fluid collection, confidence of CT-guided drainage catheter placement and visibility of anatomical landmarks in conventional images (CI) and VNC, VMI40keV, IO. RESULTS Wall thickness significantly differed between infected (n = 46) and noninfected (n = 31) FC (3.5 ± 1.8 mm vs. 1.4 ± 1.8 mm, AUC = 0.81; p < 0.05). Fluid attenuation and wall enhancement was significantly higher in infected as compared to noninfected FC in all reconstructions (p < 0.05, respectively). Highest AUC regarding A) attenuation in fluid was yielded in CI and VMI70,80keV (0.75); B) wall enhancement in CI (0.88) followed by iodine concentration (0.86). Contrast-to-noise ratio of wall vs. fluid was highest in VMI40keV (p < 0.05). All assessed qualitative parameters received significantly higher ratings when using spectral reconstructions vs. CI (p for all <0.05), except for visibility of wall enhancement. CONCLUSION Spectral reconstructions improve the assessment of infected from noninfected thoracoabdominal fluid collections and depiction of wall enhancement. Diagnostic performance of the quantitative measurements in spectral reconstructions were comparable with measurements in conventional images.
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Affiliation(s)
- Robert Peter Reimer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Roman Johannes Gertz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Lenhard Pennig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jörn Henze
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Erkan Celik
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Simon Lennartz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - David Zopfs
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Nils Große Hokamp
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Kerpener Str. 62, 50937 Cologne, Germany
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Kruis MF. Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual-energy CT. J Appl Clin Med Phys 2021; 23:e13468. [PMID: 34743405 PMCID: PMC8803285 DOI: 10.1002/acm2.13468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT. In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.
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Zopfs D, Lennartz S, Abdullayev N, Lichtenstein T, Laukamp KR, Reimer RP, Kabbasch C, Borggrefe J, Schlamann M, Neuhaus V, Große Hokamp N. Generally applicable window settings of low-keV virtual monoenergetic reconstructions in dual-layer CT-angiography of the head and neck. Quant Imaging Med Surg 2021; 11:3408-3417. [PMID: 34341719 DOI: 10.21037/qims-20-1140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
Background Increased vessel contrast in low-keV virtual monoenergetic images (VMI) in spectral detector CT angiography of the head and neck requires adaption of window settings. Aim of this study was to define generally applicable window settings of low-keV VMI. Methods Two radiologists determined ideal subjective window settings for VMI40-70 keV in 54 patients. To obtain generally applicable window settings, center and width values were modeled against the attenuation of the internal carotid artery (HUICA). This modeling was performed with and without respect to keV. Subsequently, image quality of VMI40-70 keV was assessed using the model-based determined window settings. Results With decreasing keV values, HUICA increased significantly in comparison to conventional images (CI) (P<0.05 for 40-60 keV). No significant differences between modelled and individually recorded window settings were found confirming validity of the obtained models (P values: 0.2-1.0). However, modelling with respect to keV was marginally less precise. Conclusions Window settings of low-keV VMI can be semi-automatically determined in dependency of the ICA attenuation in spectral detector CTA of the head and neck. The reported models are a promising tool to leverage the improved image quality of these images in clinical routine.
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Affiliation(s)
- David Zopfs
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Simon Lennartz
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Thorsten Lichtenstein
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Robert Peter Reimer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Victor Neuhaus
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
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A New Outlook on the Ability to Accumulate an Iodine Contrast Agent in Solid Lung Tumors Based on Virtual Monochromatic Images in Dual Energy Computed Tomography (DECT): Analysis in Two Phases of Contrast Enhancement. J Clin Med 2021; 10:jcm10091870. [PMID: 33925945 PMCID: PMC8123482 DOI: 10.3390/jcm10091870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
For some time, dual energy computed tomography (DECT) has been an established method used in a vast array of clinical applications, including lung nodule assessment. The aim of this study was to analyze (using monochromatic DECT images) how the X-ray absorption of solitary pulmonary nodules (SPNs) depends on the iodine contrast agent and when X-ray absorption is no longer dependent on the accumulated contrast agent. Sixty-six patients with diagnosed solid lung tumors underwent DECT scans in the late arterial phase (AP) and venous phase (VP) between January 2017 and June 2018. Statistically significant correlations (p ≤ 0.001) of the iodine contrast concentration were found in the energy range of 40–90 keV in the AP phase and in the range of 40–80 keV in the VP phase. The strongest correlation was found between the concentrations of the contrast agent and the scanning energy of 40 keV. At the higher scanning energy, no significant correlations were found. We concluded that it is most useful to evaluate lung lesions in DECT virtual monochromatic images (VMIs) in the energy range of 40–80 keV. We recommend assessing SPNs in only one phase of contrast enhancement to reduce the absorbed radiation dose.
