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Mück J, Reiter E, Klingert W, Bertolani E, Schenk M, Nikolaou K, Afat S, Brendlin AS. Towards safer imaging: A comparative study of deep learning-based denoising and iterative reconstruction in intraindividual low-dose CT scans using an in-vivo large animal model. Eur J Radiol 2024; 171:111267. [PMID: 38169217 DOI: 10.1016/j.ejrad.2023.111267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Computed tomography (CT) scans are a significant source of medically induced radiation exposure. Novel deep learning-based denoising (DLD) algorithms have been shown to enable diagnostic image quality at lower radiation doses than iterative reconstruction (IR) methods. However, most comparative studies employ low-dose simulations due to ethical constraints. We used real intraindividual animal scans to investigate the dose-reduction capabilities of a DLD algorithm in comparison to IR. MATERIALS AND METHODS Fourteen veterinarian-sedated alive pigs underwent 2 CT scans on the same 3rd generation dual-source scanner with two months between each scan. Four additional scans ensued each time, with mAs reduced to 50 %, 25 %, 10 %, and 5 %. All scans were reconstructed ADMIRE levels 2 (IR2) and a novel DLD algorithm, resulting in 280 datasets. Objective image quality (CT numbers stability, noise, and contrast-to-noise ratio) was measured via consistent regions of interest. Three radiologists independently rated all possible dataset combinations per time point for subjective image quality (-1 = inferior, 0 = equal, 1 = superior). The points were averaged for a semiquantitative score, and inter-rater agreement was measured using Spearman's correlation coefficient and adequately corrected mixed-effects modeling analyzed objective and subjective image quality. RESULTS Neither dose-reduction nor reconstruction method negatively impacted CT number stability (p > 0.999). In objective image quality assessment, the lowest radiation dose achievable by DLD when comparing noise (p = 0.544) and CNR (p = 0.115) to 100 % IR2 was 25 %. Overall, inter-rater agreement of the subjective image quality ratings was strong (r ≥ 0.69, mean 0.93 ± 0.05, 95 % CI 0.92-0.94; each p < 0.001), and subjective assessments corroborated that DLD at 25 % radiation dose was comparable to 100 % IR2 in image quality, sharpness, and contrast (p ≥ 0.281). CONCLUSIONS The DLD algorithm can achieve image quality comparable to the standard IR method but with a significant dose reduction of up to 75%. This suggests a promising avenue for lowering patient radiation exposure without sacrificing diagnostic quality.
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Affiliation(s)
- Jonas Mück
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Elisa Reiter
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Wilfried Klingert
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Elisa Bertolani
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Martin Schenk
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
| | - Andreas S Brendlin
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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Brendlin AS, Wrazidlo R, Almansour H, Estler A, Plajer D, Vega SGC, Klingert W, Bertolani E, Othman AE, Schenk M, Afat S. How Real Are Computed Tomography Low Dose Simulations? An Investigational In-Vivo Large Animal Study. Acad Radiol 2023; 30:1678-1694. [PMID: 36669998 DOI: 10.1016/j.acra.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES CT low-dose simulation methods have gained significant traction in protocol development, as they lack the risk of increased patient exposure. However, in-vivo validations of low-dose simulations are as uncommon as prospective low-dose image acquisition itself. Therefore, we investigated the extent to which simulated low-dose CT datasets resemble their real-dose counterparts. MATERIALS AND METHODS Fourteen veterinarian-sedated alive pigs underwent three CT scans on the same third generation dual-source scanner with 2 months between each scan. At each time, three additional scans ensued, with mAs reduced to 50%, 25%, and 10%. All scans were reconstructed using wFBP and ADMIRE levels 1-5. Matching low-dose datasets were generated from the 100% scans using reconstruction-based and DICOM-based simulations. Objective image quality (CT numbers stability, noise, and signal-to-noise ratio) was measured via consistent regions of interest. Three radiologists independently rated all possible dataset combinations per time point for subjective image quality (-1=inferior, 0=equal, 1=superior). The points were averaged for a semiquantitative score, and inter-rater-agreement was measured using Spearman's correlation coefficient. A structural similarity index (SSIM) analyzed the voxel-wise similarity of the volumes. Adequately corrected mixed-effects analysis compared objective and subjective image quality. Multiple linear regression with three-way interactions measured the contribution of dose, reconstruction mode, simulation method, and rater to subjective image quality. RESULTS There were no significant differences between objective and subjective image quality of reconstruction-based and DICOM-based simulation on all dose levels (p≥0.137). However, both simulation methods produced significantly lower objective image quality than real-dose images below 25% mAs due to noise overestimation (p<0.001; SSIM≤89±3). Overall, inter-rater-agreement was strong (r≥0.68, mean 0.93±0.05, 95% CI 0.92-0.94; each p<0.001). In regression analysis, significant decreases in subjective image quality were observed for lower radiation doses (b ≤ -0.387, 95%CI -0.399 to -0.358; p<0.001) but not for reconstruction modes, simulation methods, raters, or three-way interactions (p≥0.103). CONCLUSION Simulated low-dose CT datasets are subjectively and objectively indistinguishable from their real-dose counterparts down to 25% mAs, making them an invaluable tool for efficient low-dose protocol development.
