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Scheschenja M, Bastian MB, Wessendorf J, Owczarek AD, König AM, Viniol S, Mahnken AH. ChatGPT: Evaluating answers on contrast media related questions and finetuning by providing the model with the ESUR guideline on contrast agents. Curr Probl Diagn Radiol 2024; 53:488-493. [PMID: 38670921 DOI: 10.1067/j.cpradiol.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This study aimed to assess the feasibility of GPT-4 for answering questions related to contrast media with and without the context of the European Society of Urogenital Radiology (ESUR) guideline on contrast agents. The overarching goal was to determine whether contextual enrichment by providing guideline information improves answers of GPT-4 for clinical decision-making in radiology. METHODS A set of 64 questions, based on the ESUR guideline on contrast agents mirroring pertinent sections, was developed and posed to GPT-4 both directly and after providing the guideline using a plugin. Responses were graded by experienced radiologists for quality of information and accuracy in pinpointing information from the guideline as well as by radiology residents for utility, using Likert-scales. RESULTS GPT-4's performance improved significantly with the guideline. Without the guideline, average quality rating was 3.98, which increased to 4.33 with the guideline (p = 0036). In terms of accuracy, 82.3% of answers matched the information from the guideline. Utility scores also reflected a significant improvement with the guideline, with average scores of 4.1 (without) and 4.4 (with) (p = 0.008) with a Fleiss´ Kappa of 0.44. CONCLUSION GPT-4, when contextually enriched with a guideline, demonstrates enhanced capability in providing guideline-backed recommendations. This approach holds promise for real-time clinical decision-support, making guidelines more actionable. However, further refinements are necessary to maximize the potential of large language models (LLMs). Inherent limitations need to be addressed.
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Affiliation(s)
- Michael Scheschenja
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany.
| | - Moritz B Bastian
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
| | - Joel Wessendorf
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
| | - Andreas D Owczarek
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
| | - Alexander M König
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University of Marburg, Baldingerstrasse 1, Marburg, DE 35043, Germany
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Natembeya MC, Anudjo MNK, Ackah JA, Osei MB, Akudjedu TN. The environmental sustainability implications of contrast media supply chain disruptions during the COVID-19 pandemic: A document analysis of international practice guidelines. Radiography (Lond) 2024; 30 Suppl 1:43-54. [PMID: 38901086 DOI: 10.1016/j.radi.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Travel restrictions implemented during the acute phases of the COVID-19 pandemic disrupted supply chain for critical radiology consumables including contrast media (CM) leading to shortages. Consequently, some departments had to restructure their clinical workflows in accordance to recommended guidelines to ensure safe continuity of patient care. This study aimed to summarise the temporary crisis-driven recommendations with implicit environmental sustainability essence and to analyse how these measures might inform the development of a more sustainable, long-term clinical guideline for safer and cost-effective CM usage without compromising diagnostic quality. METHODS Documents were obtained through an electronic database search together with a relevant manual search in Google Scholar and relevant reference lists. The selected documents were subjected to a pre-defined eligibility criteria for inclusion. The READ approach was employed for document analysis and a thematic analysis of the obtained data was conducted. RESULTS Of the 17 documents included, 70% (n = 12) emanate from the United States of America. The summary of the findings relate to minimising CM usage through strategic clinical approaches including optimisation of CM volumes, prioritisation of non-contrast imaging and/or alternative imaging depending on patient need without compromising diagnostic quality. CONCLUSION Critical lessons of sustainability essence are implicitly embedded in the policy guidelines issued during the periods of acute CM shortage in the COVID-19 pandemic. These lessons were themed around CM conservation based on: type and priority of medical imaging investigation, kind of imaging modality and use of smaller vials over multi-dose vials packaging. IMPLICATIONS FOR PRACTICE The temporary crisis-driven strategies may offer critical lessons for post-pandemic service delivery to enhance patient safety while saving cost and promoting greener practice via strategic clinical and operational monitoring of CM through policy renewal, education and training and collaboration with industry partners.
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Affiliation(s)
- M C Natembeya
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - J A Ackah
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - M B Osei
- Department of People & Organisations, Bournemouth University Business School, Bournemouth University, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK.
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De Sousa JMB, Rios GM, Fonseca JRF, Alves JDDDC. Cerebral thromboembolic complications during cerebral angiography and their risk factors in different subgroups: Analysis of 2,457 procedures. Neurol Sci 2024; 45:2759-2768. [PMID: 38217787 DOI: 10.1007/s10072-024-07302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE Diagnostic cerebral digital subtraction angiography (DSA) is an invasive examination that involves catheterization of the major supra-aortic arterial trunks and evaluation of intracranial vessels for diagnostic purposes. Although considered the gold standard method for investigating cerebrovascular diseases, DSA carries measurable and potentially serious complication rates. This report describes the frequency of neurological and non-neurological complications of DSA performed in five hospitals in the state of São Paulo, Brazil, and analyzes them in different disease subgroups. It has a special focus on thromboembolic cerebral complications. METHODS We retrospectively reviewed clinical records of all adult patients who underwent DSAs between January 2019 and December 2022. Demographic variables, DSA reports, CT/MRI reports, and clinical follow-up notes were reviewed. RESULTS Twenty-four patients experienced some type of complication among 2,457 diagnostic DSAs (0.97%). Thromboembolic complications were recorded in 9 patients (0.36%), and access site hematomas larger than 5 cm were registered in six patients (0.24%). There was a statistical trend for thromboembolic complications in patients with cervical and/or intracranial atherosclerosis (p = 0.07), but age was not associated with them (p = 0.93). Patients who received heparin had lower rates of embolic complications than those who did not receive it, but there was no statistically significant difference (p = 0.17). Intravenous administration of heparin showed a trend toward significance with groin hematoma (p = 0.10). CONCLUSION Diagnostic catheter DSAs have low complication rates.
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Affiliation(s)
- Jorge Murilo Barbosa De Sousa
- Clínica NeuroEV, Rua Botucatu, 591, Sala 104, São Paulo, SP, 04023-062, Brazil.
- Conjunto Hospitalar Do Mandaqui, São Paulo, SP, Brazil.
- Hospital IGESP, São Paulo, SP, Brazil.
- Hospital Villa Lobos Rede D'Or, São Paulo, SP, Brazil.
- Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem - FIDI, São Paulo, SP, Brazil.
| | - Gleyson Moraes Rios
- Clínica NeuroEV, Rua Botucatu, 591, Sala 104, São Paulo, SP, 04023-062, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem - FIDI, São Paulo, SP, Brazil
- Hospital Galileo, Valinhos, SP, Brazil
- Hospital Unimed Piracicaba, Piracicaba, SP, Brazil
| | - José Roberto Falco Fonseca
- Clínica NeuroEV, Rua Botucatu, 591, Sala 104, São Paulo, SP, 04023-062, Brazil
- Hospital IGESP, São Paulo, SP, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem - FIDI, São Paulo, SP, Brazil
| | - João de Deus da Costa Alves
- Clínica NeuroEV, Rua Botucatu, 591, Sala 104, São Paulo, SP, 04023-062, Brazil
- Conjunto Hospitalar Do Mandaqui, São Paulo, SP, Brazil
- Hospital IGESP, São Paulo, SP, Brazil
- Hospital Villa Lobos Rede D'Or, São Paulo, SP, Brazil
- Hospital Galileo, Valinhos, SP, Brazil
- Hospital Unimed Piracicaba, Piracicaba, SP, Brazil
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Rašiová M, Schlager O, Heiss C, Brodmann M, Olinic DM, Boc V, Buso G, Belch J, Mazzolai L, Madaric J. Adverse reactions after intravascular iodinated contrast media administration and their management. VASA 2024; 53:193-203. [PMID: 38651340 DOI: 10.1024/0301-1526/a001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, University of Pavol Jozef Šafárik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Vascular Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, United Kingdom
| | | | - Dan Mircea Olinic
- Department of Interventional Cardiology, Medical Clinic No. 1, Emergency County Hospital, Cluj-Napoca, Romania
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - Jill Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madaric
- Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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Albano D, Mallardi C, Afat S, Agnollitto PM, Caruso D, Cannella R, Carriero S, Chupetlovska K, Clauser P, D'Angelo T, De Santis D, Dioguardi Burgio M, Dumic-Cule I, Fanni SC, Fusco S, Gatti M, Gitto S, Jankovic S, Karagechev T, Klontzas ME, Koltsakis E, Leithner D, Matišić V, Muscogiuri G, Penkova R, Polici M, Serpi F, Sofia C, Snoj Z, Akinci D'Antonoli T, Vernuccio F, Vieira J, Vieira AC, Wielema M, Zerunian M, Messina C. How young radiologists use contrast media and manage adverse reactions: an international survey. Insights Imaging 2024; 15:92. [PMID: 38530547 DOI: 10.1186/s13244-024-01658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR). METHODS A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed. RESULTS Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25-39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient's lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively. CONCLUSION Training in CM use and management ADR should be implemented in the training of radiology residents. CRITICAL RELEVANCE STATEMENT We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions. KEY POINTS • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento Di Scienze Biomediche, Chirurgiche Ed Odontoiatriche, Università Degli Studi Di Milano, Milan, Italy.
