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Gillespie CD, Yates A, Hughes M, Ewins K, McMahon G, Hynes J, Murphy MC, Galligan M, Vencken S, Alih E, Varden J, Donnelly J, Bolster F, Rowan M, Foley S, NíAinle F, MacMahon PJ. Validating the safety of low-dose CTPA in pregnancy: results from the OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) Study. Eur Radiol 2024; 34:4864-4873. [PMID: 38296849 DOI: 10.1007/s00330-024-10593-y] [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: 09/22/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Pulmonary embolism (PE) is a leading cause of pregnancy-related mortality. CT pulmonary angiogram (CTPA) is the first-line advanced imaging modality for suspected PE in pregnancy at institutes offering low-dose techniques; however, a protocol balancing safety with low dose remains undefined. The wide range of CTPA doses reported in pregnancy suggests a lack of confidence in implementing low-dose techniques in this group. PURPOSE To define and validate the safety, radiation dose and image quality of a low-dose CTPA protocol optimised for pregnancy. MATERIALS AND METHODS The OPTICA study is a prospective observational study. Pregnant study participants with suspected PE underwent the same CTPA protocol between May 2018 and February 2022. The primary outcome, CTPA safety, was judged by the reference standard; the 3-month incidence of venous thromboembolism (VTE) in study participants with a negative index CTPA. Secondary outcomes defined radiation dose and image quality. Absorbed breast, maternal effective and fetal doses were estimated by Monte-Carlo simulation on gestation-matched phantoms. Image quality was assessed by signal-to-noise and contrast-to-noise ratios and a Likert score for pulmonary arterial enhancement. RESULTS A total of 116 CTPAs were performed in 113 pregnant women of which 16 CTPAs were excluded. PE was diagnosed on 1 CTPA and out-ruled in 99. The incidence of recurrent symptomatic VTE was 0.0% (one-sided 95% CI, 2.66%) at follow-up. The mean absorbed breast dose was 2.9 ± 2.1mGy, uterine/fetal dose was 0.1 ± 0.2mGy and maternal effective dose was 1.4 ± 0.9mSv. Signal-to-noise ratio (SNR) was 11.9 ± 3.7. Contrast-to-noise ratio (CNR) was 10.4 ± 3.5. CONCLUSION The OPTICA CTPA protocol safely excluded PE in pregnant women across all trimesters, with low fetal and maternal radiation. CLINICAL RELEVANCE OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) is the first prospective study to define the achievable radiation dose, image-quality and safety of a low-dose CT pulmonary angiogram protocol optimised for pregnancy (NCT04179487). It provides the current benchmark for safe and achievable CT pulmonary angiogram doses in the pregnant population. KEY POINTS • Despite the increased use of CT pulmonary angiogram in pregnancy, an optimised low-dose protocol has not been defined and reported doses in pregnancy continue to vary widely. • The OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) study prospectively defines the achievable dose, image quality and safety of a low-dose CT pulmonary angiogram protocol using widely available technology. • OPTICA provides a benchmark for safe and achievable CT pulmonary angiogram doses in the pregnant population.
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Affiliation(s)
- Ciara D Gillespie
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland.
| | - Andrew Yates
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
| | - Mark Hughes
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
| | - Karl Ewins
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Gabriella McMahon
- Department of Obstetrics, Rotunda Hospital, Dublin, D01 P5W9, Ireland
| | - John Hynes
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
| | - Mark C Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
| | - Marie Galligan
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Sebastian Vencken
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Ekele Alih
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - John Varden
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
| | - Jennifer Donnelly
- Department of Obstetrics, Rotunda Hospital, Dublin, D01 P5W9, Ireland
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Ferdia Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Michael Rowan
- Department of Medical Physics, St James Hospital, Dublin, D08 NHY1, Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Fionnuala NíAinle
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Whitty Building, North Circular Road, Dublin 7, Dublin, D07 R2WY, Ireland
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
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Li Q, Zhang P, Zhang R, Zhang J, Tian R, Gao T, Huang Y, Zhang P, Wei W, Hong R, Wang G, Zhao J. Virtual Monoenergetic Images Facilitate Better Identification of the Arc of Riolan During Splenic Flexure Takedown. J Comput Assist Tomogr 2024; 48:640-646. [PMID: 38346810 DOI: 10.1097/rct.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study aimed to investigate whether virtual monoenergetic images (VMIs) can aid radiologists and surgeons in better identifying the arc of Riolan (AOR) and to determine the optimal kilo electron volt (keV) level. METHODS Thirty-three patients were included. Conventional images (CIs) and VMI (40-100 keV) were reconstructed using arterial phase spectral-based images. The computed tomography (CT) attenuation and noise of the AOR, the CT attenuation of the erector spinal muscle, and the background noise on VMI and CI were measured, respectively. The signal-to-noise ratio, contrast-to-noise ratio (CNR), and signal intensity ratio were calculated. The image quality of the AOR was evaluated according to a 4-point Likert grade. RESULTS The CT attenuation, noise, CNR, and signal intensity ratio of the AOR were significantly higher in VMI at 40 and 50 keV compared with CI ( P < 0.001); VMI at 40 keV was significantly higher than 50 keV ( P < 0.05). No significant difference in signal-to-noise ratio, background noise, and CT attenuation of the spinal erector muscle was observed between VMI and CI ( P > 0.05). virtual monoenergetic image at 40 keV produced the best subjective scores. CONCLUSIONS Virtual monoenergetic image at 40 keV makes it easier to observe the AOR with optimized subjective and objective image quality. This may prompt radiologists and surgeons to actively search for it and encourage surgeons to preserve it during splenic flexure takedown.
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Affiliation(s)
- Qian Li
- From the Departments of Radiology
| | - Pengfei Zhang
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | | | - Jianfeng Zhang
- The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University
| | - Ruoxi Tian
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | - Tianyi Gao
- Department of Hepatobiliary Surgery, The Third Hospital of Hebei Medical University
| | - Yu Huang
- Gastrointestinal Surgery, The Third Hospital of Hebei Medical University
| | | | - Wei Wei
- From the Departments of Radiology
| | - Rui Hong
- From the Departments of Radiology
| | - Guiying Wang
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Gliner-Ron M, Sosna J, Leichter I, Goldberg SN, Shaham D, Cohen D, Malul Y, Romman Z, Lev-Cohain N. Evaluation of the Pulmonary Arteries on CTPA With Dual Energy CT: Objective Analysis and Subjective Preferences in a Multireader Study. J Thorac Imaging 2024; 39:201-207. [PMID: 38664903 DOI: 10.1097/rti.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
PURPOSE To perform qualitative and quantitative evaluation of low-monoenergetic images (50 KeV) compared with conventional images (120 kVp) in pulmonary embolism (PE) studies and to determine the extent and clinical relevance of these differences as well as radiologists' preferences. MATERIALS AND METHODS One hundred fifty CT examinations for PE detection conducted on a single-source dual-energy CT were retrospectively evaluated. Attenuation, contrast-to-noise-ratio, and signal-to-noise-ratio were obtained in a total of 8 individual pulmonary arteries on each exam-including both central (450/1200=37.5%) and peripheral (750/1200=62.5%) locations. Results were compared between the conventional and low-monoenergetic images. For quality assessment, 41 images containing PE were presented side-by-side as pairs of slices in both conventional and monoenergetic modes and evaluated for ease in embolus detection by 9 radiologists: cardiothoracic specialists (3), noncardiothoracic specialists (3), and residents (3). Paired samples t tests, a-parametric Wilcoxon test, McNemar test, and kappa statistics were performed. RESULTS Monoenergetic images had an overall statistically significant increased average ratio of 2.09 to 2.26 ( P <0.05) for each measured vessel attenuation, with an increase in signal-to-noise ratio (23.82±9.29 vs. 11.39±3.2) and contrast-to-noise ratio (17.17±6.7 vs 7.27±2.52) ( P <0.05). Moreover, 10/150 (6%) of central pulmonary artery measurements considered suboptimal on conventional mode were considered diagnostic on the monoenergetic images (181±14.6 vs. 387.7±72.4 HU respectively, P <0.05). In the subjective evaluation, noncardiothoracic radiologists showed a preference towards low-monoenergetic images, whereas cardiothoracic radiologists did not (74.4% vs. 57.7%, respectively, P <0.05). CONCLUSIONS The SNR and CNR increase on monoenergetic images may have clinical significance particularly in the setting of sub-optimal PE studies. Noncardiothoracic radiologists and residents prefer low monoenergetic images.
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Affiliation(s)
- Masha Gliner-Ron
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Peng J, Chang CW, Xie H, Qiu RLJ, Roper J, Wang T, Ghavidel B, Tang X, Yang X. Image-domain material decomposition for dual-energy CT using unsupervised learning with data-fidelity loss. Med Phys 2024. [PMID: 38865687 DOI: 10.1002/mp.17255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Dual-energy computed tomography (DECT) and material decomposition play vital roles in quantitative medical imaging. However, the decomposition process may suffer from significant noise amplification, leading to severely degraded image signal-to-noise ratios (SNRs). While existing iterative algorithms perform noise suppression using different image priors, these heuristic image priors cannot accurately represent the features of the target image manifold. Although deep learning-based decomposition methods have been reported, these methods are in the supervised-learning framework requiring paired data for training, which is not readily available in clinical settings. PURPOSE This work aims to develop an unsupervised-learning framework with data-measurement consistency for image-domain material decomposition in DECT. METHODS The proposed framework combines iterative decomposition and deep learning-based image prior in a generative adversarial network (GAN) architecture. In the generator module, a data-fidelity loss is introduced to enforce the measurement consistency in material decomposition. In the discriminator module, the discriminator is trained to differentiate the low-noise material-specific images from the high-noise images. In this scheme, paired images of DECT and ground-truth material-specific images are not required for the model training. Once trained, the generator can perform image-domain material decomposition with noise suppression in a single step. RESULTS In the simulation studies of head and lung digital phantoms, the proposed method reduced the standard deviation (SD) in decomposed images by 97% and 91% from the values in direct inversion results. It also generated decomposed images with structural similarity index measures (SSIMs) greater than 0.95 against the ground truth. In the clinical head and lung patient studies, the proposed method suppressed the SD by 95% and 93% compared to the decomposed images of matrix inversion. CONCLUSIONS Since the invention of DECT, noise amplification during material decomposition has been one of the biggest challenges, impeding its quantitative use in clinical practice. The proposed method performs accurate material decomposition with efficient noise suppression. Furthermore, the proposed method is within an unsupervised-learning framework, which does not require paired data for model training and resolves the issue of lack of ground-truth data in clinical scenarios.