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Affiliation(s)
- Andreas S Brendlin
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany.
| | - Robin Wrazidlo
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany
| | - Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany
| | - David Plajer
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany
| | | | - Wilfried Klingert
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Tuebingen, Germany
| | - Elisa Bertolani
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Tuebingen, Germany
| | - Ahmed E Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany; Department of Neuroradiology, University Medical Center, Mainz, Germany
| | - Martin Schenk
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University, Tuebingen, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, D-72076 - Tuebingen, Germany
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Altmann S, Abello Mercado MA, Ucar FA, Kronfeld A, Al-Nawas B, Mukhopadhyay A, Booz C, Brockmann MA, Othman AE. Ultra-High-Resolution CT of the Head and Neck with Deep Learning Reconstruction-Assessment of Image Quality and Radiation Exposure and Intraindividual Comparison with Normal-Resolution CT. Diagnostics (Basel) 2023; 13:diagnostics13091534. [PMID: 37174926 PMCID: PMC10177822 DOI: 10.3390/diagnostics13091534] [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: 03/23/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To assess the benefits of ultra-high-resolution CT (UHR-CT) with deep learning-based image reconstruction engine (AiCE) regarding image quality and radiation dose and intraindividually compare it to normal-resolution CT (NR-CT). METHODS Forty consecutive patients with head and neck UHR-CT with AiCE for diagnosed head and neck malignancies and available prior NR-CT of a different scanner were retrospectively evaluated. Two readers evaluated subjective image quality using a 5-point Likert scale regarding image noise, image sharpness, artifacts, diagnostic acceptability, and assessability of various anatomic regions. For reproducibility, inter-reader agreement was analyzed. Furthermore, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and slope of the gray-value transition between different tissues were calculated. Radiation dose was evaluated by comparing CTDIvol, DLP, and mean effective dose values. RESULTS UHR-CT with AiCE reconstruction led to significant improvement in subjective (image noise and diagnostic acceptability: p < 0.000; ICC ≥ 0.91) and objective image quality (SNR: p < 0.000; CNR: p < 0.025) at significantly lower radiation doses (NR-CT 2.03 ± 0.14 mSv; UHR-CT 1.45 ± 0.11 mSv; p < 0.0001) compared to NR-CT. CONCLUSIONS Compared to NR-CT, UHR-CT combined with AiCE provides superior image quality at a markedly lower radiation dose. With improved soft tissue assessment and potentially improved tumor detection, UHR-CT may add further value to the role of CT in the assessment of head and neck pathologies.
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Affiliation(s)
- Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Mario A Abello Mercado
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Felix A Ucar
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Anirban Mukhopadhyay
- Department of Computer Science, Technical University of Darmstadt, Fraunhoferst. 5, 64283 Darmstadt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Clinic Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
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Uhe I, Meyer J, Viviano M, Naiken S, Toso C, Ris F, Buchs NC. Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature. Colorectal Dis 2021; 23:2515-2526. [PMID: 34272795 PMCID: PMC9292704 DOI: 10.1111/codi.15818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
AIM Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. METHODS This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. RESULTS Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi-colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). CONCLUSION CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.
