1
|
Pan C, Yu T, Zhao H, He J, Lu X, Tang H, Hong Y, Shang C, Wu Q, Yang A, Li C, Zhou M, Shi Y. Evaluation of pancreatic iodine uptake and related influential factors in multiphase dual-energy CT. Eur Radiol 2024:10.1007/s00330-024-10850-0. [PMID: 38913243 DOI: 10.1007/s00330-024-10850-0] [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: 12/04/2023] [Revised: 04/25/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES To establish normative values and identify potential factors influencing pancreatic iodine uptake using dual-energy CT (DECT). MATERIALS AND METHODS This retrospective study included participants without pancreatic diseases undergoing DECT at two institutions with different platforms. Their protocols both included arterial phase (AP), portal venous phase (PP), and equilibrium phase (EP), defined as 35 s-40 s, 60 s-70 s, and 150 s-180 s after injection of contrast agent, respectively. Both iodine concentration (IC) and normalised IC (NIC) were measured. Demographic features, local measurements of the pancreas and visceral fat area (VFA) were considered as potential factors influencing iodine uptake using multivariate linear regression analyses. RESULTS A total of 562 participants (median age 58 years [interquartile range: 47-67], with 282 men) were evaluated. The mean IC differed significantly between two institutions (all p < 0.001) across three contrast-enhanced phases, while the mean NIC showed no significant differences (all p > 0.05). The mean values of NIC were 0.22 at AP, 0.43 at PP and 0.45 at EP. NICAP was independently affected by VFA (β = 0.362, p < 0.001), smoking (β = -0.240, p = 0.001), and type-II diabetes (β = -0.449, p < 0.001); NICPP by VFA (β = -0.301, p = 0.017) and smoking (β = -0.291, p < 0.001); and NICEP by smoking (β = -0.154, p = 0.10) and alcohol consumption (β = -0.350, p < 0.001) with statistical power values over 0.81. CONCLUSION NIC values were consistent across institutions. Abdominal obesity, smoking, alcohol consumption, and diabetes are independent factors influencing pancreatic iodine uptake. CLINICAL RELEVANCE STATEMENT This study has provided reference normative values, influential factors and effective normalisation methods of pancreatic iodine uptake in multiphase dual-energy CT for future studies in this area as a new biological marker. KEY POINTS Evaluation of pancreatic iodine uptake measured by dual-energy CT is a promising method for future studies. Abdominal obesity, smoking, alcohol consumption, diabetes, and sex are independent factors influencing pancreatic iodine uptake. Utility of normalised iodine concentration is necessary to ensure the consistency across different institutions.
Collapse
Affiliation(s)
- Chen Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tao Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Jiani He
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Xiaomei Lu
- CT Clinical Science CT, Philips Healthcare, Shenyang, China
| | - Haiyan Tang
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Chao Shang
- Department of Neurobiology, School of Life Sciences, China Medical University, Shenyang, China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Aoran Yang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunli Li
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Minghui Zhou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
2
|
Matana Kaštelan Z, Brumini I, Poropat G, Tkalčić L, Grubešić T, Miletić D. Pancreatic Iodine Density and Fat Fraction on Dual-Energy Computed Tomography in Acute Pancreatitis. Diagnostics (Basel) 2024; 14:955. [PMID: 38732369 PMCID: PMC11083507 DOI: 10.3390/diagnostics14090955] [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: 03/28/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of our study was to investigate iodine density (ID) and fat fraction (FF) on dual-energy computed tomography (DECT) in patients with acute pancreatitis (AP). This retrospective study included 72 patients with clinically confirmed AP and 62 control subjects with DECT of the abdomen. Two radiologists assessed necrosis and measured attenuation values, ID, and FF in three pancreatic segments. We used receiver operating characteristic (ROC) analysis to determine the optimal threshold for ID for the differentiation between AP groups. The ID was significantly higher in interstitial edematous AP compared to necrotizing AP and the control group (both p < 0.05). The ROC curve analysis revealed the thresholds of ID for detecting pancreatic necrosis ≤ 2.2, ≤2.3, and ≤2.4 mg/mL (AUC between 0.880 and 0.893, p > 0.05) for the head, body, and tail, respectively. The FF was significantly higher for pancreatitis groups when compared with the control group in the head and body segments (both p < 0.001). In the tail, the difference was significant in necrotizing AP (p = 0.028). The ID values were independent of attenuation values correlated with the FF values in pancreatic tissue. Iodine density values allow for differentiation between morphologic types of AP.
