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Ratnaparkhi C, Dhok A, Gupta A, Dube A, Kurmi B, Umredkar A, Kumar S, Pande S, Ghatol S. Diagnostic Accuracy of Hounsfield Unit Value and Hounsfield Unit to Hematocrit Ratio in Predicting Cerebral Venous Sinus Thrombosis: A Retrospective Case-Control Study. Cureus 2024; 16:e57567. [PMID: 38707168 PMCID: PMC11069020 DOI: 10.7759/cureus.57567] [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] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE Non-contrast computed tomography (CT) of the brain is a primary neuroimaging modality in emergency patients suspected of having cerebral venous sinus thrombosis (CVST). The objective of the study was to determine the diagnostic accuracy of Hounsfield unit (HU) values and the ratio of HU to hematocrit value (HU/Htc) in predicting CVST in suspected patients. MATERIAL AND METHODS A retrospective, case-control study was done in a tertiary care institute which included 35 patients with CVST constituted as cases and 41 patients without CVST as controls on the basis of magnetic resonance venography (MRV). Non-contrast CT brain of all 76 subjects were assessed by two experienced radiologists independently. HU values of dural venous sinuses were calculated in both groups, and HU/Htc ratio was also determined. Statistical Package for Social Sciences (SPSS) version 25.0 (SPSS© for Windows, IBM© Corp.) was used for statistical analysis. Independent samples t-test was applied to compare the means of continuous variables. The diagnostic values were computed using the Calculator 1 tool on clinical research calculators tab on vassarstats.net. The predictive values of HU and HU/Htc ratio were estimated by the receiver operating characteristic (ROC) curve analysis. RESULTS In CVST group, the mean Hounsfield Unit (HU) value was "75.9±3.9 (mean±SD)", while in control group, it was 57.78±4.65 (mean±SD), p < 0.001. The mean HU/Htc ratio was 1.98±0.42 (mean±SD) in the CVST group and 1.51±0.12 (mean±SD) in the control group (p < 0.001). Optimum cut-off HU value was calculated as 68, with 97% sensitivity and 100% specificity. For HU/Htc ratio, optimum cut-off was calculated as 1.69, yielding 71.4% sensitivity and 100% specificity on the basis of ROC curves. The difference was not statistically significant in hemoglobin and hematocrit (Htc) values between the cases and controls. CONCLUSION The quantitative measurements like HU value and HU/Htc ratio provide an easily obtainable metric in patients with suspected CVST on non-contrast CT brain, thus enhancing the role of non-contrast CT brain in diagnosing CVST.
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Affiliation(s)
- Chetana Ratnaparkhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Avinash Dhok
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Akhil Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Amol Dube
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Bheekam Kurmi
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Ashwini Umredkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Santha Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Shilpa Pande
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
| | - Samiksha Ghatol
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS) Nagpur, Nagpur, IND
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Liu X, Zhu M, Wu M, Cheng Z, Wu X, Zhu R. Unenhanced CT-based predictive model to identify small bowel necrosis in patients with mechanical small bowel obstruction. BMC Med Imaging 2023; 23:80. [PMID: 37308879 DOI: 10.1186/s12880-023-01041-2] [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: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES To investigate the diagnostic value of unenhanced CT in mechanical small bowel obstruction (SBO) with small bowel necrosis, and to establish a predictive model. METHODS From May 2017 to December 2021, the patients with mechanical SBO admitted to our hospital were retrospectively collected. Taking pathology-confirmed small bowel necrosis as the gold standard, the experimental group was composed of patients with small bowel necrosis confirmed by pathology, and the control group was composed of patients with no intestinal necrosis confirmed by surgery or successful conservative treatment with no recurrence of intestinal obstruction during 1-month followed-up. RESULTS A total of 182 patients were enrolled in this study, 157 patients underwent surgery, of which 35 patients were accompanied with small bowel necrosis and 122 patients were not (33 patients with ischemic findings at surgery without necrosis). Finally, there were 35 patients in the experimental group and 147 patients in the control group. Multivariable logistic regression showed that increased attenuation of small bowel wall (P = 0.002), diffuse mesenteric haziness (P = 0.010), difference of CT value between mesenteric vessel and aorta (P = 0.025) and U-/C-shaped small bowel loop (P = 0.010) were independent risk factors for the diagnosis of mechanical SBO with small bowel necrosis. Through internal verification, the area under curve (AUC) of the predictive model reached 0.886 (95%CI: 0.824-0.947), and the calibration result was moderate. CONCLUSION Multiple features (increased attenuation of small bowel wall; difference of CT values between mesenteric vessel and aorta; diffuse mesenteric haziness; and U-/C-shaped small bowel loop) of unenhanced CT have clinical value in the diagnosis of mechanical SBO with small bowel necrosis. The predictive model based on these four features could achieve satisfactory efficiency.
