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Du H, Sui X, Zhao R, Wang J, Ming Y, Piao S, Wang J, Ma Z, Wang Y, Song L, Song W. A comparative analysis of deep learning and hybrid iterative reconstruction algorithms with contrast-enhancement-boost post-processing on the image quality of indirect computed tomography venography of the lower extremities. BMC Med Imaging 2024; 24:163. [PMID: 38956583 PMCID: PMC11218076 DOI: 10.1186/s12880-024-01342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE To examine whether there is a significant difference in image quality between the deep learning reconstruction (DLR [AiCE, Advanced Intelligent Clear-IQ Engine]) and hybrid iterative reconstruction (HIR [AIDR 3D, adaptive iterative dose reduction three dimensional]) algorithms on the conventional enhanced and CE-boost (contrast-enhancement-boost) images of indirect computed tomography venography (CTV) of lower extremities. MATERIALS AND METHODS In this retrospective study, seventy patients who underwent CTV from June 2021 to October 2022 to assess deep vein thrombosis and varicose veins were included. Unenhanced and enhanced images were reconstructed for AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images were obtained using subtraction software. Objective and subjective image qualities were assessed, and radiation doses were recorded. RESULTS The CT values of the inferior vena cava (IVC), femoral vein ( FV), and popliteal vein (PV) in the CE-boost images were approximately 1.3 (1.31-1.36) times higher than in those of the enhanced images. There were no significant differences in mean CT values of IVC, FV, and PV between AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images. Noise in AiCE, AiCE-boost images was significantly lower than in AIDR 3D and AIDR 3D-boost images ( P < 0.05). The SNR (signal-to-noise ratio), CNR (contrast-to-noise ratio), and subjective scores of AiCE-boost images were the highest among 4 groups, surpassing AiCE, AIDR 3D, and AIDR 3D-boost images (all P < 0.05). CONCLUSION In indirect CTV of the lower extremities images, DLR with the CE-boost technique could decrease the image noise and improve the CT values, SNR, CNR, and subjective image scores. AiCE-boost images received the highest subjective image quality score and were more readily accepted by radiologists.
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Affiliation(s)
- Huayang Du
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xin Sui
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Ruijie Zhao
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jiaru Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Ying Ming
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Sirong Piao
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jinhua Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhuangfei Ma
- Canon Medical Systems (China), No.3, Xinyuan South Road, Chaoyang District, Beijing, 100027, China
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Lan Song
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, 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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Schönfeld T, Seitz P, Krieghoff C, Ponorac S, Wötzel A, Olthoff S, Schaudt S, Steglich J, Gutberlet M, Gohmann RF. High-pitch CT pulmonary angiography (CTPA) with ultra-low contrast medium volume for the detection of pulmonary embolism: a comparison with standard CTPA. Eur Radiol 2024; 34:1921-1931. [PMID: 37656178 PMCID: PMC10873234 DOI: 10.1007/s00330-023-10101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To investigate the feasibility and image quality of high-pitch CT pulmonary angiography (CTPA) with reduced iodine volume in normal weight patients. METHODS In total, 81 normal weight patients undergoing CTPA for suspected pulmonary arterial embolism were retrospectively included: 41 in high-pitch mode with 20 mL of contrast medium (CM); and 40 with normal pitch and 50 mL of CM. Subjective image quality was assessed and rated on a 3-point scale. For objective image quality, attenuation and noise values were measured in all pulmonary arteries from the trunk to segmental level. Contrast-to-noise ratio (CNR) was calculated. Radiation dose estimations were recorded. RESULTS There were no statistically significant differences in patient and scan demographics between high-pitch and standard CTPA. Subjective image quality was rated good to excellent in over 90% of all exams with no significant group differences (p = 0.32). Median contrast opacification was lower in high-pitch CTPA (283.18 [216.06-368.67] HU, 386.81 [320.57-526.12] HU; p = 0.0001). CNR reached a minimum of eight in all segmented arteries, but was lower in high-pitch CTPA (8.79 [5.82-12.42], 11.01 [9.19-17.90]; p = 0.005). Median effective dose of high-pitch CTPA was lower (1.04 [0.72-1.27] mSv/mGy·cm; 1.49 [1.07-2.05] mSv/mGy·cm; p < 0.0001). CONCLUSION High-pitch CTPA using ultra-low contrast volume (20 mL) rendered diagnostic images for the detection of pulmonary arterial embolism in most instances. Compared to standard CTPA, the high-pitch CTPA exams with drastically reduced contrast medium volume had also concomitantly reduced radiation exposure. However, objective image quality of high-pitch CTPA was worse, though likely still within acceptable limits for confident diagnosis. CLINICAL RELEVANCE This study provides valuable insights on the performance of a high-pitch dual-source CTPA protocol, offering potential benefits in reducing contrast medium and radiation dose while maintaining sufficient image quality for accurate diagnosis in patients suspected of pulmonary embolism. KEY POINTS • High-pitch CT pulmonary angiography (CTPA) with ultra-low volume of contrast medium and reduced radiation dose renders diagnostic examinations with comparable subjective image quality to standard CTPA in most patients. • Objective image quality of high-pitch CTPA is reduced compared to standard CTPA, but contrast opacification and contrast-to-noise ratio remain above diagnostic thresholds. • Challenges of high-pitch CTPA may potentially be encountered in patients with severe heart failure or when performing a Valsalva maneuver during the examination.
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Affiliation(s)
- Tobias Schönfeld
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Department of General and Geriatric Medicine, St. Elisabeth-Hospital Leipzig, Biedermannstr. 84, 04277, Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Slavica Ponorac
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia
| | - Alexander Wötzel
- Emergency Department, Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289, Leipzig, Germany
| | - Stefan Olthoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Schaudt
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany
| | - Jonas Steglich
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany
- Leipzig Heart Institute, Russenstr. 69a, 04289, Leipzig, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany.
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Value of low-keV virtual monoenergetic plus dual-energy computed tomographic imaging for detection of acute pulmonary embolism. PLoS One 2022; 17:e0277060. [DOI: 10.1371/journal.pone.0277060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective
To compare diagnostic values between the 40 keV virtual monoenergetic plus (40 keV VMI+) dual source dual energy computed tomography (DSDECT) pulmonary angiography images and the standard mixed (90 and 150 kV) images for the detection of acute pulmonary embolism (PE).
Methods
Chest DSDECTs of 64 patients who were suspected of having acute PE were retrospectively reviewed by two independent reviewers. The assessments of acute PE of all patients on a per-location basis were compared between the 40 keV VMI+ and the standard mixed datasets (reference standard) with a two-week interval.
Results
This study consisted of 64 patients (33 women and 31 men; mean age, 60.2 years; range 18–90 years), with a total of 512 locations. The interobserver agreement (Kappa) for detection of acute PE using the 40 keV VMI+ images and the standard mixed CT images were 0.7478 and 0.8750 respectively. The area under receiver operating characteristics (AuROC) for diagnosis of acute PE using the 40 keV VMI+ was 0.882. Four locations (0.78%) revealed a false negative result. Hypodense filling defects were identified in twelve locations (1.95%) in the 40 keV VMI+ images but had been interpreted as a negative study in the standard mixed CT images. The repeated reviews revealed that each location contained a hypodense filling defect but was overlooked on the standard mixed CT images.
Conclusions
Low-energy VMI + DSDECT images have beneficial in improving the diagnostic value of acute PE in doubtful or disregarded standard mixed images.
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Hu X, Wang Z, Chen H, Zhao A, Sun N, Deng C. Diagnosing, Typing, and Staging of Renal Cell Carcinoma by Designer Matrix-Based Urinary Metabolic Analysis. Anal Chem 2022; 94:14846-14853. [PMID: 36260912 DOI: 10.1021/acs.analchem.2c01563] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Molecular diagnosing, typing, and staging have been considered to be the ideal alternatives of imaging-based detection methods in clinics. Designer matrix-based analytical tools, with high speed, throughout, efficiency and low/noninvasiveness, have attracted much attention recently for in vitro metabolite detection. Herein, we develop an advanced metabolic analysis tool based on highly porous metal oxides derived from available metal-organic frameworks (MOFs), which elaborately inherit the morphology and porosity of MOFs and newly incorporate laser adsorption capacity of metal oxides. Through optimized conditions, direct high-quality fingerprinting spectra in 0.5 μL of urine are acquired. Using these fingerprinting spectra, we can discriminate the renal cell carcinoma (RCC) from healthy controls with higher than 0.99 of area under the curve (AUC) values (R2Y(cum) = 0.744, Q2 (cum) = 0.880), as well, from patients with other tumors (R2Y(cum) = 0.748, Q2(cum) = 0.871). We also realize the typing of three RCC subtypes, including clear cell RCC, chromophobe RCC (R2Y(cum) = 0.620, Q2(cum) = 0.656), and the staging of RCC (R2Y(cum) = 0.755, Q2(cum) = 0.857). Moreover, the tumor sizes (threshold value is 3 cm) can be remarkably recognized by this advanced metabolic analysis tool (R2Y(cum) = 0.710, Q2(cum) = 0.787). Our work brings a bright prospect for designer matrix-based analytical tools in disease diagnosis, typing and staging.