Collapse
Affiliation(s)
- Zrinka Matana Kaštelan
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
| | - Ivan Brumini
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Anatomy, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
- Department of Radiological Technology, Faculty of Health Studies of the University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Goran Poropat
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia
- Department of Internal Medicine, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| | - Lovro Tkalčić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiological Technology, Faculty of Health Studies of the University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Tiana Grubešić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiology, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| | - Damir Miletić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiology, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| |
Collapse
|
3
|
Pacielli A, Vaudano GP, Bergamasco L, Prochet A, Gollini P, Perna ME. Assessment of post-thrombectomy brain hemorrhage in acute ischemic stroke with dual-energy CT: how reliable is it in clinical practice? LA RADIOLOGIA MEDICA 2024; 129:575-584. [PMID: 38368280 DOI: 10.1007/s11547-023-01749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/27/2023] [Indexed: 02/19/2024]
Abstract
PURPOSE Acute ischemic stroke is currently among the main causes of mortality in Western countries. The current guidelines suggest different flowcharts of diagnostic work-up and treatment modalities, including endovascular thrombectomy. Immediately after intra-arterial recanalization, a brain CT scan is usually performed to assess for the presence of peri-procedural complications; in this setting, it is very hard, if possible, to differentiate blood from iodinated contrast material, which is normally present in ischemic tissue because of BBB disruption. Dual-energy CT may be used for this purpose, exploiting its ability to discriminate different materials. MATERIALS AND METHODS We retrospectively studied 44 patients with acute ischemic stroke who were treated with endovascular recanalization at San Giovanni Bosco Hospital in Turin and were then scanned with DECT technology. Subsequent scan was used as standard, since iodine from contrast staining is usually reabsorbed in 24 h and blood persists longer. A χ2 test of independence was performed to examine the relationship between blood detected by DECT scan after the endovascular procedure and the presence of blood in the same areas on the following scans, with a significant result: χ2 (1, N = 37) = 10.7086, p = 0.0010. RESULTS Patients with blood detected on DECT scans had a double chance of having hemorrhagic infarction in follow-up scans, (RR 2.02). The sensitivity and specificity of DECT were respectively 70% and 90%, with an overall diagnostic accuracy of 76% and a positive and negative predictive value, respectively, of 95% and 53%. CONCLUSION Dual-energy CT scan after endovascular recanalization in ischemic stroke identifies early hemorrhagic infarction with excellent specificity and good overall diagnostic accuracy, representing a reliable diagnostic tool in everyday clinical practice.
Collapse
Affiliation(s)
- Alberto Pacielli
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy.
| | - Giacomo Paolo Vaudano
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino - A.O.U. Città della Salute e della Scienza di Torino, C.So Bramante 88, 10126, Turin, Italy
| | - Adolfo Prochet
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Paola Gollini
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Maria Elena Perna
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| |
Collapse
|
4
|
Yel I, Koch V, Gruenewald LD, Mahmoudi S, Alizadeh LS, Goekduman A, Eichler K, Vogl TJ, Dimitrova M, Booz C. Advancing Differentiation of Hepatic Metastases in Malignant Melanoma through Dual-Energy Computed Tomography Rho/Z Maps. Diagnostics (Basel) 2024; 14:742. [PMID: 38611654 PMCID: PMC11012221 DOI: 10.3390/diagnostics14070742] [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: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT)-based Rho/Z maps in differentiating between metastases and benign liver lesions in patients diagnosed with malignant melanoma compared to conventional CT value measurements. METHODS This retrospective study included 73 patients (mean age, 70 ± 13 years; 43 m/30 w) suffering from malignant melanoma who had undergone third-generation DECT as part of tumor staging between December 2017 and December 2021. For this study, we measured Rho (electron density) and Z (effective atomic number) values as well as Hounsfield units (HUs) in hypodense liver lesions. Values were compared, and diagnostic accuracy for differentiation was computed using receiver operating characteristic (ROC) curve analyses. Additional performed MRI or biopsies served as a standard of reference. RESULTS A total of 136 lesions (51 metastases, 71 cysts, and 14 hemangiomas) in contrast-enhanced DECT images were evaluated. The most notable discrepancy (p < 0.001) between measured values and the highest diagnostic accuracy for distinguishing melanoma metastases from benign cysts was observed for the Z (0.992; 95% CI, 0.956-1) parameters, followed by Rho (0.908; 95% CI, 0.842-0.953) and finally HU120kV (0.829; 95% CI, 0.751-0.891). Conversely, when discriminating between liver metastases and hemangiomas, the HU120kV parameters showed the most significant difference (p < 0.001) and yielded the highest values for diagnostic accuracy (0.859; 95% CI, 0.740-0.937), followed by the Z parameters (0.790; 95% CI, 0.681-0.876) and finally the Rho values (0.621; 95% CI, 0.501-0.730). CONCLUSIONS Rho and Z measurements derived from DECT allow for improved differentiation of liver metastases and benign liver cysts in patients with malignant melanoma compared to conventional CT value measurements. In contrast, in differentiation between liver hemangiomas and metastases, Rho/Z maps show inferior diagnostic accuracy. Therefore, differentiation between these two lesions remains a challenge for CT imaging.
Collapse
|
5
|
Ozturk MO, Aydin S. Complementary comments on diagnosis, severity and prognosis prediction of acute pancreatitis. World J Gastroenterol 2024; 30:108-111. [PMID: 38293323 PMCID: PMC10823899 DOI: 10.3748/wjg.v30.i1.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma, diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis. Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis, and dual energy computed tomography is also useful in severity assessment and prognosis prediction. Walled off necrosis is an important complication in terms of prognosis, and it is important to know its radiological findings and distinguish it from pseudocyst.