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Affiliation(s)
- Junbo Peng
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Chih-Wei Chang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Huiqiao Xie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard L J Qiu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tonghe Wang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beth Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Remy-Jardin M, Oufriche I, Guiffault L, Duhamel A, Flohr T, Schmidt B, Remy J. Diagnosis of acute pulmonary embolism: when photon-counting-detector CT replaces energy-integrating-detector CT in daily routine. Eur Radiol 2024:10.1007/s00330-024-10724-5. [PMID: 38634875 DOI: 10.1007/s00330-024-10724-5] [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: 01/19/2024] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To compare the diagnostic approach of acute pulmonary embolism (PE) with photon-counting-detector CT (PCD-CT) and energy-integrating-detector CT (EID-CT). MATERIALS AND METHODS Two cohorts underwent CT angiographic examinations with EID-CT (Group 1; n = 158) and PCD-CT (Group 2; n = 172), (b) with two options in Group 1, dual energy (Group 1a) or single energy (Group 1b) and a single option in Group 2 (spectral imaging with single source). RESULTS In Group 2, all patients benefited from spectral imaging, only accessible to 105 patients (66.5%) in Group 1, with a mean acquisition time significantly shorter (0.9 ± 0.1 s vs 4.0 ± 0 .3 s; p < 0.001) and mean values of CTDIvol and DLP reduced by 46.3% and 47.7%, respectively. Comparing the quality of 70 keV (Group 2) and averaged (Group 1a) images: (a) the mean attenuation within pulmonary arteries did not differ (p = 0.13); (b) the image noise was significantly higher (p < 0.001) in Group 2 with no difference in subjective image noise (p = 0.29); and (c) 89% of examinations were devoid of artifacts in Group 2 vs 28.6% in Group 1a. The percentage of diagnostic examinations was 95.2% (100/105; Group 1a), 100% (53/53; Group 1b), and 95.3% (164/172; Group 2). There were 4.8% (5/105; Group 1a) and 4.7% (8/172; Group 2) of non-diagnostic examinations, mainly due to the suboptimal quality of vascular opacification with the restoration of a diagnostic image quality on low-energy images. CONCLUSION Compared to EID-CT, morphology and perfusion imaging were available in all patients scanned with PCD-CT, with the radiation dose reduced by 48%. CLINICAL RELEVANCE STATEMENT PCD-CT enables scanning patients with the advantages of both spectral imaging, including high-quality morphologic imaging and lung perfusion for all patients, and fast scanning-a combination that is not simultaneously accessible with EID-CT while reducing the radiation dose by almost 50%.
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Affiliation(s)
- Martine Remy-Jardin
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France.
- IMALLIANCE-Haut-de-France, Valenciennes, France.
- Department of Thoracic Imaging, University of Lille, Lille, France.
| | - Idir Oufriche
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Lucas Guiffault
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Alain Duhamel
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France
- Department of Biostatistics, University of Lille, CHU Lille, Lille, France
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Bernhard Schmidt
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Jacques Remy
- Department of Thoracic Imaging, University of Lille, Lille, France
- Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France
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Sauranen S, Mäkelä T, Kaasalainen T, Kortesniemi M. Dual-energy computed tomography quality control: Initial experiences with a semi-automatic analysis tool. Phys Med 2024; 118:103211. [PMID: 38237302 DOI: 10.1016/j.ejmp.2024.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE A quality control (QC) system for dual-energy CT (DECT) was developed. The scope of the QC system was to monitor both the constancy of the CT images and the software used in calculating the DECT derived maps. Longitudinal analysis was based on a standard imaging protocol, a commercial multi-energy phantom, and a semi-automatic analysis tool. METHODS The phantom consisted of an elliptical body section with round slots for interchangeable inserts. It was scanned with 90kVp/Sn150kVp, automatic tube current modulation, and 9.6 mGy CTDIvol. From the two conventional CT images, scanner manufacturer's software was used to provide virtual monoenergetic images at two different energies, effective atomic number (Zeff) maps, and iodine concentration maps. The images were analyzed using an open-source tool allowing user-selected statistics of interest. The means and standard deviations of the phantom background and the iodine, calcium, and water inserts were recorded. The QC tool is available at github.com/tomakela/dectqatool. RESULTS The obtained results were generally highly consistent over time, except for the smaller diameter iodine inserts. A small change inZeff was observed after a DECT software update. The developed QC tool aided the analysis robustness: the segmentations were modifiable when needed, and small rotations or air bubbles in the water insert were easily corrected. CONCLUSION The developed QC system provided easy-to-use workflow for constancy measurements. A small deviation due to change in the post-processing was detected. The proposed imaging protocol and analysis steps, and the reported measurement variations can aid in determining action levels for DECT QC.
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Affiliation(s)
- S Sauranen
- Department of Physics, University of Helsinki, Helsinki, Finland; HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290 Helsinki, Finland.
| | - T Mäkelä
- Department of Physics, University of Helsinki, Helsinki, Finland; HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290 Helsinki, Finland
| | - T Kaasalainen
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290 Helsinki, Finland
| | - M Kortesniemi
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290 Helsinki, Finland
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Moore J, Remy J, Altschul E, Chusid J, Flohr T, Raoof S, Remy-Jardin M. Thoracic Applications of Spectral CT Scan. Chest 2024; 165:417-430. [PMID: 37619663 DOI: 10.1016/j.chest.2023.07.4225] [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: 02/20/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
TOPIC IMPORTANCE Thoracic imaging with CT scan has become an essential component in the evaluation of respiratory and thoracic diseases. Providers have historically used conventional single-energy CT; however, prevalence of dual-energy CT (DECT) is increasing, and as such, it is important for thoracic physicians to recognize the utility and limitations of this technology. REVIEW FINDINGS The technical aspects of DECT are presented, and practical approaches to using DECT are provided. Imaging at multiple energy spectra allows for postprocessing of the data and the possibility of creating multiple distinct image reconstructions based on the clinical question being asked. The data regarding utility of DECT in pulmonary vascular disorders, ventilatory defects, and thoracic oncology are presented. A pictorial essay is provided to give examples of the strengths associated with DECT. SUMMARY DECT has been most heavily studied in chronic thromboembolic pulmonary hypertension; however, it is increasingly being used across a wide spectrum of thoracic diseases. DECT combines morphologic and functional assessments in a single imaging acquisition, providing clinicians with a powerful diagnostic tool. Its role in the evaluation and treatment of thoracic diseases will likely continue to expand in the coming years as clinicians become more experienced with the technology.
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Affiliation(s)
- Jonathan Moore
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY
| | - Jacques Remy
- Univ Lille, Department of Thoracic Imaging, Lille, France
| | - Erica Altschul
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY
| | - Jesse Chusid
- Feinstein Institutes for Medical Research, and Imaging Services, Department of Radiology, Northwell Health, Manhasset, NY
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers, Forchheim, Germany
| | - Suhail Raoof
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY.
| | - Martine Remy-Jardin
- Univ Lille, Department of Thoracic Imaging, Lille, France; Univ Lille, CHU Lille, Evaluation des technologies de santé et des pratiques médicales, Lille, France
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8
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Rajiah PS, Kambadakone A, Ananthakrishnan L, Sutphin P, Kalva SP. Vascular Applications of Dual-Energy Computed Tomography. Radiol Clin North Am 2023; 61:1011-1029. [PMID: 37758354 DOI: 10.1016/j.rcl.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Dual- or multi-energy CT imaging provides several advantages over conventional CT in the context of vascular imaging. Specific advantages include the use of low-energy virtual monoenergetic images (VMIs) to boost iodine attenuation to salvage suboptimal enhanced studies, perform low-contrast material dose studies, and increase conspicuity of small vessels and lesions. Alternatively, high-energy VMIs reduce artifacts caused by some metals, endoprosthesis, calcium blooming, and beam hardening. Virtual non-contrast (VNC) images reduce radiation dose by eliminating the need for a true non-contrast acquisition in multiphasic CT studies. Iodine maps can be used to evaluate perfusion of tissues and lesions.
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Affiliation(s)
- Prabhakar S Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | | | | | - Patrick Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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9
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Douek PC, Boccalini S, Oei EHG, Cormode DP, Pourmorteza A, Boussel L, Si-Mohamed SA, Budde RPJ. Clinical Applications of Photon-counting CT: A Review of Pioneer Studies and a Glimpse into the Future. Radiology 2023; 309:e222432. [PMID: 37787672 PMCID: PMC10623209 DOI: 10.1148/radiol.222432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 10/04/2023]
Abstract
CT systems equipped with photon-counting detectors (PCDs), referred to as photon-counting CT (PCCT), are beginning to change imaging in several subspecialties, such as cardiac, vascular, thoracic, and musculoskeletal radiology. Evidence has been building in the literature underpinning the many advantages of PCCT for different clinical applications. These benefits derive from the distinct features of PCDs, which are made of semiconductor materials capable of converting photons directly into electric signal. PCCT advancements include, among the most important, improved spatial resolution, noise reduction, and spectral properties. PCCT spatial resolution on the order of 0.25 mm allows for the improved visualization of small structures (eg, small vessels, arterial walls, distal bronchi, and bone trabeculations) and their pathologies, as well as the identification of previously undetectable anomalies. In addition, blooming artifacts from calcifications, stents, and other dense structures are reduced. The benefits of the spectral capabilities of PCCT are broad and include reducing radiation and contrast material dose for patients. In addition, multiple types of information can be extracted from a single data set (ie, multiparametric imaging), including quantitative data often regarded as surrogates of functional information (eg, lung perfusion). PCCT also allows for a novel type of CT imaging, K-edge imaging. This technique, combined with new contrast materials specifically designed for this modality, opens the door to new applications for imaging in the future.
