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Zhang S, Simard M, Lapointe A, Filion É, Campeau MP, Vu TTT, Roberge D, Carrier JF, Blais D, Bedwani S, Bahig H. Evaluation of Radiation Dose Effect on Lung Function Using Iodine Maps Derived From Dual-Energy Computed Tomography. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00609-6. [PMID: 38705488 DOI: 10.1016/j.ijrobp.2024.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE There is interest in using dual-energy computed tomography (DECT) to evaluate organ function before and after radiation therapy (RT). The purpose of this study (trial identifier: NCT04863027) is to assess longitudinal changes in lung perfusion using iodine maps derived from DECT in patients with lung cancer treated with conventional or stereotactic RT. METHODS AND MATERIALS For 48 prospectively enrolled patients with lung cancer, a contrast-enhanced DECT using a dual-source CT simulator was acquired pretreatment and at 6 and 12 months posttreatment. Pulmonary functions tests (PFT) were obtained at baseline and at 6 and 12 months posttreatment. Iodine maps were extracted from the DECT images using a previously described 2-material decomposition framework. Longitudinal iodine maps were normalized using a reference region defined as all voxels with perfusion in the top 10% outside of the 5 Gy isodose volume. Normalized functional responses (NFR) were calculated for 3 dose ranges: <5, 5 to 20, and >20 Gy. Mixed model analysis was used to assess the correlation between dose metrics and NFR. Pearson correlation was used to assess if NFRs were correlated with PFT changes. RESULTS Out of the 48 patients, 21 (44%) were treated with stereotactic body RT and 27 (56%) were treated with conventionally fractionated intensity-modulated RT. Thirty-one out of these 48 patients were ultimately included in data analysis. It was found that NFR is linearly correlated with dose (P < .001) for both groups. The number of months elapsed post-RT was also found to correlate with NFR (P = .029), although this correlation was not observed for the stereotactic body RT subgroup. The NFR was not found to correlate with PFT changes. CONCLUSIONS DECT-derived iodine maps are a promising method for detailed anatomic evaluation of radiation effect on lung function, including potentially subclinical changes.
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Affiliation(s)
- Shen Zhang
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Mikaël Simard
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Département de physique, Université de Montréal, Montréal, Quebec, Canada; Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andréanne Lapointe
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Édith Filion
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Pierre Campeau
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Thi Trinh Thuc Vu
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - David Roberge
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Jean-François Carrier
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Département de physique, Université de Montréal, Montréal, Quebec, Canada
| | - Danis Blais
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Stéphane Bedwani
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Houda Bahig
- Département de radio-oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
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Chamberlin JH, Ogbonna A, Abrol S, Maisuria D, Miller E, McGuire A, Knight H, O'Doherty J, Baruah D, Schoepf UJ, Munden RF, Kabakus IM. Enhancing diagnostic precision for acute chest syndrome in sickle cell disease: insights from dual-energy CT lung perfusion mapping. Emerg Radiol 2024; 31:73-82. [PMID: 38224366 DOI: 10.1007/s10140-024-02200-w] [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] [Received: 12/09/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE Acute chest syndrome (ACS) is secondary to occlusion of the pulmonary vasculature and a potentially life-threatening complication of sickle cell disease (SCD). Dual-energy CT (DECT) iodine perfusion map reconstructions can provide a method to visualize and quantify the extent of pulmonary microthrombi. METHODS A total of 102 patients with sickle cell disease who underwent DECT CTPA with perfusion were retrospectively identified. The presence or absence of airspace opacities, segmental perfusion defects, and acute or chronic pulmonary emboli was noted. The number of segmental perfusion defects between patients with and without acute chest syndrome was compared. Sub-analyses were performed to investigate robustness. RESULTS Of the 102 patients, 68 were clinically determined to not have ACS and 34 were determined to have ACS by clinical criteria. Of the patients with ACS, 82.4% were found to have perfusion defects with a median of 2 perfusion defects per patient. The presence of any or new perfusion defects was significantly associated with the diagnosis of ACS (P = 0.005 and < 0.001, respectively). Excluding patients with pulmonary embolism, 79% of patients with ACS had old or new perfusion defects, and the specificity for new perfusion defects was 87%, higher than consolidation/ground glass opacities (80%). CONCLUSION DECT iodine map has the capability to depict microthrombi as perfusion defects. The presence of segmental perfusion defects on dual-energy CT maps was found to be associated with ACS with potential for improved specificity and reclassification.