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Affiliation(s)
- Xufang Hu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, and Department of Chemistry, Fudan University, Shanghai 200032, China
| | - Zongping Wang
- Department of Urology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310000, China
| | - Haolin Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, and Department of Chemistry, Fudan University, Shanghai 200032, China
| | - An Zhao
- Experimental Research Center, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310000, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Nianrong Sun
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, and Department of Chemistry, Fudan University, Shanghai 200032, China
| | - Chunhui Deng
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, and Department of Chemistry, Fudan University, Shanghai 200032, China
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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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A Medical Endoscope Image Enhancement Method Based on Improved Weighted Guided Filtering. MATHEMATICS 2022. [DOI: 10.3390/math10091423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In clinical surgery, the quality of endoscopic images is degraded by noise. Blood, illumination changes, specular reflection, smoke, and other factors contribute to noise, which reduces the quality of an image in an occluded area, affects doctors’ judgment, prolongs the operation duration, and increases the operation risk. In this study, we proposed an improved weighted guided filtering algorithm to enhance endoscopic image tissue. An unsharp mask algorithm and an improved weighted guided filter were used to enhance vessel details and contours in endoscopic images. The scheme of the entire endoscopic image processing, which included detail enhancement, contrast enhancement, brightness enhancement, and highlight area removal, is presented. Compared with other algorithms, the proposed algorithm maintained edges and reduced halos efficiently, and its effectiveness was demonstrated using experiments. The peak signal-to-noise ratio and structural similarity of endoscopic images obtained using the proposed algorithm were the highest. The foreground–background detail variance–background variance improved. The proposed algorithm had a strong ability to suppress noise and could maintain the structure of original endoscopic images, which improved the details of tissue blood vessels. The findings of this study can provide guidelines for developing endoscopy devices.
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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: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [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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Degerstedt SG, Winant AJ, Lee EY. Pediatric Pulmonary Embolism: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:69-82. [PMID: 34836567 DOI: 10.1016/j.rcl.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In contrast with the algorithms and screening criteria available for adults with suspected pulmonary embolism, there is a paucity of guidance on the diagnostic approach for children. The incidence of pulmonary embolism in the pediatric population and young adults is higher than thought, and there is an urgent need for updated guidelines for the imaging approach to diagnosis in the pediatric population. This article presents an up-to-date review of imaging techniques, characteristic radiologic findings, and an evidence-based algorithm for the detection of pediatric pulmonary embolism to improve the care of pediatric patients with suspected pulmonary embolism.
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Affiliation(s)
- Spencer G Degerstedt
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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10
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Task-based assessment on various optimization protocols of computed tomography Pulmonary Angiography examination. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Pop M. Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation-Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110949. [PMID: 34828662 PMCID: PMC8623802 DOI: 10.3390/children8110949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Computed tomography angiography (CTA) in infants is considered one of the most challenging radiological examinations due to difficulties in balancing start delay, contrast agent (CA) volume and flow in order to achieve optimal opacification of the large vessels. This study aimed to compare the contrast enhancement achieved by four CAs when taking into consideration CA injection parameters and patient characteristics. Methods: We performed a retrospective assessment of forty-eight consecutive cardiothoracic CTAs performed for aortic arch evaluation on children aged 0–1 year. All examinations were performed using the same 64-slice scanner and power injector using the bolus tracking technique. Axial 0.6 mm slices were used to measure large vessel enhancement using regions of interest at the level of the main pulmonary artery, ascending and descending aorta. The recorded variables included anthropometric measurements, CA type, flow rate, volume, and the average Hounsfield unit (HU) values of the blood pool. Descriptive statistics are presented as averages and standard deviations (SD) for normal distributed data or otherwise as medians and interquartile ranges (IQRs). Results: We found no statistically significant differences between age and anthropometric parameters when looking at different CAs. The median CA volume was 7 (IQR, 7–9) mL with the average flow rate of 0.94 (SD, 0.23) mL/s. Ascending aorta average HU values were 605.9 (SD, 177.23) for Iomeprol 350, 626 (SD, 183.83) for Ioversol 350, 530.83 (SD, 175.56) for Iopromide 370 and 354.91 (SD, 115.81) for Iodixanol 320. The difference in HU value for Iodixanol 320 compared to the other CAs was statistically significant. Similar differences were found for the other vascular structures. Conclusion: In CTA of infants suspected of aortic arch hypoplasia/coarctation, Iodixanol 320 provided up to 40% less enhancement of the great vessels when compared to Iomeprol 350, Ioversol 350 and Iopromide 370.
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Affiliation(s)
- Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine Pharmacy Sciences and Technology of Tirgu Mures, 540142 Tirgu Mures, Romania; ; Tel.: +40-749-260-920
- Radiology and Medical Imaging Department, Tirgu Mures Emergency Institute for Cardiovascular Diseases and Heart Transplant, 540136 Tirgu Mures, Romania
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Yamasaki Y, Kamitani T, Sagiyama K, Matsuura Y, Hida T, Nagata H. Model-based iterative reconstruction for 320-detector row CT angiography reduces radiation exposure in infants with complex congenital heart disease. ACTA ACUST UNITED AC 2021; 27:42-49. [PMID: 33290239 DOI: 10.5152/dir.2020.19633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We investigated the impact of model-based iterative reconstruction (MBIR) on 320-detector row computed tomography angiography (CTA) in infants with complex congenital heart disease (CHD). METHODS Seventy infants with complex CHD who underwent 320-detector row CTA (40 boys and 30 girls; age range, 0-22 months; median age, 60 days) were retrospectively evaluated. First, the images were reconstructed by filtered back projection (FBP), hybrid iterative reconstruction (HIR), or MBIR in 20 cases, and variables were compared among the three iterative reconstruction methods (IR test). Second, the variables were compared between 25 cases scanned using HIR and 25 cases scanned using MBIR, with a 20 standard deviation noise level for both. Attenuation values and contrast-to-noise ratios (CNRs) of the great vessels and heart chambers were calculated. Total dose-length products were recorded for all patients (radiation dose: RD test). RESULTS In the IR test, the mean CNR values were 4.8±1.3 for FBP, 6.9±1.4 for HIR, and 8.2±1.7 for MBIR (P < 0.0001). The best subjective image qualities in the great vessels and heart chambers were obtained with MBIR. In RD testing, no significant differences between HIR and MBIR in image quality (CNR: HIR, 8.4±2.4; MBIR, 8.3±2.4) were observed. The effective dose was significantly lower for MBIR than for HIR (0.7±0.2 vs. 1.1±0.3 mSv; P < 0.001). CONCLUSION The MBIR algorithm significantly improved image quality and decreased radiation exposure in 320-row CTA of infants with complex CHD, providing an alternative to FBP or HIR that is both safer and produces better results.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Matsuura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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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 1: Acquisition and Safety Considerations. Can Assoc Radiol J 2021; 73:203-213. [PMID: 33781098 DOI: 10.1177/08465371211000737] [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: 11/15/2022] Open
Abstract
Acute pulmonary embolism (APE) is a well-recognized cause of circulatory system compromise and even demise which can frequently present a diagnostic challenge for the physician. The diagnostic challenge is primarily due to the frequency of indeterminate presentations as well as several other conditions which can have a similar clinical presentation. This often obliges the physician to establish a firm diagnosis due to the potentially serious outcomes related to this disease. Computed tomography pulmonary angiography (CTPA) has increasingly cemented its role as the primary investigation tool in this clinical context and is widely accepted as the standard of care due to several desired attributes which include great accuracy, accessibility, rapid turn-around time and the ability to suggest an alternate diagnosis when APE is not the culprit. In Part 1 of this guidance document, a series of up-to-date recommendations are provided to the reader pertaining to CTPA protocol optimization (including scan range, radiation and intravenous contrast dose), safety measures including the departure from breast and gonadal shielding, population-specific scenarios (pregnancy and early post-partum) and consideration of alternate diagnostic techniques when clinically deemed appropriate.