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Affiliation(s)
| | | | - Edwin H. G. Oei
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - David P. Cormode
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Amir Pourmorteza
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Loic Boussel
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Salim A. Si-Mohamed
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Ricardo P. J. Budde
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
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10
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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11
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Wucherpfennig L, Triphan SM, Weinheimer O, Eichinger M, Wege S, Eberhardt R, Puderbach MU, Kauczor HU, Heussel CP, Heussel G, Wielpütz MO. Reproducibility of pulmonary magnetic resonance angiography in adults with muco-obstructive pulmonary disease. Acta Radiol 2023; 64:1038-1046. [PMID: 35876445 DOI: 10.1177/02841851221111486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies support magnetic resonance angiography (MRA) as a diagnostic tool for pulmonary arterial disease. PURPOSE To determine MRA image quality and reproducibility, and the dependence of MRA image quality and reproducibility on disease severity in patients with chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). MATERIAL AND METHODS Twenty patients with COPD (mean age 66.5 ± 8.9 years; FEV1% = 42.0 ± 13.3%) and 15 with CF (mean age 29.3 ± 9.3 years; FEV1% = 66.6 ± 15.8%) underwent morpho-functional chest magnetic resonance imaging (MRI) including time-resolved MRA twice one month apart (MRI1, MRI2), and COPD patients underwent non-contrast computed tomography (CT). Image quality was assessed visually using standardized subjective 5-point scales. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured by regions of interest. Disease severity was determined by spirometry, a well-evaluated chest MRI score, and by computational CT emphysema index (EI) for COPD. RESULTS Subjective image quality was diagnostic for all MRA at MRI1 and MRI2 (mean score = 4.7 ± 0.6). CNR and SNR were 4 43.8 ± 8.7 and 50.5 ± 8.7, respectively. Neither image quality score nor CNR or SNR correlated with FEV1% or chest MRI score for COPD and CF (r = 0.239-0.248). CNR and SNR did not change from MRI1 to MRI2 (P = 0.434-0.995). Further, insignificant differences in CNR and SNR between MRA at MRI1 and MRI2 did not correlate with FEV1% nor chest MRI score in COPD and CF (r = -0.238-0.183), nor with EI in COPD (r = 0.100-0.111). CONCLUSION MRA achieved diagnostic quality in COPD and CF patients and was highly reproducible irrespective of disease severity. This supports MRA as a robust alternative to CT in patients with underlying muco-obstructive lung disease.
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Affiliation(s)
- Lena Wucherpfennig
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Mf Triphan
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Wege
- Department of Pulmonology and Respiratory Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
- Department of Pulmonology and Internal intensive care, Asklepios Clinic Barmbek, Hamburg, Germany
| | - Michael U Puderbach
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Hufeland Hospital, Bad Langensalza, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Claus P Heussel
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Gudula Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, 27178University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, 27178University Hospital Heidelberg, Heidelberg, Germany
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12
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Dundas J, Leipsic JA. Contrast Medium Reduction for CTA with Photon-counting CT: A New Opportunity or More of the Same? Radiol Cardiothorac Imaging 2023; 5:e220306. [PMID: 36860828 PMCID: PMC9969205 DOI: 10.1148/ryct.220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023]
Affiliation(s)
- James Dundas
- From the Department of Radiology, Providence Health Care, Vancouver, BC, Canada (J.D.); and Department of Radiology, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.A.L.)
| | - Jonathon A. Leipsic
- From the Department of Radiology, Providence Health Care, Vancouver, BC, Canada (J.D.); and Department of Radiology, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.A.L.)
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13
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Gillespie CD, Yates A, Murphy MC, Hughes M, Ewins K, NíAinle F, Bolster F, Rowan M, Foley S, MacMahon PJ. Breast Shielding Combined With an Optimized Computed Tomography Pulmonary Angiography Pregnancy Protocol: A Special Use-Case for Shielding? J Thorac Imaging 2023; 38:36-43. [PMID: 36162076 DOI: 10.1097/rti.0000000000000677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the impact of breast shields on breast dose and image quality when combined with a low-dose computed tomography pulmonary angiography (CTPA) protocol for pregnancy. METHODS A low-dose CTPA protocol, with and without breast shields, was evaluated by anthropomorphic phantom and 20 prospectively recruited pregnant participants from January to October 2019. Thermoluminescent dosimeters measured surface and absorbed breast dose in the phantom and surface breast dose in participants. The Monte-Carlo method estimated the absorbed breast dose in participants. Image quality was assessed quantitatively by regions of interest analysis and subjectively by the Likert scale. Doses and image quality for CTPA alone were compared with CTPA with breast shields. RESULTS Mean surface and absorbed breast dose for CTPA alone were 1.3±0.4 and 2.8±1.5 mGy in participants, and 1.5±0.7 and 1.6±0.6 mGy in the phantom. Shielding reduced surface breast dose to 0.5±0.3 and 0.7±0.2 mGy in the phantom (66%) and study participants (48%), respectively. Absorbed breast dose reduced to 0.9±0.5 mGy (46%) in the phantom.Noise increased with breast shields at lower kV settings (80 to 100 kV) in the phantom; however, in study participants there was no significant difference between shield and no-shield groups for main pulmonary artery noise (no-shield: 34±9.8, shield: 36.3±7.2, P =0.56), SNR (no-shield: 11.2±3.7, shield: 10.8±2.6, P =0.74) or contrast-to-noise ratio (no-shield: 10.0±3.3, shield: 9.3±2.4, P =0.6). Median subjective image quality scores were comparable (no-shield: 4.0, interquartile range: 3.5 to 4.4, shield: 4.3, interquartile range: 4.0 to 4.5). CONCLUSION Combining low-dose CTPA with breast shields confers additional breast-dose savings without impacting image quality and yields breast doses approaching those of low-dose scintigraphy, suggesting breast shields play a role in protocol optimization for select groups.
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Affiliation(s)
| | | | | | | | - Karl Ewins
- Haematology, Mater Misericordiae University Hospital
| | | | - Ferdia Bolster
- Departments of Radiology
- School of Medicine, University College Dublin
| | - Michael Rowan
- Department of Medical Physics, St James Hospital, Dublin, Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin
| | - Peter J MacMahon
- Departments of Radiology
- School of Medicine, University College Dublin
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14
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Gruschwitz P, Petritsch B, Schmid A, Schmidt AMA, Grunz JP, Kuhl PJ, Heidenreich JF, Huflage H, Bley TA, Kosmala A. Noise-optimized virtual monoenergetic reconstructions of dual-energy CT angiographies improve assessability of the lower leg arterial segments in peripheral arterial occlusive disease. Radiography (Lond) 2023; 29:19-27. [PMID: 36209641 DOI: 10.1016/j.radi.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the influence of a noise optimized virtual monoenergetic reconstruction algorithm (VMI+) on the image quality and assessability of dual energy (DE) computed tomography angiography (CTA) of the lower extremity runoff. METHODS A total of 118 lower extremity runoff CTA performed on a 3rd generation DE-CT scanner in 109 patients (54 females; 75.6 ± 9.5 years) were included in this retrospective study. Axial image stacks were reconstructed with a standard 120 kV setting and VMI+ of different keV levels. Objective image quality criteria (contrast attenuation, signal-to-noise [SNR] and contrast-to-noise ratio [CNR]) were measured. Two radiologists evaluated subjective image quality regarding intraluminal attenuation and image noise using a 5-point Likert scale. Diagnostic accuracy for significant stenosis (>75%) and vessel occlusion was assessed for 120 kV and 50 keV VMI+ images rated by two radiologists. In all patients, a digital subtraction angiography (DSA) rated by on board-certified radiologist served as the standard of reference. RESULTS Intraluminal attenuation was highest in 40/50 keV VMI+ while SNR were similar to 120 kV images. In subjective assessment, intraluminal contrast of 50 keV images was deemed superior compared to 120 kV despite higher image noise. Sensitivity, specificity, and accuracy for detection of a vessel occlusion were similar in 50 keV VMI+ compared to 120 kV (70%/92%/84%; 70%/91%/83%; p < 0.001) but 13 of 118 (11%) lower leg runoffs were only assessable with 50 keV VMI+. CONCLUSION VMI+ reconstructions improve assessability of DE-CTA by increased luminal attenuation with consistent image noise, also allowing the evaluation of lower leg arterial segments inassessable with standard reconstructions. IMPLICATIONS FOR PRACTICE Providing higher intraluminal attenuation and similar image noise compared with conventional reconstructions, 50 keV VMI+ may be appropriate for routine evaluation of DE-CTA.
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Affiliation(s)
- P Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - B Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A Schmid
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A M A Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J-P Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - P J Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - H Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A Kosmala
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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15
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Azour L, Ko JP, Toussie D, Gomez GV, Moore WH. Current imaging of PE and emerging techniques: is there a role for artificial intelligence? Clin Imaging 2022; 88:24-32. [DOI: 10.1016/j.clinimag.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
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16
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Kaproth-Joslin K, Hobbs S, Rajiah P, Chaturvedi A, Chaturvedi A. Optimizing low contrast volume thoracic CT angiography: From the basics to the advanced. J Clin Imaging Sci 2022; 12:41. [PMID: 36128360 PMCID: PMC9479554 DOI: 10.25259/jcis_51_2022] [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] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Contrast-enhanced CT angiography (CTA) is a widely used, noninvasive imaging technique for evaluating cardiovascular structures. Contrast-induced nephrotoxicity is a concern in renal disease; however, the true nephrotoxic potential of iodinated contrast media (CM) is unknown. If a renal impaired patient requires CTA, it is important to protect the kidneys from further harm by reducing total iodinated CM volume while still obtaining diagnostic quality imaging. These same reduced volume CM techniques can also be applied to nonrenal impaired patients in times of CM shortage. This educational review discusses several modifications to CTA that can be adapted to both conventional 64-slice and the newer generation CT scanners which enable subsecond acquisition with a reduced CM volume technique. Such modifications include hardware and software adjustments and changes to both the volume and flow rate of administered CM, with the goal to reduce the dose of CM without compromising diagnostic yield.
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Affiliation(s)
| | - Susan Hobbs
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States,
| | - Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States,
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States,
| | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States,
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17
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Ananthakrishnan L, Kay FU, Zeikus EA, Chu ES, Chang J, Barr JD, Rofsky NM, Abbara S. What the Baby Formula and Medical Contrast Material Shortages Have in Common: Insights and Recommendations for Managing the Iodinated Contrast Media Shortage. Radiol Cardiothorac Imaging 2022; 4:e220101. [PMID: 35833167 PMCID: PMC9274312 DOI: 10.1148/ryct.220101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 05/25/2023]
Abstract
The impact of supply chain and supply chain logistics, including personnel directly and indirectly related to the movement of supplies, has come to light in a variety of industries since the global COVID-19 pandemic. Acutely, the experience with baby formula and iodinated contrast material exposes key vulnerabilities to supply chains. The rather sudden diminished availability of iodinated contrast material has forced health care systems to engage in more judicious use of product through catalyzing the adoption of behaviors that had been recommended and deemed reasonable prior to the shortage. The authors describe efforts at a large, academic safety net county health system to conserve iodinated contrast media by optimizing contrast media use in the CT department and changing ordering patterns of referring providers. Special attention is given to opportunities to conserve contrast material in cardiothoracic imaging, including low kV and dual-energy CT techniques. A values-based leadership philosophy and collaboration with key stakeholders facilitate effective response to the critical shortage and rapid deployment of iodinated contrast media conservation strategies. Last, while the single-supplier model is efficient and cost-effective, its application to critically necessary services such as health care must be questioned considering disruptions related to the COVID-19 pandemic. Keywords: CT, Intravenous Contrast Agents, CT-Spectral Imaging (Dual Energy) ©RSNA, 2022.