Collapse
Affiliation(s)
- Muhsin Ozgun Ozturk
- Department of Radiology, Erzincan Binali Yildirim University, Erzincan 24000, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yildirim University, Erzincan 24000, Turkey
| |
Collapse
|
6
|
Wöltjen MM, Kröger JR. [Current CT developments in imaging of pancreatic diseases]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:878-885. [PMID: 37947865 DOI: 10.1007/s00117-023-01230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Diseases of the pancreas are often diagnosed late and can have fatal consequences for patients. PURPOSE Current computed tomography (CT) developments in imaging of pancreatic diseases. MATERIALS AND METHODS Evaluation of numerous studies, especially considering modern CT techniques such as dual-energy CT and photon-counting CT but also artificial intelligence (AI) algorithms for disease detection. RESULTS Spectral imaging using dual-energy CT and photon-counting CT offers numerous advantages in the detection of pancreatic disease and can thus improve diagnostic performance but also provide additional information on any therapeutic response. Likewise, advances in the development of AI algorithms are improving diagnostic performance. CONCLUSION In the future, we can expect increasingly improved detection of pancreatic diseases, thereby enabling patients to be treated more quickly, which will consequently result in improved outcomes.
Collapse
|
7
|
Srinivas-Rao S, Cao J, Marin D, Kambadakone A. Dual-Energy Computed Tomography to Photon Counting Computed Tomography: Emerging Technological Innovations. Radiol Clin North Am 2023; 61:933-944. [PMID: 37758361 DOI: 10.1016/j.rcl.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Computed tomography (CT) has seen remarkable developments in the past several decades, radically transforming the role of imaging in day-to-day clinical practice. Dual-energy CT (DECT), an exciting innovation introduced in the early part of this century, has widened the scope of CT, opening new opportunities due to its ability to provide superior tissue characterization. The introduction of photon-counting CT (PCCT) heralds a paradigm shift in CT scanner technology representing another significant milestone in CT innovation. PCCT offers several advantages over DECT, such as improved spectral resolution, enhanced tissue characterization, reduced image artifacts, and improved image quality.
Collapse
Affiliation(s)
- Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA
| | - Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC 27710, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114-2696, USA.
| |
Collapse
|
8
|
Yuan Y, Liao K, Huang Z, Deng L, Tang H, Wang Y, Ye Z, Chen X, Song B, Li Z. Feasibility of using software-aided selection of virtual monoenergetic level for optimal image quality of acute necrotising pancreatitis based on dual-energy computed tomography: a preliminary study. BMC Med Imaging 2023; 23:95. [PMID: 37464338 PMCID: PMC10355045 DOI: 10.1186/s12880-023-01032-3] [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: 10/27/2022] [Accepted: 05/23/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of software-aided selection of monoenergetic level for acute necrotising pancreatitis (ANP) depiction compared to other automatic image series generated using dual-energy computed tomography (CT). METHODS The contrast-enhanced dual-source dual-energy CT images in the portal venous phase of 48 patients with ANP were retrospectively analysed. Contrast-to-noise ratio (CNR) of pancreatic parenchyma-to-necrosis, signal-to-noise ratio (SNR) of the pancreas, image noise, and score of subjective diagnosis were measured, calculated, and compared among the CT images of 100 kV, Sn140 kV, weighted-average 120 kV, and optimal single-energy level for CNR. RESULTS CNR of pancreatic parenchyma-to-necrosis in the images of 100 kV, Sn140 kV, weighted-average 120 kV, and the optimal single-energy level for CNR was 5.18 ± 2.39, 3.13 ± 1.35, 5.69 ± 2.35, and 9.99 ± 5.86, respectively; SNR of the pancreas in each group was 6.31 ± 2.77, 4.27 ± 1.56, 7.21 ± 2.69, and 11.83 ± 6.30, respectively; image noise in each group was 18.78 ± 5.20, 17.79 ± 4.63, 13.28 ± 3.13, and 9.31 ± 2.96, respectively; and score of subjective diagnosis in each group was 3.56 ± 0.50, 3.00 ± 0.55, 3.48 ± 0.55, and 3.88 ± 0.33, respectively. The four measurements of the optimal single-energy level for CNR images were significantly different from those of images in the other three groups (P < 0.05). CNR of pancreatic parenchyma-to-necrosis, SNR of the pancreas, and score of subjective diagnosis in the images of the optimal single-energy level for CNR were significantly higher, while the image noise was lower than those in the other three groups (all P = 0.000). CONCLUSION Optimal single-energy level imaging for CNR of dual-source CT could improve quality of CT images in patients with ANP, enhancing the display of necrosis in the pancreas.
Collapse
Affiliation(s)
- Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Kai Liao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Liping Deng
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Xinyue Chen
- CT collaboration, Siemens-healthineers, Chengdu, 610041, Sichuan, P.R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China.
| |
Collapse
|
9
|
Eklund MJ, States LJ, Acord MR, Alazraki AL, Behr GG, El-Ali AM, Morin CE, Saigal G, Shet NS, Thacker PG, Trout AT. Imaging of pediatric pancreas tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29975. [PMID: 36215203 PMCID: PMC10642208 DOI: 10.1002/pbc.29975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
Primary pancreatic tumors in children are rare with an overall age-adjusted incidence of 0.018 new cases per 100,000 pediatric patients. The most prevalent histologic type is the solid pseudopapillary neoplasm, followed by pancreatoblastoma. This paper describes relevant imaging modalities and presents consensus-based recommendations for imaging at diagnosis and follow-up.
