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Ozeki N, Iwano S, Nakamura S, Kawaguchi K, Mizuno Y, Inoue T, Nagaya M, Chen-Yoshikawa TF. Chest three-dimensional-computed tomography imaging data analysis for the variation of exercise capacity after lung lobectomy. Clin Physiol Funct Imaging 2022; 42:362-371. [PMID: 35778371 DOI: 10.1111/cpf.12777] [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: 03/08/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair-climbing to 12-m height was used to investigate whether preoperative chest 3D-computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function. METHODS Seventy-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair-climbing time, spirometry, and diffusing capacity of the lung for carbon monoxide (DLCO ) at baseline and 6-month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO2 t) was evaluated based on the stair-climbing time. RESULTS Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO2 t. Mean loss of VO2 t was -6.2%, -1.4%, -1.6%, and -0.1% in the large volume/LAV (+), large volume/LAV (-), small volume/LAV (+), and small volume/LAV (-) groups, respectively. The large volume/LAV (-) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DLCO . CONCLUSIONS Analysis of chest 3D-CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
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Gao L, Lu X, Wen Q, Hou Y. Added value of spectral parameters for the assessment of lymph node metastasis of lung cancer with dual-layer spectral detector computed tomography. Quant Imaging Med Surg 2021; 11:2622-2633. [PMID: 34079728 DOI: 10.21037/qims-20-1045] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Lymph node (LN) metastasis is an important factor affecting the treatment of lung cancer. The purpose of this article was to investigate the benefits of dual-layer spectral detector computed tomography (SDCT) for the evaluation of metastatic LNs in lung cancer. Methods Data from 93 patients with lung cancer who underwent dual-phase enhanced scanning with SDCT were retrospectively analyzed. According to the pathological findings, 166 LNs were grouped as metastatic (n=80) or non-metastatic (n=86). LNs in station 4 (n=80) and station 7 (n=35) accounted for the majority of the LNs (approximately 69.23%). The short-axis diameter of the LN, arterial enhancement fraction (AEF), normalized iodine concentration (NIC), and the slope of the spectral Hounsfield unit curve (λHU) during the arterial phase (AP) and venous phase (VP) were measured. The Mann-Whitney U test was used to statistically compare these quantitative parameters. Receiver operating characteristic (ROC) curves were plotted to identify the cutoff values, and decision curve analysis (DCA) was performed to determine the net benefit of each parameter. The diagnostic performance, obtained by combining the short-axis diameter with each of the above parameters, was also studied. Results The short-axis LN diameter, AEF, NIC, and λHU during the AP and VP all showed significant differences between the metastatic and non-metastatic groups (P<0.05). Of the parameters, the AEF had the greatest diagnostic efficiency for metastatic LNs [area under the ROC curve (AUC)AEF =0.885] with a threshold of 86.40%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and 95% confidence interval were 90.00%, 89.53%, 88.89%, 90.59%, and 0.830-0.944, respectively. When the quantitative parameters were combined with the short-axis diameter, the AUCs of the parameters, except the AEF, were significantly improved (P<0.05). Conclusions The iodine quantitative parameters from SDCT, such as the AEF, demonstrated high diagnostic performances in the differentiation of metastatic and non-metastatic LNs.
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Affiliation(s)
- Lu Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Qingyun Wen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Maehara J, Masugi Y, Abe T, Tsujikawa H, Kurebayashi Y, Ueno A, Ojima H, Okuda S, Jinzaki M, Shinoda M, Kitagawa Y, Oda Y, Honda H, Sakamoto M. Quantification of intratumoral collagen and elastin fibers within hepatocellular carcinoma tissues finds correlations with clinico-patho-radiological features. Hepatol Res 2020; 50:607-619. [PMID: 31886596 DOI: 10.1111/hepr.13484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
AIM Emerging evidence suggests a promising role for tumor stromal factors in characterizing patients with various types of malignancies, including hepatocellular carcinoma (HCC). We quantified the amount of collagen and elastin fibers in HCC samples with the aim of clarifying the clinico-patho-radiological significance of fiber deposition in HCC. METHODS We computed the amount of collagen and elastin fibers using digital image analysis of whole-slide images of Elastica van Gieson-stained tissues from 156 surgically resected HCCs. Furthermore, we assessed the correlations between the fiber content of HCC samples and clinical, pathological, and radiological features, including immunohistochemistry-based molecular subtypes and immunosubtypes. RESULTS The intratumoral area ratio of collagen in HCC tissues (median 3.4%, range 0.1-22.2%) was more than threefold that of elastin (median 0.9%, range 0.1-9.0%); there was a strong positive correlation between the amounts of collagen and elastin. Higher levels of combined collagen and elastin were significantly associated with the confluent multinodular macroscopic tumor type, the absence of a fibrous capsule, intratumoral steatosis, scirrhous tumor stroma, dense inflammatory-cell infiltrates, and the biliary/stem cell markers-positive HCC subtype. The associations of higher collagen levels with radiological findings, including heterogeneous enhancement and persistent enhancement on dynamic computed tomography, were significant. In contrast, the associations of radiological findings with elastin fibers were not significant. Intratumoral fibrous stroma in HCC comprised septum-like and perisinusoidal fibrosis; these two forms represented distinct distribution patterns of fibers and fibroblasts. CONCLUSION Quantitative analysis suggested that stromal fiber-rich HCCs likely represent a distinct clinico-patho-radiological entity.