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Greffier J, Viry A, Barbotteau Y, Frandon J, Loisy M, Oliveira F, Beregi JP, Dabli D. Phantom task‐based image quality assessment of three generations of rapid kV‐switching dual‐energy CT systems on virtual monoenergetic images. Med Phys 2022; 49:2233-2244. [DOI: 10.1002/mp.15558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Joël Greffier
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
| | - Anaïs Viry
- Institute of Radiation Physics Lausanne University Hospital and University of Lausanne Rue du Grand‐Pré 1 Lausanne 1007 Switzerland
| | - Yves Barbotteau
- Hôpital Privé Clairval – Service d'Imagerie 317, Bd du Redon Marseille 13009 France
| | - Julien Frandon
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
| | - Maeliss Loisy
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
| | - Fabien Oliveira
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
| | - Jean Paul Beregi
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
| | - Djamel Dabli
- Department of medical imaging CHU Nîmes Univ Montpellier, Nîmes Medical Imaging Group Nîmes 2992 France
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19
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Tipre DN, Cidon M, Moats RA. Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19. Mol Imaging Biol 2022; 24:526-536. [PMID: 35041149 PMCID: PMC8764889 DOI: 10.1007/s11307-021-01700-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 hypoxemic patients although sharing a same etiology (SARS-CoV-2 infection) present themselves quite differently from one another. Patients also respond differently to prescribed medicine and to prone Vs supine bed positions. A severe pulmonary ventilation-perfusion mismatch usually triggers moderate to severe COVID-19 cases. Imaging can aid the physician in assessing severity of COVID-19. Although useful for their portability X-ray and ultrasound serving on the frontline to evaluate lung parenchymal abnormalities are unable to provide information about pulmonary vasculature and blood flow redistribution which is a consequence of hypoxemia in COVID-19. Advanced imaging modalities such as computed tomography, single-photon emission tomography, and electrical impedance tomography use a sharp algorithm visualizing pulmonary ventilation-perfusion mismatch in the abnormal and in the apparently normal parenchyma. Imaging helps to access the severity of infection, lung performance, ventilation-perfusion mismatch, and informs strategies for medical treatment. This review summarizes the capacity of these imaging modalities to assess ventilation-perfusion mismatch in COVID-19. Despite having limitations, these modalities provide vital information on blood volume distribution, pulmonary embolism, pulmonary vasculature and are useful to assess severity of lung disease and effectiveness of treatment in COVID-19 patients.
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Affiliation(s)
- Dnyanesh N Tipre
- Translational Biomedical Imaging Laboratory, Department of Radiology, Children's Hospital Los Angeles, The Saban Research Institute, 4650 Sunset Blvd Rm 305, Los Angeles, CA, USA.
| | - Michal Cidon
- Department of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rex A Moats
- Translational Biomedical Imaging Laboratory, Department of Radiology, Children's Hospital Los Angeles, The Saban Research Institute, 4650 Sunset Blvd Rm 305, Los Angeles, CA, USA
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20
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Hu H, Zheng S, Hou M, Zhu K, Chen C, Wu Z, Qi L, Ren Y, Wu B, Xu Y, Yan C, Zhao B. Functionalized Au@Cu-Sb-S Nanoparticles for Spectral CT/Photoacoustic Imaging-Guided Synergetic Photo-Radiotherapy in Breast Cancer. Int J Nanomedicine 2022; 17:395-407. [PMID: 35115774 PMCID: PMC8800589 DOI: 10.2147/ijn.s338085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radiotherapy (RT) is clinically well-established cancer treatment. However, radioresistance remains a significant issue associated with failure of RT. Phototherapy-induced radiosensitization has recently attracted attention in translational cancer research. Methods Cu-Sb-S nanoparticles (NPs) coated with ultra-small Au nanocrystals (Au@Cu-Sb-S) were synthesized and characterized. The biosafety profiles, absorption of near-infrared (NIR) laser and radiation-enhancing effect of the NPs were evaluated. In vitro and in vivo spectral computed tomography (CT) imaging and photoacoustic (PA) imaging were performed in 4T1 breast cancer-bearing mice. The synergetic radio-phototherapy was assessed by in vivo tumor inhibition studies. Results Au@Cu-Sb-S NPs were prepared by in situ growth of Au NCs on the surface of Cu-Sb-S NPs. The cell viability experiments showed that the combination of Au@Cu-Sb-S+NIR+RT was significantly more cytotoxic to tumor cells than the other treatments at concentrations above 25 ppm Sb. In vitro and in vivo spectral CT imaging demonstrated that the X-ray attenuation ability of Au@Cu-Sb-S NPs was superior to that of the clinically used Iodine, particularly at lower KeV levels. Au@Cu-Sb-S NPs showed a concentration-dependent and remarkable PA signal brightening effect. In vivo tumor inhibition studies showed that the prepared Au@Cu-Sb-S NPs significantly suppressed tumor growth in 4T1 breast cancer-bearing mice treated with NIR laser irradiation and an intermediate X-ray dose (4 Gy). Conclusion These results indicate that Au@Cu-Sb-S integrated with spectral CT, PA imaging, and phototherapy-enhanced radiosensitization is a promising multifunctional theranostic nanoplatform for clinical applications.
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Affiliation(s)
- Honglei Hu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Shuting Zheng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Meirong Hou
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Kai Zhu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Chuyao Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Zede Wu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Li Qi
- Guangdong Provincial Key Laboratory of Medical Image Processing, Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Yunyan Ren
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Bin Wu
- Institute of Respiratory Diseases, Respiratory Department, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, People’s Republic of China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
| | - Bingxia Zhao
- Guangzhou Key Laboratory of Tumor Immunology Research, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Experimental Education/Administration Center, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Correspondence: Bingxia Zhao; Yikai Xu, Tel +86 20 61647272; +86 20 62787333, Email ;
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21
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Vlahos I, Jacobsen MC, Godoy MC, Stefanidis K, Layman RR. Dual-energy CT in pulmonary vascular disease. Br J Radiol 2022; 95:20210699. [PMID: 34538091 PMCID: PMC8722250 DOI: 10.1259/bjr.20210699] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a "one-stop shop" for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
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Affiliation(s)
- Ioannis Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rick R Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Majeed NF, Ali SM, Therrien J, Wald C, Wortman JR. Virtual Monoenergetic Spectral Detector CT for Preoperative CT Angiography in Liver Donors. Curr Probl Diagn Radiol 2021; 51:517-523. [PMID: 34839975 DOI: 10.1067/j.cpradiol.2021.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of virtual monoenergetic images (VMI) in pre-operative CT angiography of potential donors for living donor adult liver transplantation (LDALT), and to determine the optimal energy level to maximize vascular signal-to-noise and contrast-to-noise ratios (SNR and CNR, respectively). MATERIALS AND METHODS We retrospectively evaluated 29 CT angiography studies performed preoperatively in potential liver donors on a spectral detector CT scanner. All studies included arterial, early venous, and delayed venous phase imaging. Conventional polyenergetic images were generated for each patient, as well as virtual monoenergetic images in 10 keV increments from 40 -100 keV. Arteries (aorta and celiac, superior mesenteric, common hepatic, right and left hepatic arteries) were assessed on arterial phase images; portal venous system branches (splenic, superior mesenteric, main, right, and left portal veins) on early venous phase images; and hepatic veins on late venous phase images. Vascular attenuation, background parenchymal attenuation, and noise were measured on each set of virtual monoenergetic and conventional images. RESULTS Background hepatic and vascular noise decreased with increasing keV, with the lowest noise at 100 keV. Vascular SNR and CNR increased with decreasing keV and were highest at 40 keV, with statistical significance compared with conventional ( P < 0.05). CONCLUSIONS In preoperative CT angiography for potential liver donors, the optimal keV for assessing the vasculature to improve SNR and CNR is 40 keV. Use of low keV VMI in LDALT CT protocols may facilitate detection of vascular anatomical variants that can impact surgical planning.
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Affiliation(s)
- Noor Fatima Majeed
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA.
| | - Sarah Maria Ali
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
| | - Jaclyn Therrien
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
| | - Jeremy R Wortman
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
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23
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Majeed NF, Braschi Amirfarzan M, Wald C, Wortman JR. Spectral detector CT applications in advanced liver imaging. Br J Radiol 2021; 94:20201290. [PMID: 34048285 PMCID: PMC8248211 DOI: 10.1259/bjr.20201290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Spectral detector CT (SDCT) has many applications in advanced liver imaging. If appropriately utilized, this technology has the potential to improve image quality, provide new diagnostic information, and allow for decreased radiation dose. The purpose of this review is to familiarize radiologists with the uses of SDCT in liver imaging. CONCLUSION SDCT has a variety of post-processing techniques, which can be used in advanced liver imaging and can significantly add value in clinical practice.