Collapse
Affiliation(s)
- Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adina L Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M El-Ali
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Narendra S Shet
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
10
|
Borges AP, Antunes C, Caseiro-Alves F. Spectral CT: Current Liver Applications. Diagnostics (Basel) 2023; 13:diagnostics13101673. [PMID: 37238163 DOI: 10.3390/diagnostics13101673] [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: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Using two different energy levels, dual-energy computed tomography (DECT) allows for material differentiation, improves image quality and iodine conspicuity, and allows researchers the opportunity to determine iodine contrast and radiation dose reduction. Several commercialized platforms with different acquisition techniques are constantly being improved. Furthermore, DECT clinical applications and advantages are continually being reported in a wide range of diseases. We aimed to review the current applications of and challenges in using DECT in the treatment of liver diseases. The greater contrast provided by low-energy reconstructed images and the capability of iodine quantification have been mostly valuable for lesion detection and characterization, accurate staging, treatment response assessment, and thrombi characterization. Material decomposition techniques allow for the non-invasive quantification of fat/iron deposition and fibrosis. Reduced image quality with larger body sizes, cross-vendor and scanner variability, and long reconstruction time are among the limitations of DECT. Promising techniques for improving image quality with lower radiation dose include the deep learning imaging reconstruction method and novel spectral photon-counting computed tomography.
Collapse
Affiliation(s)
- Ana P Borges
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Célia Antunes
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Filipe Caseiro-Alves
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| |
Collapse
|
11
|
Extracellular Volume Fraction Calculated Using Contrast-Enhanced Computed Tomography as a Biomarker of Oxaliplatin-Induced Sinusoidal Obstruction Syndrome: A Preliminary Histopathological Analysis. JOURNAL OF ONCOLOGY 2023; 2023:1440257. [PMID: 36824665 PMCID: PMC9943597 DOI: 10.1155/2023/1440257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
Background Oxaliplatin (OX)-based chemotherapy induces sinusoidal obstruction syndrome (SOS) in the nontumorous liver parenchyma, which can increase the risk of liver resection due to colorectal liver metastasis (CRLM). The extracellular volume (ECV) calculated from contrast-enhanced computed tomography (CT) has been reported to reflect the morphological change of hepatic fibrosis. The present retrospective study aimed to evaluate the ECV fraction as a predictive factor for OX-induced SOS. Methods Our study included 26 patients who underwent liver resection for CRLM after OX-based chemotherapy with a preoperative dynamic CT of appropriate quality. We investigated the relationship between the pathological SOS grade and the ECV fraction. Results Overall, 26 specimens from the patients were graded with the SOS classification of Rubbia-Brandt et al. as follows: grade 0, n = 17 (65.4%); grade 1, n = 4 (15.4%); and grade 2, n = 5 (19.2%). No specimens showed grade 3 SOS. In a univariate analysis, the ECV fraction in grade 0 SOS was significantly lower than that in grade 1 + 2 SOS (26.3 ± 3.4% vs. 30.6 ± 7.0%; P = 0.025). The cutoff value and AUC value of the ECV fraction to distinguish between grades 0 and 1 + 2 were 27.5% and 0.771, respectively. Conclusions Measurement of the ECV fraction was found to be a potential noninvasive diagnostic method for determining early-stage histopathological sinusoidal injury induced by OX-based chemotherapy.
Collapse
|
12
|
Huang S, Liang Y, Zhong X, Luo Q, Yao X, Nong Z, Luo Y, Luo L, Jiang W, Qin X, Lv Y. Pancreatic fat fraction in dual-energy computed tomography as a potential quantitative parameter in the detection of type 2 diabetes mellitus. Eur J Radiol 2023; 159:110668. [PMID: 36608599 DOI: 10.1016/j.ejrad.2022.110668] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/01/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the clinical value of measuring pancreatic fat fraction using dual-energy computed tomography (DECT) in association with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective study included patients who underwent abdominal DECT between September 2021 and July 2022. The fat fractions in the head, body, and tail of the pancreas were calculated using fat maps generated from unenhanced DECT images, and CT values were measured at the same locations. The intraclass correlation coefficient (ICC) was used to analyze the reproducibility of measurements from two observers. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS Seventy-eight patients, including 45 T2DM patients and 33 controls, were enrolled. The fat fractions of the pancreas were significantly higher in the T2DM group than in the control group (pancreatic head: 8.4 ± 6.3 % vs 5.1 ± 3.9 %; pancreatic body: 4.8 ± 4.0 % vs 2.7 ± 3.9 %; and pancreatic tail: 5.3 ± 3.2 % vs 2.7 ± 2.9 %, all p < 0.05). And the CT values of the pancreas were significantly lower in the T2DM group than in the control group (pancreatic head: 41.1 ± 8.5 HU vs 45.7 ± 4.6 HU; pancreatic body: 44.4 ± 5.0 HU vs 47.4 ± 3.7 HU; and pancreatic tail: 44.5 ± 5.0 HU vs 47.6 ± 3.2 HU, all p < 0.05). The fat fraction of the pancreatic tail was the best indicator for distinguishing T2DM patients from the controls (area under the curve: 0.716 (95 % CI: 0.601, 0.832), sensitivity: 64.4 % (95 % CI: 48.7 %, 77.7 %), and specificity: 78.8 % (95 % CI: 60.6 %, 90.4 %)). CONCLUSION The DECT fat fractions of the pancreas could be a valuable additional parameter in the detection of T2DM.