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Affiliation(s)
- Xianwei Liu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China.
| | - MingJie Zhu
- Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Sichuan province, Leshan, China
| | - Ming Wu
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Zhangsong Cheng
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Xiaoyu Wu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
| | - Renfang Zhu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
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Cademartiri F, Meloni A, Pistoia L, Degiorgi G, Clemente A, De Gori C, Positano V, Celi S, Berti S, Emdin M, Panetta D, Menichetti L, Punzo B, Cavaliere C, Bossone E, Saba L, Cau R, Grutta LL, Maffei E. Dual Source Photon-Counting Computed Tomography-Part II: Clinical Overview of Neurovascular Applications. J Clin Med 2023; 12:jcm12113626. [PMID: 37297821 DOI: 10.3390/jcm12113626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Photon-counting detector (PCD) is a novel computed tomography detector technology (photon-counting computed tomography-PCCT) that presents many advantages in the neurovascular field, such as increased spatial resolution, reduced radiation exposure, and optimization of the use of contrast agents and material decomposition. In this overview of the existing literature on PCCT, we describe the physical principles, the advantages and the disadvantages of conventional energy integrating detectors and PCDs, and finally, we discuss the applications of the PCD, focusing specifically on its implementation in the neurovascular field.
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Affiliation(s)
| | - Antonella Meloni
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Giulia Degiorgi
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Simona Celi
- BioCardioLab, Department of Bioengineering, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Michele Emdin
- Department of Cardiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Daniele Panetta
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Luca Menichetti
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Bruna Punzo
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Carlo Cavaliere
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy
| | - Luca Saba
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Riccardo Cau
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, Department of Radiology, University Hospital "P. Giaccone", 90127 Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
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Redente EF, Kopf KW, Bahadur AN, Robichaud A, Lundblad LK, McDonald LT. Application-specific approaches to MicroCT for evaluation of mouse models of pulmonary disease. PLoS One 2023; 18:e0281452. [PMID: 36757935 PMCID: PMC9910664 DOI: 10.1371/journal.pone.0281452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The advent of micro-computed tomography (microCT) has provided significant advancement in our ability to generate clinically relevant assessments of lung health and disease in small animal models. As microCT use to generate outcomes analysis in pulmonary preclinical models has increased there have been substantial improvements in image quality and resolution, and data analysis software. However, there are limited published methods for standardized imaging and automated analysis available for investigators. Manual quantitative analysis of microCT images is complicated by the presence of inflammation and parenchymal disease. To improve the efficiency and limit user-associated bias, we have developed an automated pulmonary air and tissue segmentation (PATS) task list to segment lung air volume and lung tissue volume for quantitative analysis. We demonstrate the effective use of the PATS task list using four distinct methods for imaging, 1) in vivo respiration controlled scanning using a flexiVent, 2) longitudinal breath-gated in vivo scanning in resolving and non-resolving pulmonary disease initiated by lipopolysaccharide-, bleomycin-, and silica-exposure, 3) post-mortem imaging, and 4) ex vivo high-resolution scanning. The accuracy of the PATS task list was compared to manual segmentation. The use of these imaging techniques and automated quantification methodology across multiple models of lung injury and fibrosis demonstrates the broad applicability and adaptability of microCT to various lung diseases and small animal models and presents a significant advance in efficiency and standardization of preclinical microCT imaging and analysis for the field of pulmonary research.