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Affiliation(s)
- Jordan H Chamberlin
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Alexis Ogbonna
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Sameer Abrol
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Dhruw Maisuria
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Emily Miller
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Aaron McGuire
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Heather Knight
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Jim O'Doherty
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
- Siemens Medical Solutions, Malvern, PA, USA
| | - Dhiraj Baruah
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Reginald F Munden
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA
| | - Ismail M Kabakus
- Department of Radiology and Radiologic Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, USA.
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Ohno Y, Ozawa Y, Nagata H, Bando S, Cong S, Takahashi T, Oshima Y, Hamabuchi N, Matsuyama T, Ueda T, Yoshikawa T, Takenaka D, Toyama H. Area-Detector Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel) 2023; 13:2518. [PMID: 37568881 PMCID: PMC10416899 DOI: 10.3390/diagnostics13152518] [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: 06/05/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
An area-detector CT (ADCT) has a 320-detector row and can obtain isotropic volume data without helical scanning within an area of nearly 160 mm. The actual-perfusion CT data within this area can, thus, be obtained by means of continuous dynamic scanning for the qualitative or quantitative evaluation of regional perfusion within nodules, lymph nodes, or tumors. Moreover, this system can obtain CT data with not only helical but also step-and-shoot or wide-volume scanning for body CT imaging. ADCT also has the potential to use dual-energy CT and subtraction CT to enable contrast-enhanced visualization by means of not only iodine but also xenon or krypton for functional evaluations. Therefore, systems using ADCT may be able to function as a pulmonary functional imaging tool. This review is intended to help the reader understand, with study results published during the last a few decades, the basic or clinical evidence about (1) newly applied reconstruction methods for radiation dose reduction for functional ADCT, (2) morphology-based pulmonary functional imaging, (3) pulmonary perfusion evaluation, (4) ventilation assessment, and (5) biomechanical evaluation.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan;
| | - Shuji Bando
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Shang Cong
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Tomoki Takahashi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
| | - Takeshi Yoshikawa
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi 673-0021, Hyogo, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan; (Y.O.)
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Valentini A, Franchi P, Cicchetti G, Messana G, Chiffi G, Strappa C, Calandriello L, Del Ciello A, Farchione A, Preda L, Larici AR. Pulmonary Hypertension in Chronic Lung Diseases: What Role Do Radiologists Play? Diagnostics (Basel) 2023; 13:diagnostics13091607. [PMID: 37174998 PMCID: PMC10178805 DOI: 10.3390/diagnostics13091607] [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: 03/20/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Pulmonary hypertension (PH) is a pathophysiological disorder, defined by a mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest, as assessed by right heart catheterization (RHC). PH is not a specific disease, as it may be observed in multiple clinical conditions and may complicate a variety of thoracic diseases. Conditions associated with the risk of developing PH are categorized into five different groups, according to similar clinical presentations, pathological findings, hemodynamic characteristics, and treatment strategy. Most chronic lung diseases that may be complicated by PH belong to group 3 (interstitial lung diseases, chronic obstructive pulmonary disease, combined pulmonary fibrosis, and emphysema) and are associated with the lowest overall survival among all groups. However, some of the chronic pulmonary diseases may develop PH with unclear/multifactorial mechanisms and are included in group 5 PH (sarcoidosis, pulmonary Langerhans' cell histiocytosis, and neurofibromatosis type 1). This paper focuses on PH associated with chronic lung diseases, in which radiological imaging-particularly computed tomography (CT)-plays a crucial role in diagnosis and classification. Radiologists should become familiar with the hemodynamical, physiological, and radiological aspects of PH and chronic lung diseases in patients at risk of developing PH, whose prognosis and treatment depend on the underlying disease.
