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Yuan D, Li L, Zhang Y, Qi K, Zhang M, Zhang W, Lyu P, Zhang Y, Gao J, Liu J. Image quality improvement in head and neck CT angiography: Individualized post-trigger delay versus fixed delay. Eur J Radiol 2023; 168:111142. [PMID: 37832195 DOI: 10.1016/j.ejrad.2023.111142] [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: 08/26/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To compare the contrast media opacification of head and neck CT angiography (CTA) between conventional fixed trigger delay and individualized post-trigger delay (PTD). METHODS In this prospective study (April-October 2022), 196 consecutive participants were randomly divided into two groups to perform head and neck CTA in bolus tracking with either an individualized PTD (Group A) or a fixed 4-second PTD (Group B). All CT and contrast media protocol parameters were consistent between the two groups. One reader evaluated objective image quality, while two readers rated subjective image quality. Objective image quality was compared between groups via two-sample t-test, while the subjective ratings were compared with chi-square analysis. RESULTS Participants' clinical information including sex, age, weight, body weight index (BMI), and heart rate were not statistically different between two groups (all p > 0.05). Individualized PTD ranging from 3.5 to 7.9 s (average 5.6 s), which is shorter than fixed delays (p < 0.05). Both readers rated better subjective image quality for the Group A (p < 0.05). The mean vessel enhancement was significantly higher in Group A in all vessels (all p < 0.05). CONCLUSIONS Compared to the fixed post-trigger delay in bolus tracking technique, individualized post-trigger delay could achieve reliable scan timing, optimize vessel opacification and obtain better image quality for head and neck CT angiography.
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Affiliation(s)
- Dian Yuan
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Linfeng Li
- Siemens Healthineers GmbH, Forchheim, Germany
| | - Yicun Zhang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Ke Qi
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Mengyuan Zhang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Weiting Zhang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Peijie Lyu
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Yonggao Zhang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Jianbo Gao
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Jie Liu
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China.
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Yuan D, Wang Y, Lin S, Gutjahr R, Lyu P, Zhang Y, Gao J, Liu J. Patient-specific post-trigger delay in coronary CT angiography: A prospective study comparing with fixed delay. Eur J Radiol 2023; 163:110813. [PMID: 37043884 DOI: 10.1016/j.ejrad.2023.110813] [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: 03/05/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To validate the peak enhancement timing of a patient-specific post-trigger delay (PTD) in Coronary CT angiography (CCTA) and compare its image quality against a fixed PTD. METHODS In this prospective study, 204 consecutive participants were randomly divided into two groups to perform CCTA in bolus tracking with either a fixed 5-second PTD (Group A) or a patient-specific PTD (Group B). Test bolus was also performed in Group B to determine the reference peak enhancement timing. One reader evaluated objective image quality, while two readers rated subjective image quality. The predicted PTD was validated through correlation and agreement analysis with the reference measurement. Objective image quality was compared between groups via two-sample t-test and linear regression, while the subjective ratings were compared with chi-square analysis. RESULTS The two groups each had 102 participants with comparable characteristics (52.9 ± 11.3 versus 52.1 ± 11.3 years of age, and 53 versus 52 males). The scan timing from patient-specific PTD demonstrated strong correlation (R = 0.77) and consistency (ICC = 0.618) with the reference peak timing. Both readers rated better subjective image quality for the Group B (p < 0.001). The mean vessel enhancement was significantly higher in Group B in all coronary vessels (all p < 0.05). After adjusting for the participant variation, the patient-specific PTD strategy was associated with an average of 33.5 HU higher enhancement compared to the fixed PTD. CONCLUSIONS Patient-specific delay could achieve reliable scan timing, optimize vessel opacification and obtain better image quality in CCTA.
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Affiliation(s)
- Dian Yuan
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Yiran Wang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Shushen Lin
- Siemens Healthineers GmbH, Forchheim, Germany
| | | | - Peijie Lyu
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Yonggao Zhang
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Jianbo Gao
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China
| | - Jie Liu
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China.