Collapse
Affiliation(s)
- Shiqi Huang
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Yuhong Liang
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Xixi Zhong
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Qunzhi Luo
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Xinqun Yao
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Zhuo Nong
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Yi Luo
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Lian Luo
- Siemens Healthineers Ltd, Guangzhou 510080, Guangdong, PR China
| | - Wei Jiang
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Xiangyun Qin
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China
| | - Yaping Lv
- Department of Radiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou 545007, Guangxi, PR China.
| |
Collapse
|
13
|
Wu J, Qiao H. Medical Imaging Technology and Imaging Agents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1199:15-38. [PMID: 37460725 DOI: 10.1007/978-981-32-9902-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Medical imaging is a technology that studies the interaction between human body and irradiations of X-ray, ultrasound, magnetic field, etc. and represents anatomical structures of human organs/tissues with the implication of irradiation attenuation in the form of grayscales. With these medical images, detailed information on health status and disease diagnosis may be judged by clinical physicians to determine an appropriate therapy approach. This chapter will give a systematic introduction on the modalities, classifications, basic principles, and biomedical applications of traditional medical imaging along with the types, construction, and major features of the corresponding contrast agents or imaging probes.
Collapse
Affiliation(s)
- Jieting Wu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Huanhuan Qiao
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
| |
Collapse
|
14
|
Multi-Energy CT Applications. Radiol Clin North Am 2023; 61:1-21. [DOI: 10.1016/j.rcl.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
15
|
Kai K, Hiyoshi M, Imamura N, Hamada T, Yano K, Sato Y, Sakae T, Komi M, Nakamura T, Choijookhuu N, Hishikawa Y, Nanashima A. A Preliminary Pathological Evaluation of Extracellular Volume Fraction with Contrast-enhanced Computed Tomography as a Novel Quantitative Parameter of Pancreatic Fibrosis. Intern Med 2023; 62:1107-1115. [PMID: 37062714 PMCID: PMC10183286 DOI: 10.2169/internalmedicine.0410-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Objective The extracellular volume (ECV) calculated based on contrast-enhanced computed tomography (CT) has been reported as a novel imaging parameter reflecting the morphological change of fibrosis in several parenchymal organs. Our retrospective study assessed the validity of the ECV fraction for diagnosing pancreatic fibrosis and the appropriate imaging condition as the "equilibrium phase". Methods In 27 patients undergoing multiphasic CT and subsequent pancreaticoduodenectomy, we investigated pathological fibrotic changes related to the ECV fraction and conducted analyses using the value obtained by subtracting the equilibrium CT value of the portal vein from that of the abdominal aorta (Ao-PVequilibrium) to estimate eligibility of the equilibrium phase. Results In all patients, the ECV fraction showed a weak positive correlation with the collagenous compartment ratio (r=0.388, p=0.045). All patients were divided into two groups - the high-Ao-PVequilibrium group and low-Ao-PVequilibrium group - based on the median value. No significant correlation was found in the high-Ao-PVequilibrium group, whereas a significant correlation was observed in the low-Ao-PVequilibrium group (r=0.566, p=0.035). Conclusion The ECV fraction is a possible predictive factor for histopathological pancreatic fibrosis. In its clinical application, the eligibility of the "equilibrium phase" may affect the diagnostic capability. It will be necessary to verify the imaging conditions in order to improve the accuracy of the diagnosis.
Collapse
Affiliation(s)
- Kengo Kai
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| | - Masahide Hiyoshi
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| | - Naoya Imamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| | - Takeomi Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| | - Koichi Yano
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, University of Miyazaki Faculty of Medicine, Japan
| | - Takehumi Sakae
- Department of Radiology, University of Miyazaki Faculty of Medicine, Japan
| | - Masanori Komi
- Department of Radiology, University of Miyazaki Faculty of Medicine, Japan
| | - Takashi Nakamura
- Department of Radiology, University of Miyazaki Faculty of Medicine, Japan
| | - Narantsog Choijookhuu
- Department of Anatomy, Histochemistry and Cell Biology, University of Miyazaki Faculty of Medicine, Japan
| | - Yoshitaka Hishikawa
- Department of Anatomy, Histochemistry and Cell Biology, University of Miyazaki Faculty of Medicine, Japan
| | - Atsushi Nanashima
- Department of Surgery, University of Miyazaki Faculty of Medicine, Japan
| |
Collapse
|
16
|
CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3770-3781. [PMID: 35972550 DOI: 10.1007/s00261-022-03638-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the significance of CT perfusion parameters predicting response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Seventy patients with PDAC prospectively had CT perfusion acquisition incorporated into baseline multiphase staging CT. Twenty-eight who were naïve to therapy were retained for further investigation. Perfusion was performed 5-42.5 s after contrast, followed by parenchymal and portal venous phases. Blood flow (BF), blood volume (BV), and permeability surface area product (PS) were calculated using deconvolution algorithms. Patients were categorized as responders or non-responders per RECIST 1.1. Perfusion variables with AUC ≥ 0.70 in differentiating responders from non-responders were retained. Logistic regression was used to assess associations between baseline perfusion variables and response. RESULTS 18 of 28 patients showed favorable response to therapy. Baseline heterogeneity variables in tumor max ROI were higher in non-responders than responders [median BF coefficient of variation (CV) 0.91 vs. 0.51 respectively, odds ratio (OR) 6.8 per one standard deviation (1-SD) increase, P = 0.047; median PS CV 1.6 vs. 0.68, OR 3.9 per 1-SD increase, P = 0.047; and median BV CV 0.75 vs. 0.54, OR = 4.0 per 1-SD increase, P = 0.047]. Baseline BV mean in tumor center was lower in non-responders than responders (median BV mean: 0.74 vs. 2.9 ml/100 g respectively, OR 0.28 per 1-SD increase, P = 0.047). CONCLUSION For patients with PDAC receiving neoadjuvant therapy, lower and more heterogeneous perfusion parameters correlated with an unfavorable response to therapy. Such quantitative information can be acquired utilizing a comprehensive protocol interleaving perfusion CT acquisition with standard of care multiphase CT scans using a single contrast injection, which could be used to identify surgical candidates and predict outcome.