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Affiliation(s)
- Elsie T Nguyen
- Department of Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Cameron Hague
- Department of Radiology, University of British Columbia, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Ontario, Canada
| | - Brett Memauri
- Department of Radiology, University of Manitoba, Cardiothoracic Sciences Division, St. Boniface General Hospital, Ontario, Canada
| | - Carolina Souza
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jana Taylor
- Department of Radiology, McGill University Health Centre, Ontario, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada.,Department of Radiology, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
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14
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Du Y, Shi GF, Wang YN, Wang Q, Feng H. Repeatability of small lung nodule measurement in low-dose lung screening: a phantom study. BMC Med Imaging 2020; 20:112. [PMID: 33008318 PMCID: PMC7532632 DOI: 10.1186/s12880-020-00510-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/14/2020] [Indexed: 12/05/2022] Open
Abstract
Background Lung cancer screening revealed that people with small pulmonary nodules are mostly asymptomatic and that some of these people are at risk of developing lung cancer, so we intended to explore the repeatability of small lung nodule measurement in low-dose lung screening. Methods We scanned eight ground-glass nodules (GGNs) and solid nodules, with diameters of 3, 5, 8, and 10 mm. They were divided according to the different combination schemes of tube voltage (KV) and tube current (mA) as 70, 80, 100, and 120 KV, and currents of nine tubes were divided as 20, 30, 40, 50, 60, 70, 80, 90, and 100 mAs. Results Compared with the conventional dose group (120 kVp, 100 mAs), the nodule diameter and solid nodule volume measured by all scanning combinations were more consistent (P > 0.05), the volumes of 10 mm GGNs combinations were consistent (P > 0.05), the volumes of 8 mm GGNs were consistent (P > 0.05), the volumes of 5 mm GGNs combinations were consistent (P > 0.05), and the volumes of 3 mm were consistent (P > 0.05). Conclusion In lung cancer screening, CT parameters should be as follows: tube voltage is more than 80 kVp, and tube current is 80 mAs in order to meet the requirements for the accurate measurement of the diameter and volume of pulmonary nodules.
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Affiliation(s)
- Yu Du
- Department of Radiology, the Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Gao-Feng Shi
- Department of Radiology, the Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China.
| | - Ya-Ning Wang
- Department of Radiology, the Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Qi Wang
- Department of Radiology, the Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Hui Feng
- Department of Radiology, the Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
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15
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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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16
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Heidkamp J, Weijs WLJ, van Engen-van Grunsven ACH, de Laak-de Vries I, Maas MC, Rovers MM, Fütterer JJ, Steens SCA, Takes RP. Assessment of surgical tumor-free resection margins in fresh squamous-cell carcinoma resection specimens of the tongue using a clinical MRI system. Head Neck 2020; 42:2039-2049. [PMID: 32119170 PMCID: PMC7496932 DOI: 10.1002/hed.26125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Current intraoperative methods of visual inspection and tissue palpation by the surgeon, and frozen section analysis cannot reliably prevent inadequate surgical margins in patients treated for oral squamous-cell carcinoma (OSCC). This study assessed feasibility of MRI for the assessment of surgical resection margins in fresh OSCC specimens. METHODS Ten consecutive tongue specimens containing OSCC were scanned using 3 T clinical whole-body MRI. Two radiologists independently annotated OSCC location and minimal tumor-free margins. Whole-mount histology was the reference standard. RESULTS The positive predictive values (PPV) and negative predictive values (NPV) for OSCC localization were 96% and 75%, and 87% and 79% for reader 1 and 2, respectively. The PPV and NPV for identification of margins <5 mm were 38% and 91%, and 5% and 87% for reader 1 and 2, respectively. CONCLUSIONS MRI accurately localized OSCC with high inter-reader agreement in fresh OSCC specimens, but it seemed not yet feasible to accurately assess the surgical margin status.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem L J Weijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Ilse de Laak-de Vries
- Department of Pathology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marnix C Maas
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan C A Steens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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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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18
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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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Watanabe R, Funama Y, Takaki T, Oda S, Nakaura T, Murakami S, Aoki T. Additive value of split-bolus single-phase CT scan protocol for preoperative assessment of lung cancer patients referred for video-assisted thoracic surgery. Radiol Phys Technol 2019; 12:409-416. [PMID: 31654374 DOI: 10.1007/s12194-019-00541-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
We aimed to assess the additive value of the split-bolus single-phase computed tomography (CT) scan protocol to preoperatively assess patients with lung cancer, who were referred for video-assisted thoracic surgery, when compared to a standard staging CT protocol. We included 160 patients with lung cancer who underwent a split-bolus single-phase CT scan protocol (split-bolus protocol), which can acquire whole-body staging CT and pulmonary artery-vein separation CT angiography (PA-PV CTA) in a single acquisition and 160 patients who underwent whole-body staging CT (standard protocol). We compared the quality of the staging CT images of hepatic parenchyma, portal vein, and hepatic vein between both protocols. We also investigated image quality on PA-PV CTA images in the split-bolus protocol and recorded the number of patients that underwent the 3D PA-PV CTA imaging process. The split-bolus protocol for staging CT images demonstrated a slightly higher enhancement with regard to the hepatic parenchyma (p = 0.007) and hepatic vein (p = 0.006) than the standard protocol. There was no significant difference in the quality of the staging CT images between both protocols (p = 0.067). The mean CT number for the main pulmonary artery and the left atrium for the PA-PV CTA images in the split-bolus protocol were 289.1 HU and 172.8 HU, respectively. Among the images associated with the split-bolus protocol, 98.1% were of appropriate quality for 3D PA-PV CTA imaging. The split-bolus protocol is a dose-efficient protocol to acquire the staging CT and PA-PV CTA images in a single session and provides sufficient image quality for preoperative assessment in patients with lung cancer.
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Affiliation(s)
- Ryo Watanabe
- Graduate School of Health Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Takeshi Takaki
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Seitaro Oda
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seiichi Murakami
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
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Karim MKA, Sabarudin A, Muhammad NA, Ng KH. A comparative study of radiation doses between phantom and patients via CT angiography of the intra-/extra-cranial, pulmonary, and abdominal/pelvic arteries. Radiol Phys Technol 2019; 12:374-381. [PMID: 31468370 DOI: 10.1007/s12194-019-00532-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
This study aimed to evaluate effective dose and size-specific dose estimate (SSDE) of computed tomography angiography (CTA) examination using an anthropomorphic phantom. We included three CTA examination protocols to evaluate the intra- and extra-cranial arteries, pulmonary artery (CTPA), and abdominal vessels. Patient SSDEs were measured retrospectively to estimate patient dose, relative to the bodyweight of the patient and volume CT dose index (CTDIvol). Our findings revealed that the highest dose was absorbed by the left lobe of the thyroid gland during intra-/extra-cranial CTA and CTPA, that is, 14.11 ± 0.24 mGy and 16.20 ± 3.95 mGy, respectively. However, the highest absorbed dose in abdominal/pelvic CTA was the gonads (8.98 ± 0.30 mGy), while other radiosensitive organs in intra- and extra-cranial CTA, CTPA, and abdominal/pelvic CTA did not demonstrate significant differences between organs/structures with p value 0.88, 0.11, and 0.54, respectively. The estimated effective dose in intra-/extra-cranial CTA was lower in patients (0.80 ± 0.60 mSv) than in the phantom (0.83 mSv), but it was the opposite for CTPA, with the effective dose being higher in patients (7.54 ± 3.09 mSv) than in the phantom (6.68 mSv). Similar to the effective dose, only CTPA SSDEs were significantly higher in men than in women (19.74 ± 4.79 mGy versus 7.9 mGy). Effective dose and SSDE are clinically relevant parameters that can help estimate a more accurate patient dose based on a patient's size.
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Affiliation(s)
- M K A Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - A Sabarudin
- Programme of Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - N A Muhammad
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - K H Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Radiologist Performance in the Detection of Pulmonary Embolism: Features that Favor Correct Interpretation and Risk Factors for Errors. J Thorac Imaging 2019; 33:350-357. [PMID: 30142136 DOI: 10.1097/rti.0000000000000361] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aimed to assess the factors contributing toward accurate detection and erroneous interpretation of pulmonary embolism (PE). MATERIALS AND METHODS Over 13 months, all computed tomography pulmonary angiography studies were retrospectively rereviewed by a chest radiologist. Two additional chest radiologists assessed cases with disagreement between the first interpretation and rereview. The number, extent, and location of PE and specialty training, experience, time of study, kV, resident prelim, use of iterative reconstruction, signal to noise ratio (SNR), and reports describing the study as "limited" were recorded. Parametric and nonparametric statistical testing was performed (significance P<0.05). RESULTS Of 2555 computed tomography pulmonary angiography cases assessed, there were 230 true positive (170 multiple, 60 single PE), 2271 true negative, 35 false-negative (15 multiple and 20 single PE), and 19 false-positive studies. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of radiologists was 86.8%, 99.2%, 92.4%, 98.5%, and 97.9%. Sensitivity for the detection of multiple and central PE was significantly higher than the detection of single and peripheral PE, respectively (P<0.01 for both). The sensitivity of thoracic radiologists (91.7%) was higher than nonthoracic (82.8%) and reached significance for single PE (89.2% vs. 61.4%, P<0.02). Errors were more likely in cases with lower SNR (P=0.04) and those described as limited (P<0.001). Misses occurred more frequently in the upper lobe posterior and lower lobe lateral segments and subsegments (P=0.038). CONCLUSIONS The accuracy for PE detection is high, but errors are more likely in studies with single PE interpreted by nonthoracic radiologists, especially when located in certain segments and in cases with low SNR or described as limited.