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Affiliation(s)
- Adele Valentini
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Franchi
- Department of Diagnostic Radiology, G. Mazzini Hospital, 64100 Teramo, Italy
| | - Giuseppe Cicchetti
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Gaia Messana
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Greta Chiffi
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Strappa
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucio Calandriello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Annemilia Del Ciello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Alessandra Farchione
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Lorenzo Preda
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Anna Rita Larici
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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Fujita Y, Kent M, Wisner E, Johnson L, Stern J, Qi L, Boone J, Yamamoto T. Combined Assessment of Pulmonary Ventilation and Perfusion with Single-Energy Computed Tomography and Image Processing. Acad Radiol 2021; 28:636-646. [PMID: 32534966 DOI: 10.1016/j.acra.2020.04.004] [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: 10/18/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To establish a proof-of-principle for combined assessment of pulmonary ventilation and perfusion using single-energy computed tomography (CT) and image processing/analysis (denoted as single-energy CT ventilation/perfusion imaging). MATERIALS AND METHODS Breath-hold CT scans were acquired at end-expiration and end-inspiration before injection of iodinated contrast agents, and repeated at end-inspiration after contrast injection for 17 canines (8 normal and 9 diseased lung subjects). Ventilation images were calculated with deformable image registration to map the end-expiratory and end-inspiratory CT images and quantitative analysis for regional volume changes as surrogates for ventilation. Perfusion images were calculated by subtracting the end-inspiratory precontrast CT from the deformably registered end-inspiratory postcontrast CT, yielding a map of regional Hounsfield unit enhancement as a surrogate for perfusion. Ventilation-perfusion matching, spatial heterogeneity, and gravitationally directed gradients were compared between two groups using a Wilcoxon rank-sum test. RESULTS The normal group had significantly higher Dice similarity coefficients for spatial overlap of segmented functional volumes between ventilation and perfusion (median 0.40 vs. 0.33, p = 0.05), suggesting stronger ventilation-perfusion matching. The normal group also had greater Spearman's correlation coefficients based on 16 regions of interest (median 0.58 vs. 0.40, p = 0.09). The coefficients of variation were comparable (median, ventilation 0.71 vs. 0.91, p = 0.60; perfusion 0.63 vs. 0.75, p = 0.27). The linear regression slopes of gravitationally directed gradient were also comparable for ventilation (median, ventilation -0.26 vs. -0.18, p = 0.19; perfusion -0.17 vs. -0.06, p = 0.11). CONCLUSION These findings provide proof-of-principle for single-energy CT ventilation/perfusion imaging.
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7
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[Urology - what are the most important trends over the last decade?]. MMW Fortschr Med 2018; 160:99-102. [PMID: 30421185 DOI: 10.1007/s15006-018-1134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Bustos Fiore A, González Vázquez M, Trinidad López C, Mera Fernández D, Costas Álvarez M. Defectos de perfusión en el mapa de iodo pulmonar: causas y semiología. RADIOLOGIA 2018; 60:303-311. [DOI: 10.1016/j.rx.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/22/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
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9
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Bustos Fiore A, González Vázquez M, Trinidad López C, Mera Fernández D, Costas Álvarez M. Perfusion defects in pulmonary perfusion iodine maps: Causes and semiology. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Kharat A, Hachulla AL, Noble S, Lador F. Modern diagnosis of chronic thromboembolic pulmonary hypertension. Thromb Res 2017; 163:260-265. [PMID: 28918335 DOI: 10.1016/j.thromres.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/26/2017] [Accepted: 09/04/2017] [Indexed: 12/28/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) should be suspected in patients presenting persistent dyspnea three months after a pulmonary embolism or in patients presenting with acute pulmonary embolism and suggestive images on the CT-scan. For these patients, a specific diagnostic work-up should be performed. First step consists of the ventilation/perfusion (V/Q) scan which is a good screening test due to its high sensitivity and high negative predictive value. Pulmonary angiography remains the gold standard approach for the confirmation of the diagnosis and pre-surgical evaluation of CTEPH. New emerging technologies such as Dual-Energy Computed Tomography angiography (DECT) and Computed Tomography angiography (CTA) are developing and broadly available. These non invasive methods provide diagnostic information similar to conventional pulmonary angiography and surgical operability information. They are to be considered as an alternative in the diagnostic approach of patients with CTEPH as presented in the ESC/ERS guidelines. Haemodynamic measurement whiles exercising during right heart catheterization may improve diagnostic sensitivity of CTEPH and could therefore be used as a diagnostic test in patient with normal haemodynamic at rest.