Collapse
|
17
|
Value of Dual-Energy CT Perfusion Analysis in Patients with Acute Pancreatitis: Correlation and Discriminative Diagnostic Accuracy with Varying Disease Severity. Diagnostics (Basel) 2022; 12:diagnostics12112601. [PMID: 36359446 PMCID: PMC9689096 DOI: 10.3390/diagnostics12112601] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study investigates the correlation and discriminative diagnostic accuracy of dual-energy CT (DECT)-derived imaging biomarkers in patients with acute pancreatitis of varying severity. Methods: In this retrospective study, we included 51 patients with acute pancreatitis who had undergone portal-venous phase DECT of the abdomen. Three blinded readers independently performed region-of-interest measurements on DECT images in the inflammatory pancreatic parenchyma. The correlation between modified CT severity index (CTSI) and quantitative imaging parameters was investigated using Pearson correlation coefficient. We performed receiver operator curve (ROC) analysis to assess diagnostic accuracy of the quantitative image parameters for the differentiation between mild/moderate versus severe acute pancreatitis. The optimal discriminative cut-off value to diagnose severe acute pancreatitis was determined using the Youden index. Results: Moderate correlations were found between CTSI scores and iodine density (Pearson’s correlation coefficient r = −0.65; p < 0.001), as well as attenuation (r = −0.55; p < 0.001) and normalized iodine uptake (r = −0.50; p < 0.001). ROC curve analysis revealed highest ability to differentiate mild/moderate from severe acute pancreatitis for iodine density (AUC = 0.86, 95% confidence interval 0.75 to 0.97). An optimal iodine density threshold of ≤1.63 mg/mL was found to indicate severe acute pancreatitis with a sensitivity of 81.3% and specificity of 77.1%. Conclusion: DECT-derived iodine density correlates with acute pancreatitis severity and may facilitate prediction of severe acute pancreatitis.
Collapse
|
18
|
Virarkar MK, Vulasala SSR, Gupta AV, Gopireddy D, Kumar S, Hernandez M, Lall C, Bhosale P. Virtual Non-contrast Imaging in The Abdomen and The Pelvis: An Overview. Semin Ultrasound CT MR 2022; 43:293-310. [PMID: 35738815 DOI: 10.1053/j.sult.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Virtual non-contrast (VNC) imaging is a post-processing technique generated from contrast-enhanced scans using dual-energy computed tomography (DECT). It is generated by removing iodine from imaging acquired at multiple energies. Myriad clinical studies have shown its ability to diagnose the various abdominal and pelvic pathologies discussed in the article. VNC is also a problem-solving tool for characterizing incidentally detected lesions ("incidentalomas"), often decreasing the need for additional follow-up imaging. It also obviates the multiphase image acquisitions to evaluate hematuria, hepatic steatosis, aortic endoleaks, and gastrointestinal bleeding by generating image datasets from different tissue attenuation values. The scope of this article is to provide an overview of various applications of VNC imaging obtained by DECT in the abdomen and pelvis.
Collapse
Affiliation(s)
- Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mauricio Hernandez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
19
|
Mroueh N, Cao J, Kambadakone A. Dual-Energy CT in the Pancreas. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1744494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an evolving imaging technology that is gaining popularity, particularly in different abdominopelvic applications. Essentially, DECT uses two energy spectra simultaneously to acquire CT attenuation data which is used to distinguish among structures with different tissue composition. The wide variety of reconstructed image data sets makes DECT especially attractive in pancreatic imaging. This article reviews the current literature on DECT as it applies to imaging the pancreas, focusing on pancreatitis, trauma, pancreatic ductal adenocarcinoma, and other solid and cystic neoplasms. The advantages of DECT over conventional CT are highlighted, including improved lesion detection, radiation dose reduction, and enhanced image contrast. Additionally, data exploring the ideal protocol for pancreatic imaging using DECT is reviewed. Finally, limitations of DECT in pancreatic imaging as well as recommendations for future research are provided.