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Ye H. Effect of Patient Factors on Portal Vein and Hepatic Contrast Enhancement at Computed Tomography Scan With Protocol Combining Fixed Injection Duration and Patients’ Body Weight Tailored Dose of Contrast Material. Cureus 2022; 14:e29283. [PMID: 36147863 PMCID: PMC9482779 DOI: 10.7759/cureus.29283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Fixed injection duration with patients’ body weight tailored dose of contrast material was recommended as the practical scan protocol in multiphasic contrast-enhanced abdominal computed tomography (CT). This study evaluated the effect of the demographic variables on portal vein and hepatic contrast enhancement in hepatic arterial phase (HAP), aiming to reduce the patient-to-patient variability and optimize the HAP images. Methods This retrospective analysis included 87 patients who underwent abdominal enhancement multiphase CT from April to June 2022. All the patients were examined using protocol combining fixed injection duration and patients’ body weight tailored dose of contrast material. Univariate and multivariate linear regression analyses were performed between all patient characteristics and the contrast-enhanced CT number of portal vein and hepatic parenchyma during HAP. Results Univariate linear regression analysis demonstrated statistically significant correlations between the CT number of hepatic parenchyma, and the body mass index (BMI), body surface area (BSA), and total body weight (TBW) (all P < 0.001) during HAP. However, multivariate linear regression analysis showed that the BMI or BMI and age were of independent predictive values (P < 0.001). Also, only the age was independently and negatively related to the CT number of portal vein enhancement during HAP (r = 0.240, P < 0.05) according to univariate linear regression analysis. Conclusions Univariate linear regression analysis revealed a significant inverse correlation between portal vein CT value and age. By multivariate linear regression analysis, only the BMI and age were significantly correlated with liver parenchymal enhancement, while gender, TBW, BSA, and HT were not.
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Optimize scan timing in abdominal multiphase CT: Bolus tracking with an individualized post-trigger delay. Eur J Radiol 2021; 148:110139. [PMID: 35021118 DOI: 10.1016/j.ejrad.2021.110139] [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: 10/12/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To conduct a head-to-head comparison in terms of image quality and diagnostic confidence between an individualized post-trigger delay and a conventional fixed post-trigger delay in bolus tracking abdominal multiphase CT. METHODS AND MATERIALS Abdominal multiphase CT was performed in 104 patients with either of the two bolus tracking strategies: an individualized post-trigger delay (group A) and fixed post-trigger delay of 11 s (group B). All CT scan parameters and contrast media protocol parameters were consistent between the two groups. Quantitative parameters (organs and blood vessels enhancement, image noise, signal-to-noise ratios [SNRs] and contrast-to-noise ratios [CNRs]) and qualitative visual parameters (overall image quality and diagnostic confidence) were compared. Quantitative and qualitative image quality for the two groups were compared using the Mann-Whitney U and independent sample t test. Degrees of agreement between two radiologists were evaluated using the Kappa analysis. RESULTS In the arterial phase (AP), images of group A provided higher attenuation (P ≤ 0.001). Although SNRs of liver, pancreas and aorta were similar in AP between the two groups, CNRs of liver, pancreas and portal vein in group A were significantly higher than those in group B (all P values ≤ 0.002). The overall subjective image quality and diagnostic confidence between the two groups were similar (P = 0.809; P = 0.768). CONCLUSION Compared to a fixed post-trigger delay using bolus tracking, application of an individualized post-trigger delay can optimize the objective image quality in arterial phase without compromising diagnostic quality in abdominal multiphase CT.
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Li J, Wang YH, Zheng FL, Chen XY, Lin Y, Zhu CR, Wu YF, Xu Q, Jin ZY, Xue HD. Feasibility of utilizing ultra-low-dose contrast medium for pancreatic artery depiction using the combination of advanced virtual monoenergetic imaging and high-concentration contrast medium: an intra-patient study. Insights Imaging 2021; 12:166. [PMID: 34767101 PMCID: PMC8589906 DOI: 10.1186/s13244-021-01079-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The least amount of contrast medium (CM) should be used under the premise of adequate diagnosis. The purpose of this study is to evaluate the feasibility of utilizing ultra-low-dose (224 mgI/kg) CM for pancreatic artery depiction using the combination of advanced virtual monoenergetic imaging (VMI+) and high-concentration (400 mgI/mL) CM.
Materials and methods 41 patients who underwent both normal dose CM (ND-CM, 320 mgI/kg) and low dose CM (LD-CM, 224 mgI/kg) thoracoabdominal enhanced CT for tumor follow-up were prospectively included. The VMI+ at the energy level of 40-kev for LD-CM images was reconstructed. CT attenuation, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs) of the abdominal artery, celiac artery, and superior mesenteric artery (SMA) and qualitative scores of pancreatic arteries depiction were recorded and compared among the three groups (ND-CM, LD-CM, and VMI+ LD-CM images). ANOVA and Friedman tests were used for statistical analysis. Results All quantitative and qualitative parameters on LD-CM images were lower than that on ND-CM images (all p < 0.01). There were no significant differences of all arteries’ qualitative scores between ND-CM and VMI+ LD-CM images (all p > 0.05). VMI+ LD-CM images had the highest mean CT and CNR values of all arteries (all p < 0.0001). The CM volume was 52.6 ± 9.4 mL for the ND-CM group and 37.0 ± 6.7 mL for the LD-CM group. Conclusion Ultra-low-dose CM (224 mgI/kg) was feasible for depicting pancreatic arteries. Inferior angiographic image quality could be successfully compensated by VMI+ and high-concentration CM.