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Affiliation(s)
- Elizabeth F. Redente
- Department of Pediatrics, National Jewish Health, Denver, Colorado, United States of America
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Katrina W. Kopf
- Department of Academic Affairs, National Jewish Health, Denver, Colorado, United States of America
| | - Ali N. Bahadur
- Bruker BioSpin Corporation, Billerica, Massachusetts, United States of America
| | | | | | - Lindsay T. McDonald
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America
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Hoegger MJ, Ludwig DR, Zulfiqar M, Raptis DA, Shetty AS. Enhancing the interpretation of unenhanced abdominopelvic CT. Curr Probl Diagn Radiol 2022; 51:787-797. [DOI: 10.1067/j.cpradiol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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Canakci ME, Acar N, Kuas C, Ozakin E, Tiryaki Bastug B, Karakilic E, Ozdemir AO. Diagnostic Value of Hounsfield Unit and Hematocrit Levels in Cerebral Vein Thrombosis in the Emergency Department. J Emerg Med 2021; 61:234-240. [PMID: 34429219 DOI: 10.1016/j.jemermed.2021.07.016] [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: 03/18/2021] [Revised: 05/27/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unenhanced computed tomography (CT) is a frequently used imaging method in patients who are evaluated in the emergency department with suspected cerebral vein thrombosis (CVT). OBJECTIVES The aim of this study was to investigate the usefulness of the Hounsfield unit (HU) value determined by CT and its ratio to the patient's hematocrit (Htc) value in the diagnosis of cerebral vein thrombosis. METHODS This retrospective study evaluated 41 patients with acute cerebral venous sinus thrombosis and 41 age- and sex-matched control participants. Two experienced observers independently evaluated the CT scan and measured the attenuation of the dural sinuses. RESULTS There was no significant difference in age, gender, hemoglobin, and Htc values between the two groups. The mean HU value was 75 ± 7 HU in the CVT group and 52 ± 6 HU in the control group (p < 0.001). The mean HU/Htc ratio was 1.9 ± 0.3 in the CVT group and 1.3 ± 0.1 in the control group (p < 0.001). The optimal threshold value for HU was determined as 66, and sensitivity at this value was 93%, and specificity was 98%. The optimal threshold value for HU/Htc was determined as 1.64, and the sensitivity at this value was 90% and the specificity was 100%. CONCLUSION Hyperattenuation in the dural sinuses and the HU/Htc ratio in unenhanced brain CT scans have high diagnostic value in detecting CVT.
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Affiliation(s)
| | - Nurdan Acar
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Caglar Kuas
- Emergency Department, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Engin Ozakin
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Evvah Karakilic
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
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Mühl-Benninghaus R, Dressler J, Haußmann A, Simgen A, Reith W, Yilmaz U. Utility of Hounsfield unit in the diagnosis of tandem occlusion in acute ischemic stroke. Neurol Sci 2020; 42:2391-2396. [PMID: 33052575 PMCID: PMC8159780 DOI: 10.1007/s10072-020-04798-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
Background Tandem occlusions can complicate medical and endovascular stroke treatment. To identify these occlusions, computed tomography angiography (CTA) represents the best imaging modality. However, CTA is still not initially performed in some patients not admitted directly to stroke centers. Early identification of an additional occlusion of the proximal extracranial internal carotid artery may improve the best suitable treatment strategy. The purpose of this study was to find a valuable threshold of thrombus attenuation in a non-contrast head CT (NCCT) scan to facilitate a safe diagnosis of tandem occlusions. Materials and methods Consecutive patients with acute middle cerebral artery (MCA) occlusions who underwent endovascular treatment were identified from our registry of neuroendovascular interventions. Thrombus attenuations of the affected MCA and contralateral vessel were measured by NCCT. To compare individual baseline blood attenuations, the difference between the thrombus attenuation and the contralateral MCA attenuation (referred to as ΔTM) was calculated. Results Three hundred and twenty-five patients were included. There was a highly significant difference between mean thrombus attenuation with isolated MCA occlusion and additional extracranial internal carotid artery (ICA) occlusion (49.9 ± 8 vs. 56.2 ± 10 Hounsfield units (HU); P < 0.001). The area under the receiver operating characteristic curve of ΔTM was 0.72. The optimal threshold value was 13.5 HU, with a sensitivity of 67.5% and a specificity of 68.6%. Conclusion Despite a significant difference in thrombus attenuation in MCA occlusions with an additional extracranial ICA occlusion compared with isolated MCA occlusions, a relevant threshold of thrombus attenuation was not found.