Collapse
Affiliation(s)
- Nayla Mroueh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
20
|
Ebrahimian S, Singh R, Netaji A, Madhusudhan KS, Homayounieh F, Primak A, Lades F, Saini S, Kalra MK, Sharma S. Characterization of Benign and Malignant Pancreatic Lesions with DECT Quantitative Metrics and Radiomics. Acad Radiol 2022; 29:705-713. [PMID: 34412944 DOI: 10.1016/j.acra.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES To compare dual energy CT (DECT) quantitative metrics and radiomics for differentiating benign and malignant pancreatic lesions on contrast enhanced abdomen CT. MATERIALS AND METHODS Our study included 103 patients who underwent contrast-enhanced DECT for assessing focal pancreatic lesions at one of the two hospitals (Site A: age 68 ± 12 yrs; malignant = 41, benign = 18; Site B: age 46 ± 2 yrs; malignant = 23, benign = 21). All malignant lesions had histologic confirmation, and benign lesions were stable on follow up CT (>12 months) or had characteristic benign features on MRI. Arterial-phase, low- and high-kV DICOM images were processed with the DECT Tumor Analysis (DETA) to obtain DECT quantitative metrics such as HU, iodine and water content from a region of interest (ROI) over focal pancreatic lesions. Separately, we obtained DECT radiomics from the same ROI. Data were analyzed with multiple logistic regression and receiver operating characteristics to generate area under the curve (AUC) for best predictive variables. RESULTS DECT quantitative metrics and radiomics had AUCs of 0.98-0.99 at site A and 0.89-0.94 at site B data for classifying benign and malignant pancreatic lesions. There was no significant difference in the AUCs and accuracies of DECT quantitative metrics and radiomics from lesion rims and volumes among patients at both sites (p > 0.05). Supervised learning-based model with data from the two sites demonstrated best AUCs of 0.94 (DECT radiomics) and 0.90 (DECT quantitative metrics) for characterizing pancreatic lesions as benign or malignant. CONCLUSION Compared to complex DECT radiomics, quantitative DECT information provide a simpler but accurate method of differentiating benign and malignant pancreatic lesions.
Collapse
Affiliation(s)
- Shadi Ebrahimian
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom court, Boston, MA 02114
| | - Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom court, Boston, MA 02114
| | - Arjunlokesh Netaji
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Fatemeh Homayounieh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom court, Boston, MA 02114
| | - Andrew Primak
- Siemens Medical Solutions USA Inc., Malvern, Pennsylvania
| | | | - Sanjay Saini
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom court, Boston, MA 02114
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom court, Boston, MA 02114.
| | - Sanjay Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
21
|
Utility of Quantitative Metrics from Dual-Layer Spectral-Detector CT for Differentiation of Pancreatic Neuroendocrine Tumor and Neuroendocrine Carcinoma. AJR Am J Roentgenol 2022; 218:999-1009. [PMID: 35043668 DOI: 10.2214/ajr.21.27017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The 2019 WHO classification separates neuroendocrine neoplasms (NENs) into neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC), which are considered to represent pathologically distinct entities warranting different management approaches. Dual-layer spectral-detector CT (DLCT) may aid their differentiation through specific material decomposition. Objective: To assess the utility of quantitative metrics derived from DLCT for the differentiation of pancreatic NET and NEC. Methods: This retrospective study included 104 patients (mean age 51±13 years; 53 women, 51 men) with pathologically confirmed NEN [89 NET, including 22 grade 1, 48 grade 2, and 19 grade 3 (G3); 15 NEC], who underwent multiphase DLCT within 15 days before biopsy or resection. Two radiologists independently placed ROIs to record tumor attenuation, iodine concentration (IC), and effective atomic number (Zeff) across phases, and also assessed qualitative features (composition, homogeneity, margins, calcifications, main pancreatic duct dilation, vascular invasion, lymphadenopathy). Interreader agreement was assessed. Mean values between readers were obtained for quantitative measures; consensus was reached for qualitative features. NET and NEC were compared using multivariable regression analysis and ROC analysis. Results: Interobserver agreement, expressed as intraclass correlation coefficients, ranged from 0.879 to 0.992 for quantitative metrics, and, expressed as kappa coefficients, from 0.763 to 0.823 for qualitative features. In multivariable analysis of qualitative and quantitative features, significant independent predictors of NEC (P<.05) were IC in portal venous phase (1.3 mg/mL in NEC vs 2.7 mg/mL in NET), Zeff in portal venous phase (8.1 vs 8.6), and attenuation in portal venous phase (78.2 vs 113.5 HU). AUC for predicting NEC was 0.897 for IC, 0.884 for Zeff, 0.921 for combination of IC and Zeff, and 0.855 for attenuation. Predicted probability based on combination of IC and Zeff achieved sensitivity of 93.3% and specificity of 80.9% for NEC. Significant independent predictors (P<.05) for differentiating G3 NET and NEC were IC (1.3 vs 2.0 mg/mL; AUC=0.789) and attenuation (78.2 vs 90.3 HU; AUC=0.647), both measured in portal venous phase. Conclusion: Incorporation of DLCT-metrics improves differentiation of NET and NEC compared with conventional CT attenuation and qualitative features. Clinical Impact: DLCT may help select patients with pancreatic NENs for platinum-based chemotherapies.
Collapse
|
22
|
Qiu L, Hu J, Weng Z, Liu S, Jiang G, Cai X. A prospective study of dual-energy computed tomography for differentiating metastatic and non-metastatic lymph nodes of colorectal cancer. Quant Imaging Med Surg 2021; 11:3448-3459. [PMID: 34341722 DOI: 10.21037/qims-20-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
Background Colorectal cancer (CRC) is the third most common malignancy worldwide, and lymph node metastasis is considered to be a risk factor for local recurrence and a poor prognosis in colorectal cancer. However, there remains a lack of reliable and non-invasive biomarkers to identify the lymph node status of CRC patients preoperatively. The purpose of this study was to explore the ability of dual-energy computed tomography (DECT) to differentiate metastatic from non-metastatic lymph nodes in colorectal cancer. Methods Seventy-one patients with primary colorectal cancer underwent contrast-enhanced dual-energy computed tomography imaging preoperatively. The colorectal specimen was scanned postoperatively, and lymph nodes were matched to the pathology report. The following dual-energy computed tomography quantitative parameters were analyzed: dual-energy curve slope value (λHU), standardized iodine concentration (n△HU), iodine water ratio (nIWR), electron density value (nρeff), and effective atom-number (nZ), based on metastatic and non-metastatic lymph node differentiation. Also, sensitivity and specificity analyses were performed using receiver operating characteristic curves. Results In all patients, one hundred and fifty lymph nodes, including 66 non-metastatic and 84 metastatic lymph nodes, were matched using the radiological-pathological correlation. Metastatic nodes had significantly greater λHU, n△HU, and nIWR values than non-metastatic nodes in both the arterial and venous phases (P<0.01). The area under curve (AUC), sensitivity, and specificity were 0.80, 80%, and 66% for λHU; 0.86, 70%, and 95% for n△HU; and 0.88, 71%, and 95% for nIWR in the arterial phase. There was no significant difference in electron density and effective Z values between metastatic and non-metastatic lymph nodes. Conclusions DECT quantitative parameters may help differentiate between metastatic and normal lymph nodes in patients with CRC.