| | - Carmen Mallardi
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Milan, Italy
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Paulo Moraes Agnollitto
- Ribeirão Preto Medical School, Radiology Division of the Department of Medical Imaging, Hematology and Clinical Oncology, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Serena Carriero
- Department of Radiology and Interventional Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kalina Chupetlovska
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Tommaso D'Angelo
- Diagnostic and Inverventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Domenico De Santis
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Université Paris Cité, INSERM, Centre de Recherche Sur L'inflammation, 75018, Paris, France
| | - Ivo Dumic-Cule
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- University North, 104 Brigade 3, 42000, Varazdin, Croatia
| | | | - Stefano Fusco
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Sonja Jankovic
- Center for Radiology, University Clinical Center Nis, Nis, Republic of Serbia
| | | | - Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Emmanouil Koltsakis
- Department of Radiology, Karolinska University Hospital of Stockholm, Stockholm, Sweden
| | - Doris Leithner
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Vid Matišić
- St. Catherine Specialty Hospital, 10000, Zagreb, Croatia
| | | | - Ralitsa Penkova
- Radiology Department, Acibadem City Clinic Tokuda Hospital, 51B Nikola Y. Vaptsarov Blvd, Sofia, 1407, Bulgaria
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
- PhD School in Traslational Medicine and Oncology, Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Carmelo Sofia
- Diagnostic and Inverventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Ziga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Tugba Akinci D'Antonoli
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - João Vieira
- Radiology, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Catarina Vieira
- Radiology Department, Hospital CUF Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mirjam Wielema
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
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Zhong J, Chen L, Xing Y, Lu J, Shi Y, Wang Y, Deng Y, Jiang R, Lu W, Wang S, Hu Y, Ge X, Ding D, Zhang H, Zhu Y, Yao W. Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease. Insights Imaging 2024; 15:77. [PMID: 38499879 PMCID: PMC10948651 DOI: 10.1186/s13244-024-01644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/10/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them. METHODS We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool. RESULTS Ten guidelines were included, with a median STAR score of 46.0 (range 28.5-61.5). The guidelines performed well in "Recommendations" domain (31/40, 78%), while poor in "Registry" (0/20, 0%) and "Protocol" domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means. CONCLUSION Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols. CRITICAL RELEVANCE STATEMENT The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow. KEY POINTS • Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Liwei Chen
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Junjie Lu
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yuping Shi
- Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yibin Wang
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yi Deng
- University of Washington School of Pharmacy, Seattle, WA, 98105, USA
| | - Run Jiang
- Department of Pharmacovigilance, Shanghai Hansoh BioMedical Co., Ltd, Shanghai, 201203, China
| | - Wenjie Lu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Silian Wang
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Xiang Ge
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Defang Ding
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, 200025, China.
| | - Ying Zhu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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7
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Piarulli S, Riedel JA, Fossum FN, Kermen F, Hansen BH, Kvæstad B, Olsvik PA, Farkas J. Effects of gadolinium (Gd) and a Gd-based contrast agent (GBCA) on early life stages of zebrafish (Danio rerio). CHEMOSPHERE 2024; 350:140950. [PMID: 38114019 DOI: 10.1016/j.chemosphere.2023.140950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
Gadolinium (Gd) is one of the rare earth elements (REY) and is widely used in magnetic resonance imaging (MRI) contrast agents. Anthropogenic Gd enrichment has frequently been found in wastewater treatment plant effluents in industrialised countries, rising concerns regarding effects on aquatic biota. This study investigates the acute toxicity and sublethal effects of Gd in two forms, as inorganic salt (GdCl3) and as Gd-based contrast agent (GBCA), on early life stages of zebrafish (Danio rerio). Nominal exposure concentrations ranged from 3 to 3000 μg L-1, with an exposure duration of 96 h. None of the two tested compounds were acutely toxic to embryos and larvae. Similarly, we did not observe any effects on larval development and locomotive behaviour. However, we found significant changes in the brain activity of larvae exposed to the highest concentrations of GdCl3 and the GBCA. Our findings show that Gd can have sublethal effects on developing fish at lower concentrations than reported previously, highlighting the necessity of investigating the long-term fate and effects of GBCAs released into the aquatic environment.
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Affiliation(s)
- Stefania Piarulli
- Department of Climate and Environment, SINTEF Ocean, Brattørkaia 17C, 7010, Trondheim, Norway.
| | - Juliane A Riedel
- Faculty of Biosciences and Aquaculture, Nord University, Universitetsalléen 11, 8026, Bodø, Norway
| | - Frida N Fossum
- Department of Biology, Norwegian University of Science and Technology, Høgskoleringen 5, 7491, Trondheim, Norway
| | - Florence Kermen
- Department of Biology, Norwegian University of Science and Technology, Høgskoleringen 5, 7491, Trondheim, Norway; Department of Neuroscience, University of Copenhagen, Blegdamsvej 3b, 2200, Copenhagen, Denmark
| | - Bjørn Henrik Hansen
- Department of Climate and Environment, SINTEF Ocean, Brattørkaia 17C, 7010, Trondheim, Norway
| | - Bjarne Kvæstad
- Department of Fisheries and New Biomarine Industry, SINTEF Ocean, Brattørkaia 17C, 7010, Trondheim, Norway
| | - Pål A Olsvik
- Faculty of Biosciences and Aquaculture, Nord University, Universitetsalléen 11, 8026, Bodø, Norway
| | - Julia Farkas
- Department of Climate and Environment, SINTEF Ocean, Brattørkaia 17C, 7010, Trondheim, Norway.
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8
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Rybczynska DN, Markiet KE, Pienkowska JM, Szurowska E, Frydrychowski A. To assess the quantitative features of focal liver lesions in gadoxetic acid enhanced MRI and to determine whether these features can accurately differentiate benign form malignant lesions. Eur J Radiol 2024; 171:111288. [PMID: 38194844 DOI: 10.1016/j.ejrad.2024.111288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/07/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE The study aims at assessing the quantitative features which distinguish focal liver lesions (FLLs) in gadoxetic acid (GA) enhanced liver MRI and at determining whether these features can accurately differentiate benign from malignant lesions. MATERIAL AND METHODS 107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal - Wallis, Mann - Whitney U and post hoc Dunn's tests were applied to assess if there were any significant differences in the ROI values between individual lesions. The variables with the p values of < 0.05 were considered statistically significant. RESULTS We found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases. We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions. CONCLUSIONS There were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.
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Affiliation(s)
- Dorota N Rybczynska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland; Institute of Human Physiology, Medical University of Gdansk, Gdansk, Poland.
| | - Karolina E Markiet
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Joanna M Pienkowska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Edyta Szurowska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
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9
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Courchesne M, Manrique G, Bernier L, Moussa L, Cresson J, Gutzeit A, Froehlich JM, Koh DM, Chartrand-Lefebvre C, Matoori S. Gender Differences in Pharmacokinetics: A Perspective on Contrast Agents. ACS Pharmacol Transl Sci 2024; 7:8-17. [PMID: 38230293 PMCID: PMC10789139 DOI: 10.1021/acsptsci.3c00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/18/2024]
Abstract
Gender is an important risk factor for adverse drug reactions. Women report significantly more adverse drug reactions than men. There is a growing consensus that gender differences in drug PK is a main contributor to higher drug toxicity in women. These differences stem from physiological differences (body composition, plasma protein concentrations, and liver and kidney function), drug interactions, and comorbidities. Contrast agents are widely used to enhance diagnostic performance in computed tomography and magnetic resonance imaging. Despite their broad use, these contrast agents can lead to important adverse reactions including hypersensitivity reactions, nephropathy, and hyperthyroidism. Importantly, female gender is one of the main risk factors for contrast agent toxicity. As these adverse reactions may be related to gender differences in PK, this perspective aims to describe distribution and elimination pathways of commonly used contrast agents and to critically discuss gender differences in these processes.
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Affiliation(s)
- Myriam Courchesne
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Gabriela Manrique
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Laurie Bernier
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Leen Moussa
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Jeanne Cresson
- Clinical
Research Group, Klus Apotheke Zurich, 8032 Zurich, Switzerland
| | - Andreas Gutzeit
- Department
of Health Sciences and Medicine, University
of Lucerne, Frohburgstaße 3, 6002 Luzern, Switzerland
- Institute
of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, 6006 Lucerne, Switzerland
- Department
of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Dow-Mu Koh
- Cancer Research
UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Carl Chartrand-Lefebvre
- Radiology
Department, Centre Hospitalier de l’Université
de Montréal (CHUM), Montreal, Quebec H2X 3E4, Canada
- Centre
de Recherche du Centre Hospitalier de l’Université de
Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Simon Matoori
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
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10
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Thomas NP, Pierce TT, Ozturk A, Lee SJ, Crawford B, Hennessy DW, Park A, Sagar P, Heng M, Lozano Calderón S. Assessment of the added value of intravenous gadolinium for knee osteosarcoma resection planning in pediatric and young adult patients. J Surg Oncol 2023; 128:1190-1194. [PMID: 37525571 DOI: 10.1002/jso.27415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND OBJECTIVES To assess the impact of Gadolinium-enhanced magnetic resonance imaging (MRI) sequences on Preoperative imaging evaluation and surgical planning parameters for osteosarcoma (OS) of the knee in pediatric and young adult patients. METHODS Thirty MRI scans of patients with OS about the knee were reviewed by five orthopedic oncologists. Key preoperative parameters (neurovascular bundle involvement, intra-articular tumor extension, extent of intramedullary extension) and surgical plans were evaluated based on non-contrast versus Gd contrast enhanced sequences. Assessment agreement, inter-rater agreement, and intrarater agreement between pre and postcontrast images were evaluated via Kappa statistics. RESULTS Moderate agreement was seen between non and contrast-enhanced assessment of neurovascular involvement and intra-articular tumor extension. Intrarater reproducibility was substantial for neurovascular bundle involvement (precontrast Kappa: 0.63, postcontrast Kappa: 0.69). Intrarater reproducibility was also substantial for precontrast (Kappa: 0.70) and moderate for postcontrast (Kappa: 0.50) assessment of intra-articular tumor extension. Planned resection length and choice of surgical approach were similar between sequences. The addition of Gd-enhanced sequences improved the inter-rater agreement across collected parameters. CONCLUSIONS While some findings suggest that contrast enhanced sequences may not significantly alter the assessment of key preoperative planning parameters by orthopedic oncologists, they may help reduce variability among providers with differing experience levels.