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Affiliation(s)
- Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
| | - Julia Dressler
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
| | - Alena Haußmann
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg, Germany
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Mokli Y, Pfaff J, dos Santos DP, Herweh C, Nagel S. Computer-aided imaging analysis in acute ischemic stroke - background and clinical applications. Neurol Res Pract 2019; 1:23. [PMID: 33324889 PMCID: PMC7650084 DOI: 10.1186/s42466-019-0028-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/29/2019] [Indexed: 12/22/2022] Open
Abstract
Tools for medical image analysis have been developed to reduce the time needed to detect abnormalities and to provide more accurate results. Particularly, tools based on artificial intelligence and machine learning techniques have led to significant improvements in medical imaging interpretation in the last decade. Automatic evaluation of acute ischemic stroke in medical imaging is one of the fields that witnessed a major development. Commercially available products so far aim to identify (and quantify) the ischemic core, the ischemic penumbra, the site of arterial occlusion and the collateral flow but they are not (yet) intended as standalone diagnostic tools. Their use can be complementary; they are intended to support physicians' interpretation of medical images and hence standardise selection of patients for acute treatment. This review provides an introduction into the field of computer-aided diagnosis and focuses on the automatic analysis of non-contrast-enhanced computed tomography, computed tomography angiography and perfusion imaging. Future studies are necessary that allow the evaluation and comparison of different imaging strategies and post-processing algorithms during the diagnosis process in patients with suspected acute ischemic stroke; which may further facilitate the standardisation of treatment and stroke management.
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Affiliation(s)
- Yahia Mokli
- Department of Neurology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Johannes Pfaff
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christian Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
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Smith AG, Rowland Hill C. Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol 2017; 91:20170573. [PMID: 29144166 DOI: 10.1259/bjr.20170573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that may be harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain. For MT, imaging must in addition detect and characterize intra-arterial thrombus and assess the intra and extracranial arterial architecture. More advanced imaging techniques may be used to assess more accurately the volume of non-viable and potentially salvageable brain tissue. It is highly likely that further research will identify patients who would benefit from treatment beyond currently accepted time windows for IVT (4.5 h) and MT (6 h) and patients with an unknown time of symptom onset. Current evidence indicates that best outcomes are achieved when treatment is instituted as soon as possible after symptom onset. A rapid, efficient imaging pathway including interpretation is fundamental to achieving the best outcomes. This review summarizes current techniques for imaging assessment of acute stroke, highlighting strengths and limitations of each. The optimum pathway is a balance between diagnostic information, local resources, specialization and the time taken to acquire, process and interpret the data. As new evidence emerges, it is likely that the minimum required imaging data will change.