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Affiliation(s)
- Aileen Kharat
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Division of Radiology, University Hospitals of Geneva, Geneva, Switzerland; Pulmonary Hypertension Program, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Noble
- Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland; Pulmonary Hypertension Program, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Lador
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland; Pulmonary Hypertension Program, University Hospitals of Geneva, Geneva, Switzerland; Geneva University, Faculty of Medicine, Switzerland.
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Provost K, Leblond A, Gauthier-Lemire A, Filion É, Bahig H, Lord M. Reproducibility of Lobar Perfusion and Ventilation Quantification Using SPECT/CT Segmentation Software in Lung Cancer Patients. J Nucl Med Technol 2017; 45:185-192. [PMID: 28408698 DOI: 10.2967/jnmt.117.191056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
Planar perfusion scintigraphy with 99mTc-labeled macroaggregated albumin is often used for pretherapy quantification of regional lung perfusion in lung cancer patients, particularly those with poor respiratory function. However, subdividing lung parenchyma into rectangular regions of interest, as done on planar images, is a poor reflection of true lobar anatomy. New tridimensional methods using SPECT and SPECT/CT have been introduced, including semiautomatic lung segmentation software. The present study evaluated inter- and intraobserver agreement on quantification using SPECT/CT software and compared the results for regional lung contribution obtained with SPECT/CT and planar scintigraphy. Methods: Thirty lung cancer patients underwent ventilation-perfusion scintigraphy with 99mTc-macroaggregated albumin and 99mTc-Technegas. The regional lung contribution to perfusion and ventilation was measured on both planar scintigraphy and SPECT/CT using semiautomatic lung segmentation software by 2 observers. Interobserver and intraobserver agreement for the SPECT/CT software was assessed using the intraclass correlation coefficient, Bland-Altman plots, and absolute differences in measurements. Measurements from planar and tridimensional methods were compared using the paired-sample t test and mean absolute differences. Results: Intraclass correlation coefficients were in the excellent range (above 0.9) for both interobserver and intraobserver agreement using the SPECT/CT software. Bland-Altman analyses showed very narrow limits of agreement. Absolute differences were below 2.0% in 96% of both interobserver and intraobserver measurements. There was a statistically significant difference between planar and SPECT/CT methods (P < 0.001) for quantification of perfusion and ventilation for all right lung lobes, with a maximal mean absolute difference of 20.7% for the right middle lobe. There was no statistically significant difference in quantification of perfusion and ventilation for the left lung lobes using either method; however, absolute differences reached 12.0%. The total right and left lung contributions were similar for the two methods, with a mean difference of 1.2% for perfusion and 2.0% for ventilation. Conclusion: Quantification of regional lung perfusion and ventilation using SPECT/CT-based lung segmentation software is highly reproducible. This tridimensional method yields statistically significant differences in measurements for right lung lobes when compared with planar scintigraphy. We recommend that SPECT/CT-based quantification be used for all lung cancer patients undergoing pretherapy evaluation of regional lung function.
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Affiliation(s)
- Karine Provost
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Antoine Leblond
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Annie Gauthier-Lemire
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Édith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Martin Lord
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
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Li X, Chen GZ, Zhao YE, Schoepf UJ, Albrecht MH, Bickford MW, Gu HF, Zhang LJ, Lu GM. Radiation Optimized Dual-source Dual-energy Computed Tomography Pulmonary Angiography: Intra-individual and Inter-individual Comparison. Acad Radiol 2017; 24:13-21. [PMID: 27789203 DOI: 10.1016/j.acra.2016.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to intra-individually and inter-individually compare image quality, radiation dose, and diagnostic accuracy of dual-source dual-energy computed tomography pulmonary angiography (CTPA) protocols in patients with suspected pulmonary embolism (PE). METHODS Thirty-three patients with suspected PE underwent initial and follow-up dual-energy CTPA at 80/Sn140 kVp (group A) or 100/Sn140 kVp (group B), which were assigned based on tube voltages. Subjective and objective CTPA image quality and lung perfusion map image quality were evaluated. Diagnostic accuracies of CTPA and perfusion maps were assessed by two radiologists independently. Effective dose (ED) was calculated and compared. RESULTS Mean computed tomography (CT) values of pulmonary arteries were higher in group A than group B (P = .006). There was no difference in signal-to-noise ratio and contrast-to-noise ratio between the two groups (both P > .05). Interobserver agreement for evaluating subjective image quality of CTPA and color-coded perfusion images was either good (κ = 0.784) or excellent (κ = 0.887). Perfusion defect scores and diagnostic accuracy of CTPA showed no difference between both groups (both P > .05). Effective dose of group A was reduced by 45.8% compared to group B (P < .001). CONCLUSIONS Second-generation dual-source dual-energy CTPA with 80/Sn140 kVp allows for sufficient image quality and diagnostic accuracy for detecting PE while substantially reducing radiation dose.