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Affiliation(s)
- Nathan P Thomas
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theodore T Pierce
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Ultrasound Research and Translation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arinc Ozturk
- Center for Ultrasound Research and Translation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stella J Lee
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brooke Crawford
- Deparment of Orthopaedic Surgery, Musculoskeletal Oncology Service, Univerisity of Miami - Miller Medical School, Miami, Florida, USA
| | - David W Hennessy
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Park
- Department of Orthopaedics Surgery, University of Colorado, Aurora, Colorado, USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Santiago Lozano Calderón
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Mahmoudi S, Gruenewald LD, Eichler K, Althoff FC, Martin SS, Bernatz S, Booz C, Yel I, Kinzler MN, Ziegengeist NS, Torgashov K, Mohammed H, Geyer T, Scholtz JE, Hammerstingl RM, Weber C, Hardt SE, Sommer CM, Gruber-Rouh T, Leistner DM, Vogl TJ, Koch V. Multiparametric Evaluation of Radiomics Features and Dual-Energy CT Iodine Maps for Discrimination and Outcome Prediction of Thymic Masses. Acad Radiol 2023; 30:3010-3021. [PMID: 37105804 DOI: 10.1016/j.acra.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the diagnostic value of radiomics features and dual-source dual-energy CT (DECT) based material decomposition in differentiating low-risk thymomas, high-risk thymomas, and thymic carcinomas. MATERIALS AND METHODS This retrospective study included 32 patients (16 males, mean age 66 ± 14 years) with pathologically confirmed thymic masses who underwent contrast-enhanced DECT between 10/2014 and 01/2023. Two experienced readers evaluated all patients regarding conventional radiomics features, as well as DECT-based features, including attenuation (HU), iodine density (mg/mL), and fat fraction (%). Data comparisons were performed using analysis of variance and chi-square statistic tests. Receiver operating characteristic curve analysis and Cox-regression tests were used to discriminate between low-risk/high-risk thymomas and thymic carcinomas. RESULTS Of the 32 thymic tumors, 12 (38%) were low-risk thymomas, 11 (34%) were high-risk thymomas, and 9 (28%) were thymic carcinomas. Values differed significantly between low-risk thymoma, high-risk thymoma, and thymic carcinoma regarding DECT-based features (p ≤ 0.023) and 30 radiomics features (p ≤ 0.037). The area under the curve to differentiate between low-risk/high-risk thymomas and thymic cancer was 0.998 (95% CI, 0.915-1.000; p < 0.001) for the combination of DECT imaging parameters and radiomics features, yielding a sensitivity of 100% and specificity of 96%. During a follow-up of 60 months (IQR, 35-60 months), the multiparametric approach including radiomics features, DECT parameters, and clinical parameters showed an excellent prognostic power to predict all-cause mortality (c-index = 0.978 [95% CI, 0.958-0.998], p = 0.003). CONCLUSION A multiparametric approach including conventional radiomics features and DECT-based features facilitates accurate, non-invasive discrimination between low-risk/high-risk thymomas and thymic carcinomas.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.).
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Friederike C Althoff
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt am Main, Germany (F.C.A.)
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany (M.N.K.)
| | - Nicole Suarez Ziegengeist
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Katerina Torgashov
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Hanin Mohammed
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Tobias Geyer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Christophe Weber
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany (C.W., S.E.H.)
| | - Stefan E Hardt
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany (C.W., S.E.H.)
| | - Christof M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.M.S.)
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - David M Leistner
- Department of Internal Medicine III, University Hospital Frankfurt, Frankfurt am Main, Germany (D.M.L.)
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
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12
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Mahmoudi S, Gruenewald LD, Eichler K, Martin SS, Booz C, Bernatz S, Lahrsow M, Yel I, Gotta J, Biciusca T, Mohammed H, Ziegengeist NS, Torgashov K, Hammerstingl RM, Sommer CM, Weber C, Almansour H, Bucolo G, D'Angelo T, Scholtz JE, Gruber-Rouh T, Vogl TJ, Koch V. Advanced biomedical imaging for accurate discrimination and prognostication of mediastinal masses. Eur J Clin Invest 2023; 53:e14075. [PMID: 37571983 DOI: 10.1111/eci.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND To investigate the potential of radiomic features and dual-source dual-energy CT (DECT) parameters in differentiating between benign and malignant mediastinal masses and predicting patient outcomes. METHODS In this retrospective study, we analysed data from 90 patients (38 females, mean age 51 ± 25 years) with confirmed mediastinal masses who underwent contrast-enhanced DECT. Attenuation, radiomic features and DECT-derived imaging parameters were evaluated by two experienced readers. We performed analysis of variance (ANOVA) and Chi-square statistic tests for data comparison. Receiver operating characteristic curve analysis and Cox regression tests were used to differentiate between mediastinal masses. RESULTS Of the 90 mediastinal masses, 49 (54%) were benign, including cases of thymic hyperplasia/thymic rebound (n = 10), mediastinitis (n = 16) and thymoma (n = 23). The remaining 41 (46%) lesions were classified as malignant, consisting of lymphoma (n = 28), mediastinal tumour (n = 4) and thymic carcinoma (n = 9). Significant differences were observed between benign and malignant mediastinal masses in all DECT-derived parameters (p ≤ .001) and 38 radiomic features (p ≤ .044) obtained from contrast-enhanced DECT. The combination of these methods achieved an area under the curve of .98 (95% CI, .893-1.000; p < .001) to differentiate between benign and malignant masses, with 100% sensitivity and 91% specificity. Throughout a follow-up of 1800 days, a multiparametric model incorporating radiomic features, DECT parameters and gender showed promising prognostic power in predicting all-cause mortality (c-index = .8 [95% CI, .702-.890], p < .001). CONCLUSIONS A multiparametric approach combining radiomic features and DECT-derived imaging biomarkers allows for accurate and noninvasive differentiation between benign and malignant masses in the anterior mediastinum.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maximilian Lahrsow
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Teodora Biciusca
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hanin Mohammed
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nicole Suarez Ziegengeist
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katerina Torgashov
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christof M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christophe Weber
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Tuebingen, Germany
| | - Giuseppe Bucolo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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13
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Lyu J, Fu Y, Yang M, Xiong Y, Duan Q, Duan C, Wang X, Xing X, Zhang D, Lin J, Luo C, Ma X, Bian X, Hu J, Li C, Huang J, Zhang W, Zhang Y, Su S, Lou X. Generative Adversarial Network-based Noncontrast CT Angiography for Aorta and Carotid Arteries. Radiology 2023; 309:e230681. [PMID: 37962500 DOI: 10.1148/radiol.230681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Iodinated contrast agents (ICAs), which are widely used in CT angiography (CTA), may cause adverse effects in humans, and their use is time-consuming and costly. Purpose To develop an ICA-free deep learning imaging model for synthesizing CTA-like images and to assess quantitative and qualitative image quality as well as the diagnostic accuracy of synthetic CTA (Syn-CTA) images. Materials and Methods A generative adversarial network (GAN)-based CTA imaging model was trained, validated, and tested on retrospectively collected pairs of noncontrast CT and CTA images of the neck and abdomen from January 2017 to June 2022, and further validated on an external data set. Syn-CTA image quality was evaluated using quantitative metrics. In addition, two senior radiologists scored the visual quality on a three-point scale (3 = good) and determined the vascular diagnosis. The validity of Syn-CTA images was evaluated by comparing the visual quality scores and diagnostic accuracy of aortic and carotid artery disease between Syn-CTA and real CTA scans. Results CT scans from 1749 patients (median age, 60 years [IQR, 50-68 years]; 1057 male patients) were included in the internal data set: 1137 for training, 400 for validation, and 212 for testing. The external validation set comprised CT scans from 42 patients (median age, 67 years [IQR, 59-74 years]; 37 male patients). Syn-CTA images had high similarity to real CTA images (normalized mean absolute error, 0.011 and 0.013 for internal and external test set, respectively; peak signal-to-noise ratio, 32.07 dB and 31.58 dB; structural similarity, 0.919 and 0.906). The visual quality of Syn-CTA and real CTA images was comparable (internal test set, P = .35; external validation set, P > .99). Syn-CTA showed reasonable to good diagnostic accuracy for vascular diseases (internal test set: accuracy = 94%, macro F1 score = 91%; external validation set: accuracy = 86%, macro F1 score = 83%). Conclusion A GAN-based model that synthesizes neck and abdominal CTA-like images without the use of ICAs shows promise in vascular diagnosis compared with real CTA images. Clinical trial registration no. NCT05471869 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhang and Turkbey in this issue.
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Affiliation(s)
- Jinhao Lyu
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Ying Fu
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Mingliang Yang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Yongqin Xiong
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Qi Duan
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Caohui Duan
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Xueyang Wang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Xinbo Xing
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Dong Zhang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Jiaji Lin
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Chuncai Luo
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Xiaoxiao Ma
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Xiangbing Bian
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Jianxing Hu
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Chenxi Li
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Jiayu Huang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Wei Zhang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Yue Zhang
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Sulian Su
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
| | - Xin Lou
- From the Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China (J. Lyu, Y.X., Q.D., C.D., X.W., X.X., D.Z., J. Lin, C. Luo, X.M., X.B., J. Hu, C. Li, J. Huang, X.L.); College of Medical Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China (Y.F., M.Y., X.L.); Department of Radiology, Brain Hospital of Hunan Province, Changsha, China (W.Z.); Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Y.Z.); and Department of Radiology, Xiamen Humanity Hospital, Xiamen, China (S.S.)
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Daowtak K, Pilapong C, Tochaikul G, Moonkum N. Effect of iodinated contrast media on peripheral blood mononuclear cells in terms of cell viability, cell cycle and oxidative stress in an in vitro system. Toxicol Mech Methods 2023; 33:667-674. [PMID: 37403420 DOI: 10.1080/15376516.2023.2230486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
Iodine contrast agents are essential for diagnostic purposes in radiology and have significant medical benefits. However, they pose a risk of causing allergic reactions or adverse cellular effects. In this study, we examine the in vitro effects of iodine contrast agents (Iopamiro 370, Ultravist 370, Visipaque 320, and Optiray 350) on cellular functions of human peripheral blood mononuclear. The findings reveal that a concentration of 50 mgI/ml of iodine contrast agents causes a 50% reduction in cell viability, but lower concentrations of 2.5, 5.0, and 10.0 mgI/ml do not affect the cell cycle. Furthermore, the contrast agents decrease oxidative stress levels in cells. In conclusion, this study demonstrates that iodine contrast agents can be used safely in appropriate concentrations for diagnostic purposes without affecting the cell cycle and preventing oxidative stress on normal cells. The insights gained from this study could aid in the development of diagnostic contrast agents in the future of medicine.