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Affiliation(s)
- Noor Fatima Majeed
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Marta Braschi Amirfarzan
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Jeremy R Wortman
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
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24
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Kayano S. [5. Principles of Dual-energy CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:515-523. [PMID: 34011795 DOI: 10.6009/jjrt.2021_jsrt_77.5.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shingo Kayano
- Department of Radiological Technology, Tohoku University Hospital
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25
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Bos D, König B, Blex S, Zensen S, Opitz M, Maier S, Forsting M, Zylka W, Kühl H, Wetter A, Guberina N. EXPERIMENTAL EXAMINATION OF RADIATION DOSES OF DUAL- AND SINGLE-ENERGY COMPUTED TOMOGRAPHY IN CHEST AND UPPER ABDOMEN IN A PHANTOM STUDY. RADIATION PROTECTION DOSIMETRY 2021; 193:237-246. [PMID: 33893506 DOI: 10.1093/rpd/ncab052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
The aim of this phantom study is to examine radiation doses of dual- and single-energy computed tomography (DECT and SECT) in the chest and upper abdomen for three different multi-slice CT scanners. A total of 34 CT protocols were examined with the phantom N1 LUNGMAN. Four different CT examination types of different anatomic regions were performed both in single- and dual-energy technique: chest, aorta, pulmonary arteries for suspected pulmonary embolism and liver. Radiation doses were examined for the CT dose index CTDIvol and dose-length product (DLP). Radiation doses of DECT were significantly higher than doses for SECT. In terms of CTDIvol, radiation doses were 1.1-3.2 times higher, and in terms of DLP, these were 1.1-3.8 times higher for DECT compared with SECT. The third-generation dual-source CT applied the lowest dose in 7 of 15 different examination types of different anatomic regions.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Britta König
- Faculty of Physical Engineering, Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, Gelsenkirchen 45897, Germany
| | - Sebastian Blex
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Sandra Maier
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
| | - Waldemar Zylka
- Faculty of Physical Engineering, Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, Gelsenkirchen 45897, Germany
| | - Hilmar Kühl
- Department of Radiology, St. Bernhard-Hospital Kamp-Lintfort GmbH, Bürgermeister-Schmelzing-Str. 90, Kamp-Lintfort 47475, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, Hamburg 21075, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany
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26
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Gong H, Marsh JF, D'Souza KN, Huber NR, Rajendran K, Fletcher JG, McCollough CH, Leng S. Deep-learning-based direct synthesis of low-energy virtual monoenergetic images with multi-energy CT. J Med Imaging (Bellingham) 2021; 8:052104. [PMID: 33889658 DOI: 10.1117/1.jmi.8.5.052104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/18/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: We developed a deep learning method to reduce noise and beam-hardening artifact in virtual monoenergetic image (VMI) at low x-ray energy levels. Approach: An encoder-decoder type convolutional neural network was implemented with customized inception modules and in-house-designed training loss (denoted as Incept-net), to directly estimate VMI from multi-energy CT images. Images of an abdomen-sized water phantom with varying insert materials were acquired from a research photon-counting-detector CT. The Incept-net was trained with image patches ( 64 × 64 pixels ) extracted from the phantom data, as well as synthesized, random-shaped numerical insert materials. The whole CT images ( 512 × 512 pixels ) with the remaining real insert materials that were unseen in network training were used for testing. Seven contrast-enhanced abdominal CT exams were used for preliminary evaluation of Incept-net generalizability over anatomical background. Mean absolute percentage error (MAPE) was used to evaluate CT number accuracy. Results: Compared to commercial VMI software, Incept-net largely suppressed beam-hardening artifact and reduced noise (53%) in phantom study. Incept-net presented comparable CT number accuracy at higher-density ( P -value [0.0625, 0.999]) and improved it at lower-density inserts ( P - value = 0.0313 ) with overall MAPE: Incept-net [2.9%, 4.6%]; commercial-VMI [6.7%, 10.9%]. In patient images, Incept-net suppressed beam-hardening artifact and reduced noise (up to 50%, P - value = 0.0156 ). Conclusion: In this preliminary study, Incept-net presented the potential to improve low-energy VMI quality.
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Affiliation(s)
- Hao Gong
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Jeffrey F Marsh
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Karen N D'Souza
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Nathan R Huber
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Kishore Rajendran
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Joel G Fletcher
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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Assessment of Virtual Monoenergetic Images in Run-off Computed Tomography Angiography: A Comparison Study to Conventional Images From Spectral Detector Computed Tomography. J Comput Assist Tomogr 2021; 45:232-237. [PMID: 33369991 PMCID: PMC7972299 DOI: 10.1097/rct.0000000000001126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aims of this study were to evaluate image quality of virtual monoenergetic images (VMIs) compared with conventional images (CIs) from spectral detector CT (SDCT) and to explore the optimal energy level in run-off computed tomography angiography (CTA).
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28
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Nguyen ET, Hague C, Manos D, Memauri B, Souza C, Taylor J, Dennie C. Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 2: Technical Issues and Interpretation Pitfalls. Can Assoc Radiol J 2021; 73:214-227. [PMID: 33781102 DOI: 10.1177/08465371211000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The investigation of acute pulmonary embolism is a common task for radiologists in Canada. Technical image quality and reporting quality must be excellent; pulmonary embolism is a life-threatening disease that should not be missed but overdiagnosis and unnecessary treatment should be avoided. The most frequently performed imaging investigation, computed tomography pulmonary angiogram (CTPA), can be limited by poor pulmonary arterial opacification, technical artifacts and interpretative errors. Image quality can be affected by patient factors (such as body habitus, motion artifact and cardiac output), intravenous (IV) contrast protocols (including the timing, rate and volume of IV contrast administration) and common physics artifacts (including beam hardening). Mimics of acute pulmonary embolism can be seen in normal anatomic structures, disease in non-vascular structures and pulmonary artery filling defects not related to acute pulmonary emboli. Understanding these pitfalls can help mitigate error, improve diagnostic quality and optimize patient outcomes. Dual energy computed tomography holds promise to improve imaging diagnosis, particularly in clinical scenarios where routine CTPA may be problematic, including patients with impaired renal function and patients with altered cardiac anatomy.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, 33540Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Hague
- Department of Radiology, 12358University of British Columbia, Vancouver, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brett Memauri
- Cardiothoracic Sciences Division, St. Boniface General Hospital, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolina Souza
- Department of Medical Imaging, 10055The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jana Taylor
- 54473McGill University Health Centre, Montreal, Quebec, Canada
| | - Carole Dennie
- Department of Medical Imaging, 10055The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- 27337Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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29
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the use of iodinated contrast media in patients with kidney disease 2018. Clin Exp Nephrol 2020; 24:1-44. [PMID: 31709463 PMCID: PMC6949208 DOI: 10.1007/s10157-019-01750-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiromitsu Hayashi
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazutaka Aonuma
- Cardiology Department, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Taichi Sato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Toei
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryusuke Murakami
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Eri Koshi
- Department of Nephrology, Komaki City Hospital, Aichi, Japan
| | - Tomoki Kosugi
- Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Sugawara H, Takayanagi T, Ishikawa T, Katada Y, Fukui R, Yamamoto Y, Suzuki S. New Fast kVp Switching Dual-Energy CT: Reduced Severity of Beam Hardening Artifacts and Improved Image Quality in Reduced-Iodine Virtual Monochromatic Imaging. Acad Radiol 2020; 27:1586-1593. [PMID: 31837969 DOI: 10.1016/j.acra.2019.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES To compare degradation of the image quality due to beam hardening artifacts in reduced-iodine-dose virtual monochromatic imaging (VMI) between a new fast kVp switching dual-energy computed tomography (CT) scanner (Revolution CT) and the conventional dual-energy scanner (Discovery CT). MATERIALS AND METHODS First, a phantom study was performed to quantitatively evaluate beam hardening artifacts in images obtained by VMI reconstruction at different energy levels. In the second study, we performed a retrospective evaluation of the images of 28 patients who had undergone reduced-iodine (300 mg/kg) dual-energy scanning in both Revolution CT and Discovery CT. We evaluated each image quantitatively by measuring the contrast-to-noise ratio (CNR) and qualitatively by scoring the artifacts and image quality. We also calculated the modulation transfer function (MTF) and noise power spectrum (NPS) of the two scanners. RESULTS In the phantom study, VMI reconstruction of the CT images at 40-70 keV was associated with a significantly greater reduction in the severity of the artifacts in the Revolution CT images as compared to the Discovery CT images. In the retrospective study, there were no significant differences in the CT value of the aorta, noise, or CNR between the two scanners, but the scores for image quality were significantly higher in the Revolution CT images as compared to the Discovery CT images. The MTF of Revolution CT was higher than that of Discovery CT, reflecting the better spatial resolution. CONCLUSION In Revolution CT, beam hardening artifacts were reduced in reduced-iodine VMI at lower energy levels compared to Discovery CT, contributing to better image quality.
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Split-Bolus, Single-Acquisition, Dual-Phase Abdominopelvic CT Angiography for the Evaluation of Lung Transplant Candidates: Image Quality and Resource Utilization. AJR Am J Roentgenol 2020; 215:1520-1527. [PMID: 33052735 DOI: 10.2214/ajr.19.22335] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the image quality and resource utilization of single-injection, split-bolus, dual-enhancement abdominopelvic CT angiography (hereafter referred to as dual-enhancement CTA) performed for combined vascular and solid organ assessment compared with those of single-injection, single-enhancement abdominopelvic CT angiography (hereafter referred to as single-enhancement CTA) for vascular assessment in combination with additional examinations (CT, MRI, and US) performed to assess for malignancy in lung transplant candidates. MATERIALS AND METHODS. We retrospectively reviewed 100 patients who underwent abdominopelvic CTA examinations before lung transplant. Cohort A (n = 50) underwent dual-enhancement CTA and cohort B (n = 50) underwent single-enhancement CTA. Contrast opacification of the vasculature was assessed along the abdominal aorta through the right femoral artery. Solid organ enhancement was assessed in the right lobe of the liver and the right renal cortex. Measurements of mean radiation dose, contrast exposure, and cost of the studies (in U.S. dollars) were compared. RESULTS. Mean (± SD) vascular enhancement on dual-enhancement CTA and single-enhancement CTA was 334.2 ± 26.5 HU (coefficient of variation, 8.3%) and 340.0 ± 21.6 HU (coefficient of variation, 6.5%) (p = 0.23), respectively. For dual-enhancement CTA and single-enhancement CTA, mean liver enhancement was 125.8 ± 30.5 HU and 60.4 ± 6.9 HU (p < 0.01), respectively, whereas mean renal cortical enhancement was 260.3 ± 62.2 HU and 133.4 ± 38.6 HU (p < 0.01), respectively. The mean IV contrast volume was 150 mL for dual-enhancement CTA and 75 mL for single-enhancement CTA. Cohort A underwent six additional imaging studies (one of which was a CT colonography study with an effective dose of 19.0 mSv) at a total cost of $9840 per patient. Cohort B underwent 44 additional imaging studies (mean effective dose, 12.7 ± 6.5 mSv) at a total cost of $12,846 per patient (resulting in a 30.6% reduction in cost for dual-enhancement CTA studies; p < 0.0001). CONCLUSION. Dual-enhancement abdominopelvic CTA allows combined vascular and abdominopelvic solid organ assessment with improved image quality and a lower cost compared with traditional imaging pathways.
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Digumarthy SR, Singh R, Rastogi S, Otrakji A, Homayounieh F, Zhang EW, McDermott S, Kalra MK. Low contrast volume dual-energy CT of the chest: Quantitative and qualitative assessment. Clin Imaging 2020; 69:305-310. [PMID: 33045474 DOI: 10.1016/j.clinimag.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the image quality of chest CT performed on dual-energy scanners using low contrast volume for routine chest (DECT-R) and pulmonary angiography (DECTPA) protocols. MATERIALS AND METHODS This retrospective study included dual-energy CT scans of chest performed with low contrast volume in 84 adults (34M:50F; Age 69 ± 16 years: Weight 71 ± 16kg). There were 42 patients with DECT-R and 42 patients with DECT-PA protocols. Images were reviewed by two thoracic radiologists. Qualitative assessment was done on a four-point scale, for subjective assessment of contrast enhancement and artifacts (1 = Excellent, 2 = optimal, 3 = suboptimal, and 4 = Limited) in the pulmonary arteries and thoracic aorta, on virtual monoenergetic and material decomposition iodine (MDI) images. Quantitative assessment was performed by measuring the CT (Hounsfield) units in aorta and pulmonary arteries. The estimated glomerular filtration rate (eGFR) was calculated before and after CT scans. Two tailed student's t-test was performed to assess the significance of findings, and strength of correlation between readers was determined by Cohen's kappa test. RESULTS DECT-PA and DECT-R demonstrated excellent/adequate contrast density within the pulmonary arteries (up to segmental branch), and aorta. There was no suboptimal or limited examination. There was strong interobserver agreement for arterial enhancement in pulmonary arteries (kappa = 0.62-0.89) and for thoracic aorta (kappa = 0.62-0.94). Pulmonary emboli were seen in 3/42(7%) in DECT-R and in 5/42(12%) in DECT-PA. There was no significant change in eGFR before and after IV contrast injection (p = 0.46-0.52). CONCLUSION DECT-R and DECT-PA performed with low contrast volume provide diagnostic quality opacification of the pulmonary vessels and aorta vessels.
