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Impact of various iodine concentrations of iohexol and iodixanol contrast media on image reconstruction techniques in a vascular-specific contrast media phantom: quantitative and qualitative image quality assessment. Radiol Med 2020; 126:221-230. [PMID: 32671555 DOI: 10.1007/s11547-020-01253-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study is to investigate the impact of iodine quantification on image reconstruction when employing a vascular-specific contrast media phantom with varying iodine concentrations. MATERIALS AND METHODS A 30-cm phantom simulating arterial and venous blood vessel diameters was manufactured. Small (9 mm) and medium (12 mm) cylinders contained iodine concentrations from 10 to 100% while large (21 mm) cylinders were in quartiles from 25 to 100% diluted in blood equivalent medium. Each phantom was filled with either iohexol 350 mgI/mL (Group A) or iodixanol 320 mgI/mL (Group B) and then scanned separately. For each group, tube potential (80-140 kVp) and current (50-400 mAs) were changed and all image series were reconstructed with filtered back projection (FBP), hybrid-based iterative reconstruction (HBIR) and model-based iterative reconstruction (MBIR). Mean opacification was measured in all groups. All data were compared employing an independent t test and Pearson's correlation. Visual grading characteristic (VGC) and Cohens' kappa analyses were performed. RESULTS At 80 kVp, mean opacification using HBIR was significantly higher in Group B (2165 ± 1108 HU) than in Group A (2040 ± 1036 HU) (p < 0.009). At 140 kVp, MBIR and HBIR were greater in Group A (1704 ± 1033 HU and 1685 ± 1023 HU) versus Group B (1567 ± 1036 HU and 1567 ± 1034 HU) (p < 0.022). CNR using FBP, HBIR and MBIR was higher in Group B (46 ± 42 HU, 70 ± 163 HU and 83 ± 74 HU, respectively) than in Group A (43 ± 39 HU, 174 ± 130 HU and 80 ± 65 HU, respectively) (p < 0.0001-0.035). Qualitative image analysis demonstrated no difference in Cohen's kappa analysis. VGC was higher in Group A at all image reconstruction groups. CONCLUSION Iohexol outperforms iodixanol in observer performance when assessing image reconstruction techniques and iodine concentrations in a vascular-specific contrast media phantom.
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Peristaltic Contrast Media Injection Improved Image Quality and Decreased Radiation and Contrast Dose When Compared With Direct Drive Injection During Liver Computed Tomography. J Comput Assist Tomogr 2020; 44:209-216. [DOI: 10.1097/rct.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saade C, Hamieh N, Deeb IAS, Haddad M, Abi-Ghanem AS, Ghieh D, El-Merhi F. An augmented patient-specific approach to administration of contrast agent for CT renal angiography. Int Braz J Urol 2019; 45:1022-1032. [PMID: 31268642 PMCID: PMC6844352 DOI: 10.1590/s1677-5538.ibju.2018.0366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/14/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose This hybrid retrospective and prospective study performed on 200 consecutive patients undergoing renal CTA, investigates the opacification of renal vasculature, radiation dose, and reader confidence. Materials and Methods 100 patients were assigned retrospectively to protocol A and the other 100 were allocated prospectively to protocol B. Both protocols implemented a contrast material and saline flow rate of 4.5 mL/sec. Protocol A utilized a 100 mL of low-osmolar nonionic IV contrast material (Ioversol 350 mg I/mL) while protocol B employed a patient-tailored contrast media formula using iso-osmolar non-ionic (Iodixanol 320 mg I/mL). Results Arterial opacification in the abdominal aorta and in the bilateral main proximal renal arteries demonstrated no statistical significance (p>0.05). Only the main distal renal artery of the left kidney in protocol B was statistically significant (p<0.046). In the venous circulation, the IVC demonstrated a significant reduction in opacification in protocol B (59.39 HU ± 19.39) compared to A (87.74 HU ± 34.06) (p<0.001). Mean CNR for protocol A (22.68 HU ± 13.72) was significantly higher than that of protocol B (14.75 HU ± 5.76 p< 0.0001). Effective dose was significantly reduced in protocol B (2.46 ± 0.74 mSv) compared to A (3.07 ± 0.68 mSv) (p<0.001). Mean contrast media volume was reduced in protocol B (44.56 ± 14.32 mL) with lower iodine concentration. ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (p< 0.0001), with inter-reader agreement increasing from moderate to excellent in renal arterial visualization. Conclusion Employing a patient-tailored contrast media injection protocol shows a significant refinement in the visualization of renal vasculature and reader confidence during renal CTA.