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Affiliation(s)
- Krai Daowtak
- Department of Medical Technology, Naresuan University, Phitsanulok, Thailand
| | - Chalermchai Pilapong
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nutthapong Moonkum
- Faculty of Radiological Technology, Rangsit University, Patumthani, Thailand
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15
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Lin WC, Chen CM, Westphalen AC, Lin TY, Chang CH, Chen LK, Lin CW, Yeh CC, Yu J, Jeng LB, Chen JH. Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference. J Magn Reson Imaging 2023; 58:894-904. [PMID: 36573963 DOI: 10.1002/jmri.28571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors. PURPOSE To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady-state free-precession (bSSFP) non-contrast-enhanced MRA (NC-MRA), and to evaluate if bSSFP NC-MRA can potentially be a substitute for CTA. STUDY TYPE Prospective. POPULATION Fifty-six consecutive potential living-related liver donors (30.9 ± 8.4 years; 31 men). FIELD STRENGTH/SEQUENCE 1.5T; four bSSFP NC-MRA sequences: respiratory-triggered (Inhance inflow inversion recovery [IFIR]) and three breath-hold (BH); and CTA. ASSESSMENT The artery-to-liver contrast (Ca-l) was quantified. Three radiologists independently assigned visualization scores using a four-point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC-MRA sequences. STATISTICAL TESTS Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca-l of each NC-MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed-rank test. P-value <0.05 was considered statistically significant. RESULTS Inhance IFIR Ca-l was significantly higher than all BH bSSFP Ca-l (0.56 [0.45-0.64] vs. 0.37 [0.29-0.47] to 0.41 [0.23-0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC-MRA (4 [4-4] vs. 4 [3 to 4-4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC-MRA (4 [3 to 4-4] vs. 1 [1-2] to 4 [4-4]). The median visualization scores were all 4 [4-4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1-4], 53.6%). The identification rates of arterial variants were 92.9%-97% on Inhance IFIR. DATA CONCLUSIONS Although CTA is superior to the NC-MRA, all NC-MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wei-Ching Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
- Department of Biomedical Imaging and Radiological Science, School of Medicine, China Medical University, Taichung, Taiwan
- AI Innovation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Antonio Carlos Westphalen
- Departments of Radiology, Urology and Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Tzu-Yang Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Chia Hao Chang
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Li-Kuang Chen
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Chia-Wei Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, Asia University Hospital, Taichung, Taiwan
| | - Jiaxin Yu
- AI Innovation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- Department of Radiological Sciences, University of California, Irvine, California, USA
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16
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Fraga Rivas P, de Miguel Criado J, García Del Salto Lorente L, Gutiérrez Velasco L, Quintana Valcarcel P. Patient safety in magnetic resonance imaging. RADIOLOGIA 2023; 65:447-457. [PMID: 37758335 DOI: 10.1016/j.rxeng.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/29/2023] [Indexed: 10/03/2023]
Abstract
Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.
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Affiliation(s)
- P Fraga Rivas
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain.
| | - J de Miguel Criado
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L García Del Salto Lorente
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L Gutiérrez Velasco
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Quintana Valcarcel
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
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18
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Sáenz de Santa María R, Labella M, Bogas G, Doña I, Torres MJ. Hypersensitivity to gadolinium-based contrast. Curr Opin Allergy Clin Immunol 2023; 23:300-306. [PMID: 37357781 DOI: 10.1097/aci.0000000000000911] [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: 06/27/2023]
Abstract
PURPOSE OF REVIEW The use of contrast media is increasing in recent decades. Although gadolinium-based contrast agents (GBCAs) are generally well tolerated, adverse reactions, including hypersensitivity reactions (HSRs), although infrequent, may occur. It is important to perform a thorough allergological evaluation in patients with suspected GBCA-HSRs to avoid potentially serious reactions in subsequent exposures. RECENT FINDINGS Data on GBCA-HSRs are scarce. Most published articles dealing with skin tests and drug provocation tests (DPTs) with GBCAs are case series and small cohorts. Controversies exist about the role of premedication for preventing HSRs on subsequent exposures. Selection of well tolerated alternatives is based on potential cross-reactivity among GBCAs; however, the extent of cross-reactivity among them remains unclear. SUMMARY As premedication is not useful because breakthrough reactions are frequent in patients with GBCA-HSRs in subsequent exposures, an allergological evaluation is required. Available data suggest a high negative predictive value of skin tests, being crucial for guiding the selection of an alternative GBCA. However, DPTs are still necessary to confirm or exclude the diagnosis or find alternative GBCAs. Cross-reactivity is high among GBCAs belonging from the same group, mainly among macrocyclic compounds, so this must be taken into account for selecting alternatives.
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Affiliation(s)
- Rocío Sáenz de Santa María
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Marina Labella
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Gádor Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
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Ling LLL, Zhang VJW, Lim HY, Lim MJ, Ho P. Clinical predictors of pulmonary embolism for inpatients: are computed tomography pulmonary angiograms being requested appropriately? Intern Med J 2023; 53:1224-1230. [PMID: 35049098 DOI: 10.1111/imj.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The heterogeneity of inpatient pulmonary embolism (PE) presentations may lead to computed tomography pulmonary angiograms (CTPA) being over-requested. Current clinical predictors for PE, including Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC), have predominantly focussed on outpatient and emergency department populations. AIM To determine the clinical indicators for ordering inpatient CTPA and the predictors of positive scans for PE. METHODS Consecutive inpatient CTPA (performed >24 h after admission) from January 2017 to December 2017 were retrospectively reviewed. Variables including baseline characteristics, vital signs and risk factors for PE were extracted. RESULTS A total of 312 CTPA was reviewed (average patient age 67 years; 46% male) and 36 CTPA were positive for PE (11.5%). The average time to inpatient CTPA request was 7 days. Clinical indicators associated with positive scans were hypoxia (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.1-5.6), tachypnoea (OR 2.5; 95% CI 1.2-6.0), recent surgery or immobilisation (OR 2.7; 95% CI 1.2-6.4), S1Q3T3 pattern on electrocardiogram (ECG; OR 7.2; 95% CI 1.4-35.7) and right bundle branch block pattern on ECG (OR 4.7; 95% CI 1.6-13.1). Hypotension, fever and malignancy were not significant. Both PERC and Wells criteria had poor positive predictive value (12% and 27% respectively), but the negative predictive value for PERC and Wells was 100% and 95.8% respectively. CONCLUSION Inpatient CTPA appear to be over-requested and can potentially be rationalised based on a combination of clinical predictors and Wells criteria and/or PERC rule. Further prospective studies are needed to develop accurate clinical decision tools targeted towards inpatients.
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Affiliation(s)
- Lisa Luo-Lan Ling
- Department of Haematology, Northern Health, Melbourne, Victoria, Australia
| | | | - Hui Yin Lim
- Department of Haematology, Northern Health, Melbourne, Victoria, Australia
| | - Ming Joe Lim
- Department of Radiology, Northern Health, Melbourne, Victoria, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Health, Melbourne, Victoria, Australia
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20
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Potočnik J, Foley S, Thomas E. Current and potential applications of artificial intelligence in medical imaging practice: A narrative review. J Med Imaging Radiat Sci 2023; 54:376-385. [PMID: 37062603 DOI: 10.1016/j.jmir.2023.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND AND PURPOSE Artificial intelligence (AI) is present in many areas of our lives. Much of the digital data generated in health care can be used for building automated systems to bring improvements to existing workflows and create a more personalised healthcare experience for patients. This review outlines select current and potential AI applications in medical imaging practice and provides a view of how diagnostic imaging suites will operate in the future. Challenges associated with potential applications will be discussed and healthcare staff considerations necessary to benefit from AI-enabled solutions will be outlined. METHODS Several electronic databases, including PubMed, ScienceDirect, Google Scholar, and University College Dublin Library Database, were used to identify relevant articles with a Boolean search strategy. Textbooks, government sources and vendor websites were also considered. RESULTS/DISCUSSION Many AI-enabled solutions in radiographic practice are available with more automation on the horizon. Traditional workflow will become faster, more effective, and more user friendly. AI can handle administrative or technical types of work, meaning it is applicable across all aspects of medical imaging practice. CONCLUSION AI offers significant potential to automate most of the manual tasks, ensure service consistency, and improve patient care. Radiographers, radiation therapists, and clinicians should ensure they have adequate understanding of the technology to enable ethical oversight of its implementation.
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Affiliation(s)
- Jaka Potočnik
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland.
| | - Shane Foley
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland
| | - Edel Thomas
- University College Dublin School of Medicine, Radiography & Diagnostic Imaging, Room A223, Belfield, Dublin 4, Ireland
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21
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Mehta R, Bu Y, Zhong Z, Dan G, Zhong PS, Zhou C, Hu W, Zhou XJ, Xu M, Wang S, Karaman MM. Characterization of breast lesions using multi-parametric diffusion MRI and machine learning. Phys Med Biol 2023; 68:085006. [PMID: 36808921 DOI: 10.1088/1361-6560/acbde0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/21/2023] [Indexed: 02/23/2023]
Abstract
Objective. To investigate quantitative imaging markers based on parameters from two diffusion-weighted imaging (DWI) models, continuous-time random-walk (CTRW) and intravoxel incoherent motion (IVIM) models, for characterizing malignant and benign breast lesions by using a machine learning algorithm.Approach. With IRB approval, 40 women with histologically confirmed breast lesions (16 benign, 24 malignant) underwent DWI with 11b-values (50 to 3000 s/mm2) at 3T. Three CTRW parameters,Dm,α, andβand three IVIM parametersDdiff,Dperf, andfwere estimated from the lesions. A histogram was generated and histogram features of skewness, variance, mean, median, interquartile range; and the value of the 10%, 25% and 75% quantiles were extracted for each parameter from the regions-of-interest. Iterative feature selection was performed using the Boruta algorithm that uses the Benjamin Hochberg False Discover Rate to first determine significant features and then to apply the Bonferroni correction to further control for false positives across multiple comparisons during the iterative procedure. Predictive performance of the significant features was evaluated using Support Vector Machine, Random Forest, Naïve Bayes, Gradient Boosted Classifier (GB), Decision Trees, AdaBoost and Gaussian Process machine learning classifiers.Main Results. The 75% quantile, and median ofDm; 75% quantile off;mean, median, and skewness ofβ;kurtosis ofDperf; and 75% quantile ofDdiffwere the most significant features. The GB differentiated malignant and benign lesions with an accuracy of 0.833, an area-under-the-curve of 0.942, and an F1 score of 0.87 providing the best statistical performance (p-value < 0.05) compared to the other classifiers.Significance. Our study has demonstrated that GB with a set of histogram features from the CTRW and IVIM model parameters can effectively differentiate malignant and benign breast lesions.