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Does the Tube Voltage Affect the Characterization of Coronary Plaques on 100- and 120-kVp Computed Tomography Scans. J Comput Assist Tomogr 2019; 43:416-422. [PMID: 30762654 DOI: 10.1097/rct.0000000000000845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic performance of 100- and 120-kVp coronary computed tomography (CT) angiography (CCTA) scans for the identification of coronary plaque components. METHODS We included 116 patients with coronary plaques who underwent CCTA and integrated backscatter intravascular ultrasound studies. On 100-kVp scans, we observed 24 fibrous and 24 fatty/fibrofatty plaques; on 120-kVp scans, we noted 27 fibrous and 41 fatty/fibrofatty plaques. We compared the fibrous and the fatty/fibrofatty plaques, the CT number of the coronary lumen, and the radiation dose on scans obtained at 100 and 120 kVp. We also compared the area under the receiver operating characteristic (ROC) curve of the coronary plaques on 100- and 120-kVp scans with their ROC curves on integrated backscatter intravascular ultrasound images. RESULTS The mean CT numbers of fatty and fatty/fibrofatty plaques were 5.71 ± 36.5 and 76.6 ± 33.7 Hounsfield units (HU), respectively, on 100-kVp scans; on 120-kVp scans, they were 13.9 ± 29.4 and 54.5 ± 22.3 HU, respectively. The CT number of the coronary lumen was 323.1 ± 81.2 HU, and the radiation dose was 563.7 ± 81.2 mGy-cm on 100-kVp scans; these values were 279.3 ± 61.8 HU and 819.1 ± 115.1 mGy-cm on 120-kVp scans. The results of ROC curve analysis identified 30.5 HU as the optimal diagnostic cutoff value for 100-kVp scans (area under the curve = 0.93, 95% confidence interval = 0.87-0.99, sensitivity = 95.8%, specificity = 78.9%); for 120-kVp plaque images, the optimal cutoff was 37.4 HU (area under the curve = 0.87, 95% confidence interval = 0.79-0.96, sensitivity = 82.1%, specificity = 85.7%). CONCLUSIONS For the discrimination of coronary plaque components, the diagnostic performance of 100- and 120-kVp CCTA scans is comparable.
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Bankier AA, Dennie C. Modern Diagnosis in the Evaluation of Pulmonary Vascular Disease. IDKD SPRINGER SERIES 2019. [DOI: 10.1007/978-3-030-11149-6_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Heidkamp J, Zusterzeel PL, van Engen‐van Grunsven AC, Overduin CG, Veltien A, Maat A, Rovers MM, Fütterer JJ. MRI evaluation of vulvar squamous-cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor-free margins. NMR IN BIOMEDICINE 2019; 32:e4025. [PMID: 30431192 PMCID: PMC6587990 DOI: 10.1002/nbm.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
In the surgical treatment of vulvar squamous-cell carcinoma (VSCC), tumor-free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor-free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor-free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy-proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR-scanner. Whole mount H&E-stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor-free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non-blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty-four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non-blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor-free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Petra L.M. Zusterzeel
- Department of Obstetrics and GynaecologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Arie Maat
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maroeska M. Rovers
- Department of Operating RoomsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
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Kaasalainen T, Mäkelä T, Kelaranta A, Kortesniemi M. The Use of Model-based Iterative Reconstruction to Optimize Chest CT Examinations for Diagnosing Lung Metastases in Patients with Sarcoma: A Phantom Study. Acad Radiol 2019; 26:50-61. [PMID: 29724675 DOI: 10.1016/j.acra.2018.03.028] [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: 02/16/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES This phantom study aimed to evaluate low-dose (LD) chest computed tomography (CT) protocols using model-based iterative reconstruction (MBIR) for diagnosing lung metastases in patients with sarcoma. MATERIALS AND METHODS An adult female anthropomorphic phantom was scanned with a 64-slice CT using four LD protocols and a standard-dose protocol. Absorbed organ doses were measured with 10 metal-oxide-semiconductor field-effect transistor dosimeters. Furthermore, Monte Carlo simulations were performed to estimate organ and effective doses. Image quality in terms of image noise, contrast, and resolution was measured from the CT images reconstructed with conventional filtered back projection, adaptive statistical iterative reconstruction, and MBIR algorithms. All the results were compared to the performance of the standard-dose protocol. RESULTS Mean absorbed organ and effective doses were reduced by approximately 95% with the LD protocol (100-kVp tube voltage and a fixed 10-mA tube current) compared to the standard-dose protocol (120-kVp tube voltage and tube current modulation) while yielding an acceptable image quality for diagnosing round-shaped lung metastases. The effective doses ranged from 0.16 to 2.83 mSv in the studied protocols. The image noise, contrast, and resolution were maintained or improved when comparing the image quality of LD protocols using MBIR to the performance of the standard-dose chest CT protocol using filtered back projection. The small round-shaped lung metastases were delineated at levels comparable to the used protocols. CONCLUSIONS Radiation exposure in patients can be reduced significantly by using LD chest CT protocols and MBIR algorithm while maintaining image quality for detecting round-shaped lung metastases.
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Masuda T, Funama Y, Nakaura T, Tahara M, Yamashita Y, Kiguchi M, Imada N, Sato T, Awai K. Radiation Dose Reduction with a Low-Tube Voltage Technique for Pediatric Chest Computed Tomographic Angiography Based on the Contrast-to-Noise Ratio Index. Can Assoc Radiol J 2018; 69:390-396. [DOI: 10.1016/j.carj.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 03/08/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction The aim of this study was to evaluate the radiation dose and image quality at low tube-voltage pediatric chest computed tomographic angiography (CTA) that applies the same contrast-to-noise ratio (CNR) index as the standard tube voltage technique. Materials and Methods Contrast-enhanced chest CTA scans of 100 infants were acquired on a 64-row multidetector computed tomography (MDCT) scanner. In the retrospective study, we evaluated 50 images acquired at 120 kVp; the image noise level was set at 25 Hounsfield units. In the prospective study, we used an 80-kVp protocol; the image noise level was 40 Hounsfield units because the iodine contrast was 1.6 times higher than on 120-kVp scans; the CNR was as in the 120-kVp protocol. We compared the CT number, image noise, CT dose index volume (CTDIvol), and the dose-length product on scans acquired with the 2 protocols. A diagnostic radiologist and a pediatric cardiologist visually evaluated all CTA images. Results The mean CTDIvol and the mean dose-length product were 0.5 mGy and 7.8 mGy-cm for 80- and 1.2 mGy and 20.8 mGy-cm for 120-kVp scans, respectively ( P < .001). The mean CTDIvol was 42% lower at 80 kVp than at 120 kVp, and there was no significant difference in the visual scores assigned to the CTA images ( P = .28). Conclusions With the CNR index being the same at 80-kVp and 120-kVp imaging, the radiation dose delivered to infants subjected to chest CTA can be reduced without degradation of the image quality.
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Affiliation(s)
- Takanori Masuda
- Department of Radiological Technology, Tsuchiya General Hospital, Hiroshima, Japan
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiro Tahara
- Department of Pediatric Cardiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yukari Yamashita
- Department of Radiological Technology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Masao Kiguchi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoyuki Imada
- Department of Radiological Technology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomoyasu Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Masuda T, Funama Y, Nakaura T, Satou T, Okimoto T, Yamashita Y, Imada N, Awai K. Radiation Dose Reduction at Low Tube Voltage CCTA Based on the CNR Index. Acad Radiol 2018; 25:1298-1304. [PMID: 29599007 DOI: 10.1016/j.acra.2018.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES We compared the radiation dose and diagnostic accuracy on 120- and 100-kVp coronary computed tomography angiography (CCTA) scans whose contrast-to-noise ratio (CNR) was the same. MATERIALS AND METHODS We studied 1311 coronary artery segments from 100 patients. For 120-kVp scans, the targeted image level was set at 25 Hounsfield units (HU). For 100-kVp scans, the targeted noise level was set at 30 HU to obtain the same CNR as at 120 kVp. We compared the CNR and the radiation dose on scans acquired at 120 and 100 kVp. Invasive coronary angiography (ICA) images were evaluated by an interventional coronary angiography specialist, and CCTA images were evaluated by a radiologist. Coronary artery disease was defined as a luminal narrowing ≧50% for ICA and CCTA. With ICA considered the gold standard, the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed on both 120- and 100-kVp CCTA images. We also compared the diagnostic accuracy for area under the receiver operating characteristic curve of the ICA and CCTA performed at 120 and 100 kVp. Two blinded observers visually evaluated the septal branch. RESULTS The mean dose-length product was 48% lower at 100 kVp than at 120 kVp (P < .01). Under the 120-kVp CCTA protocol, the area under the curve, 95% confidence interval, sensitivity, specificity, positive predictive value, and negative predictive value were 0.94%, 0.91%-0.96%, 94.0%, 93.0%, 82.3%, and 98.1%, respectively; at 100 kVp these values were 0.94%, 0.92%-0.97%, 96.1%, 92.0%, 85.2%, and 98.0%, respectively. Area under the receiver operating characteristic curve analysis revealed no significant difference in diagnostic accuracy between the two protocols (P = .87). CONCLUSIONS At the same CNR, the 100-kVp CCTA protocol may help to reduce the radiation dose by approximately 50% compared to the 120-kVp protocol without degradation of diagnostic accuracy.