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Bron G, Scemama U, Villes V, Fakhry N, Salas S, Chagnaud C, Bendahan D, Varoquaux A. A new CT dynamic maneuver "Mouth Opened with Tongue Extended" can improve the clinical TNM staging of oral cavity and oropharynx squamous cell carcinomas. Oral Oncol 2019; 94:41-46. [PMID: 31178211 DOI: 10.1016/j.oraloncology.2019.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/12/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of "Mouth Open with Tongue Extended" dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI. MATERIAL Retrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used. RESULTS CTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (p < 0.001). CONCLUSIONS CTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging.
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Affiliation(s)
- Guillaume Bron
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France.
| | - Ugo Scemama
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Virginie Villes
- Department of Public Healthcare EA 3279, Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Nicolas Fakhry
- Department of Otorhinolaryngology-Head and Neck Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
| | - Sebastien Salas
- Department of Oncology, Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Christophe Chagnaud
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France; Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - David Bendahan
- Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Arthur Varoquaux
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France; Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
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Zein-El-Dine S, Bou Akl I, Mohamad M, Chmaisse A, Chahwan S, Asmar K, El-Merhi F, Saade C. Split-bolus contrast injection protocol enhances the visualization of the thoracic vasculature and reduced radiation dose during chest CT. Br J Radiol 2018; 91:20180509. [PMID: 30160182 DOI: 10.1259/bjr.20180509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the visualization of mediastinal lymph nodes during thoracic CT employing a multiphasic contrast media (CM) protocol. METHODS Institutional review board approved retrospective study consisting of 300 patients with known chest malignancy. Patients were allocated to one of two CM protocols: Protocol A, consisted of dual bolus (Phase 1:100 ml CM followed by 100 ml saline chaser) i.v. injected at 2.5 ml s-1; Protocol B employed 100 ml of CM using a multiphasic injection protocol (Phase 1 and 2:60 ml contrast and saline, followed by Phase 3 and 4:40 ml contrast and saline injected at 2.5 ml s-1) with a fixed scan delay of 70 s for each acquisition. Attenuation profiles of the thoracic arteries and veins were calculated as well as the arterio-venous contrast ratios (AVCR). Receiver operating characteristic (ROC), visual grading characteristic (VGC), and Cohen's kappa analysis were assessed. RESULTS Arterial opacification was up to 24% (p < 0.032) higher in protocol B than A, whereas, in the veins it was significantly lower in protocol B than A, with a maximum reduction of up to 84% (p < 0.0001). There was no statistical significance between the central and peripheral pulmonary arteries [>263 Hounsfield units (HU)] in each protocol. Protocol B, demonstrated significant improvement in AVCR at various anatomical sites (p < 0.002). Radiation dose was significantly reduced in protocol B compared to A (p < 0.004). Both ROC and VGC demonstrated significantly higher Az score for protocol B compared to A (p < 0.0001) with an increased inter reader agreement from poor to excellent. CONCLUSION Employing a multiphasic CM protocol significantly improves opacification of the thoracic vasculature and visualization of mediastinal lymph nodes during thoracic CT. ADVANCES IN KNOWLEDGE Uniform opacification between thoracic arteries and veins increases the delineation between vasculature and lymph nodes, reduces radiation dose when employing a multiphase contrast media injection protocol.
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Affiliation(s)
- Salah Zein-El-Dine
- 1 Respiratory Medicine Department, American University of Beirut Medical Center , Beirut , Lebanon
| | - Imad Bou Akl
- 1 Respiratory Medicine Department, American University of Beirut Medical Center , Beirut , Lebanon
| | - Maha Mohamad
- 2 Diagnostic Radiology Department, University of Beirut Medical Center , Beirut , Lebanon
| | - Ahmad Chmaisse
- 2 Diagnostic Radiology Department, University of Beirut Medical Center , Beirut , Lebanon
| | - Stephanie Chahwan
- 2 Diagnostic Radiology Department, University of Beirut Medical Center , Beirut , Lebanon
| | - Karl Asmar
- 2 Diagnostic Radiology Department, University of Beirut Medical Center , Beirut , Lebanon
| | - Fadi El-Merhi
- 2 Diagnostic Radiology Department, University of Beirut Medical Center , Beirut , Lebanon
| | - Charbel Saade
- 3 Faculty of Health Sciences, Medical Imaging Sciences, American University of Beirut , Beirut , Lebanon
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