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Affiliation(s)
- Rahul Mehta
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Yangyang Bu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Zheng Zhong
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Guangyu Dan
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ping-Shou Zhong
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Changyu Zhou
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Weihong Hu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiaohong Joe Zhou
- Departments of Radiology and Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Maosheng Xu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Shiwei Wang
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - M Muge Karaman
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
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22
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Robertson N, Sempere L, Kenyon E, Mallet C, Smith K, Hix J, Halim A, Fan J, Moore A. Omniparticle Contrast Agent for Multimodal Imaging: Synthesis and Characterization in an Animal Model. Mol Imaging Biol 2023; 25:401-412. [PMID: 36071300 PMCID: PMC9989039 DOI: 10.1007/s11307-022-01770-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Individual imaging modalities have certain advantages, but each suffers from drawbacks that other modalities may overcome. The goal of this study was to create a novel contrast agent suitable for various imaging modalities that after a single administration can bridge and strengthen the collaboration between the research fields as well as enrich the information obtained from any one modality. PROCEDURES The contrast agent platform is based on dextran-coated iron oxide nanoparticles (for MRI and MPI) and synthesized using a modified co-precipitation method, followed by a series of conjugation steps with a fluorophore (for fluorescence and photoacoustic imaging), thyroxine (for CT imaging), and chelators for radioisotope labeling (for PET imaging). The fully conjugated agent was then tested in vitro in cell uptake, viability, and phantom studies and in vivo in a model of intraductal injection and in a tumor model. RESULTS The agent was synthesized, characterized, and tested in vitro where it showed the ability to produce a signal on MRI/MPI/FL/PA/CT and PET images. Studies in cells showed the expected concentration-dependent uptake of the agent without noticeable toxicity. In vivo studies demonstrated localization of the agent to the ductal tree in mice after intraductal injection with different degrees of resolution, with CT being the best for this particular application. In a model of injected labeled tumor cells, the agent produced a signal with all modalities and showed persistence in tumor cells confirmed by histology. CONCLUSIONS A fully functional omniparticle contrast agent was synthesized and tested in vitro and in vivo in two animal models. Results shown here point to the generation of a potent signal in all modalities tested without detrimental toxicity. Future use of this agent includes its exploration in various models of human disease including image-guided diagnostic and therapeutic applications.
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Affiliation(s)
- Neil Robertson
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Lorenzo Sempere
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Elizabeth Kenyon
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Christiane Mallet
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI, 48824, USA
| | - Kylie Smith
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI, 48824, USA
- Department of Biomedical Engineering, College of Engineering, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
| | - Jeremy Hix
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI, 48824, USA
| | - Alan Halim
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Jinda Fan
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, 775 Woodlot Drive, East Lansing, MI, 48824, USA
- Department of Biomedical Engineering, College of Engineering, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA
| | - Anna Moore
- Precision Health Program, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA.
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, East Lansing, MI, 48824, USA.
- Department of Chemistry, College of Natural Sciences, Michigan State University, 578 S Shaw Lane, East Lansing, MI, 48824, USA.
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23
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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24
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Kim H, Lee H, Lee S, Choi YW, Choi YJ, Kim KH, Seo W, Shin CW, Cho S. A feasibility study on deep-neural-network-based dose-neutral dual-energy digital breast tomosynthesis. Med Phys 2023; 50:791-807. [PMID: 36273397 DOI: 10.1002/mp.16071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/01/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diagnostic performance based on x-ray breast imaging is subject to breast density. Although digital breast tomosynthesis (DBT) is reported to outperform conventional mammography in denser breasts, mass detection and malignancy characterization are often considered challenging yet. PURPOSE As an improved diagnostic solution to the dense breast cases, we propose a dual-energy DBT imaging technique that enables breast compositional imaging at comparable scanning time and patient dose compared to the conventional single-energy DBT. METHODS The proposed dual-energy DBT acquires projection data by alternating two different energy spectra. Then, we synthesize unmeasured projection data using a deep neural network that exploits the measured projection data and adjacent projection data obtained under the other x-ray energy spectrum. For material decomposition, we estimate partial path lengths of an x-ray through water, lipid, and protein from the measured and the synthesized projection data with the object thickness information. After material decomposition in the projection domain, we reconstruct material-selective DBT images. The deep neural network is trained with the numerical breast phantoms. A pork meat phantom is scanned with a prototype dual-energy DBT system to demonstrate the feasibility of the proposed imaging method. RESULTS The developed deep neural network successfully synthesized missing projections. Material-selective images reconstructed from the synthesized data present comparable compositional contrast of the cancerous masses compared with those from the fully measured data. CONCLUSIONS The proposed dual-energy DBT scheme is expected to substantially contribute to enhancing mass malignancy detection accuracy particularly in dense breasts.
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Affiliation(s)
- Hyeongseok Kim
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Hoyeon Lee
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung Lee
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Young-Wook Choi
- Korea Electrotechnology Research Institute (KERI), Ansan, South Korea
| | - Young Jin Choi
- Korea Electrotechnology Research Institute (KERI), Ansan, South Korea
| | - Kee Hyun Kim
- Korea Electrotechnology Research Institute (KERI), Ansan, South Korea
| | | | | | - Seungryong Cho
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea.,Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea.,KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea.,KAIST Institute for IT Convergence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
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25
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End-to-End Deep-Learning-Based Diagnosis of Benign and Malignant Orbital Tumors on Computed Tomography Images. J Pers Med 2023; 13:jpm13020204. [PMID: 36836437 PMCID: PMC9960119 DOI: 10.3390/jpm13020204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
Determining the nature of orbital tumors is challenging for current imaging interpretation methods, which hinders timely treatment. This study aimed to propose an end-to-end deep learning system to automatically diagnose orbital tumors. A multi-center dataset of 602 non-contrast-enhanced computed tomography (CT) images were prepared. After image annotation and preprocessing, the CT images were used to train and test the deep learning (DL) model for the following two stages: orbital tumor segmentation and classification. The performance on the testing set was compared with the assessment of three ophthalmologists. For tumor segmentation, the model achieved a satisfactory performance, with an average dice similarity coefficient of 0.89. The classification model had an accuracy of 86.96%, a sensitivity of 80.00%, and a specificity of 94.12%. The area under the receiver operating characteristics curve (AUC) of the 10-fold cross-validation ranged from 0.8439 to 0.9546. There was no significant difference on diagnostic performance of the DL-based system and three ophthalmologists (p > 0.05). The proposed end-to-end deep learning system could deliver accurate segmentation and diagnosis of orbital tumors based on noninvasive CT images. Its effectiveness and independence from human interaction allow the potential for tumor screening in the orbit and other parts of the body.
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26
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Dell’Aquila K, Hodges H, Moshiri M, Katz DS, Elojeimy S, Revzin MV, Tembelis M, Revels JW. Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options. Abdom Radiol (NY) 2023; 48:1663-1678. [PMID: 36595067 PMCID: PMC9808767 DOI: 10.1007/s00261-022-03779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.
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Affiliation(s)
- Kevin Dell’Aquila
- grid.260914.80000 0001 2322 1832New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA
| | - Hannah Hodges
- grid.266832.b0000 0001 2188 8502Department of Radiology, University of New Mexico, Albuquerque, NM USA
| | - Mariam Moshiri
- grid.412807.80000 0004 1936 9916Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Douglas S. Katz
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Saeed Elojeimy
- grid.259828.c0000 0001 2189 3475Department of Radiology, Medical University of South Carolina, Charleston, SC USA
| | - Margarita V. Revzin
- grid.47100.320000000419368710Department of Radiology, Yale University School of Medicine, New Haven, CT USA
| | - Miltiadis Tembelis
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Jonathan W. Revels
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island Division, 560 1St Avenue, 2nd Floor, New York, NY 10016 USA
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27
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Lopci E, Aide N, Dimitrakopoulou-Strauss A, Dercle L, Iravani A, Seban RD, Sachpekidis C, Humbert O, Gheysens O, Glaudemans AWJM, Weber WA, Van den Abbeele AD, Wahl RL, Scott AM, Pandit-Taskar N, Hicks RJ. Perspectives on joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards for [ 18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors. Cancer Imaging 2022; 22:73. [PMID: 36539908 PMCID: PMC9769012 DOI: 10.1186/s40644-022-00512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Response assessment in the context of immunomodulatory treatments represents a major challenge for the medical imaging community and requires a multidisciplinary approach with involvement of oncologists, radiologists, and nuclear medicine specialists. There is evolving evidence that [18F]FDG PET/CT is a useful diagnostic modality for this purpose. The clinical indications for, and the principal aspects of its standardization in this context have been detailed in the recently published "Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0". These recommendations arose from a fruitful collaboration between international nuclear medicine societies and experts in cancer treatment. In this perspective, the key elements of the initiative are reported, summarizing the core aspects of the guidelines for radiologists and nuclear medicine physicians. Beyond the previous guidelines, this perspective adds further commentary on how this technology can advance development of novel therapeutic approaches and guide management of individual patients.
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Affiliation(s)
- E. Lopci
- grid.417728.f0000 0004 1756 8807Nuclear Medicine Unit, IRCCS – Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI Italy
| | - N. Aide
- grid.411149.80000 0004 0472 0160Nuclear Medicine Department, University Hospital, Caen, France ,grid.460771.30000 0004 1785 9671INSERM ANTICIPE, Normandie University, Caen, France
| | - A. Dimitrakopoulou-Strauss
- grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210 Heidelberg, Germany
| | - L. Dercle
- grid.239585.00000 0001 2285 2675Department of Radiology, New York Presbyterian, Columbia University Irving Medical Center, New York, NY USA
| | - A. Iravani
- grid.34477.330000000122986657Department of Radiology, The University of Washington, Seattle, USA ,grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Center, Seattle, USA
| | - R. D. Seban
- grid.418596.70000 0004 0639 6384Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210 Saint-Cloud, France ,Laboratoire d’Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401 Orsay, France
| | - C. Sachpekidis
- grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210 Heidelberg, Germany
| | - O. Humbert
- grid.460782.f0000 0004 4910 6551Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d’Azur, Nice, France ,grid.460782.f0000 0004 4910 6551TIRO-UMR E 4320, Université Côte d’Azur, Nice, France
| | - O. Gheysens
- grid.48769.340000 0004 0461 6320Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A. W. J. M. Glaudemans
- grid.4494.d0000 0000 9558 4598Nuclear Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W. A. Weber
- grid.6936.a0000000123222966Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - A. D. Van den Abbeele
- grid.38142.3c000000041936754XDepartment of Imaging, Dana-Farber Cancer Institute and Department of Radiology, Mass General Brigham Hospitals, Harvard Medical School, Boston, MA USA
| | - R. L. Wahl
- grid.4367.60000 0001 2355 7002Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO USA
| | - A. M. Scott
- grid.410678.c0000 0000 9374 3516Department of Molecular Imaging and Therapy, Austin Health, Studley Rd, Heidelberg, VIC 3084 Australia ,grid.482637.cOlivia Newton-John Cancer Research Institute, Heidelberg, Australia ,grid.1008.90000 0001 2179 088XFaculty of Medicine, University of Melbourne, Melbourne, Australia ,grid.1018.80000 0001 2342 0938School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - N. Pandit-Taskar
- grid.51462.340000 0001 2171 9952Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA ,grid.5386.8000000041936877XWeill Cornell Medical College, New York, NY 10065 USA
| | - R. J. Hicks
- grid.1008.90000 0001 2179 088XThe Department of Medicine, St Vincent’s Medical School, the University of Melbourne, Melbourne, Australia
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Perelli F, Turrini I, Giorgi MG, Renda I, Vidiri A, Straface G, Scatena E, D’Indinosante M, Marchi L, Giusti M, Oliva A, Grassi S, De Luca C, Catania F, Vizzielli G, Restaino S, Gullo G, Eleftheriou G, Mattei A, Signore F, Lanzone A, Scambia G, Cavaliere AF. Contrast Agents during Pregnancy: Pros and Cons When Really Needed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416699. [PMID: 36554582 PMCID: PMC9779218 DOI: 10.3390/ijerph192416699] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 05/13/2023]
Abstract
Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.