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Wang X, Liu D, Jiang S, Zeng X, Li L, Yu T, Zhang J. Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer. Korean J Radiol 2021; 22:502-512. [PMID: 33569928 PMCID: PMC8005343 DOI: 10.3348/kjr.2020.0310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. Materials and Methods This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Zeff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. Results Low keV MEI (+) at 40–50 keV showed increased CNR and SNRbreast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNRbreast lesion: 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Zeff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). Conclusion Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.
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Affiliation(s)
- Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Shixi Jiang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Lan Li
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Tao Yu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
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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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Zopfs D, Große Hokamp N, Reimer R, Bratke G, Maintz D, Bruns C, Mallmann C, Persigehl T, Haneder S, Lennartz S. Value of spectral detector CT for pretherapeutic, locoregional assessment of esophageal cancer. Eur J Radiol 2020; 134:109423. [PMID: 33302024 DOI: 10.1016/j.ejrad.2020.109423] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the diagnostic value of spectral detector dual-energy CT-derived low-keV virtual monoenergetic images (VMI) and iodine overlays (IO) for locoregional, pretherapeutic assessment of esophageal cancer. METHOD 74 patients with biopsy-proven esophageal cancer who underwent pre-therapeutic, portal-venous-phase staging examinations of the chest and abdomen were retrospectively included. Quantitative image analysis was performed ROI-based within the tumor, healthy esophageal wall, peri-esophageal lymph nodes, azygos vein, aorta, liver, diaphragm, and mediastinal fat. Two radiologists evaluated delineation of the primary tumor and locoregional lymph nodes, assessment of the celiac trunk and diagnostic certainty regarding tumor infiltration in conventional images (CI), VMI from 40 to 70 keV and IO. Moreover, presence/absence of advanced tumor infiltration (T3/T4) was determined binary using all available images. RESULTS VMI40-60keV showed significantly higher attenuation and signal-to-noise ratio compared to CI for all assessed ROIs, peaking at VMI40keV (p < 0.05). Contrast-to-noise ratio of tumor/esophagus (VMI40keV/CI: 7.7 ± 4.7 vs. 2.3 ± 1.5), tumor/diaphragm (VMI40keV/CI: 9.0 ± 5.5 vs. 2.2 ± 1.7) and tumor/liver (4.3 ± 5.5 vs. 1.9 ± 2.1) were all significantly higher compared to CI (p < 0.05). Qualitatively, lymph node delineation and diagnostic certainty regarding tumor infiltration received highest ratings both in IO and VMI40keV, whereas vascular assessment was rated highest in VMI40keV and primary tumor delineation in IO. Sensitivity/Specificity/Accuracy for detecting advanced tumor infiltration using the combination of CI, VMI40-70keV and IO was 42.4 %/82.0 %/56.3 %. CONCLUSIONS IO and VMI40-60keV improve qualitative assessment of the primary tumor and depiction of lymph nodes and vessels at pretherapeutic SDCT of esophageal cancer patients yet do not mitigate the limitations of CT in determining tumor infiltration.
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Affiliation(s)
- David Zopfs
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nils Große Hokamp
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Robert Reimer
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Grischa Bratke
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Christoph Mallmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Thorsten Persigehl
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stefan Haneder
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Simon Lennartz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany; Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA.