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Pourmorteza A, Symons R, Reich DS, Bagheri M, Cork TE, Kappler S, Ulzheimer S, Bluemke DA. Photon-Counting CT of the Brain: In Vivo Human Results and Image-Quality Assessment. AJNR Am J Neuroradiol 2017; 38:2257-2263. [PMID: 28982793 DOI: 10.3174/ajnr.a5402] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/20/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Photon-counting detectors offer the potential for improved image quality for brain CT but have not yet been evaluated in vivo. The purpose of this study was to compare photon-counting detector CT with conventional energy-integrating detector CT for human brains. MATERIALS AND METHODS Radiation dose-matched energy-integrating detector and photon-counting detector head CT scans were acquired with standardized protocols (tube voltage/current, 120 kV(peak)/370 mAs) in both an anthropomorphic head phantom and 21 human asymptomatic volunteers (mean age, 58.9 ± 8.5 years). Photon-counting detector thresholds were 22 and 52 keV (low-energy bin, 22-52 keV; high-energy bin, 52-120 keV). Image noise, gray matter, and white matter signal-to-noise ratios and GM-WM contrast and contrast-to-noise ratios were measured. Image quality was scored by 2 neuroradiologists blinded to the CT detector type. Reproducibility was assessed with the intraclass correlation coefficient. Energy-integrating detector and photon-counting detector CT images were compared using a paired t test and the Wilcoxon signed rank test. RESULTS Photon-counting detector CT images received higher reader scores for GM-WM differentiation with lower image noise (all P < .001). Intrareader and interreader reproducibility was excellent (intraclass correlation coefficient, ≥0.86 and 0.79, respectively). Quantitative analysis showed 12.8%-20.6% less image noise for photon-counting detector CT. The SNR of photon-counting detector CT was 19.0%-20.0% higher than of energy-integrating detector CT for GM and WM. The contrast-to-noise ratio of photon-counting detector CT was 15.7% higher for GM-WM contrast and 33.3% higher for GM-WM contrast-to-noise ratio. CONCLUSIONS Photon-counting detector brain CT scans demonstrated greater gray-white matter contrast compared with conventional CT. This was due to both higher soft-tissue contrast and lower image noise for photon-counting CT.
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Affiliation(s)
- A Pourmorteza
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland.,Department of Radiology and Imaging Sciences (A.P.), Emory University School of Medicine, Atlanta, Georgia
| | - R Symons
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland.,Department of Imaging and Pathology (R.S.), Medical Imaging Research Centre, University Hospitals, Leuven, Belgium
| | - D S Reich
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland.,Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - M Bagheri
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland
| | - T E Cork
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland.,Departments of Radiological Sciences and Bioengineering (T.E.C.), University of California, Los Angeles, Los Angeles, California
| | - S Kappler
- Siemens (S.K., S.U.), Erlangen, Germany
| | | | - D A Bluemke
- From the Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland
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11
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Hyperattenuating Sign: An Important Finding to Diagnose Pulmonary Embolism at Unenhanced Chest CT. AJR Am J Roentgenol 2017; 209:W201. [PMID: 28829166 DOI: 10.2214/ajr.17.18204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Clues to vascular disorders at non-contrast CT of the chest, abdomen, and pelvis. Abdom Radiol (NY) 2017; 42:2175-2187. [PMID: 28365786 DOI: 10.1007/s00261-017-1113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Non-contrast chest CT scans are commonly performed while CT scans of the abdomen and pelvis are performed in a select subset of patients; those with limited renal function, an allergy to iodinated contrast, in the setting of suspected renal calculus, retroperitoneal hematoma, common duct calculus, abdominal aortic aneurysm with or without rupture, and in patients undergoing a PET-CT scan. In the absence of intravenous contrast, vascular structures may prove challenging to evaluate, yet their assessment is an important component of every non-contrast CT examination. We describe the key imaging features of both arterial and venous pathology, and review clues and common associated non-vascular findings, which can help the radiologist identify vascular disorders at non-contrast CT. Briefly, alternative imaging options are discussed.