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Affiliation(s)
- Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Irene Turrini
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
- Correspondence:
| | - Maria Gabriella Giorgi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Irene Renda
- Division of Obstetrics and Gynecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy
| | - Annalisa Vidiri
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Gianluca Straface
- Obstetrics and Gynecology Unit, Policlinico Abano Terme, 35031 Abano Terme, Italy
| | - Elisa Scatena
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco D’Indinosante
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Laura Marchi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco Giusti
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carmen De Luca
- Teratology Information Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Catania
- Department of Obstetrics and Gynecology, Ospedale “Santa Maria Alla Gruccia”, 52025 Montevarchi, Italy
| | - Giuseppe Vizzielli
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Stefano Restaino
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Giuseppe Gullo
- IVF Public Center, Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, University of Palermo, 90146 Palermo, Italy
| | - Georgios Eleftheriou
- Poison Control Center and Teratology Information Service, Hospital Papa Giovanni XIII, 24127 Bergamo, Italy
| | - Alberto Mattei
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Fabrizio Signore
- Obstetrics and Gynecology Unit, Santo Eugenio Hospital, 00144 Rome, Italy
- School of Medicine, Unicamillus University Rome, 00131 Rome, Italy
| | - Antonio Lanzone
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecology and Obstetrics Fatebenefratelli Isola Tiberina, 00186 Rome, Italy
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Chilanga CC, Lysdahl KB. Ethical impact of suboptimal referrals on delivery of care in radiology department. JOURNAL OF MEDICAL ETHICS 2022; 48:1020-1025. [PMID: 34429384 DOI: 10.1136/medethics-2021-107335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit-risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.
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Affiliation(s)
- Catherine Chilute Chilanga
- Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Kristin Bakke Lysdahl
- Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
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Retrospective study of Ct brain imaging findings indicated for infants at a tertiary care hospital. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Computed tomography in the diagnosis of pathologies in children is becoming increasingly popular.
The aim: to study findings of referrals for CT scans (Computerised Tomography) of the brain in children in the department of Radiology in a developing environment.
Materials and methods: retrospective imaging observational study was done in a 1000 bedded tertiary care hospital in South India in the year 2022 from April to August for 5 months under 16 slice CT scan. Cases are referred from the department of Pediatrics to the department of Radiology as part of the routine clinical evaluation and treatment protocol.
Results: Our sample includes 100 infants; after exclusion criteria total of 60 infants' brain CTs were taken into account, and analysed their imaging from radiology department records. Of 60 cases, 18 (30 %) showed HIE Pattern, and 42 (70 %) had normal plain CT Brain findings. However, due to clinical signs and symptoms, they are evaluated under сontrast CT imaging (after checking creatinine levels), showing 20 cases (33.3 %) are standard, 10 cases (16.6 %) show meningitis, and 2 cases (3.3 %) show SOL. Out of 18 cases of HIE, 10 cases (16.6 %) are under less than 6 months and they undergone neuro sonogram showing 4 cases (6.6 %) normal NSG, 2 cases (3.3 %) showing grade IV HIE, another 2 cases (3.3 %) showing grade II, III HIE Findings.
Conclusions: Our study concluded that plain CT brain showed normal in the majority of the cases which came to the department of Radiology after admission to the hospital. Those cases with strong clinical history are evaluated with contrast CT and evaluated the findings. After contrast imaging, most cases showing their infective, obstructive, and other causes of illness are interpreted. However, its role is minimal for seizures in which CT/CECT shows normal study. Under 6 months, NSG is a suitable method for evaluating and screening the infant's brain.
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Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana. Radiol Res Pract 2022; 2022:4736455. [PMID: 36248021 PMCID: PMC9553476 DOI: 10.1155/2022/4736455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache. Methods A multicenter retrospective analysis of four years' CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval. Results A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age (p=0.002) and facility CT was performed (p < 0.0001). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement. Conclusion CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended.
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Haubold J, Jost G, Theysohn JM, Ludwig JM, Li Y, Kleesiek J, Schaarschmidt BM, Forsting M, Nensa F, Pietsch H, Hosch R. Contrast Media Reduction in Computed Tomography With Deep Learning Using a Generative Adversarial Network in an Experimental Animal Study. Invest Radiol 2022; 57:696-703. [PMID: 35438659 DOI: 10.1097/rli.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This feasibility study aimed to use optimized virtual contrast enhancement through generative adversarial networks (GAN) to reduce the dose of iodine-based contrast medium (CM) during abdominal computed tomography (CT) in a large animal model. METHODS Multiphasic abdominal low-kilovolt CTs (90 kV) with low (low CM, 105 mgl/kg) and normal contrast media doses (normal CM, 350 mgl/kg) were performed with 20 healthy Göttingen minipigs on 3 separate occasions for a total of 120 examinations. These included an early arterial, late arterial, portal venous, and venous contrast phase. One animal had to be excluded because of incomplete examinations. Three of the 19 animals were randomly selected and withheld for validation (18 studies). Subsequently, the GAN was trained for image-to-image conversion from low CM to normal CM (virtual CM) with the remaining 16 animals (96 examinations). For validation, region of interest measurements were performed in the abdominal aorta, inferior vena cava, portal vein, liver parenchyma, and autochthonous back muscles, and the contrast-to-noise ratio (CNR) was calculated. In addition, the normal CM and virtual CM data were presented in a visual Turing test to 3 radiology consultants. On the one hand, they had to decide which images were derived from the normal CM examination. On the other hand, they had to evaluate whether both images are pathological consistent. RESULTS Average vascular CNR (low CM 6.9 ± 7.0 vs virtual CM 28.7 ± 23.8, P < 0.0001) and parenchymal (low CM 1.5 ± 0.7 vs virtual CM 3.8 ± 2.0, P < 0.0001) CNR increased significantly by GAN-based contrast enhancement in all contrast phases and was not significantly different from normal CM examinations (vascular: virtual CM 28.7 ± 23.8 vs normal CM 34.2 ± 28.8; parenchymal: virtual CM 3.8 ± 2.0 vs normal CM 3.7 ± 2.6). During the visual Turing testing, the radiology consultants reported that images from normal CM and virtual CM were pathologically consistent in median in 96.5% of the examinations. Furthermore, it was possible for the examiners to identify the normal CM data as such in median in 91% of the cases. CONCLUSIONS In this feasibility study, it could be demonstrated in an experimental setting with healthy Göttingen minipigs that the amount of CM for abdominal CT can be reduced by approximately 70% by GAN-based contrast enhancement with satisfactory image quality.
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Affiliation(s)
- Johannes Haubold
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer AG, Berlin
| | - Jens Matthias Theysohn
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen
| | - Johannes Maximilian Ludwig
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen
| | - Yan Li
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen
| | - Jens Kleesiek
- Institute of Artificial Intelligence in Medicine, University Hospital Essen, Germany
| | | | - Michael Forsting
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen
| | | | | | - René Hosch
- Institute of Artificial Intelligence in Medicine, University Hospital Essen, Germany
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Liu J, Tian Y, Duzgol C, Akin O, Ağıldere AM, Haberal KM, Coşkun M. Virtual contrast enhancement for CT scans of abdomen and pelvis. Comput Med Imaging Graph 2022; 100:102094. [PMID: 35914340 PMCID: PMC10227907 DOI: 10.1016/j.compmedimag.2022.102094] [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: 12/02/2021] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022]
Abstract
Contrast agents are commonly used to highlight blood vessels, organs, and other structures in magnetic resonance imaging (MRI) and computed tomography (CT) scans. However, these agents may cause allergic reactions or nephrotoxicity, limiting their use in patients with kidney dysfunctions. In this paper, we propose a generative adversarial network (GAN) based framework to automatically synthesize contrast-enhanced CTs directly from the non-contrast CTs in the abdomen and pelvis region. The respiratory and peristaltic motion can affect the pixel-level mapping of contrast-enhanced learning, which makes this task more challenging than other body parts. A perceptual loss is introduced to compare high-level semantic differences of the enhancement areas between the virtual contrast-enhanced and actual contrast-enhanced CT images. Furthermore, to accurately synthesize the intensity details as well as remain texture structures of CT images, a dual-path training schema is proposed to learn the texture and structure features simultaneously. Experiment results on three contrast phases (i.e. arterial, portal, and delayed phase) show the potential to synthesize virtual contrast-enhanced CTs directly from non-contrast CTs of the abdomen and pelvis for clinical evaluation.