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Affiliation(s)
- Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew W Bickford
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Hai Feng Gu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
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Ameli-Renani S, Rahman F, Nair A, Ramsay L, Bacon JL, Weller A, Sokhi HK, Devaraj A, Madden B, Vlahos I. Dual-energy CT for imaging of pulmonary hypertension: challenges and opportunities. Radiographics 2015; 34:1769-90. [PMID: 25384277 DOI: 10.1148/rg.347130085] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Computed tomography (CT) is routinely used in the evaluation of patients with pulmonary hypertension (PH) to assess vascular anatomy and parenchymal morphology. The introduction of dual-energy CT (DECT) enables additional qualitative and quantitative insights into pulmonary hemodynamics and the extent and variability of parenchymal enhancement. Lung perfusion assessed at pulmonary blood volume imaging correlates well with findings at scintigraphy, and pulmonary blood volume defects seen in pulmonary embolism studies infer occlusive disease with increased risk of right heart dysfunction. Similarly, perfusion inhomogeneities seen in patients with PH closely reflect mosaic lung changes and may be useful for severity assessment and prognostication. The use of DECT may increase detection of peripheral thromboembolic disease, which is of particular prognostic importance in patients with chronic thromboembolic PH with microvascular involvement. Other DECT applications for imaging of PH include low-kilovoltage images with greater inherent iodine conspicuity and iodine-selective color-coded maps of vascular perfusion (both of which can improve visualization of vascular enhancement), virtual nonenhanced imaging (which better depicts vascular calcification), and, potentially, ventricular perfusion maps (to assess myocardial ischemia). In addition, quantitative assessment of central vascular and parenchymal enhancement can be used to evaluate pulmonary hemodynamics in patients with PH. The current status and potential advantages and limitations of DECT for imaging of PH are reviewed, and current evidence is supplemented with data from a tertiary referral center for PH.
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Affiliation(s)
- Seyed Ameli-Renani
- From the Department of Radiology (S.A.R., F.R., A.N., L.R., A.W., H.K.S., A.D., I.V.) and Pulmonary Hypertension Unit (J.L.B., B.M.), St George's Hospital, Blackshaw Road, London SW17 0PZ, England
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Tang CX, Schoepf UJ, Chowdhury SM, Fox MA, Zhang LJ, Lu GM. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol 2015; 45:1431-9. [PMID: 25846076 PMCID: PMC4553120 DOI: 10.1007/s00247-015-3336-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U. Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mary A. Fox
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
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15
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Meysman M, Everaert H, Buls N, Nieboer K, de Mey J. Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment. Eur J Radiol 2015; 84:1816-9. [DOI: 10.1016/j.ejrad.2015.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
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16
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Cai XR, Feng YZ, Qiu L, Xian ZH, Yang WC, Mo XK, Wang XB. Iodine Distribution Map in Dual-Energy Computed Tomography Pulmonary Artery Imaging with Rapid kVp Switching for the Diagnostic Analysis and Quantitative Evaluation of Acute Pulmonary Embolism. Acad Radiol 2015; 22:743-51. [PMID: 25772582 DOI: 10.1016/j.acra.2015.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the diagnostic value of dual-energy (DE) computed tomography pulmonary angiography (CTPA) for acute pulmonary embolism (PE) using a helical DE scan mode with rapid kVp switching. MATERIALS AND METHODS Seventy-six patients with suspected acute PE underwent DE CTPA. Two readers independently assessed and measured the iodine maps. CTPA images were assessed for the presence, location, and degree of PE as the standard of reference. Iodine maps were used to identify the perfusion defect (PD), and the diagnostic accuracy of iodine maps was calculated. The iodine concentrations of PDs and normal lung parenchyma were also measured and compared. RESULTS A per-patient analysis showed the 84.6% sensitivity and 96.0% specificity of iodine map for PE, and on per-segment analysis, the sensitivity and specificity for PE were 82.9% and 99.6%, respectively. Intraobserver and interobserver variability correlations were excellent, with k values from 0.806 to 1.000. Quantitative analysis showed there was a significant difference for iodine concentration between circumscribed/patchy PDs or wedge-shaped PDs consistent with PE and normal lung parenchyma (P < .05). The intraobserver reliability of reader 1 was from 0.928 to 0.997, and reader 2 was from 0.912 to 0.995. And, the interobserver reliability between two readers was from 0.967 to 0.999. CONCLUSIONS CTPA based on DE scanning with rapid kVp switching can provide both morphologic analysis and quantitative evaluation of PD related to acute PE in addition to standard CTPA data. Quantification of iodine concentration may be helpful for identifying the presence or absence of PE.