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Affiliation(s)
- Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Ramandeep Singh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shivam Rastogi
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Alexi Otrakji
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Fatemeh Homayounieh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Eric W Zhang
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Foti G, Silva R, Faccioli N, Fighera A, Menghini R, Campagnola A, Carbognin G. Identification of pulmonary embolism: diagnostic accuracy of venous-phase dual-energy CT in comparison to pulmonary arteries CT angiography. Eur Radiol 2020; 31:1923-1931. [PMID: 32965572 DOI: 10.1007/s00330-020-07286-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/27/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of venous-phase dual-energy computed tomography (VP-DECT) in the identification of PE compared with standard CT pulmonary angiography (CTPA). METHODS This prospective IRB-approved study included 61 consecutive oncology patients (35 females, 26 males, mean age 66.91 years) examined by CTPA and VP-DECT. DECT data were post-processed on a SyngoVia workstation to obtain monoenergetic images (MEI+). The diagnosis of PE was based on the presence of any vascular perfusion defects. DECT images were evaluated independently by two radiologists (8 and 16 years of experience). A consensus reading of CTPA images (two senior radiologists, 18 and 24 years of experience) represented the reference for diagnosis. The diagnostic accuracy values of VP-DECT on a per-patient and per-lobe basis were assessed. Interobserver agreement was calculated using k-statistics. A value of p < 0.05 was considered statistically significant. RESULTS Thirty of 61 patients (49.18%) were diagnosed with PE by CTPA, with 57/366 lobes being involved (15.57%). The sensitivity and specificity of the per-patient analysis of VP-DECT images were 90.0% (27/30) and 100% (31/31) respectively, for both readers. As concerns the per-lobe analysis, the sensitivity ranged from 100% for the right lower lobe to 50% for the left upper lobe for reader 1, and from 100% for the left upper lobe to 69.23% for the lingula for reader 2. The interobserver agreement ranged from 0.8671 (patients' analysis) to 0.6419 (lobes' analysis). CONCLUSION VP-DECT could be considered an accurate imaging tool for diagnosing PE in a selected, high-prevalence population, compared with CTPA. KEY POINTS • With regard to the patients' analysis, venous-phase DECT sensitivity and specificity in diagnosing pulmonary embolism were 90% and 100%, respectively, for both readers. • With regard to the lobes' analysis, the sensitivity ranged from 100 to 50%, for reader 1, and from 100 to 69.23%, for reader 2, respectively. • The sensitivity and specificity of lung perfusion maps obtained from venous DECT were 73.33% and 67.74% as concerns the patients' analysis and 71.92% and 75.72% as regards the lobes' analysis, respectively.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 1, 37024, Negrar, VR, Italy.
| | - Ronaldo Silva
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Niccolò Faccioli
- Department of Radiology, Verona University Hospital, Verona, Italy
| | | | | | | | - Giovanni Carbognin
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 1, 37024, Negrar, VR, Italy
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Konietzke P, Weinheimer O, Wagner WL, Wuennemann F, Hintze C, Biederer J, Heussel CP, Kauczor HU, Wielpütz MO. Optimizing airway wall segmentation and quantification by reducing the influence of adjacent vessels and intravascular contrast material with a modified integral-based algorithm in quantitative computed tomography. PLoS One 2020; 15:e0237939. [PMID: 32813730 PMCID: PMC7437894 DOI: 10.1371/journal.pone.0237939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Quantitative analysis of multi-detector computed tomography (MDCT) plays an increasingly important role in assessing airway disease. Depending on the algorithms used, airway dimensions may be over- or underestimated, primarily if contrast material was used. Therefore, we tested a modified integral-based method (IBM) to address this problem. Methods Temporally resolved cine-MDCT was performed in seven ventilated pigs in breath-hold during iodinated contrast material (CM) infusion over 60s. Identical slices in non-enhanced (NE), pulmonary-arterial (PA), systemic-arterial (SA), and venous phase (VE) were subjected to an in-house software using a standard and a modified IBM. Total diameter (TD), lumen area (LA), wall area (WA), and wall thickness (WT) were measured for ten extra- and six intrapulmonary airways. Results The modified IBM significantly reduced TD by 7.6%, LA by 12.7%, WA by 9.7%, and WT by 3.9% compared to standard IBM on non-enhanced CT (p<0.05). Using standard IBM, CM led to a decrease of all airway parameters compared to NE. For example, LA decreased from 80.85±49.26mm2 at NE, to 75.14±47.96mm2 (-7.1%) at PA (p<0.001), 74.96±48.55mm2 (-7.3%) at SA (p<0.001), and to 78.95±48.94mm2 (-2.4%) at VE (p = 0.200). Using modified IBM, the differences were reduced to -3.1% at PA, -2.9% at SA and -0.7% at VE (p<0.001; p<0.001; p = 1.000). Conclusions The modified IBM can optimize airway wall segmentation and reduce the influence of CM on quantitative CT. This allows a more precise measurement as well as potentially the comparison of enhanced with non-enhanced scans in inflammatory airway disease.
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Affiliation(s)
- Philip Konietzke
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Willi L. Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Christian Hintze
- Department of Diagnostic Radiology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Radiologie Rein-Nahe, Bingen, Germany
| | - Juergen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Claus P. Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
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Deep Learning Versus Iterative Reconstruction for CT Pulmonary Angiography in the Emergency Setting: Improved Image Quality and Reduced Radiation Dose. Diagnostics (Basel) 2020; 10:diagnostics10080558. [PMID: 32759874 PMCID: PMC7460033 DOI: 10.3390/diagnostics10080558] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/01/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022] Open
Abstract
To compare image quality and the radiation dose of computed tomography pulmonary angiography (CTPA) subjected to the first deep learning-based image reconstruction (DLR) (50%) algorithm, with images subjected to the hybrid-iterative reconstruction (IR) technique (50%). One hundred forty patients who underwent CTPA for suspected pulmonary embolism (PE) between 2018 and 2019 were retrospectively reviewed. Image quality was assessed quantitatively (image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) and qualitatively (on a 5-point scale). Radiation dose parameters (CT dose index, CTDIvol; and dose-length product, DLP) were also recorded. Ninety-three patients were finally analyzed, 48 with hybrid-IR and 45 with DLR images. The image noise was significantly lower and the SNR (24.4 ± 5.9 vs. 20.7 ± 6.1) and CNR (21.8 ± 5.8 vs. 18.6 ± 6.0) were significantly higher on DLR than hybrid-IR images (p < 0.01). DLR images received a significantly higher score than hybrid-IR images for image quality, with both soft (4.4 ± 0.7 vs. 3.8 ± 0.8) and lung (4.1 ± 0.7 vs. 3.6 ± 0.9) filters (p < 0.01). No difference in diagnostic confidence level for PE between both techniques was found. CTDIvol (4.8 ± 1.4 vs. 4.0 ± 1.2 mGy) and DLP (157.9 ± 44.9 vs. 130.8 ± 41.2 mGy∙cm) were lower on DLR than hybrid-IR images. DLR both significantly improved the image quality and reduced the radiation dose of CTPA examinations as compared to the hybrid-IR technique.
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Lennartz S, Große Hokamp N, Zäske C, Zopfs D, Bratke G, Glauner A, Maintz D, Persigehl T, Chang DH, Hickethier T. Virtual monoenergetic images preserve diagnostic assessability in contrast media reduced abdominal spectral detector CT. Br J Radiol 2020; 93:20200340. [PMID: 32644824 DOI: 10.1259/bjr.20200340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate if low-keV virtual monoenergetic images (VMI40keV) from abdominal spectral detector CT (SDCT) with reduced intravenous contrast media application (RCM) provide abdominal assessment similar to conventional images with standard contrast media (SCM) dose. METHODS 78 patients with abdominal SDCT were retrospectively included: 41 patients at risk for adverse reactions who received 44 RCM examinations with 50 ml and 37 patients who underwent 44 SCM examinations with 100 ml of contrast media (CM) and who were matched for effective body diameters. RCM, SCM images and RCM-VMI40keV were reconstructed. Attenuation and signal-to-noise ratio (SNR) of liver, pancreas, kidneys, lymph nodes, psoas muscle, aorta and portal vein were assessed ROIs-based. Contrast-to-noise ratios (CNR) of lymph nodes vs aorta/portal vein were calculated. Two readers evaluated organ/vessel contrast, lymph node delineation, image noise and overall assessability using 4-point Likert scales. RESULTS RCM were inferior to SCM images in all quantitative/qualitative criteria. RCM-VMI40keV and SCM images showed similar lymph node and muscle attenuation (p = 0.83,0.17), while for all other ROIs, RCM-VMI40keV showed higher attenuation (p ≤ 0.05). SNR was comparable between RCM-VMI40keV and SCM images (p range: 0.23-0.99). CNR of lymph nodes was highest in RCM-VMI40keV (p ≤ 0.05). RCM-VMI40keV received equivalent or higher scores than SCM in all criteria except for organ contrast, overall assessability and image noise, where SCM were superior (p ≤ 0.05). However, RCM-VMI40keV received proper or excellent scores in 88.6/94.2/95.4% of the referring cases. CONCLUSIONS VMI40keV counteract contrast deterioration in CM reduced abdominal SDCT, facilitating diagnostic assessment. ADVANCES IN KNOWLEDGE SDCT-derived VMI40keV provide adequate depiction of vessels, organs and lymph nodes even at notable CM reduction.