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Affiliation(s)
- Isabelle Uhe
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Jeremy Meyer
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Manuela Viviano
- Division of Gynaecology and ObstetricsOspedale Regionale di LuganoLuganoSwitzerland
| | - Surrennaidoo Naiken
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
- Pôle santé Vallée de JouxLe ChenitSwitzerland
| | - Christian Toso
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Frédéric Ris
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Nicolas C. Buchs
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
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Diagnostic Performance of a Contrast-Enhanced Ultra-Low-Dose High-Pitch CT Protocol with Reduced Scan Range for Detection of Pulmonary Embolisms. Diagnostics (Basel) 2021; 11:diagnostics11071251. [PMID: 34359338 PMCID: PMC8304674 DOI: 10.3390/diagnostics11071251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To evaluate the diagnostic performance of a simulated ultra-low-dose (ULD), high-pitch computed tomography pulmonary angiography (CTPA) protocol with low tube current (mAs) and reduced scan range for detection of pulmonary embolisms (PE). (2) Methods: We retrospectively included 130 consecutive patients (64 ± 16 years, 69 female) who underwent clinically indicated high-pitch CTPA examination for suspected acute PE on a 3rd generation dual-source CT scanner (SOMATOM FORCE, Siemens Healthineers, Forchheim, Germany). ULD datasets with a realistic simulation of 25% mAs, reduced scan range (aortic arch-basal pericardium), and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 5 were created. The effective radiation dose (ED) of both datasets (standard and ULD) was estimated using a dedicated dosimetry software solution. Subjective image quality and diagnostic confidence were evaluated independently by three reviewers using a 5-point Likert scale. Objective image quality was compared using noise measurements. For assessment of diagnostic accuracy, patients and pulmonary vessels were reviewed binarily for affection by PE, using standard CTPA protocol datasets as the reference standard. Percentual affection of pulmonary vessels by PE was computed for disease severity (modified Qanadli score). (3) Results: Mean ED in ULD protocol was 0.7 ± 0.3 mSv (16% of standard protocol: 4.3 ± 1.7 mSv, p < 0.001, r > 0.5). Comparing ULD to standard protocol, subjective image quality and diagnostic confidence were comparably good (p = 0.486, r > 0.5) and image noise was significantly lower in ULD (p < 0.001, r > 0.5). A total of 42 patients (32.2%) were affected by PE. ULD protocol had a segment-based false-negative rate of only 0.1%. Sensitivity for detection of any PE was 98.9% (95% CI, 97.2-99.7%), specificity was 100% (95% CI, 99.8-100%), and overall accuracy was 99.9% (95% CI, 98.6-100%). Diagnoses correlated strongly between ULD and standard protocol (Chi-square (1) = 42, p < 0.001) with a decrease in disease severity of only 0.48% (T = 1.667, p = 0.103). (4) Conclusions: Compared to a standard CTPA protocol, the proposed ULD protocol proved reliable in detecting and ruling out acute PE with good levels of image quality and diagnostic confidence, as well as significantly lower image noise, at 0.7 ± 0.3 mSv (84% dose reduction).
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Larsen NE, Mikkelsen E, Knudsen AR, Larsen LP. Low-dose CT for diagnosing intestinal obstruction and pneumoperitoneum; need for retakes and diagnostic accuracy. Acta Radiol Open 2021; 10:2058460121989313. [PMID: 33786202 PMCID: PMC7958640 DOI: 10.1177/2058460121989313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background One of the main concerns using low-dose (LD) CT for evaluation of patients with suspected intestinal obstruction or pneumoperitoneum is the potential need to make an additional standard-dose (SD) CT scan (retake) due to insufficient diagnostic accuracy of the LD CT. Purpose To determine the frequency of retakes and evaluate the diagnostic accuracy of LD CT for the assessment of intestinal obstruction and pneumoperitoneum. Material and Methods This retrospective study registered all LD CT scans over a one-year period at Aarhus University Hospital, Denmark in patients with suspected intestinal obstruction or perforation, comprising a total of 643 LD CT scans. A retake was defined as a SD CT scan of the abdomen and pelvis performed with or without intravenous contrast within 72 h after the initial LD CT due to either continued suspicion of intestinal obstruction or perforation or due to unclarified secondary findings. The sensitivity and specificity of LD CT for diagnosing intestinal obstruction and pneumoperitoneum compared to the discharge diagnoses of the scanned patients were determined. Results The frequency of retakes was 3%. The overall LD CT sensitivity and specificity for assessment of patients with suspected intestinal obstruction and pneumoperitoneum was 83% and 99%, respectively, but higher in certain subgroups. Conclusions LD CT led to few retakes and had a high diagnostic accuracy for diagnosing intestinal obstruction and pneumoperitoneum. Thus, LD CT can be recommended as the examination of choice in patients with suspected intestinal obstruction or perforation in order to reduce radiation dose.