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Tromeur C, van der Pol LM, Le Roux PY, Ende-Verhaar Y, Salaun PY, Leroyer C, Couturaud F, Kroft LJM, Huisman MV, Klok FA. Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning for diagnosing pulmonary embolism during pregnancy: a systematic review and meta-analysis. Haematologica 2018; 104:176-188. [PMID: 30115658 PMCID: PMC6312023 DOI: 10.3324/haematol.2018.196121] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/14/2018] [Indexed: 01/19/2023] Open
Abstract
Differences between computed tomography pulmonary angiography and ventilation-perfusion lung scanning in pregnant patients with suspected acute pulmonary embolism are not well-known, leading to ongoing debate on which test to choose. We searched in PubMed, EMBASE, Web of Science and the Cochrane Library databases and identified all relevant articles and abstracts published up to October 1, 2017. We assessed diagnostic efficiency, frequency of non-diagnostic results and maternal and fetal exposure to radiation exposure. We included 13 studies for the diagnostic efficiency analysis, 30 for the analysis of non-diagnostic results and 22 for the radiation exposure analysis. The pooled rate of false negative test results was 0% for both imaging strategies with overlapping confidence intervals. The pooled rates of non-diagnostic results with computed tomography pulmonary angiography and ventilation-perfusion lung scans were 12% (95% confidence interval: 8-17) and 14% (95% confidence interval: 10-18), respectively. Reported maternal and fetal radiation exposure doses were well below the safety threshold, but could not be compared between the two diagnostic methods given the lack of high quality data. Both imaging tests seem equally safe to rule out pulmonary embolism in pregnancy. We found no significant differences in efficiency and radiation exposures between computed tomography pulmonary angiography and ventilation-perfusion lung scanning although direct comparisons were not possible.
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Affiliation(s)
- Cécile Tromeur
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands .,Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Liselotte M van der Pol
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands.,Department of Internal Medicine, Haga Teaching Hospital, the Hague, the Netherlands
| | | | - Yvonne Ende-Verhaar
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | | | - Christophe Leroyer
- Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Francis Couturaud
- Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
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Abstract
Cardiovascular CT (CCT) is an important imaging modality in congenital and acquired paediatric heart disease. Technological advances have resulted in marked improvements in spatial and temporal resolution of CCT with a concomitant increase in speed of data acquisition and a decrease in radiation dose. This has elevated CCT from being sparingly used to an essential diagnostic tool in the daily multimodality imaging practice alongside echocardiography, cardiovascular MR and invasive angiography. The application of CCT in paediatric congenital and acquired heart disease can be both technically and diagnostically challenging. This review highlights important considerations for current state of the art CCT across the spectrum of heart disease encountered in children.
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Affiliation(s)
- Kristian H Mortensen
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Oliver Tann
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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Martin SS, van Assen M, Griffith LP, De Cecco CN, Varga-Szemes A, Bauer MJ, Wichmann JL, Vogl TJ, Schoepf UJ. Dual-Energy CT Pulmonary Angiography: Quantification of Disease Burden and Impact on Management. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0297-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dane B, Patel H, O'Donnell T, Girvin F, Brusca-Augello G, Alpert JB, Niu B, Attia M, Babb J, Ko JP. Image Quality on Dual-energy CTPA Virtual Monoenergetic Images: Quantitative and Qualitative Assessment. Acad Radiol 2018; 25:1075-1086. [PMID: 29398436 DOI: 10.1016/j.acra.2017.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast. MATERIALS AND METHODS The study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50-60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40-150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P <.05 was considered significant. RESULTS Region of interest mean CT number increased as keV decreased, with 40 keV having the highest value (P < .001). Mean SNR was highest for 40-60 keV (P <.05) (14.5-14.7) and was higher (P <.05) than all remaining energies (90-150 keV) for all vessel regions combined. Contrast to noise ratio was highest for 40 keV (P <.001) and decreased as keV increased. SNR was highest at 60 and 70 keV, only slightly higher than 40-50 keV (P <.05). Reader scores for 40-50 keV were greater than other energies and weighted-average images (P <.05). CONCLUSIONS Kiloelectron volt images of 40-50 keV from the second-generation algorithm optimize attenuation on dual-energy CTPA and can potentially aid in interpretation and avoiding nondiagnostic examinations.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016.
| | - Hersh Patel
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Francis Girvin
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Jeffrey B Alpert
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Bowen Niu
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - James Babb
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
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Improved display of cervical intervertebral discs on water (iodine) images: incidental findings from single-source dual-energy CT angiography of head and neck arteries. Eur Radiol 2018; 29:153-160. [DOI: 10.1007/s00330-018-5603-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
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Yin XP, Gao BL, Li CY, Zhou H, Zhao L, Zheng YT, Zhao YX. Optimal Monochromatic Imaging of Spectral Computed Tomography Potentially Improves the Quality of Hepatic Vascular Imaging. Korean J Radiol 2018; 19:578-584. [PMID: 29962864 PMCID: PMC6005939 DOI: 10.3348/kjr.2018.19.4.578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 02/01/2018] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the efficiency of spectral computed tomography (CT) optimal monochromatic images in improving imaging quality of liver vessels. Materials and Methods The imaging data of 35 patients with abdominal CT angiography were retrospectively analyzed. Hepatic arteries, portal veins, and hepatic veins were reconstructed with mixed energy (quality check, QC), 70 keV and optimal monochromatic mode. Comparative parameters were analyzed including CT value, image noise (IN), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and subjective qualitative analysis. Results The optimal monochromatic value for assessment of the common hepatic artery, portal vein, and hepatic vein ranged between 49 keV and 53 keV, with a mean of 51 keV. There were statistically significant differences (p < 0.001) among the optimal monochromatic, 70 keV and QC images with regards to the hepatic vascular CT value, IN, CNR, SNR, and subjective qualitative score. CNR of the common hepatic artery in the optimal monochromatic, 70 keV and QC groups was 24.6 ± 10.9, 18.1 ± 8.3, and 11.6 ± 4.6, respectively (p < 0.001) with subjective scores of 4.7 ± 0.2, 4.0 ± 0.3, and 3.6 ± 0.4, respectively (p < 0.001). CNR of the hepatic portal vein was 6.9 ± 2.7, 4.3 ± 1.9, and 3.0 ± 2.1, respectively (p < 0.001) with subjective scores of 4.5 ± 0.3, 3.9 ± 0.4, and 3.3 ± 0.3, respectively (p < 0.001). CNR of the hepatic vein was 5.7 ± 2.3, 4.2 ± 1.9, and 2.7 ± 1.4, respectively with subjective scores of 4.3 ± 0.3, 3.8 ± 0.4, and 3.2 ± 0.3, respectively (p < 0.001). Conclusion Optimal monochromatic images can lead to improvement in the imaging parameters and optimization of the image quality of the common hepatic artery, hepatic portal vein and hepatic vein compared with conventional mixed kV and with 70 keV datasets.