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Affiliation(s)
- Xiang-Ran Cai
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - You-Zhen Feng
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - Lin Qiu
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - Zhao-Hui Xian
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - Wen-Cai Yang
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - Xu-Kai Mo
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China
| | - Xiao-Bai Wang
- Medical Imaging Center, Department of Radiology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou 510630, China.
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Bosco JIE, Khoo RN, Peh WCG. Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus. Singapore Med J 2014; 55:281-6. [PMID: 24862753 DOI: 10.11622/smedj.2014073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton's hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.
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Affiliation(s)
| | | | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, 90 Yishun Central, Singapore 768828.
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18
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Ohana M, Jeung MY, Labani A, El Ghannudi S, Roy C. Thoracic dual energy CT: acquisition protocols, current applications and future developments. Diagn Interv Imaging 2014; 95:1017-26. [PMID: 24780370 DOI: 10.1016/j.diii.2014.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thanks to a simultaneous acquisition at high and low kilovoltage, dual energy computed tomography (DECT) can achieve material-based decomposition (iodine, water, calcium, etc.) and reconstruct images at different energy levels (40 to 140keV). Post-processing uses this potential to maximise iodine detection, which elicits demonstrated added value for chest imaging in acute and chronic embolic diseases (increases the quality of the examination and identifies perfusion defects), follow-up of aortic endografts and detection of contrast uptake in oncology. In CT angiography, these unique features are taken advantage of to reduce the iodine load by more than half. This review article aims to set out the physical basis for the technology, the acquisition and post-processing protocols used, its proven advantages in chest pathologies, and to present future developments.
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Affiliation(s)
- M Ohana
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
| | - M Y Jeung
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Labani
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - S El Ghannudi
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - C Roy
- Department of Radiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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19
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Aran S, Shaqdan KW, Abujudeh HH. Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations. Emerg Radiol 2014; 21:391-405. [DOI: 10.1007/s10140-014-1208-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/17/2014] [Indexed: 02/05/2023]
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20
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Abstract
Patients with stone disease usually present to the urologist with acute colic pain. For the right choice of therapy the diagnosis needs to be confirmed using one of many imaging methods, including ultrasonography, abdominal radiography, intravenous urography, non-contrast-enhanced computed tomography (CT), CT and magnetic resonance imaging (MRI) urography and dual-energy CT. The techniques differ in the availability, diagnostic sensitivity and specificity and level of radiation exposure. Compared to the others dual-energy CT allows distinction between different stone compositions with high accuracy and can affect the choice of therapy. This article on imaging and diagnosis of urolithiasis discusses the different imaging methods and highlights dual-energy CT and its distinctive features.
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21
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Dual-energy lung perfusion and ventilation CT in children. Pediatr Radiol 2013; 43:298-307. [PMID: 23417255 DOI: 10.1007/s00247-012-2465-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 07/09/2012] [Indexed: 12/13/2022]
Abstract
Dual-energy thoracic CT provides two key insights into lung physiology, i.e. regional perfusion and ventilation, and has been actively investigated to find clinically relevant applications since the introduction of dual-source CT. This functional information provided by dual-energy thoracic CT is supplementary because high-resolution thoracic anatomy is entirely preserved on dual-energy thoracic CT. In addition, virtual non-contrast imaging can omit pre-contrast scanning. In this respect, dual-energy CT imaging technique is at least dose-neutral, which is a critical requirement for paediatric imaging. In this review, imaging protocols, analysis methods, clinical applications and diagnostic pitfalls of dual-energy thoracic CT for evaluating lung perfusion and ventilation in children are described.