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Affiliation(s)
- Nis E Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Mikkelsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders R Knudsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Agostini A, Borgheresi A, Bruno F, Natella R, Floridi C, Carotti M, Giovagnoni A. New advances in CT imaging of pancreas diseases: a narrative review. Gland Surg 2021; 9:2283-2294. [PMID: 33447580 DOI: 10.21037/gs-20-551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the material-selective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
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Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison. Diagnostics (Basel) 2021; 11:diagnostics11010118. [PMID: 33450942 PMCID: PMC7828410 DOI: 10.3390/diagnostics11010118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/12/2022] Open
Abstract
To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 1–5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 (p = 1.000, r = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard (p = 1.000, r > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909–0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.
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Inoue A, Furukawa A, Takaki K, Imai Y, Ota S, Nitta N, Watanabe Y. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol 2020; 39:209-224. [PMID: 33034849 DOI: 10.1007/s11604-020-01053-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract lesions are major causes of acute abdominal pain. A rapid, accurate, and reliable diagnosis is required to manage patients. Magnetic resonance imaging (MRI) is a nonionizing modality that is beneficial for pregnant women, children, and young adults who are sensitive to ionizing radiation. For patients with renal impairment who are not accurately diagnosed with noncontrast computed tomography, noncontrast MRI can serve as an alternative diagnostic modality. MRI protocols used for acute abdominal pain are supposed to be optimized and prioritized to shorten scanning times. Single-shot T2-weighted and fat-suppressed T2-weighted imaging are important pulse sequences that are used to reveal pathology and inflammation in the gastrointestinal tract. Diffusion-weighted imaging clearly depicts inflammation and abscesses as hyperintense lesions. Most acute gastrointestinal tract lesions, including inflammation, ischemia, obstruction, and perforation, demonstrate bowel wall thickening. Bowel obstruction and adynamic ileus present bowel dilatation, and perforation and penetration show bowel wall defects. MRI can be used to reveal these pathological findings with some characteristics depending on their underlying pathophysiology. This review article discusses imaging modalities for acute abdominal pain, describes a noncontrast MRI protocol for acute abdominal pain caused by gastrointestinal tract lesions, and reviews MRI findings of acute gastrointestinal tract lesions.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, National Hospital Organization, Higashi-ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-8505, Japan.
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Gavrielli S, Yan C, Rogalla P, Anconina R, Metser U. Ultra-low dose CT abdomen and pelvis for the detection of acute abdominal pathology in the emergency room: initial experience from an academic hospital. Emerg Radiol 2020; 28:15-21. [PMID: 32557166 DOI: 10.1007/s10140-020-01804-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study is to describe our initial experience using ULDCT performed in the emergency room in the evaluation of acute abdominal pathology. METHODS Data from consecutive patients who underwent ULDCT for assessment of bowel obstruction, free intraperitoneal air, unexplained abdominal pain, or fecal loading for constipation between June 1, 2016 and March 31, 2017 was retrospectively assessed. Demographic data, radiation dose, CT findings, and clinical outcomes including performance of full dose contrast-enhanced CT (CECT), hospitalization, and surgery was collected. Concordance of ULDCT to CECT was calculated. RESULTS ULDCT was performed in 325 patients (188 women and 137 men; mean age, 65.1 years). ULDCT detected acute abdominal pathology in 134/325 (41.2%), and in 89/134 (66.4%) it was concordant with the clinical working diagnosis. The average dose length product (DLP) was 101.6 mGy cm (range 51.7-614; median, 82.6). CECT was performed in 44/325 patients (13.5%). In 7/44 (15.9%), CECT identified discordant findings which likely impacted management. A greater proportion of patients were admitted to hospital after a positive ULDCT 99/137 (72.3%), compared to those with a negative study 81/188 (43.1%); p < 0.0001(Chi2, 27.30). Of those admitted to hospital, 11/99 (11.1%) with positive ULDCT had surgery compared to 1/81 (1.2%) with a negative ULDCT; p < 0.008 (Chi2, 6.98). CONCLUSION With its high clinical yield and similar radiation dose, ULDCT appears as a suitable alternative to abdominal radiography for the detection of select acute abdominal pathology in the emergency room.