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Affiliation(s)
- Xiao-Ping Yin
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Bu-Lang Gao
- Department of Medical Research, Shijiazhuang First Hospital, Shijiazhuang 050011, China
| | - Cai-Ying Li
- The Second Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Huan Zhou
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Liang Zhao
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Ya-Ting Zheng
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
| | - Yong-Xia Zhao
- Department of CT and MRI, Affiliated Hospital of Hebei University, Baoding 071002, China
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Leithner D, Gruber-Rouh T, Beeres M, Wichmann JL, Mahmoudi S, Martin SS, Lenga L, Albrecht MH, Booz C, Vogl TJ, Scholtz JE. 90-kVp low-tube-voltage CT pulmonary angiography in combination with advanced modeled iterative reconstruction algorithm: effects on radiation dose, image quality and diagnostic accuracy for the detection of pulmonary embolism. Br J Radiol 2018; 91:20180269. [PMID: 29792729 DOI: 10.1259/bjr.20180269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate low-tube-voltage 90-kVp CT pulmonary angiography (CTPA) with advanced modeled iterative reconstruction algorithm (Admire) compared to 120-kVp equivalent dual-energy (DE) acquisition with regards to radiation exposure, image quality and diagnostic accuracy for pulmonary embolism (PE) assessment. METHODS CTPA studies of 40 patients with suspected PE (56.7 ± 16.3 years) performed on a third-generation 192-slice dual-source CT scanner were retrospectively included. 120-kVp equivalent linearly-blended (60% 90-kVp, 40% 150-kVp) and 90-kVp images were reconstructed. Attenuation and noise of the pulmonary trunk were measured to calculate contrast-to-noise ratios (CNR). Three radiologists assessed the presence of central and segmental PE and diagnostic confidence. Interobserver agreement was calculated using intraclass correlation coefficient (ICC). Radiation exposure was assessed as effective dose (ED). RESULTS Pulmonary trunk CNR values were significantly increased in 90-kVp compared to linearly-blended series (15.4 ± 6.3 vs 11.3 ± 4.6, p < 0.001). Diagnostic accuracy for PE assessment was similar in both series with excellent interobserver agreement (p = 0.48; ICC, 0.83; p = 0.48). Overall confidence for PE assessment was rated excellent for both series with a significant advantage for linearly-blended series (p < 0.001; 4.1 vs 3.8). ED was reduced by 37.2% with 90-kVp compared to 120-kVp equivalent image series (1.1 ± 0.6 vs 1.7 ± 0.7 mSv, p < 0.001). CONCLUSION 90-kVp CTPA with Admire provided increased quantitative image quality with similar diagnostic accuracy and confidence for PE assessment compared to 120-kVp equivalent acquisition, while radiation dose was reduced by 37.2%. Advances in knowledge: 90-kVp CTPA with an advanced iterative reconstruction algorithm results in excellent image quality and reduction of radiation exposure without limiting diagnostic performance.
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Affiliation(s)
- Doris Leithner
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany.,2 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Tatjana Gruber-Rouh
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Martin Beeres
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Julian L Wichmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Scherwin Mahmoudi
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Simon S Martin
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Lukas Lenga
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Moritz H Albrecht
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Christian Booz
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Thomas J Vogl
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Jan-Erik Scholtz
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany.,3 Department of Radiology, Massachusetts General Hospital, Cardiac MR PET CT Program, Harvard Medical School , Boston, MA , USA
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Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018; 8:225-243. [PMID: 30057872 DOI: 10.21037/cdt.2017.12.01] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Imaging plays an important role in the evaluation and management of acute pulmonary embolism (PE). Computed tomography (CT) pulmonary angiography (CTPA) is the current standard of care and provides accurate diagnosis with rapid turnaround time. CT also provides information on other potential causes of acute chest pain. With dual-energy CT, lung perfusion abnormalities can also be detected and quantified. Chest radiograph has limited utility, occasionally showing findings of PE or infarction, but is useful in evaluating other potential causes of chest pain. Ventilation-perfusion (VQ) scan demonstrates ventilation-perfusion mismatches in these patients, with several classification schemes, typically ranging from normal to high. Magnetic resonance imaging (MRI) also provides accurate diagnosis, but is available in only specialized centers and requires higher levels of expertise. Catheter pulmonary angiography is no longer used for diagnosis and is used only for interventional management. Echocardiography is used for risk stratification of these patients. In this article, we review the role of imaging in the evaluation of acute PE.
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Affiliation(s)
- Alastair J E Moore
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Wachsmann
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Murthy R Chamarthy
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lloyd Panjikaran
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Yuki Tanabe
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
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Li W, Li A, Wang B, Niu X, Cao X, Wang X, Shi H. Automatic spectral imaging protocol and iterative reconstruction for radiation dose reduction in typical hepatic hemangioma computed tomography with reduced iodine load: a preliminary study. Br J Radiol 2018; 91:20170978. [PMID: 29714501 DOI: 10.1259/bjr.20170978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of automatic spectral imaging protocol selection (ASIS) and adaptive statistical iterative reconstruction (ASiR) technique in the reduction of radiation and contrast medium dose in typical hepatic hemangioma (HH) dual energy spectral CT (DEsCT). METHODS 62 patients with suspected HH were randomly divided into two groups equally: Group A, conventional 120-kVp CT with standard iodine load; Group B, DEsCT with ASIS technique and reduced iodine load, two sets of monochromatic spectral images were reconstructed: 69 keV level with 30% ASiR (Group B1) and 52 keV level with 50% ASiR (Group B2). The radiation and total iodine dose, quantitative analysis (standard deviation value, contrast-to-noise and contrast enhancement ratio) and qualitative analysis were evaluated. RESULTS No difference was observed in the standard deviation values, subjective image noise, and the diagnostic acceptability score among the three groups (p > 0.05). Contrast to noise [Group B2 vs A, B1 in arterial phase (AP): 19.51 ± 6.29 vs 15.77 ± 5.93, 11.46 ± 2.84; Group B2 vs A, B1 in portal venous phase (PVP): 9.96 ± 2.18 vs 8.19 ± 3.04, 6.01 ± 1.82], contrast enhancement ratio (Group B2 vs A, B1 in AP: 6.88 ± 2.01 vs 5.47 ± 2.01, 4.15 ± 1.28; Group B2 vs A, B1 in PVP: 5.58 ± 1.02 vs 4.54 ± 1.13, 3.49 ± 0.83), and the lesion conspicuity score (Group B2 vs A, B1 in AP: 3.93 ± 0.26 vs 3.45 ± 0.51, 3.10 ± 0.49; Group B2 vs A, B1 in PVP: 3.90 ± 0.31 vs 3.48 ± 0.57, 3.14 ± 0.44) for Group B2 were higher than those in Group A and B1 (p < 0.05). Compared to Group A, the radiation dose and total iodine dose in Group B were reduced by 30 and 41%, respectively (radiation dose in Group B vs A: 5.53 ± 1.59 vs 7.91± 2.71 mSv; iodine dose in Group B vs A: 18.85 ± 2.88 vs 31.78±3.89 ml; p < 0.05). CONCLUSION DEsCT with ASIS and ASiR technique can reduce the radiation dose without image quality degradation as compared to the conventional 120-kVp CT. The monochromatic spectral images at 52 keV level with 50% ASiR allows the reduction in total iodine dose without deteriorating diagnostic performance. Advances in knowledge: ASIS combined with ASiR technique, by using monochromatic spectral images at 52 keV level, represents a feasible imaging protocol to reduce the radiation and total iodine dose in assessment of typical HH.
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Affiliation(s)
- Wei Li
- 1 Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University , Jinan, Shandong , China
| | - Aiyin Li
- 1 Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University , Jinan, Shandong , China
| | - Bin Wang
- 2 Department of Medical Imaging, ZhangQiu district hospital of TCM , Jinan, Shandong , China
| | - Xiuyuan Niu
- 2 Department of Medical Imaging, ZhangQiu district hospital of TCM , Jinan, Shandong , China
| | - Xin Cao
- 1 Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University , Jinan, Shandong , China
| | - Xinyi Wang
- 1 Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University , Jinan, Shandong , China
| | - Hao Shi
- 1 Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University , Jinan, Shandong , China
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Zhao Y, Zuo Z, Cheng S, Wu Y. CT pulmonary angiography using organ dose modulation with an iterative reconstruction algorithm and 3D Smart mA in different body mass indices: image quality and radiation dose. Radiol Med 2018; 123:676-685. [DOI: 10.1007/s11547-018-0899-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
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Jeong YJ, Choo KS, Nam KJ, Lee JW, Kim JY, Jung HJ, Lim SJ. Image quality and radiation dose of CT venography with double dose reduction using model based iterative reconstruction: comparison with conventional CT venography using filtered back projection. Acta Radiol 2018; 59:546-552. [PMID: 28766981 DOI: 10.1177/0284185117725780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B ( P < 0.01). Noise in group A was significantly lower than in group B except for PV and contrast-to-noise ratio were not significantly different in the two groups ( P > 0.05). In addition, radiation dose in group A was significantly lower than in group B ( P < 0.001). Subjective image quality comparison revealed group A was statistically inferior to group B except for subjective image noise. Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.