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Kumar Y, Hooda K, Li S, Goyal P, Gupta N, Adeb M. Abdominal aortic aneurysm: pictorial review of common appearances and complications. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:256. [PMID: 28706924 DOI: 10.21037/atm.2017.04.32] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are defined as focal dilatations of the abdominal aorta that are 50% greater than the proximal normal segment or when it is more than 3 cm in maximum diameter. The early diagnosis and treatment is very important to prevent catastrophic complications. Due to its ability to assess the peri-aortic soft tissue and the exact extension of aneurysm, as well as its excellent vascular opacification and multiplanar reconstruction capabilities, computed tomography angiography (CTA) has become an integral part of the evaluation of AAA and has virtually replaced conventional angiography for the evaluation of AAA. Knowledge of the characteristic imaging features of AAA is essential for the prompt diagnosis of life-threatening complications. In this pictorial essay, we will discuss the CTA findings in AAA and its complications including rupture, infection, aorto-enteric fistula and aorto-caval fistula.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Shuo Li
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Nishant Gupta
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Melkamu Adeb
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
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14
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Hyperdense artery sign on computed tomography in acute coronary syndrome. Coron Artery Dis 2017; 28:625-626. [PMID: 28574900 DOI: 10.1097/mca.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Nuances of the unenhanced abdominal CT: careful inspection discloses critical findings. ACTA ACUST UNITED AC 2015; 40:2883-93. [DOI: 10.1007/s00261-015-0422-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Coulier B, Van den Broeck S, Deprez FC. Extreme Anemia Causing Unusual "Black-out" of the Cerebral Vessels on Noncontrast Brain CT. Clin Neuroradiol 2014; 25:197-9. [PMID: 24788299 DOI: 10.1007/s00062-014-0306-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- B Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Bouge, 5004, Namur, Belgium,
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18
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Imaging findings of acute intravascular thrombus on non-enhanced computed tomography. Emerg Radiol 2014; 21:271-7. [PMID: 24652034 DOI: 10.1007/s10140-014-1210-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
Intravascular thrombosis and thromboembolism are critical diagnoses which are frequently made on contrast-enhanced computed tomography (CECT) or Doppler ultrasound. For a variety of reasons, some patients with acute intravascular pathology are imaged using CT without intravenous contrast. In the acute setting, the increased Hounsfield unit (HU) density of the thrombus compared to the blood pool allows the diagnosis to be made, or at least suggested, on non-enhanced computed tomography (NECT). The increased density of the clot is commonly referred to as the "hyperdense vessel sign." This is a well-known finding in the setting of stroke, but hyperdense vessels can also signal arterial or venous thrombosis in the chest, abdomen, pelvis, and extremities. Once a hyperdense vessel sign is noted on NECT, further exploration with CECT, angiography, or ultrasound may then be performed. Here, we present a pictorial review of the appearance of acute intravascular thrombosis as seen on non-enhanced computed tomography.
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19
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Taheri MS, Haghighatkhah H, Pourghorban R, Hosseini A. Multidetector computed tomography findings of abdominal aortic aneurysm and its complications: a pictorial review. Emerg Radiol 2013; 20:443-51. [DOI: 10.1007/s10140-013-1128-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/28/2022]
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20
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Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol 2013; 34:1568-72. [PMID: 23471024 DOI: 10.3174/ajnr.a3469] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Brain CT is widely used to exclude or confirm acute cerebral venous sinus thrombosis. The purpose of this study was to assess the value of attenuation measurement and the H:H ratio on unenhanced brain CT scans in the diagnosis of acute cerebral venous sinus thrombosis. MATERIALS AND METHODS This retrospective study evaluated 20 patients with acute cerebral venous sinus thrombosis and 20 age- and sex-matched control participants without thrombosis. Three experienced observers independently evaluated the unenhanced brain CT scan for the presence of cerebral venous sinus thrombosis and measured the attenuation in the dural sinuses. Interreader differences were examined, as well as densities and H:H ratio between patients with acute cerebral venous sinus thrombosis and control participants. RESULTS A significant difference in the average sinus attenuation was found between patients with acute cerebral venous sinus thrombosis (73.9 ± 9.2 HU) and the control group (52.8 ± 6.7 HU; P < .0001). A similar difference was found for the H:H ratio (1.91 ± 0.32 vs 1.33 ± 0.12 in patients with and without cerebral venous sinus thrombosis, respectively; P < .0001). Optimal thresholds of 62 HU and 1.52 lead to accuracies of 95% for average sinus attenuation and 97.5% for the H:H ratio, respectively. CONCLUSIONS Hyperattenuation and the H:H ratio in the dural sinuses on unenhanced brain CT scans have a high accuracy in the detection of acute cerebral venous sinus thrombosis.