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Affiliation(s)
- Shlomo Gavrielli
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada
| | - Charles Yan
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada
| | - Patrik Rogalla
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada
| | - Reut Anconina
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON, M5G 2M9, Canada.
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11
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Abstract
MRI and MRCP play an important role in the diagnosis of chronic pancreatitis (CP) by imaging pancreatic parenchyma and ducts. MRI/MRCP is more widely used than computed tomography (CT) for mild to moderate CP due to its increased sensitivity for pancreatic ductal and gland changes; however, it does not detect the calcifications seen in advanced CP. Quantitative MR imaging offers potential advantages over conventional qualitative imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of detected changes. These techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in the diagnosis of chronic pancreatitis. Given the fact that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing MRI/MRCP-based, more robust diagnostic criteria combining ductal and parenchymal findings. Among cross-sectional imaging modalities, multi-detector CT (MDCT) has been a cornerstone for evaluating chronic pancreatitis (CP) since it is ubiquitous, assesses primary disease process, identifies complications like pseudocyst or vascular thrombosis with high sensitivity and specificity, guides therapeutic management decisions, and provides images with isotropic resolution within seconds. Conventional MDCT has certain limitations and is reserved to provide predominantly morphological (e.g., calcifications, organ size) rather than functional information. The emerging applications of radiomics and artificial intelligence are poised to extend the current capabilities of MDCT. In this review article, we will review advanced imaging techniques by MRI, MRCP, CT, and ultrasound.
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12
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Lee KH, Shim YS, Park SH, Park SH, Choi SJ, Pak SY, Cheong H. Comparison of standard-dose and half-dose dual-source abdominopelvic CT scans for evaluation of acute abdominal pain. Acta Radiol 2019; 60:946-954. [PMID: 30376718 DOI: 10.1177/0284185118809544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background With the increasing number of computed tomography (CT) scans used for evaluation of acute abdominal pain, patient radiation exposure has increased rapidly. Purpose To determine whether the diagnostic performance of half-dose abdominopelvic CT is non-inferior to that of standard-dose CT for patients with acute abdominal pain. Material and Methods Ninety-eight patients with acute abdominal pain underwent dual-source abdominopelvic CT. Three sets of CT images were reconstructed: standard-dose filtered back projection (FBP); half-dose FBP; and half-dose sinogram-affirmed iterative reconstruction (SAFIRE3). Diagnostic performance of the standard-dose scan was compared with that of the half-dose scans by using a non-inferiority test with a 10% margin. The overall image quality was subjectively measured. Results Diagnostic performance for overall disease diagnosis with half-dose scans (area under the receiver operating characteristic curve [AUC] = 0.835 for FBP, 0.881 for SAFIRE3) was non-inferior to that of standard-dose FBP (AUC = 0.891) (95% confidence interval lower limit difference = −5.6% [half-dose FBP], −1.2% [half-dose SAFIRE3]). The diagnostic sensitivity for detection of neoplastic disease was lower with half-dose (75.0%) than with standard-dose FBP (91.7%). Effective dose and dose-length product with standard-dose imaging were 7.99 ± 2.55 mSv and 533.1 ± 170.3 mGy·cm, respectively; those of half-dose imaging were 3.99 ± 1.28 mSv and 266.6 ± 85.2 mGy·cm, respectively. The image quality was lower with half-dose than with standard-dose FBP scans ( P < 0.01). Conclusion Diagnostic performance of half-dose CT is non-inferior to that of standard-dose scan for evaluation of acute abdominal pain, despite inferior image quality.