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Affiliation(s)
- Yeo-Jin Jeong
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki Seok Choo
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hyuk Jae Jung
- Department of Vascular surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Soo Jin Lim
- Department of Cardiology, Kim Hae Gang-il Hospital, KyoungNam, Republic of Korea
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Sasaki T, Fujimoto Y, Ishitoya S, Nabaa B, Watanabe N, Yamaki T, Takahashi K. Improved detectability of thromboses of the lower limb using low kilovoltage computed tomography. Medicine (Baltimore) 2018; 97:e9775. [PMID: 29419670 PMCID: PMC5944700 DOI: 10.1097/md.0000000000009775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
To determine the utility of low kilovoltage computed tomographic venography (CTV) for the detection of deep venous thrombus in the lower limbs.Twenty-one thrombi in 19 enrolled patients were investigated in this retrospective study. Patients were initially scanned using CTV at 100 kVp, at the femur level, followed by an immediate switch to 80 kVp. We assessed the CT values of thrombi and veins and performed subjective evaluation for detecting thrombi using a 5-point scoring system: 1, unable to evaluate due to noise or artifacts; 2, equivocal venous thrombus; 3, possible venous thrombus; 4, probable venous thrombus; and 5, definite venous thrombus.Venous density on 100-kVp images (mean ± SD [standard deviation]: 122 ± 23 HU, 95% confidence interval [CI]: 111-133 Hounsfield unit [HU]) was significantly lower than that on 80-kVp images (136 ± 24 HU, 95% CI: 125-147 HU, P < .001). There was no significant difference in thrombi between 100-kVp images (55 ± 14 HU, 95% CI: 49-61 HU) and 80-kVp images (57 ± 16, 95% CI: 50-64 HU, P = .168). The thrombus to vein ratio on 100-kVp images (0.47 ± 0.20, 95% CI: 0.39-0.56) was significantly higher than that on 80-kVp images (0.44 ± 0.16, 95% CI: 0.37-0.51, P = .048). The mean 5-point score was significantly higher on the 80-kVp images (4.76) than on the 100-kVp images (4.45, P = .016).Lower kilovoltage CTV significantly improved thrombotic to venous contrasts in the lower limbs.
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Should Dual-Energy Computed Tomography Pulmonary Angiography Replace Single-Energy Computed Tomography Pulmonary Angiography in Pregnant and Postpartum Patients? J Comput Assist Tomogr 2018; 42:25-32. [PMID: 28786905 DOI: 10.1097/rct.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aims to compare single-energy (SE) and dual-energy (DE) computed tomography pulmonary angiography (CTPA) for evaluation of suspected pulmonary embolism in pregnant and postpartum patients. MATERIALS AND METHODS Our study included 59 CTPA performed in pregnant/postpartum women (study group) comprised of 38 SE-CTPA and 21 DE-CTPA. The control group of 21 age- and weight-matched nonpregnant/nonpostpartum women underwent DE-CTPA. Two radiologists assessed pulmonary arterial enhancement, image quality, and artifacts. κ Test and analysis of variance were performed. RESULTS Fourteen of 38 pregnant/postpartum women (37%) had suboptimal SE-CTPA compared with just 10% (2/21) suboptimal DE-CTPA studies (P = 0.02). Mean Hounsfield unit (HU) in the pulmonary trunk was 550 ± 68 HU in the DE-CTPA pregnant/postpartum group and 245 ± 12 HU in the SE-CTPA (P < 0.001). The mean volume computed tomography dose index in the pregnant/postpartum patients for DE-CTPA and SE-CTPA were 9 ± 2 and 19 ± 8 mGy, respectively (P < 0.001). CONCLUSIONS Dual-energy CTPA substantially increased arterial enhancement for evaluation of pulmonary embolism in pregnant and postpartum women compared with SE-CTPA.
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Improved Delineation of Pulmonary Embolism and Venous Thrombosis Through Frequency Selective Nonlinear Blending in Computed Tomography. Invest Radiol 2017; 52:240-244. [PMID: 27861205 DOI: 10.1097/rli.0000000000000333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that a novel frequency selective nonlinear blending (NLB) algorithm increases the delineation of pulmonary embolism and venous thrombosis in portal-venous phase whole-body staging computed tomography (CT). MATERIALS AND METHODS A cohort of 67 patients with incidental pulmonary embolism and/or venous thrombosis in contrast-enhanced oncological staging CT were retrospectively selected. Computed tomography data sets were acquired 65 to 90 seconds after intravenous iodine contrast administration using state-of-the-art multi-detector CT scanners. A novel frequency selective NLB postprocessing technique was applied to reconstructed standard CT images. Two readers determined the most suitable settings to increase the delineation of pulmonary embolism and venous thrombosis. Outcome measure included region of interest and contrast-to-noise ratio (CNR) analyses, image noise, overall image quality, subjective delineation, as well as number and size of emboli and thrombi. Statistical testing included quantitative comparisons of Hounsfield units of thrombus and vessel, image noise and related CNR values and subjective image analyses of image noise, image quality and thrombus delineation, number and size in standard, and NLB images. RESULTS Using frequency selective NLB settings with a center of 100 HU, delta of 40 HU, and a slope of 5, CNR values of pulmonary embolism (StandardCNR, 10 [6, 16]; NLBCNR, 22 [15, 30]; P < 0.001) and venous thrombosis (StandardCNR, 8 [5, 15]; NLBCNR, 12 [7, 19]; P = 0.0007) increased. Mean vascular enhancement using NLB was significantly higher than in standard images for pulmonary arteries (Standard, 138 [118, 191] HU; NLB, 269 [176, 329] HU; P < 0.0001) and veins (Standard, 120 [103, 162] HU; NLB, 169 [132, 217] HU; P < 0.0001), respectively. Image noise was not significantly different between standard and NLB images (P = 0.64-0.88). There was substantial to almost perfect interrater agreement as well as a significant increase of overall image quality (P < 0.004) and subjective delineation of the thrombotic material (P < 0.0001) in both subgroups. Nonlinear blending images revealed 8 additional segmental and 13 subsegmental emboli. Thrombus sizes were not significantly different, but subjective accuracy of the measurement could be significantly increased using NLB (P = 0.03). CONCLUSIONS Postprocessing of standard whole-body staging CT images with frequency selective NLB improves image quality and the delineation of pulmonary embolism and venous thrombosis.
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D’Angelo T, Bucher AM, Lenga L, Arendt CT, Peterke JL, Caruso D, Mazziotti S, Blandino A, Ascenti G, Othman AE, Martin SS, Leithner D, Vogl TJ, Wichmann JL. Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography. Eur Radiol 2017; 28:1393-1401. [DOI: 10.1007/s00330-017-5059-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 12/30/2022]
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Hwang JY, Choo KS, Choi YY, Kim JH, Ryu H, Han J, Kim YW, Jeon UB, Nam KJ. Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration. Pediatr Radiol 2017; 47:701-709. [PMID: 28236133 DOI: 10.1007/s00247-017-3795-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/22/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. OBJECTIVE To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. MATERIALS AND METHODS The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. RESULTS Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. CONCLUSION The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups.
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Affiliation(s)
- Jae-Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.
| | - Yoon Young Choi
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Junhee Han
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Yong-Woo Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Ung Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
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Radiation dose-reduction strategies in thoracic CT. Clin Radiol 2017; 72:407-420. [DOI: 10.1016/j.crad.2016.11.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 01/08/2023]
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Halpenny D, Park B, Alpert J, Latson L, Kim N, Babb J, Shiau M, Ko J. Low dose computed tomography pulmonary angiography protocol for imaging pregnant patients: Can dose reduction be achieved without reducing image quality? Clin Imaging 2017; 44:101-105. [PMID: 28500985 DOI: 10.1016/j.clinimag.2017.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/09/2017] [Accepted: 03/29/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the effect of low dose computed tomography pulmonary angiography (CTPA) on radiation dose in pregnant patients. MATERIALS AND METHODS An old CTPA protocol for pregnant patients was compared to a new protocol. Protocol changes included: decreased kVp; increased contrast injection rate; imaging after shallow inspiration. Patients undergoing CTPA before (phase 1 group) or after (phase 2 group) the protocol change, were assessed. RESULTS Effective dose was lower in the phase 2 group (0.95 v 1.66 mSv; p<0.001). Quantitative noise was lower in the phase 1 group (p<0.001). CONCLUSION Low dose CTPA tailored for pregnancy reduces dose in pregnant patients.