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Abstract
OBJECTIVE Dual-energy scanning is a breakthrough in CT technology that has several applications in chest and abdominal imaging. Dual-energy CT also has potential for head and neck imaging. This review describes the role of dual-energy CT in head and neck imaging. CONCLUSION As with other body regions, both image fusion and material characterization dual-energy applications can be used for head and neck imaging. Early results are promising, and further research is encouraged.
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23
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Geyer LL, Scherr M, Körner M, Wirth S, Deak P, Reiser MF, Linsenmaier U. Imaging of acute pulmonary embolism using a dual energy CT system with rapid kVp switching: Initial results. Eur J Radiol 2012; 81:3711-8. [DOI: 10.1016/j.ejrad.2011.02.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 02/22/2011] [Indexed: 11/15/2022]
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Fuld MK, Halaweish AF, Haynes SE, Divekar AA, Guo J, Hoffman EA. Pulmonary perfused blood volume with dual-energy CT as surrogate for pulmonary perfusion assessed with dynamic multidetector CT. Radiology 2012. [PMID: 23192773 DOI: 10.1148/radiol.12112789] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare measurements of regional pulmonary perfused blood volume (PBV) and pulmonary blood flow (PBF) obtained with computed tomography (CT) in two pig models. MATERIALS AND METHODS The institutional animal care and use committee approved all animal studies. CT-derived PBF and PBV were determined in four anesthetized, mechanically ventilated, supine swine by using two methods for creating pulmonary parenchymal perfusion heterogeneity. Two animals were examined after sequentially moving a pulmonary arterial balloon catheter from a distal to a central location, and two others were examined over a range of static airway pressures, which varied the extents of regional PBF. Lung sections were divided into blocks and Pearson correlation coefficients calculated to compare matching regions between the two methods. RESULTS CT-derived PBF, CT-derived PBV, and their associated coefficients of variation (CV) were closely correlated on a region-by-region basis in both the balloon occlusion (Pearson R = 0.91 and 0.73 for animals 1 and 2, respectively; Pearson R = 0.98 and 0.87 for comparison of normalized mean and CV for animals 1 and 2, respectively) and lung inflation studies (Pearson R = 0.94 and 0.74 for animals 3 and 4, respectively; Pearson R = 0.94 and 0.69 for normalized mean and CV for animals 3 and 4, respectively). When accounting for region-based effects, correlations remained highly significant at the P < .001 level. CONCLUSION CT-derived PBV heterogeneity is a suitable surrogate for CT-derived PBF heterogeneity.
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Affiliation(s)
- Matthew K Fuld
- Department of Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, CC 701 GH, Iowa City, IA 52241, USA
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Delgado Sánchez-Gracián C, Martínez Rodríguez C, Trinidad López C. [Dual-energy computed tomography: what is it useful for?]. RADIOLOGIA 2012; 55:346-52. [PMID: 22835641 DOI: 10.1016/j.rx.2012.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/22/2012] [Accepted: 03/28/2012] [Indexed: 11/15/2022]
Abstract
Dual-energy CT is one of the newest and most attractive fields in radiology today. New generation scanners can acquire datasets with different X-ray spectra, which facilitates the characterization of certain chemical elements, making it possible to detect functional alterations in the absence of morphologic or densitometric anomalies. The capability of characterizing these elements is enabling new applications to be developed for clinical practice and changing the way we work. The aim of this article is to explain what dual-energy CT studies are, the techniques available for performing them, the advantages and disadvantages of these studies, and what we might expect from this field in the future.
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Kim BH, Seo JB, Chae EJ, Lee HJ, Hwang HJ, Lim C. Analysis of perfusion defects by causes other than acute pulmonary thromboembolism on contrast-enhanced dual-energy CT in consecutive 537 patients. Eur J Radiol 2012; 81:e647-52. [DOI: 10.1016/j.ejrad.2012.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/12/2012] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
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