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Affiliation(s)
- Junki Maehara
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Tokiya Abe
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kurebayashi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Akihisa Ueno
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hidenori Ojima
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeo Okuda
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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Looking for Lepidic Component inside Invasive Adenocarcinomas Appearing as CT Solid Solitary Pulmonary Nodules (SPNs): CT Morpho-Densitometric Features and 18-FDG PET Findings. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7683648. [PMID: 30733967 PMCID: PMC6348850 DOI: 10.1155/2019/7683648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/30/2018] [Indexed: 12/17/2022]
Abstract
Objective To investigate CT morphologic and densitometric features and 18-FDG PET findings of surgically excised lung adenocarcinomas "mixed subtype" with predominant lepidic component, appearing as solid solitary pulmonary nodules (SPNs) on CT scan. Materials and Methods Approval for this study was given from each local institutional review board according to its retrospective nature. Nodules pathologically classified as lung adenocarcinoma mixed subtype with bronchioloalveolar otherwise lepidic predominant component, in three different Italian institutions (Napoli; Varese; Parma), were retrospectively selected. Results 22 patients were identified. The number of SPNs with smooth margins was significantly lower with respect to the number of SPNs with spiculated margins (p: 0.033), radiating spiculations (p: 0.019), and notch sign (p: 0.011). Mean contrast enhancement (CE) was 53.34 HU (min 5.5 HU, max 112 HU); considering 15 HU as cut-off value, CE was positive in 20/22 cases. No significant correlation was found between size and CE. Mean SUVmax was 2.21, ranging from 0.2 up to 7.5 units; considering 2.5 units as cut-off, SUVmax was positive in 7/22 cases. The number of SPNs with positive CE was significantly higher than the number of SPNs with positive SUVmax (p: 0.0005). Conclusion CT generally helps in identifying solid SPN suspicious for malignancy but 18-FDG PET may result in false-negative evaluation; when 18-FDG PET findings of a solid SPN are negative even though CT morphology and CE suggest malignancy, radiologist should consider that lepidic component may be present inside the invasive tumor, despite the absence of ground glass.
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Ito R, Iwano S, Shimamoto H, Umakoshi H, Kawaguchi K, Ito S, Kato K, Naganawa S. A comparative analysis of dual-phase dual-energy CT and FDG-PET/CT for the prediction of histopathological invasiveness of non-small cell lung cancer. Eur J Radiol 2017; 95:186-191. [PMID: 28987666 DOI: 10.1016/j.ejrad.2017.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs). MATERIALS AND METHODS We selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44-85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using "syngo Dual Energy Lung Nodules" application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis. RESULTS The A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p=0.011, p=0.021, and p=0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p=0.020) but not with lymphatic permeation or vascular invasion (p=0.088 and p=0.100, respectively). In the subgroup of patients with lesion diameters ≤2cm, the A/D ratio was significantly correlated with locoregional invasiveness (p=0.040), while the SUVmax was not (p=0.121). CONCLUSION For the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.
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Affiliation(s)
- Rintaro Ito
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Shingo Iwano
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan.
| | - Hironori Shimamoto
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Hiroyasu Umakoshi
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Koji Kawaguchi
- Nagoya University Graduate School of Medicine, Department of Thoracic Surgery, Japan
| | - Shinji Ito
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Katsuhiko Kato
- Nagoya University Graduate School of Medicine, Department of Radiological and Medical Laboratory Sciences, Japan
| | - Shinji Naganawa
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
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Cha MJ, Lee KS, Kim HS, Lee SW, Jeong CJ, Kim EY, Lee HY. Improvement in imaging diagnosis technique and modalities for solitary pulmonary nodules: from ground-glass opacity nodules to part-solid and solid nodules. Expert Rev Respir Med 2016; 10:261-78. [PMID: 26751340 DOI: 10.1586/17476348.2016.1141053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With advances in CT technology and the popularity of low-dose CT as a device for lung cancer screening, the detection rate of sub-solid pulmonary nodules as well as solid nodules has been increased. Distinguishing solid from sub-solid features is an essential step in the CT evaluation of solitary pulmonary nodules (SPNs) because strategies for nodule characterization and guidelines for management are different for each category. In addition to conventional CT parameters, numerous novel concepts and modalities have been developed. Although there is currently no single effective method for differentiating malignant from benign nodules, growth rate measurement using volumetry, evaluation of tumor vascularity on dynamic helical CT, dual-energy CT and MRI and physiologic evaluation with PET/CT can all be useful for nodule characterization. New techniques such as tomosynthesis can improve detection over radiography alone. The purpose of this article is to enhance our understanding of the evidence-based strategies involved in diagnosing SPNs.