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Affiliation(s)
- Jingya Liu
- The City College of New York, New York, NY 10031, USA
| | - Yingli Tian
- The City College of New York, New York, NY 10031, USA.
| | - Cihan Duzgol
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Day PL, Wermers M, Pazdernik V, Bornhorst J, Jannetto PJ. Assessment of gadolinium and iodine concentrations in kidney stones and correlation with contrast agent exposure, stone matrix composition, and patient demographic factors. J Trace Elem Med Biol 2022; 73:127022. [PMID: 35751946 DOI: 10.1016/j.jtemb.2022.127022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gadolinium-based contrast agents (GBCAs) and Iodinated contrast media are widely utilized to increase medical imaging sensitivity. With predominant renal elimination, the potential for the incorporation of contrast agent derived gadolinium and iodine into kidney stones remains largely uncharacterized. The study objective was to measure gadolinium and iodine concentrations within kidney stones. Observed elemental concentrations were correlated with prior contrast agent administration, kidney stone composition, age, gender, and smoking status. METHODS Kidney stones from 96 patients were analyzed by Fourier Transform Infrared Spectroscopy to determine stone composition. Residual kidney stone material was digested and analyzed by Inductively Coupled Plasma Mass Spectrometry to determine gadolinium and iodine concentrations. Univariable and multivariable lognormal linear regression were performed to study the relationship between kidney stone element concentrations and contrast agent administration, kidney stone composition, age, gender, and smoking status. RESULTS Median iodine and gadolinium stone concentrations were 6.4 (range 0.6-3997) and 0.1 (range ≤0.013-113.5) µg/g respectively. Elevated gadolinium was strongly associated with GBCA history with a hazard rate of 2.20 (95 % CI 1.14-3.25 P < 0.001). Gadolinium was positively associated with smoking, as well as stones comprised of apatite and calcium oxalate. Iodine concentrations were negatively associated with uric acid stones. CONCLUSION Gadolinium, but not iodine, concentrations in kidney stones was strongly correlated with contrast exposure history. Stone matrix composition and demographic factors, particularly smoking, can influence observed kidney stone elemental concentrations. Additional studies are needed to determine if exposure to gadolinium and iodine promote the formation of stone matrix and/or reflect exposure history.
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Affiliation(s)
- Patrick L Day
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN USA.
| | - Michelle Wermers
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN USA
| | - Vanessa Pazdernik
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN USA
| | - Joshua Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN USA
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN USA
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Pseudocontinuous Arterial Spin Labeling: Clinical Applications and Usefulness in Head and Neck Entities. Cancers (Basel) 2022; 14:cancers14163872. [PMID: 36010866 PMCID: PMC9405982 DOI: 10.3390/cancers14163872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Conventional imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging may be inadequate to accurately diagnose lesions of the head and neck because they vary widely. Recently, the arterial spin labeling technique, especially pseudocontinuous arterial spin labeling (pCASL) with the three-dimensional (3D) readout method, has been dramatically developed to improve diagnostic performance for lesion differentiation, which can show prominent blood flow characteristics. Here, we demonstrate the clinical usefulness of 3D pCASL for diagnosing various entities, including inflammatory lesions, hypervascular lesions, and neoplasms in the head and neck, for evaluating squamous cell carcinoma (SCC) treatment responses, and for predicting SCC prognosis. Abstract As functional magnetic resonance imaging, arterial spin labeling (ASL) techniques have been developed to provide quantitative tissue blood flow measurements, which can improve the performance of lesion diagnosis. ASL does not require contrast agents, thus, it can be applied to a variety of patients regardless of renal impairments and contrast agent allergic reactions. The clinical implementation of head and neck lesions is limited, although, in recent years, ASL has been increasingly utilized in brain lesions. Here, we review the development of the ASL techniques, including pseudocontinuous ASL (pCASL). We compare readout methods between three-dimensional (3D) turbo spin-echo and 2D echo planar pCASL for the clinical applications of pCASL to head and neck lesions. We demonstrate the clinical usefulness of 3D pCASL for diagnosing various entities, including inflammatory lesions, hypervascular lesions, and neoplasms; for evaluating squamous cell carcinoma (SCC) treatment responses, and for predicting SCC prognosis.
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Safety considerations related to intravenous contrast agents in pediatric imaging. Pediatr Radiol 2022:10.1007/s00247-022-05470-z. [PMID: 35941280 DOI: 10.1007/s00247-022-05470-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Intravenous contrast media are used in MRI, CT and US studies for anatomical evaluation and lesion characterization. Safety is always of paramount importance when administering any contrast media to children, and it is important for radiologists and ordering providers to be knowledgeable of the safety profiles and potential adverse events that can occur. This manuscript reviews the frequency and types of adverse events associated with intravenous contrast agents reported in the pediatric literature. Overall, intravenous contrast agents are very safe to use in children. However, familiarity with how to treat and prevent these uncommon events is crucial in preventing poor outcomes. In addition, an understanding of gadolinium deposition in tissues can help facilitate conversations with concerned physicians and parents. This review provides a concise yet comprehensive reference for radiologists and ordering providers on intravenous contrast safety considerations in the pediatric patient.
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Tijmes FS, Karur GR. Imaging of Heritable Thoracic Aortic Disease. Semin Roentgenol 2022; 57:364-379. [DOI: 10.1053/j.ro.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022]
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Umakoshi H, Nihashi T, Takada A, Hirasawa N, Ishihara S, Takehara Y, Naganawa S, Davenport MS, Terasawa T. Iodinated Contrast Media Substitution to Prevent Recurrent Hypersensitivity Reactions: A Systematic Review and Meta-Analysis. Radiology 2022; 305:341-349. [DOI: 10.1148/radiol.220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chilanga CC, Olerud HM, Lysdahl KB. The value of referral information and assessment - a cross sectional study of radiographers' perceptions. BMC Health Serv Res 2022; 22:893. [PMID: 35810310 PMCID: PMC9271238 DOI: 10.1186/s12913-022-08291-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals. Methods A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test–retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables. Results Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% ‘frequent’/‘very frequent’ responses. Use for patient identification purposes received the highest score (97% ‘frequently’/‘very frequently’ responses), followed by ensuring imaging of the correct body region (79% ‘very frequently’ responses). Radiographers not currently working in clinical practice ranked the ‘usefulness’ of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% ‘agree’/‘strongly agree’ scores. The items ranked highest were promotes radiographers’ professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively. Conclusion Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.
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Affiliation(s)
- Catherine Chilute Chilanga
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway.
| | - Hilde Merete Olerud
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway
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Santos Armentia E, Martín Noguerol T, Silva Priegue N, Delgado Sánchez-Gracián C, Trinidad López C, Prada González R. Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging. RADIOLOGIA 2022; 64:333-347. [DOI: 10.1016/j.rxeng.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
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Santos Armentia E, Martín-Noguerol T, Silva Priegue N, Delgado Sánchez-Gracián C, Trinidad López C, Prada González R. Análisis de las fortalezas, oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Contrast Media Adverse Drug Reactions in Highly Polluted Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127077. [PMID: 35742323 PMCID: PMC9223239 DOI: 10.3390/ijerph19127077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
Iodinated- (ICM) and gadolinium-based (GCM) contrast media are used in radiology imaging techniques, such as computer tomography (CT) and magnetic resonance (MR), respectively. The paper aims to analyze the adverse drug reactions of ICM and GCM on different sites of the body in a highly polluted environment. We analyzed the pharmacovigilance in contrast media on the basis of reports submitted to the Regional Center for Monitoring of Adverse Drug Reactions (ADR) at the Department of Clinical Pharmacology in Wrocław. Safety profiles were compared between different ICM and GCM and at the system organ level using the proportional reporting ratio (PRR). We analyzed 124 reports of adverse reactions related to contrast agents between 2006 and 2021. Our findings revealed that ADR combinations occurred more frequently after the use of iodinated contrast agents (72.08%) than gadolinium contrast agents (27.92%). Iomeprol and Iopromide were identified as the most frequently reported media. Each medium presented a different safety profile. Skin disorders are the most common adverse drug reactions among patients using both iodine- and gadolinium-based contrast media. Gadolinium-based contrast agents are characterized by similar organ toxicity. Conversely, iodine-based contrast agents are more diverse—some of which show tissue specificity, such as Iodixanol for the gastrointestinal system or Iohexol for the respiratory tract. This study shows relatively high occurrence of respiratory tract related ADRs in Wrocław. We also prove that it is possible to choose the most optimal contrast agent for patients with specific organ site problems to omit the possible complications.
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Lopci E, Hicks RJ, Dimitrakopoulou-Strauss A, Dercle L, Iravani A, Seban RD, Sachpekidis C, Humbert O, Gheysens O, Glaudemans AWJM, Weber W, Wahl RL, Scott AM, Pandit-Taskar N, Aide N. Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [ 18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:2323-2341. [PMID: 35376991 PMCID: PMC9165250 DOI: 10.1007/s00259-022-05780-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The goal of this guideline/procedure standard is to assist nuclear medicine physicians, other nuclear medicine professionals, oncologists or other medical specialists for recommended use of [18F]FDG PET/CT in oncological patients undergoing immunotherapy, with special focus on response assessment in solid tumors. METHODS In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard. CONCLUSIONS The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [18F]FDG PET/CT during immunotherapy. Local variations to this guideline should be taken into consideration. PREAMBLE The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association founded in 1985 to facilitate worldwide communication among individuals pursuing clinical and academic excellence in nuclear medicine. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote science, technology and practical application of nuclear medicine. The Australian and New Zealand Society of Nuclear Medicine (ANZSNM), founded in 1969, represents the major professional society fostering the technical and professional development of nuclear medicine practice across Australia and New Zealand. It promotes excellence in the nuclear medicine profession through education, research and a commitment to the highest professional standards. EANM, SNMMI and ANZSNM members are physicians, technologists, physicists and scientists specialized in the research and clinical practice of nuclear medicine. All three societies will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the EANM/SNMMI/ANZSNM, has undergone a thorough consensus process, entailing extensive review. These societies recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents based on current knowledge. They are not intended to be inflexible rules or requirements of practice, nor should they be used to establish a legal standard of care. For these reasons and those set forth below, the EANM, SNMMI and ANZSNM caution against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals considering the unique circumstances of each case. Thus, there is no implication that an action differing from what is laid out in the guidelines/procedure standards, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines/procedure standards. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/ guidelines will not ensure a successful outcome. All that should be expected is that practitioners follow a reasonable course of action, based on their level of training, current knowledge, clinical practice guidelines, available resources and the needs/context of the patient being treated. The sole purpose of these guidelines is to assist practitioners in achieving this objective. The present guideline/procedure standard was developed collaboratively by the EANM, the SNMMI and the ANZSNM, with the support of international experts in the field. They summarize also the views of the Oncology and Theranostics and the Inflammation and Infection Committees of the EANM, as well as the procedure standards committee of the SNMMI, and reflect recommendations for which the EANM and SNMMI cannot be held responsible. The recommendations should be taken into the context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions.