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Affiliation(s)
- Ki Hyun Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong Ho Park
- Division of Abdominal Radiology, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong Yong Pak
- Imaging and Computer Vision Division, Siemens Healthcare, Seoul, Republic of Korea
| | - Hyunhee Cheong
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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13
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Effect of a novel denoising technique on image quality and diagnostic accuracy in low-dose CT in patients with suspected appendicitis. Eur J Radiol 2019; 116:198-204. [PMID: 31153565 DOI: 10.1016/j.ejrad.2019.04.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022]
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14
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Zinsser D, Maurer M, Do PL, Weiß J, Notohamiprodjo M, Bamberg F, Othman AE. Reduced scan range abdominopelvic CT in patients with suspected acute appendicitis - impact on diagnostic accuracy and effective radiation dose. BMC Med Imaging 2019; 19:4. [PMID: 30635023 PMCID: PMC6329115 DOI: 10.1186/s12880-019-0304-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/02/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To evaluate a reduced range CT protocol in patients with suspected acute appendicitis as compared to standard abdominal CT regarding diagnostic performance, effective radiation dose and organ doses. METHODS In this study, we retrospectively included 90 patients (43 female, mean age 56.7 ± 17 years) with suspected acute appendicitis who underwent CT of abdomen and pelvis. From those CTs, we reconstructed images with a reduced scan range from L1 to the the pubic symphysis. Full range and reduced range datasets were assessed by two radiologists for i) coverage of the Appendix, ii) presence/absence of appendicitis and iii) presence of differential diagnoses. Furthermore, effective radiation doses as well as organ doses were calculated using a commercially available dose management platform (Radimetrics, Bayer HealthCare). RESULTS The Appendix was covered by the reduced range CT in all cases. In 66 patients CT confirmed the presence of appendicitis. In 14 patients, other relevant differential diagnoses were identified by CT, whereas in 10 patients no relevant findings were detected. Both readers identified all patients with appendicitis on both full and reduced range CT. For reduced range CT, total effective dose was 39% lower than for full range CT (reduced range: 4.5 [1.9-11.2] vs. full range: 7.4 [3.3-18.8] mSv; p ≤ 0.001). Notably, a remarkable reduction of organ dose in the female breasts by 97% (0.1 [0.1-0.6] vs. 3.8 [0.5-18.8] mSv; p ≤ 0.001) and in the testicles in males by 81% (3.4 [0.7-32.7] vs. 17.6 [5.4-52.9] mSv; p ≤ 0.001) was observed for reduced range CT compared to full range CT. CONCLUSIONS In patients with suspected acute appendicitis, reduced range abdominopelvic CT results in a comparable diagnostic performance with a remarkable reduction of total effective radiation dose and organ doses (especially breast dose in female and testicle dose in male patients) as compared to full range CT.
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Affiliation(s)
- Dominik Zinsser
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Michael Maurer
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Phuong-Linh Do
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ahmed E Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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15
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Moloney F, James K, Twomey M, Ryan D, Grey TM, Downes A, Kavanagh RG, Moore N, Murphy MJ, Bye J, Carey BW, McSweeney SE, Deasy C, Andrews E, Shanahan F, Maher MM, O'Connor OJ. Low-dose CT imaging of the acute abdomen using model-based iterative reconstruction: a prospective study. Emerg Radiol 2018; 26:169-177. [PMID: 30448900 DOI: 10.1007/s10140-018-1658-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/09/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms. MATERIALS AND METHODS Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10-20% and 80-90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews. RESULTS A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m2 than those with BMI ≥ 25 kg/m2 (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis. CONCLUSIONS Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Karl James
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - David Ryan
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Tyler M Grey
- School of Medicine, University College Cork, Cork, Ireland
| | - Amber Downes
- School of Medicine, University College Cork, Cork, Ireland
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Niamh Moore
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Mary Jane Murphy
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | | | - Brian W Carey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.
| | - Sean E McSweeney
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Emmett Andrews
- Department of Surgery, Cork University Hospital, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
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