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Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Harvard Medial School, 55 Fruit Street, White 270, Boston, MA 02114, USA.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne,Weyertal 115b, 50931, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Charlotte Zäske
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Grischa Bratke
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Andreas Glauner
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - De-Hua Chang
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Department of Radiology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Wu H, Chen X, Zhou H, Qin B, Cao J, Pan Z, Wang Z. An optimized test bolus for computed tomography pulmonary angiography and its application at 80 kV with 10 ml contrast agent. Sci Rep 2020; 10:10208. [PMID: 32576901 PMCID: PMC7311447 DOI: 10.1038/s41598-020-67145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/04/2020] [Indexed: 01/31/2023] Open
Abstract
Computed tomography pulmonary angiography (CTPA) is usually used for pulmonary embolism (PE) detection. However, the determination of scan timing remains a challenge due to the short scan duration of CTPA. We aimed to develop an optimized test bolus to determine scan delay in CTPA. The time-enhancement curves were obtained by measuring the enhancement within a region of interest in the main pulmonary artery and vein. A total of 70 patients were randomly divided into two groups (n = 35 each): the control group underwent CTPA using the test bolus approach and the test group underwent CTPA using the biphasic time-enhancement curves approach. Tube voltages of 100 kVp and 80 kVp and 20 ml and 10 ml contrast agent were adopted in the control and test groups, respectively. The CT numbers, image quality, PE detection was evaluated. There was a point of intersection between the pulmonary artery and vein test bolus enhancement curves. The scan delay time (TDELAY) was obtained based on the time at intersection (TCROSS) and the scan duration (TSD): TDELAY = TCROSS − TSD. The mean CT numbers for pulmonary vein in the control were higher than those in the test group (all p < 0.001). The image quality for the pulmonary arteries in the test group was better than that in the control group (p < 0.01), with artifact reduction in the superior vena cava. Segmental PE could be detected using the optimized protocol. The radiation dose and iodine load in the test group were all lower than those in the control (p < 0.01). We established an approach to calculate the scan delay of CTPA, and this approach could be used for CTPA at 80 kVp with 10 ml contrast agent.
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Affiliation(s)
- Huiming Wu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao Chen
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Zhou
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Qin
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian Cao
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhaochun Pan
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongqiu Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Reducing Radiation Dose and Contrast Medium Volume With Application of Dual-Energy CT in Children and Young Adults. AJR Am J Roentgenol 2020; 214:1199-1205. [DOI: 10.2214/ajr.19.22231] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Computed tomography angiography (CTA) has become a mainstay for the imaging of vascular diseases, because of high accuracy, availability, and rapid turnaround time. High-quality CTA images can now be routinely obtained with high isotropic spatial resolution and temporal resolution. Advances in CTA have focused on improving the image quality, increasing the acquisition speed, eliminating artifacts, and reducing the doses of radiation and iodinated contrast media. Dual-energy computed tomography provides material composition capabilities that can be used for characterizing lesions, optimizing contrast, decreasing artifact, and reducing radiation dose. Deep learning techniques can be used for classification, segmentation, quantification, and image enhancement.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55904, USA.
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McCollough CH, Boedeker K, Cody D, Duan X, Flohr T, Halliburton SS, Hsieh J, Layman RR, Pelc NJ. Principles and applications of multienergy CT: Report of AAPM Task Group 291. Med Phys 2020; 47:e881-e912. [DOI: 10.1002/mp.14157] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Kirsten Boedeker
- Canon (formerly Toshiba) Medical Systems Corporation 1440 Warnall Ave Los Angeles CA 90024 USA
| | - Dianna Cody
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Xinhui Duan
- Southwestern Medical Center University of Texas 5323 Harry Hines Blvd Dallas TX 75390‐9071 USA
| | - Thomas Flohr
- Siemens Healthcare GmbH Siemensstr. 3 Forchheim BY 91031 Germany
| | | | - Jiang Hsieh
- GE Healthcare Technologies 3000 N. Grandview Blvd. W-1190 Waukesha WI 53188 USA
| | - Rick R. Layman
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Norbert J. Pelc
- Stanford University 443 Via Ortega, Room 203 Stanford CA 94305‐4125 USA
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Sauter AP, Shapira N, Kopp FK, Aichele J, Bodden J, Knipfer A, Rummeny EJ, Noël PB. CTPA with a conventional CT at 100 kVp vs. a spectral-detector CT at 120 kVp: Comparison of radiation exposure, diagnostic performance and image quality. Eur J Radiol Open 2020; 7:100234. [PMID: 32420413 PMCID: PMC7215101 DOI: 10.1016/j.ejro.2020.100234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/10/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022] Open
Abstract
With SD-CT, increased radiation exposure is not present. In the current study, CTDIvol was lower with SD-CT than with C-CT, even when 100 kVp was used for the latter. With SD-CT, higher levels of diagnostic performance and image quality can be achieved. SD-CT may be the system of choice due to the availability of spectral data and thus additional image information.
Purpose To compare CT pulmonary angiographies (CTPAs) as well as phantom scans obtained at 100 kVp with a conventional CT (C-CT) to virtual monochromatic images (VMI) obtained with a spectral detector CT (SD-CT) at equivalent dose levels as well as to compare the radiation exposure of both systems. Material and Methods In total, 2110 patients with suspected pulmonary embolism (PE) were examined with both systems. For each system (C-CT and SD-CT), imaging data of 30 patients with the same mean CT dose index (4.85 mGy) was used for the reader study. C-CT was performed with 100 kVp and SD-CT was performed with 120 kVp; for SD-CT, virtual monochromatic images (VMI) with 40, 60 and 70 keV were calculated. All datasets were evaluated by three blinded radiologists regarding image quality, diagnostic confidence and diagnostic performance (sensitivity, specificity). Contrast-to-noise ratio (CNR) for different iodine concentrations was evaluated in a phantom study. Results CNR was significantly higher with VMI at 40 keV compared to all other datasets. Subjective image quality as well as sensitivity and specificity showed the highest values with VMI at 60 keV and 70 keV. Hereby, a significant difference to 100 kVp (C-CT) was found for image quality. The highest sensitivity was found using VMI at 60 keV with a sensitivity of more than 97 % for all localizations of PE. For diagnostic confidence and subjective contrast, highest values were found with VMI at 40 keV. Conclusion Higher levels of diagnostic performance and image quality were achieved for CPTAs with SD-CT compared to C-CT given similar dose levels. In the clinical setting SD-CT may be the modality of choice as additional spectral information can be obtained.
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Key Words
- BMI, body mass index
- C-CT, conventional spiral CT
- CNR, contrast-to-noise ratio
- CT, computed tomography
- CTDIVOL, volume-weighted CT dose index
- CTPA, CT pulmonary angiography
- Computed tomography angiography
- DE-CT, dual-Energy CT
- DLP, dose length product
- DS-CT, dual-Source CT
- ED, effective dose
- HU, Hounsfield Units
- IQ, image quality
- PE, pulmonary embolism
- Patient safety
- Pulmonary embolism
- ROI, region of interest
- Radiation exposure
- Radiologic
- SD-CT, spectral-detector CT
- Technology
- VMI, virtual monochromatic images
- kVp, peak kilovoltage
- keV, kilo-electronvolt
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Affiliation(s)
- Andreas P Sauter
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Nadav Shapira
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Philips Healthcare, Haifa, Israel
| | - Felix K Kopp
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Juliane Aichele
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Jannis Bodden
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Andreas Knipfer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Ernst J Rummeny
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Peter B Noël
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Jiang Y, Zhang X, Sheng K, Niu T, Xue Y, Lyu Q, Xu L, Luo C, Yang P, Yang C, Wang J, Hu X. Noise Suppression in Image-Domain Multi-Material Decomposition for Dual-Energy CT. IEEE Trans Biomed Eng 2020; 67:523-535. [DOI: 10.1109/tbme.2019.2916907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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43
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Cicero G, Ascenti G, Albrecht MH, Blandino A, Cavallaro M, D'Angelo T, Carerj ML, Vogl TJ, Mazziotti S. Extra-abdominal dual-energy CT applications: a comprehensive overview. Radiol Med 2020; 125:384-397. [PMID: 31925704 DOI: 10.1007/s11547-019-01126-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
Unlike conventional computed tomography, dual-energy computed tomography is a relatively novel technique that exploits ionizing radiations at different energy levels. The separate radiation sets can be achieved through different technologies, such as dual source, dual layers or rapid switching voltage. Body tissue molecules vary for their specific atomic numbers and electron density, and the interaction with different sets of radiations results in different attenuations, allowing to their final distinction. In particular, iodine recognition and quantification have led to important information about intravenous contrast medium delivery within the body. Over the years, useful post-processing algorithms have also been validated for improving tissue characterization. For instance, contrast resolution improvement and metal artifact reduction can be obtained through virtual monoenergetic images, dose reduction by virtual non-contrast reconstructions and iodine distribution highlighting through iodine overlay maps. Beyond the evaluation of the abdominal organs, dual-energy computed tomography has also been successfully employed in other anatomical districts. Although lung perfusion is one of the most investigated, this evaluation has been extended to narrowly fields of application, such as musculoskeletal, head and neck, vascular and cardiac. The potential pool of information provided by dual-energy technology is already wide and not completely explored, yet. Therefore, its performance continues to raise increasing interest from both radiologists and clinicians.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Alfredo Blandino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marco Cavallaro
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Maria Ludovica Carerj
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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Rajiah P, Ciancibello L, Novak R, Sposato J, Landeras L, Gilkeson R. Ultra-low dose contrast CT pulmonary angiography in oncology patients using a high-pitch helical dual-source technology. ACTA ACUST UNITED AC 2020; 25:195-203. [PMID: 31063136 DOI: 10.5152/dir.2019.17498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to determine if the image quality and vascular enhancement are preserved in computed tomography pulmonary angiography (CTPA) studies performed with ultra-low contrast and optimized radiation dose using high-pitch helical mode of a second generation dual source scanner. METHODS We retrospectively evaluated oncology patients who had CTPA on a 128-slice dual-source scanner, with a high-pitch helical mode (3.0), following injection of 30 mL of Ioversal at 4 mL/s with body mass index (BMI) dependent tube potential (80-120 kVp) and current (130-150 mAs). Attenuation, noise, and signal-to-noise ratio (SNR) were measured in multiple pulmonary arteries. Three independent readers graded the images on a 5-point Likert scale for central vascular enhancement (CVE), peripheral vascular enhancement (PVE), and overall quality. RESULTS There were 50 males and 101 females in our study. BMI ranged from 13 to 38 kg/m2 (22.8±4.4 kg/m2). Pulmonary embolism was present in 29 patients (18.9%). Contrast enhancement and SNR were excellent in all the pulmonary arteries (395.3±131.1 and 18.3±5.7, respectively). Image quality was considered excellent by all the readers, with average reader scores near the highest possible score of 5.0 (CVE, 4.83±0.48; PVE, 4.68±0.65; noise/quality, 4.78±0.47). The average radiation dose length product (DLP) was 161±60 mGy.cm. CONCLUSION Using a helical high-pitch acquisition technique, CTPA images of excellent diagnostic quality, including visualization of peripheral segmental/sub-segmental branches can be obtained using an ultra-low dose of iodinated contrast and low radiation dose.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Ciancibello
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ronald Novak
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
| | - Jennifer Sposato
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Landeras
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Kamr WH, El-Tantawy AM, Harraz MM, Tawfik AI. Pulmonary embolism: Low dose contrast MSCT pulmonary angiography with modified test bolus technique. Eur J Radiol Open 2020; 7:100254. [PMID: 32984447 PMCID: PMC7494793 DOI: 10.1016/j.ejro.2020.100254] [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] [Received: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 11/04/2022] Open
Abstract
Test bolus technique increase the diagnostic quality score of the scans performed. Provides better evaluation of the pulmonary arteries and its subsegmental branches. Increase the main pulmonary artery average density, decrease average density of the aorta and pulmonary veins. Increase the confidence and accuracy rate of diagnostic examinations. Volume of IV contrast decreased by 40 % than in bolus tracking.