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Affiliation(s)
- Darragh Halpenny
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA.
| | - Brian Park
- New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Jeffrey Alpert
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA
| | - Larry Latson
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA
| | - Nancy Kim
- New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - James Babb
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA
| | - Maria Shiau
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA
| | - Jane Ko
- Department of Thoracic Radiology, New York University School of Medicine, 660 1st Ave, NY 10016, USA
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Caruso D, Parinella AH, Schoepf UJ, Stroebel MH, Mangold S, Wichmann JL, Varga-Szemes A, Ball BD, De Santis D, Laghi A, De Cecco CN. Optimization of window settings for standard and advanced virtual monoenergetic imaging in abdominal dual-energy CT angiography. Abdom Radiol (NY) 2017; 42:772-780. [PMID: 27878637 DOI: 10.1007/s00261-016-0963-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the optimal window setting for displaying virtual monoenergetic reconstructions of third generation dual-source, dual-energy CT (DECT) angiography of the abdomen. METHODS Forty-five patients were evaluated with DECT angiography (90/150 kV, 180/90 ref. mAs). Three datasets were reconstructed: standard linear blending (M_0.6), 70 keV traditional virtual monoenergetic (M70), and 40 keV advanced noise-optimized virtual monoenergetic (M40+). The best window setting (width and level, W/L) was assessed by two blinded observers and was correlated with aortic attenuation to obtain the Optimized W/L setting (O-W/L). Subjective image quality was assessed, and vessel diameters were measured to determine any possible influences between different W/L settings. Repeated measures of variance were used to evaluate comparison of W/L values, image quality, and vessel sizing between M_0.6, M70, and M40+. RESULTS The Best W/L (B-W/L) for M70 and M40+ was 880/280 and 1410/450, respectively. Results from regression analysis inferred an O-W/L of 850/270 for M70 and 1350/430 for M40+. Significant differences for W and L were found between the Best and the Optimized W/L for M40+, and between M70 and M40+ for both the Best and Optimized W/L. No significant differences for vessel measurements were found using the O-W/L for M40+ compared to the standard M_0.6 (p ≥ 0.16), and significant differences were observed when using the B-W/L with M40+ compared to M_0.6 (p ≤ 0.04). CONCLUSION In order to optimize virtual monoenergetic imaging with both traditional M70 and advanced M40+, adjusting the W/L settings is necessary. Our results suggest a W/L setting of 850/270 for M70 and 1350/430 for M40+.
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Affiliation(s)
- Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Ashley H Parinella
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.
- Division of Cardiology, Department of MedicineMedical, University of South Carolina, Charleston, SC, USA.
| | - Maxwell H Stroebel
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - B Devon Ball
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Domenico De Santis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA
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Al-Rammah TY, Alohaly A, Albatsh K. Reducing computed tomography radiation dose in diagnosing pulmonary embolism. Pak J Med Sci 2017; 32:1444-1448. [PMID: 28083042 PMCID: PMC5216298 DOI: 10.12669/pjms.326.11347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Computed tomography angiography plays a major role in the diagnosis of pulmonary embolism. Radiation dose associated with it is a major concern; therefore it is important to optimize protocols and techniques to ensure minimum radiation dose. Methods: The study compares two protocols i. Conventional Timing Bolus CT protocol and Delayed Timing Bolus protocol used to assist suspected pulmonary embolism patients. Results: A significant reduction in the average effective dose (39%) was noticed when using the delayed timing bolus protocol. Conclusion: Delayed timing bolus protocol has a good impact on radiation dose without affecting the value of the computed tomography angiography study.
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Affiliation(s)
- Tamader Y Al-Rammah
- Tamader Y. AL-Rammah, Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Amani Alohaly
- Amani Alohaly, Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Kamal Albatsh
- Kamal Albatsh, King Khalid University Hospital, King Saud University, Saudi Arabia
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Weiss J, Notohamiprodjo M, Bongers M, Schabel C, Mangold S, Nikolaou K, Bamberg F, Othman AE. Noise-optimized monoenergetic post-processing improves visualization of incidental pulmonary embolism in cancer patients undergoing single-pass dual-energy computed tomography. Radiol Med 2017; 122:280-287. [PMID: 28070843 DOI: 10.1007/s11547-016-0717-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate noise-optimized monoenergetic postprocessing of dual-energy CT (DE-CT) on image quality in patients with incidental pulmonary embolism in single-pass portal-venous phase CT (CTpv). MATERIALS AND METHODS 20 Consecutive patients with incidental pulmonary embolism in contrast-enhanced oncological follow-up DE-CTpv examination were included in this study. Images were acquired with a 3rd generation DE-CT system in DE mode (100/Sn150 kV) and activated tube current modulation 90 s after contrast agent administration. Subsequently, virtual monoenergetic images (MEI+) were reconstructed at five different keV levels (40, 55, 70, 85, 100) and compared to the standard linearly blended (M_0.8) CTpv images. Image quality was assessed qualitatively (vascular contrast and detectability of embolism, image noise, iodine influx artifact; two independent readers; 5-point Likert scale; 5 = excellent) and quantitatively by calculating signal-to-noise (SNR) and contrast-to-noise ratios (CNR). RESULTS Highest vessel contrast and highest detectability of embolism were observed in MEI+ at 40 keV (4.7 ± 0.4) and 55 keV (4.2 ± 0.6) with significant differences as compared to CTpv (3.6 ± 0.5) and high keV reconstructions (70, 85, 100; p ≤ 0.01). Image noise significantly increased at 40 keV MEI+ compared to all other MEI+ reconstructions and CTpv (p < 0.001). SNR and CNR calculations were highest at 40 keV MEI+ followed by 55 keV and CTpv with significant differences to high keV MEI+ (85-100). CONCLUSIONS Computed MEI+ at low keV levels allow for improved vessel contrast and visualisation of incidental pulmonary embolism in patients with portal-venous phase CT scans by substantially increasing CNR and SNR.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Malte Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Christoph Schabel
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Stefanie Mangold
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Ahmed E Othman
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Chen EL, Ross JA, Grant C, Wilbur A, Mehta N, Hart E, Mar WA. Improved Image Quality of Low-Dose CT Pulmonary Angiograms. J Am Coll Radiol 2017; 14:648-653. [PMID: 28082157 DOI: 10.1016/j.jacr.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The use of CT pulmonary angiography (CTPA) to evaluate for pulmonary embolism has been increasing, and carries a significant radiation dose. We evaluate image quality of lower-dose images, taking into account patient size as well as the effects of image postprocessing. METHODS A total of 250 CTPAs were retrospectively reviewed. The following parameters were obtained: kVp, mA, dose length product, Hounsfield units (HU) with standard deviation in the main pulmonary artery, transverse scout measurement, and subjective image quality. RESULTS Radiation dose decreased 55% by reducing kVp from 120 to 100, and 60% from 100 to 80 kVp. Radiation dose decreased 82% from 120 to 80 kVp. Noise increased 38% from 120 kVp to 100 kVp, and increased 23% from 100 kVp to 80 kVp. Adding an overlapped reconstructed image decreased noise by 16% to 21%. Despite the increase in image noise, diagnostic quality was significantly improved at 80 and 100 kVp, compared with 120 kVp, with an average subjective quality rating of 3.8, 4.0, and 3.2, respectively, and an average pulmonary artery density of 536, 423, and 278 HU. Even in larger patients, qualitative image quality was better at 100 kVp compared with 120 kVp, with an average quality rating of 3.6 versus 2.9, respectively. CONCLUSIONS Radiation dose exposure can be easily reduced on CTPA by lowering kVp, which at the same time improves image quality. Studies using a lower kVp were of significantly higher diagnostic quality. This held true even in larger patients.
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Affiliation(s)
- Eric L Chen
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jeremy A Ross
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Andrew Wilbur
- University of Illinois at Chicago, Chicago, Illinois
| | | | - Eric Hart
- Northwestern Memorial Hospital, Chicago, Illinois
| | - Winnie A Mar
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
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50
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Li X, Chen GZ, Zhao YE, Schoepf UJ, Albrecht MH, Bickford MW, Gu HF, Zhang LJ, Lu GM. Radiation Optimized Dual-source Dual-energy Computed Tomography Pulmonary Angiography: Intra-individual and Inter-individual Comparison. Acad Radiol 2017; 24:13-21. [PMID: 27789203 DOI: 10.1016/j.acra.2016.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to intra-individually and inter-individually compare image quality, radiation dose, and diagnostic accuracy of dual-source dual-energy computed tomography pulmonary angiography (CTPA) protocols in patients with suspected pulmonary embolism (PE). METHODS Thirty-three patients with suspected PE underwent initial and follow-up dual-energy CTPA at 80/Sn140 kVp (group A) or 100/Sn140 kVp (group B), which were assigned based on tube voltages. Subjective and objective CTPA image quality and lung perfusion map image quality were evaluated. Diagnostic accuracies of CTPA and perfusion maps were assessed by two radiologists independently. Effective dose (ED) was calculated and compared. RESULTS Mean computed tomography (CT) values of pulmonary arteries were higher in group A than group B (P = .006). There was no difference in signal-to-noise ratio and contrast-to-noise ratio between the two groups (both P > .05). Interobserver agreement for evaluating subjective image quality of CTPA and color-coded perfusion images was either good (κ = 0.784) or excellent (κ = 0.887). Perfusion defect scores and diagnostic accuracy of CTPA showed no difference between both groups (both P > .05). Effective dose of group A was reduced by 45.8% compared to group B (P < .001). CONCLUSIONS Second-generation dual-source dual-energy CTPA with 80/Sn140 kVp allows for sufficient image quality and diagnostic accuracy for detecting PE while substantially reducing radiation dose.
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Affiliation(s)
- Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew W Bickford
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Hai Feng Gu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Nanjing, Jiangsu, 210002, China.
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