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Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions. Eur Radiol 2020; 31:3468-3477. [PMID: 33180163 PMCID: PMC8043945 DOI: 10.1007/s00330-020-07379-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
Objectives To investigate whether the increased soft tissue contrast of virtual monoenergetic images (VMIs) obtained from a spectral detector computed tomography (SDCT) system improves washout assessment of arterially hyper-enhancing liver lesions. Methods Fifty-nine arterially hyper-enhancing lesions in 31 patients (age 65 ± 9 years, M/W 20/11) were included in this IRB-approved study. All patients underwent multi-phase SDCT for HCC screening. MRI, CEUS or biopsy within 3 months served as standard of reference to classify lesions as LiRADS 3 or 4/5. VMIs and conventional images (CIs) were reconstructed. Visual analysis was performed on 40, 60, and 80 kiloelectronvolt (keV) and CIs by 3 radiologists. Presence and visibility of washout were assessed; image quality and confidence of washout evaluation were evaluated on 5-point Likert scales. Signal-to-noise ratio (SNR), lesion-to-liver contrast-to-noise ratio (CNR) (|HUlesion–HUliver|/SDliver) and washout (|HUlesion–HUliver|) were calculated. Statistical assessment was performed using ANOVA and Wilcoxon test. Results On subjective lesion analysis, the highest level of diagnostic confidence and highest sensitivity for the detection of lesion washout were found for 40-keV VMIs (40 keV vs. CI, 81.3 vs. 71.3%). Image quality parameters were significantly better in low-kiloelectronvolt VMIs than in CIs (p < 0.05; e.g. SNRliver: 40 keV vs. CIs, 12.5 ± 4.1 vs. 5.6 ± 1.6). In LiRADS 4/5 lesions, CNR and quantitative washout values were significantly higher in 40-keV VMIs compared to CIs (p < 0.05; e.g. CNR and washout in 40 keV vs. CIs, 2.3 ± 1.6 vs. 0.8 ± 0.5 and 29.0 ± 19.1 vs. 12.9 ± 6.9 HU, respectively). Conclusion By increasing lesion contrast, low-kiloelectronvolt VMIs obtained from SDCT improve washout assessment of hyper-enhancing liver lesions with respect to washout visibility and diagnostic confidence. Key Points • Low-kiloelectronvolt virtual monoenergetic images from spectral detector CT facilitate washout assessment in arterially hyper-enhancing liver lesions. • Image quality and quantitative washout parameters as well as subjective washout visibility and diagnostic confidence benefit from low-kiloelectronvolt virtual monoenergetic images. Electronic supplementary material The online version of this article (10.1007/s00330-020-07379-3) contains supplementary material, which is available to authorized users.
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Lennartz S, Große Hokamp N, Zäske C, Zopfs D, Bratke G, Glauner A, Maintz D, Persigehl T, Chang DH, Hickethier T. Virtual monoenergetic images preserve diagnostic assessability in contrast media reduced abdominal spectral detector CT. Br J Radiol 2020; 93:20200340. [PMID: 32644824 DOI: 10.1259/bjr.20200340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate if low-keV virtual monoenergetic images (VMI40keV) from abdominal spectral detector CT (SDCT) with reduced intravenous contrast media application (RCM) provide abdominal assessment similar to conventional images with standard contrast media (SCM) dose. METHODS 78 patients with abdominal SDCT were retrospectively included: 41 patients at risk for adverse reactions who received 44 RCM examinations with 50 ml and 37 patients who underwent 44 SCM examinations with 100 ml of contrast media (CM) and who were matched for effective body diameters. RCM, SCM images and RCM-VMI40keV were reconstructed. Attenuation and signal-to-noise ratio (SNR) of liver, pancreas, kidneys, lymph nodes, psoas muscle, aorta and portal vein were assessed ROIs-based. Contrast-to-noise ratios (CNR) of lymph nodes vs aorta/portal vein were calculated. Two readers evaluated organ/vessel contrast, lymph node delineation, image noise and overall assessability using 4-point Likert scales. RESULTS RCM were inferior to SCM images in all quantitative/qualitative criteria. RCM-VMI40keV and SCM images showed similar lymph node and muscle attenuation (p = 0.83,0.17), while for all other ROIs, RCM-VMI40keV showed higher attenuation (p ≤ 0.05). SNR was comparable between RCM-VMI40keV and SCM images (p range: 0.23-0.99). CNR of lymph nodes was highest in RCM-VMI40keV (p ≤ 0.05). RCM-VMI40keV received equivalent or higher scores than SCM in all criteria except for organ contrast, overall assessability and image noise, where SCM were superior (p ≤ 0.05). However, RCM-VMI40keV received proper or excellent scores in 88.6/94.2/95.4% of the referring cases. CONCLUSIONS VMI40keV counteract contrast deterioration in CM reduced abdominal SDCT, facilitating diagnostic assessment. ADVANCES IN KNOWLEDGE SDCT-derived VMI40keV provide adequate depiction of vessels, organs and lymph nodes even at notable CM reduction.