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Affiliation(s)
- Min Jae Cha
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Kyung Soo Lee
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Hyun Su Kim
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - So Won Lee
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Chae Jin Jeong
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Eun Young Kim
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Ho Yun Lee
- a Department of Radiology and Center for Imaging Science , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response. Eur Radiol 2014; 24:1981-8. [PMID: 24895031 DOI: 10.1007/s00330-014-3223-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 04/11/2014] [Accepted: 05/07/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the potential contribution of iodine uptake calculation from dual-phase dual-energy CT (DE-CT) for lymph node staging and therapy response monitoring in lung cancer patients. METHODS Retrospective analysis of 27 patients with non-small cell lung carcinoma (NSCLC), who underwent dual-phase DE-CT before and after chemotherapy, was performed. Iodine uptake (mg/mL) and total iodine uptake (mg) were calculated using prototype software in the early (arterial) and late (venous) post-contrast circulatory phase in 110 mediastinal lymph nodes. The arterial enhancement fraction (AEF) was calculated and compared with lymph node size and response to chemotherapy. RESULTS A significant difference of AEF was observed between enlarged (90.4%; 32.3-238.5%) and non-enlarged (72.7%; -37.5-237.5%) lymph nodes (p = 0.044) before treatment onset. A significantly different change of AEF in responding (decrease of 26.3%; p = 0.022) and non-responding (increase of 43.0%; p = 0.031) lymph nodes was demonstrated. A higher value of AEF before treatment was observed in lymph nodes with subsequent favourable response (88.6% vs. 77.7%; p = 0.122), but this difference did not reach statistical significance. CONCLUSIONS The dual-phase DE-CT examination with quantification of ratio of early and late post-contrast iodine uptake is a feasible and promising method for the functional evaluation of mediastinal lymph nodes including therapy response assessment. KEY POINTS • Dual-phase DE-CT is beneficial for mediastinal lymph node assessment in NSCLC. • Arterial to venous iodine uptake ratio was higher in enlarged lymph nodes. • Change of arterial enhancement fraction correlated to therapy response.
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Iwano S, Kishimoto M, Ito S, Kato K, Ito R, Naganawa S. Prediction of pathologic prognostic factors in patients with lung adenocarcinomas: comparison of thin-section computed tomography and positron emission tomography/computed tomography. Cancer Imaging 2014; 14:3. [PMID: 25609076 PMCID: PMC4212530 DOI: 10.1186/1470-7330-14-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/09/2014] [Indexed: 11/19/2022] Open
Abstract
Background The ratio of the maximum diameter of consolidation to the maximum tumor diameter (C/T ratio) on thin-section computed tomography (TSCT) and the maximum standardized uptake value (SUVmax) on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) are often used as preoperative independent variables to evaluate the invasiveness of lung adenocarcinoma. We investigated the associations between these independent variables and pathologic invasiveness in pulmonary adenocarcinomas. Methods We selected patients with peripheral lung adenocarcinomas, definitively diagnosed by surgical resection, with diameters of ≤ 30 mm over a 4-year period ending in December 2010. The association between 3 independent variables (tumor size, SUVmax, and C/T ratio) and pathologic prognostic factors was evaluated using logistic analysis. Results We evaluated a total of 163 primary lung adenocarcinomas in 148 patients (93 males and 55 females; age range: 34 to 84 years). Using multivariate logistic regression analysis, SUVmax and the C/T ratio were significantly associated with tumor invasiveness (odds ratio [OR] = 1.227; p = 0.025 and OR = 1.019; p = 0.008, respectively). Tumor size was not associated with invasiveness (OR = 1.003; p = 0.925). For solid type adenocarcinomas, only SUVmax was significantly associated with invasiveness (OR = 1.558; p = 0.003). For subsolid type adenocarcinomas, only the C/T ratio was significantly associated with invasiveness (OR = 1.030; p = 0.009). Conclusions Both the C/T ratio and the SUVmax are significantly correlated with pathologic invasiveness in patients with small lung adenocarcinomas, while there was a difference between the 2 evaluations. Solid type adenocarcinomas with SUVmax values of ≥ 4.4 and subsolid type adenocarcinomas with C/T ratio ≥ 53% were so highly invasive.
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CT Dynamics: The Shift from Morphology to Function. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-012-0004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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