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Affiliation(s)
- E Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - R J Hicks
- The Department of Medicine, St Vincent's Medical School, the University of Melbourne, Melbourne, Australia
| | - A Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - L Dercle
- Department of Radiology, New York Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - A Iravani
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - R D Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France
| | - C Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - O Humbert
- Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
- TIRO-UMR E 4320, Université Côte d'Azur, Nice, France
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A W J M Glaudemans
- Nuclear Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Weber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - R L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Studley Rd, Heidelberg, Victoria, 3084, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - N Pandit-Taskar
- Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10021, USA
| | - N Aide
- Nuclear Medicine Department, University Hospital, Caen, France
- INSERM ANTICIPE, Normandie University, Caen, France
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The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review. Life (Basel) 2022; 12:life12060826. [PMID: 35743857 PMCID: PMC9224719 DOI: 10.3390/life12060826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 01/22/2023] Open
Abstract
Iodinated contrast media (ICM) during contrast-enhanced computed tomography (CECT) in the emergency department (ED) is essential to diagnose acute conditions, despite risks of contrast-induced nephropathy (CIN) development and its associated complications. This systematic review aims to evaluate the incidence of CIN and CIN-induced complications, and to explore the relevance of classical risk factors for CIN among ED patients receiving ICM. PubMed, Cochrane, and Web of Science were used on 30 August 2021 to search for peer-reviewed English articles reporting on CIN incidence among ED patients aged ≥18 years who underwent an intravenous CECT. The inclusion criteria included studies that were in English, peer-reviewed, and involved ED patients aged ≥18 years who underwent single intravenous CECT. Studies on intra-arterial procedures and preventive strategies, meta-analyses, clinical guidelines, review articles, and case reports were excluded. The JBI critical appraisal checklist was applied to assess the risk of bias. In total, 18 studies were included wherein 15 were retrospective studies while three were prospective studies. We found a relatively higher CIN incidence in the ED, with variations owing to the CIN definitions. Several classical risk factors including acute hypotension remain linked to CIN onset in ED settings unlike factors such as age and diabetes. While risk of adverse renal events due to CIN is low, there is higher risk of CIN-induced mortality in the ED. Therefore, with the higher incidence of CIN and CIN-induced mortality rates in the ED, ICM administration during CECT in the ED should still be clinically justified after assessing both benefits and risks.
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Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT working group of the Italian Society of Pediatric Cardiology (SICP) and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) Part I. Radiol Med 2022; 127:788-802. [PMID: 35608758 PMCID: PMC9308607 DOI: 10.1007/s11547-022-01490-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. Nevertheless, correct execution and interpretation require in-depth knowledge of all technical and clinical aspects of CHD, a careful assessment of risks and benefits before each exam, proper imaging protocols to maximize diagnostic information, minimizing harm. This position paper, written by experts from the Working Group of the Italian Society of Pediatric Cardiology and from the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, is intended as a practical guide for applying CCT and CMR in children and adults with CHD, wishing to support Radiologists, Pediatricians, Cardiologists and Cardiac Surgeons in the multimodality diagnostic approach to these patients. The first part provides a review of the most relevant literature in the field, describes each modality's advantage and drawback, making considerations on the main applications, image quality, and safety issues. The second part focuses on clinical indications and appropriateness criteria for CMR and CCT, considering the level of CHD complexity, the clinical and logistic setting and the operator expertise.
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Evaluation of radiological and temporal characteristics of acute appendicitis on the non-enhanced computed tomography images. Abdom Radiol (NY) 2022; 47:2279-2288. [PMID: 35596776 DOI: 10.1007/s00261-022-03544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
PURPOSES To investigate the relationships and interactions between temporal and radiological features of gangrene and perforation of inflamed appendices. METHODS A total of 402 patients were included who underwent laparoscopic appendectomies between January 1, 2016 and March 30, 2020 and had pathologically proved acute appendicitis and preoperative non-enhanced CT examinations. The radiological features (appendix diameter, appendicolith, appendiceal intraluminal gas, periappendiceal gas, periappendiceal fat stranding/fluid, and short axial diameter of the mesenteric lymph nodes) were obtained from the preoperative CT images of 382 patients with visible appendices. Clinical parameters and temporal variables (pre-CT delay, preoperative delay, estimated complication delay, symptom delay, and system delay) were recorded. RESULTS Among simple/suppurative, gangrenous, and perforated appendicitis, the radiological characteristics except for short axial diameters of lymph nodes, and the temporal variables other than system delay were significantly different. The Cox regression analysis identified the appendicolith as the independent risk factor for both gangrene and perforation of inflamed appendices by using the preoperative delay or estimated complication delay. By the preoperative delay, the median time for gangrene and perforation was 76.23 (95%CI 73.89-78.58) h and 77.55 (95%CI 74.12-80.98) h, respectively, if appendicolith was present. If estimated complication delay was used as the elapsed time and the appendicolith was perceptible, the median time for gangrene and perforation and was 72.33 (95%CI 62.93-81.74) h and 75.07 (95%CI 69.48-80.65) h, respectively. CONCLUSION There were interactions between the time evolution and radiological features of acute appendicitis. The evaluation of gangrene and perforation rate of acute appendicitis could be benefitted from combining the preoperative delay/estimated complication delay with CT characteristics in the preoperative urgent radiological analysis.
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Zhao X, Liang P, Yong L, Jia Y, Gao J. Radiomics Study for Differentiating Focal Hepatic Lesions Based on Unenhanced CT Images. Front Oncol 2022; 12:650797. [PMID: 35574320 PMCID: PMC9092943 DOI: 10.3389/fonc.2022.650797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives To investigate the feasibility of computer-aided discriminative diagnosis among hepatocellular carcinoma (HCC), hepatic metastasis, hepatic hemangioma, hepatic cysts, hepatic adenoma, and hepatic focal nodular hyperplasia, based on radiomics analysis of unenhanced CT images. Methods 452 patients with 77 with HCC, 104 with hepatic metastases, 126 with hepatic hemangioma, 99 with hepatic cysts, 24 with FNH, 22 with HA, who underwent CT examination from 2016 to 2018, were included. Radcloud Platform was used to extract radiomics features from manual delineation on unenhanced CT images. Most relevant radiomic features were selected from 1409 via LASSO (least absolute shrinkage and selection operator). The whole dataset was divided into training and testing set with the ratio of 8:2 using computer-generated random numbers. Support Vector Machine (SVM) was used to establish the classifier. Results The computer-aided diagnosis model was established based on radiomic features of unenhanced CT images. 27 optimal discriminative features were selected to distinguish the six different histopathological types of all lesions. The classifiers had good diagnostic performance, with the area under curve (AUC) values greater than 0.900 in training and validation groups. The overall accuracy of the training and testing set about differentiating the six different histopathological types of all lesions was 0.88 and 0.76 respectively. 34 optimal discriminative were selected to distinguish the benign and malignant tumors. The overall accuracy in the training and testing set was 0.89and 0.84 respectively. Conclusions The computer-aided discriminative diagnosis model based on unenhanced CT images has good clinical potential in distinguishing focal hepatic lesions with noninvasive radiomic features.
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Affiliation(s)
- Xitong Zhao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liuliang Yong
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Jia
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Nadarevic T, Colli A, Giljaca V, Fraquelli M, Casazza G, Manzotti C, Štimac D, Miletic D. Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2022; 5:CD014798. [PMID: 35521901 PMCID: PMC9074390 DOI: 10.1002/14651858.cd014798.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and third in terms of cancer deaths. In clinical practice, magnetic resonance imaging (MRI) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-fetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study (computed tomography (CT) or MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is considered valid to diagnose hepatocellular carcinoma. The detection of hepatocellular carcinoma amenable to surgical resection could improve the prognosis. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma may, therefore, be missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of MRI may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of MRI in people with chronic liver disease who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease. Secondary: to assess the diagnostic accuracy of MRI for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease, and to identify potential sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test of Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, and three other databases to 9 November 2021. We manually searched articles retrieved, contacted experts, handsearched abstract books from meetings held during the last 10 years, and searched for literature in OpenGrey (9 November 2021). Further information was requested by e-mails, but no additional information was provided. No data was obtained through correspondence with investigators. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and we tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 34 studies, with 4841 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time interval between the index test and the reference standard was rarely defined. Regarding applicability, we judged 15% (5/34) of studies to be at low concern and 85% (29/34) of studies to be at high concern mostly owing to characteristics of the participants, most of whom were on waiting lists for orthotopic liver transplantation, and due to pathology of the explanted liver being the only reference standard. MRI for hepatocellular carcinoma of any size and stage: sensitivity 84.4% (95% CI 80.1% to 87.9%) and specificity 93.8% (95% CI 90.1% to 96.1%) (34 studies, 4841 participants; low-certainty evidence). MRI for resectable hepatocellular carcinoma: sensitivity 84.3% (95% CI 77.6% to 89.3%) and specificity 92.9% (95% CI 88.3% to 95.9%) (16 studies, 2150 participants; low-certainty evidence). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS We found that using MRI as a second-line imaging modality to diagnose hepatocellular carcinoma of any size and stage, 16% of people with hepatocellular carcinoma would be missed, and 6% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 16% of people with resectable hepatocellular carcinoma would improperly not be resected, while 7% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Cristina Manzotti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Roditi G, Khan N, van der Molen AJ, Bellin MF, Bertolotto M, Brismar T, Correas JM, Dekkers IA, Geenen RWF, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Romanini L, Stacul F, Thomsen HS, Clément O. Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines. Eur Radiol 2022; 32:3056-3066. [PMID: 35175378 PMCID: PMC9038843 DOI: 10.1007/s00330-021-08433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 10/14/2021] [Indexed: 01/28/2023]
Abstract
NEED FOR A REVIEW Guidelines for management and prevention of contrast media extravasation have not been updated recently. In view of emerging research and changing working practices, this review aims to inform update on the current guidelines. AREAS COVERED In this paper, we review the literature pertaining to the pathophysiology, diagnosis, risk factors and treatments of contrast media extravasation. A suggested protocol and guidelines are recommended based upon the available literature. KEY POINTS • Risk of extravasation is dependent on scanning technique and patient risk factors. • Diagnosis is mostly clinical, and outcomes are mostly favourable. • Referral to surgery should be based on clinical severity rather than extravasated volume.
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Affiliation(s)
- Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Nadir Khan
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-France Bellin
- University Paris-Saclay, AP-HP, University Hospital Bicêtre, Service de Radiologie, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Jean-Michel Correas
- Université de Paris, AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Paris, France
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | - Carlo C Quattrocchi
- Imaging Center, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Alexander Radbruch
- Department of Radiology, Clinic for Diagnostic and Interventional Neuroradiology, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Henrik S Thomsen
- Department of Radiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Olivier Clément
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, 20 Rue LeBlanc, 75015, Paris, France.
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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