Purpose This study aims to prove that the test bolus technique provides a better selective imaging study of the pulmonary arterial system in comparison to the automatic bolus-tracking technique. Method A prospective study included 600 patients, classified into 2 groups where each group consisted of 300 patients. In group A, we used the bolus tracking technique with 80−100 ml of contrast while in group B test bolus technique was used with 50 mL of contrast. Results It was clear that the Main PA average density was 260.5 HU in group A and increased to 320 HU in group B with P value < 0.002. The Ascending aorta average density decreased from 250 HU in group A to 130 HU in group B with P value <.001. The average score was increased by 35 % (from 1.75 in group A to 2.8 in group B with P value < .001). The Volume of IV contrast needed decreased by 40 % in group B compared to group A. Conclusion MSCTPA using test bolus method reduces the amount of the contrast used with better opacification of the pulmonary artery and its sub segmental branches in addition to reduced artifact.
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the Use of Iodinated Contrast Media in Patients With Kidney Disease 2018. Circ J 2019; 83:2572-2607. [PMID: 31708511 DOI: 10.1253/circj.cj-19-0783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshitaka Isaka
- Japanese Society of Nephrology.,Department of Nephrology, Osaka University Graduate School of Medicine
| | - Hiromitsu Hayashi
- Japan Radiological Society.,Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School
| | - Kazutaka Aonuma
- the Japanese Circulation Society.,Cardiology Department, Institute of Clinical Medicine, University of Tsukuba
| | - Masaru Horio
- Japanese Society of Nephrology.,Kansai Medical Hospital
| | - Yoshio Terada
- Japanese Society of Nephrology.,Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University
| | - Kent Doi
- Japanese Society of Nephrology.,Department of Acute Medicine, The University of Tokyo
| | - Yoshihide Fujigaki
- Japanese Society of Nephrology.,Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Hideo Yasuda
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Taichi Sato
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Tomoyuki Fujikura
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Ryohei Kuwatsuru
- Japan Radiological Society.,Department of Radiology, Graduate School of Medicine, Juntendo University
| | - Hiroshi Toei
- Japan Radiological Society.,Department of Radiology, Graduate School of Medicine, Juntendo University
| | - Ryusuke Murakami
- Japan Radiological Society.,Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School
| | - Yoshihiko Saito
- the Japanese Circulation Society.,Department of Cardiovascular Medicine, Nara Medical University
| | - Atsushi Hirayama
- the Japanese Circulation Society.,Department of Cardiology, Osaka Police Hospital
| | - Toyoaki Murohara
- the Japanese Circulation Society.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akira Sato
- the Japanese Circulation Society.,Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Hideki Ishii
- the Japanese Circulation Society.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tadateru Takayama
- the Japanese Circulation Society.,Division of General Medicine, Department of Medicine, Nihon University School of Medicine
| | - Makoto Watanabe
- the Japanese Circulation Society.,Department of Cardiovascular Medicine, Nara Medical University
| | - Kazuo Awai
- Japan Radiological Society.,Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Seitaro Oda
- Japan Radiological Society.,Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
| | - Takamichi Murakami
- Japan Radiological Society.,Department of Radiology, Kobe University Graduate School of Medicine
| | - Yukinobu Yagyu
- Japan Radiological Society.,Department of Radiology, Kindai University, Faculty of Medicine
| | - Nobuhiko Joki
- Japanese Society of Nephrology.,Division of Nephrology, Toho University Ohashi Medical Center
| | - Yasuhiro Komatsu
- Japanese Society of Nephrology.,Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine
| | | | - Yugo Ito
- Japanese Society of Nephrology.,Department of Nephrology, St. Luke's International Hospital
| | - Ryo Miyazawa
- Japan Radiological Society.,Department of Radiology, St. Luke's International Hospital
| | - Yoshihiko Kanno
- Japanese Society of Nephrology.,Department of Nephrology, Tokyo Medical University
| | - Tomonari Ogawa
- Japanese Society of Nephrology.,Department of Nephrology & Hypertension, Saitama Medical Center
| | - Hiroki Hayashi
- Japanese Society of Nephrology.,Department of Nephrology, Fujita Health University School of Medicine
| | - Eri Koshi
- Japanese Society of Nephrology.,Department of Nephrology, Komaki City Hospital
| | - Tomoki Kosugi
- Japanese Society of Nephrology.,Nephrology, Nagoya University Graduate School of Medicine
| | - Yoshinari Yasuda
- Japanese Society of Nephrology.,Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the use of iodinated contrast media in patients with kidney disease 2018. Jpn J Radiol 2019; 38:3-46. [PMID: 31709498 DOI: 10.1007/s11604-019-00850-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiromitsu Hayashi
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazutaka Aonuma
- Cardiology Department, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Taichi Sato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Toei
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryusuke Murakami
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Eri Koshi
- Department of Nephrology, Komaki City Hospital, Aichi, Japan
| | - Tomoki Kosugi
- Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Kraus MS, Selo N, Kiefer LS, Esser M, Albtoush OM, Weiss J, Wichmann JL, Bamberg F, Othman AE. Advanced Virtual Monoenergetic Imaging: Improvement of Visualization and Differentiation of Intramuscular Lesions in Portal-Venous-phase Contrast-enhanced Dual-energy CT. Acad Radiol 2019; 26:1457-1465. [PMID: 30879946 DOI: 10.1016/j.acra.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effect of advanced monoenergetic imaging (MEI+) postprocessing algorithm on the visualization of various intramuscular lesions on portal-venous-phase contrast-enhanced dual-energy computed tomography (DECT). MATERIAL AND METHODS Thirty-nine patients (64.3 ± 11.1 years; 26 males) with various intramuscular lesions ranging from malignancy, bleeding, inflammation, edematous changes, and benign neoplasms were included and underwent DECT (100/Sn150kV). Postprocessing with MEI+ technique was used to reconstruct images at four different keV levels (40, 60, 80, 100) and compared to the standard portal-venous-phase CT (CTpv) images. Image quality was assessed qualitatively (conspicuity, delineation, sharpness, noise, and confidence) by two independent readers using 5-point Likert scales, 5 = excellent; as well as quantitatively by calculating signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR), and area under the receiver operating characteristic (ROC) curve (AUC) for lesion characterization. RESULTS Highest lesion enhancement and diagnostic confidence were observed in MEI+ 40 keV, with significant differences to CTpv (p < 0.001), as well as for malignant lesions (highest conspicuity, noise, and sharpness in MEI+ 40 keV; p < 0.001). CNR calculations revealed highest values for MEI+ 40 keV followed by 60 keV with significant differences to CTpv, and increasing energy levels. ROC analysis showed highest diagnostic accuracy for 40-keV MEI+ datasets regarding the detection of malignant/benign lesions with AUC values of 98.9% (95%-confidence interval: 96.5, 100) and a standard error of 1.2, further AUC values decreased to 83.6% for MEI+100. CONCLUSION MEI+ at low keV levels can significantly improve lesion detection of benign versus malignant intramuscular entities in patients undergoing portal-venous-phase DECT scans due to increased CNR.
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Albrecht MH, Vogl TJ, Martin SS, Nance JW, Duguay TM, Wichmann JL, De Cecco CN, Varga-Szemes A, van Assen M, Tesche C, Schoepf UJ. Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT. Radiology 2019; 293:260-271. [DOI: 10.1148/radiol.2019182297] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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50
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Sathananthan G, Johal N, Verma T, Sandhu S, Chakrabarti S, Riahi M, Human D, Leipsic J, Grewal J. Clinical Importance of Fontan Circuit Thrombus in the Adult Population: Significant Association With Increased Risk of Cardiovascular Events. Can J Cardiol 2019; 35:1807-1814. [PMID: 31813509 DOI: 10.1016/j.cjca.2019.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The impact of Fontan circuit thrombus is poorly understood. The objectives of this study were to determine (1) the incidence of Fontan circuit thrombus and proportion of silent thrombus; (2) any association between Fontan circuit thrombus and markers of Fontan circulatory dysfunction; and (3) the association of Fontan circuit thrombus with adverse cardiac outcomes. METHODS We conducted a retrospective review of adult patients who underwent the Fontan procedure (aged > 18 years) followed at St. Paul's Hospital who underwent cardiac computed tomography or magnetic resonance imaging assessment (n = 67). Fontan circulatory dysfunction markers included clinical heart failure, N-terminal pro-brain natriuretic peptide, ventricular dysfunction, atrioventricular valvular regurgitation, refractory arrhythmias, declining exercise capacity, and hepatic/renal dysfunction. Adverse cardiac outcomes were death, heart transplantation, or surgery for Fontan revision or atrioventricular valve replacement. RESULTS Fontan circuit thrombus was present in 15 of 67 patients (22%): 41% (7/17) classic/modified Fontan and 16% (8/50) total cavopulmonary connection. Incidence was 36% among those suspected to have Fontan circuit thrombus; 14% in those with no clinical/echocardiographic suspicion; and clinically silent in 40% diagnosed with Fontan thrombus. The time from Fontan surgery to Fontan circuit thrombus diagnosis was 22 ± 6 years in the classic/modified group vs 14 ± 8 years in the total cavopulmonary connection group (P = 0.03. Fontan circuit thrombus was associated with adverse cardiac outcomes (27% [4/15] vs 8% [4/52], P = 0.02), but there was no difference in Fontan circulatory dysfunction markers. CONCLUSION Given the incidence of Fontan circuit thrombus and association with adverse cardiac outcomes, routine surveillance of the Fontan circuit should strongly be considered. The identification of thrombus should lead to anticoagulation implementation/optimization, along with screening/intervention for reversible Fontan circulatory issues in an attempt to prevent adverse cardiac outcomes.
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Affiliation(s)
- Gnalini Sathananthan
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Niall Johal
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tony Verma
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sherry Sandhu
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Shantabanu Chakrabarti
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mounir Riahi
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Derek Human
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- University of British Columbia, Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jasmine Grewal
- University of British Columbia, Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada.
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