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Affiliation(s)
- P-J Buyck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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21
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Lee SY, Cha SH, Lee SH, Shin DI. Evaluation of the effect of hemoglobin or hematocrit level on dural sinus density using unenhanced computed tomography. Yonsei Med J 2013; 54:28-33. [PMID: 23225795 PMCID: PMC3521278 DOI: 10.3349/ymj.2013.54.1.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). MATERIALS AND METHODS Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. RESULTS The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). CONCLUSION Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.
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Affiliation(s)
- Seung Young Lee
- Department of Radiology, College of Medicine, Chungbuk National University, Heungdeok-gu, Cheongju, Korea.
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22
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Stratiki M, Gianniou N, Zakynthinos SG, Stathopoulos GT. Pulmonary embolism visible on unenhanced chest computed tomography. Am J Respir Crit Care Med 2012; 185:e15. [PMID: 22661531 DOI: 10.1164/rccm.201106-0957im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Magdalini Stratiki
- Department of Critical Care and Pulmonary Services, General Hospital Evangelismos, School of Medicine, National and Kapodistrian University of Athens, Greece
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23
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Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament. J Vasc Surg 2012; 56:1114-8. [PMID: 22795523 DOI: 10.1016/j.jvs.2012.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/17/2012] [Accepted: 04/20/2012] [Indexed: 11/21/2022]
Abstract
We report two cases of ruptured pancreaticoduodenal arcade aneurysms that were successfully treated by embolotherapy. In these cases, contrast-enhanced computed tomography, sagittal reformed images, and angiography revealed celiac artery stenoses due to compression by the median arcuate ligament. Computed tomography also showed acute localized dissection in the distal celiac axis, suggesting that aneurysmal rupture had occurred immediately after development of the dissection. When unruptured pancreaticoduodenal arcade aneurysms are identified in the context of celiac artery dissection, the possibility of rupture may be high and requires strict observation and consideration of embolotherapy.
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Valente T, Rossi G, Lassandro F, Marino M, Tortora G, Muto R, Scaglione M. MDCT in diagnosing acute aortic syndromes: reviewing common and less common CT findings. Radiol Med 2011; 117:393-409. [PMID: 22095416 DOI: 10.1007/s11547-011-0747-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 04/11/2011] [Indexed: 12/19/2022]
Abstract
Nontraumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. In this context, multidetector computed tomography (MDCT) is the gold standard due to its intrinsic diagnostic value; its performance approaches 100% sensitivity and specificity, and it is accepted as a first-line modality for suspected acute aortic disease. MDCT allows early recognition and characterisation of acute aortic syndromes as well as the presence of any associated complications - findings that are essential for optimising treatment and improving clinical outcomes. Although classic CT findings have long been known, other unusual signs are continually reported in the medical literature. We reviewed the classic and less common CT findings, correlating them with pathophysiology, timing and management options, to achieve a definite and timely diagnostic and therapeutic definition.
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Affiliation(s)
- T Valente
- Dipartimento d Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. V. Monaldi, Napoli, Italy
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25
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Abstract
A case of acute limb ischemia secondary to iliac artery dissection is presented along with its management. Images highlighting the features of dissection on a noncontrast computed tomography (CT) scan are presented and discussed.
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26
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Gonçalves FG, Barra FR, Matos VDL, Jovem CL, Amaral LLFD, delCarpio-O'Donovan R. Sinais em neurorradiologia: parte 1. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000200013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O uso de sinais ou analogias na interpretação de imagens na radiologia médica é prática comum e antiga entre os radiologistas. Comparação entre achados de imagem com animais, alimentos ou objetos se faz de modo natural. Muitos sinais são bastante específicos e em alguns casos patognomônicos. Independentemente do grau de especificidade, sinais auxiliam a prática radiológica. Vários sinais já foram descritos em neurorradiologia. Neste artigo os autores demonstrarão 15 sinais neurorradiológicos. Serão abordados as principais características de cada um, a sua importância na prática clínica e os seus achados de imagem.
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