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Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Harvard Medial School, 55 Fruit Street, White 270, Boston, MA 02114, USA.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne,Weyertal 115b, 50931, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Charlotte Zäske
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Grischa Bratke
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Andreas Glauner
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - De-Hua Chang
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Department of Radiology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Ishikawa T, Suzuki S, Katada Y, Takayanagi T, Fukui R, Yamamoto Y, Tanigaki K. Evaluation of three-dimensional iterative image reconstruction in virtual monochromatic imaging at 40 kilo-electron volts: phantom and clinical studies to assess the image noise and image quality in comparison with other reconstruction techniques. Br J Radiol 2020; 93:20190675. [PMID: 32208973 PMCID: PMC10993219 DOI: 10.1259/bjr.20190675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/03/2019] [Accepted: 03/24/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the image quality in virtual monochromatic imaging (VMI) at 40 kilo-electron volts (keV) with three-dimensional iterative image reconstruction (3D-IIR). METHODS A phantom study and clinical study (31 patients) were performed with dual-energy CT (DECT). VMI at 40 keV was obtained and the images were reconstructed using filtered back projection (FBP), 50% adaptive statistical iterative reconstruction (ASiR), and 3D-IIR. We conducted subjective and objective evaluations of the image quality with each reconstruction technique. RESULTS The image contrast-to-noise ratio and image noise in both the clinical and phantom studies were significantly better with 3D-IIR than with 50% ASiR, and with 50% ASiR than with FBP (all, p < 0.05). The standard deviation and noise power spectra of the reconstructed images decreased in the order of 3D-IIR to 50% ASiR to FBP, while the modulation transfer function was maintained across the three reconstruction techniques. In most subjective evaluations in the clinical study, the image quality was significantly better with 3D-IIR than with 50% ASiR, and with 50% ASiR than with FBP (all, p < 0.001). Regarding the diagnostic acceptability, all images using 3D-IIR were evaluated as being fully or probably acceptable. CONCLUSIONS The quality of VMI at 40 keV is improved by 3D-IIR, which allows the image noise to be reduced and structural details to be maintained. ADVANCES IN KNOWLEDGE The improvement of the image quality of VMI at 40 keV by 3D-IIR may increase the subjective acceptance in the clinical setting.
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Affiliation(s)
- Takuya Ishikawa
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
| | - Shigeru Suzuki
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
| | - Yoshiaki Katada
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
| | - Tomoko Takayanagi
- Department of Radiology, Graduate School of Medicine,
University of Tokyo, 7-3-1 Hongo, Bunkyo-ku,
Tokyo, 113-8655, Japan
| | - Rika Fukui
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
| | - Yuzo Yamamoto
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
| | - Koji Tanigaki
- Department of Radiology, Tokyo Women's Medical University
Medical Center East, 2-1-10 Nishiogu, Arakawa-ku,
Tokyo 116-8567, Japan
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