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Affiliation(s)
- Juan Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yu-Hong Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Fu-Ling Zheng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | | | - Yun Lin
- Global Medical and Regulatory Affairs, Bracco Imaging Medical Technologies Co., Ltd, Shanghai, China
| | - Cai-Rong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yi-Fan Wu
- Global Medical and Regulatory Affairs, Bracco Imaging Medical Technologies Co., Ltd, Shanghai, China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Hua-Dan Xue
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Inoue A, Vrtiska TJ, Lee YS, Vasconcelos RN, Weber NM, Halaweish AF, Duba I, Williamson EE, Leng S, McCollough CH, Fletcher JG. The feasibility of low iodine dynamic CT angiography with test bolus for evaluation of lower extremity peripheral artery disease. Vascular 2021; 29:927-937. [PMID: 33459205 DOI: 10.1177/1708538120986304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to determine if low iodine dynamic computed tomography angiography performed after a fixed delay or test bolus acquisition demonstrates high concordance with clinical computed tomography angiography (using a routine amount of iodinated contrast) to display lower extremity peripheral arterial disease. METHODS After informed consent, low iodine dynamic computed tomography angiography examination (using either a fixed delay or test bolus) using 50 ml of iodine contrast media was performed. A subsequent clinical computed tomography angiography using standard iodine dose (115 or 145 ml) served as the reference standard. A vascular radiologist reviewed dynamic and clinical computed tomography angiography images to categorize the lumen into "not opacified", "<50% stenosis", " 50 ̶70% stenosis", ">70% stenosis", and "occluded" for seven arterial segments in each lower extremity. Concordance between low iodine dynamic computed tomography angiography and the routine iodine reference standard was calculated. The clinical utility of 4D volume-rendered images was also evaluated. RESULTS Sixty-eight patients (average age 66.1 ± 12.3 years, male; female = 49: 19) were enrolled, with 34 patients each undergoing low iodine dynamic computed tomography angiography using fixed delay and test bolus techniques, respectively. One patient assigned to the test bolus group did not undergo low iodine computed tomography angiography due to unavailable delayed time. The fixed delay was 13 s, with test bolus acquisition resulting in a mean variable delay prior to image acquisition of 19.5 s (range; 8-32 s). Run-off to the ankle was observed using low iodine dynamic computed tomography angiography following fixed delay and test bolus acquisition in 76.4% (26/34) and 100% (33/33) of patients, respectively (p = 0.005). Considering extremities with run-off to the ankle and without severe artifact, the concordance rate between low iodine dynamic computed tomography angiography and the routine iodine reference standard was 86.8% (310/357) using fixed delay and 97.9% (425/434) using test bolus (p < 0.001). 4D volume-rendered images using fixed delay and test bolus demonstrated asymmetric flow in 57.7% (15/26) and 58.1% (18/31) (p = 0.978) of patients, and collateral blood flow in 11.5% (3/26) and 22.6% (7/31) of patients (p = 0.319), respectively. CONCLUSION Low iodine dynamic computed tomography angiography with test bolus acquisition has a high concordance with routine peripheral computed tomography angiography performed with standard iodine dose, resulting in improved run-off to the ankle compared to dynamic computed tomography angiography performed after a fixed delay. This method is useful for minimizing iodine dose in patients at risk for contrast-induced nephropathy. 4D volume-rendered computed tomography angiography images provide useful dynamic information.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Yong S Lee
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Abstract
The field of artificial intelligence (AI) is transforming almost every aspect of modern society, including medical imaging. In computed tomography (CT), AI holds the promise of enabling further reductions in patient radiation dose through automation and optimisation of data acquisition processes, including patient positioning and acquisition parameter settings. Subsequent to data collection, optimisation of image reconstruction parameters, advanced reconstruction algorithms, and image denoising methods improve several aspects of image quality, especially in reducing image noise and enabling the use of lower radiation doses for data acquisition. Finally, AI-based methods to automatically segment organs or detect and characterise pathology have been translated out of the research environment and into clinical practice to bring automation, increased sensitivity, and new clinical applications to patient care, ultimately increasing the benefit to the patient from medically justified CT examinations. In summary, since the introduction of CT, a large number of technical advances have enabled increased clinical benefit and decreased patient risk, not only by reducing radiation dose, but also by reducing the likelihood of errors in the performance and interpretation of medically justified CT examinations.
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Affiliation(s)
- C H McCollough
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; e-mail:
| | - S Leng
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; e-mail:
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