Collapse
Affiliation(s)
- Lin Qiu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Junjiao Hu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zeping Weng
- Pathology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sirun Liu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guangyu Jiang
- Pathology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiangran Cai
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
23
|
Laroia ST, Yadav K, Kumar S, Rastogi A, Kumar G, Sarin SK. Material decomposition using iodine quantification on spectral CT for characterising nodules in the cirrhotic liver: a retrospective study. Eur Radiol Exp 2021; 5:22. [PMID: 34046753 PMCID: PMC8160046 DOI: 10.1186/s41747-021-00220-6] [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: 08/04/2020] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background There is limited scientific evidence on the potential of spectral computed tomography (SCT) for differentiation of nodules in the cirrhotic liver. We aimed to assess SCT-generated material density (MD) parameters for nodule characterisation in cirrhosis. Methods Dynamic dual-energy SCT scans of cirrhotic patients performed over 3 years were retrospectively reviewed. They were classified as hepatocellular carcinoma (HCC), regenerative or indeterminate, according to the European Association for the Study of the Liver criteria. MD maps were generated to calculate the area under the curve (AUC) and cutoff values to discriminate these nodules in the hepatic arterial phase (HAP) and portal venous phase (PVP). MD maps included iodine concentration density (ICD) of the liver and nodule, lesion-to-normal liver ICD ratio (LNR) and difference in nodule ICD between HAP and PVP. Results Three hundred thirty nodules belonging to 300 patients (age 53.0 ± 12.7 years, mean ± standard deviation) were analysed at SCT (size 2.3 ± 0.8 cm, mean ± SD). One hundred thirty-three (40.3%) nodules were classified as HCC, 147 (44.5%) as regenerative and 50 (15.2%) as indeterminate. On histopathology, 136 (41.2%) nodules were classified as HCC, 183 (55.5%) as regenerative and 11 (3.3%) as dysplastic. All MD parameters on HAP and the nodule difference in ICD could discriminate pathologically proven HCC or potentially malignant nodules from regenerative nodules (p < 0.001). The AUC was 82.4% with a cutoff > 15.5 mg/mL for nodule ICD, 81.3% > 1.8 for LNR-HAP and 81.3% for difference in ICD > 3.5 mg/mL. Conclusion SCT-generated MD parameters are viable diagnostic tools for differentiating malignant or potentially malignant from benign nodules in the cirrhotic liver. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00220-6.
Collapse
Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Komal Yadav
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Senthil Kumar
- Department of HPB Surgery and Liver Transplantation, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Archana Rastogi
- Department of Clinical and Hepato-pathology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Guresh Kumar
- Department of Biostatistics and Research, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| |
Collapse
|
24
|
The extracellular volume fraction of the pancreas measured by dual-energy computed tomography: The association with impaired glucose tolerance. Eur J Radiol 2021; 141:109775. [PMID: 34020172 DOI: 10.1016/j.ejrad.2021.109775] [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: 03/06/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the clinical value of measuring the ECV fraction of the pancreas by DECT in association with an impaired glucose tolerance (IGT) estimated by the hemoglobin A1C (HbA1C) value in patients with or without cirrhosis. MATERIALS AND METHODS This retrospective study included patients who underwent contrast-enhanced dynamic CT with dual-energy mode between March 2018 and February 2019. The ECV fraction of the pancreas was calculated from iodine map images created from equilibrium-phase contrast-enhanced DECT images. The cross-sectional areas of the pancreas were also measured. RESULTS In total, 51 patients were analyzed (median age, 69 years old; 22 women). The ECV fraction of the pancreas showed a significant negative correlation with the HbA1c value in the cirrhotic group (ρ=-0.346, p = 0.048), while there was no significant correlation in the non-cirrhotic group (ρ=-0.086, p = 0.734). In the elevated HbA1C group, the ECV fraction of the pancreas in the cirrhotic patients (median, 0.247; interquartile range [IQR], 0.098) was significantly lower than that in the non-cirrhotic patients (0.332, IQR 0.113) (p = 0.024). In the elevated HbA1C group, the cross-sectional area of the pancreas was significantly larger in the cirrhotic patients than that in the non-cirrhotic patients (median [IQR]; 2945 [904] vs. 1885 [909] mm2, p = 0.019). CONCLUSION A reduction in the ECV fraction of the pancreas measured by DECT as well as the enlargement of the pancreatic parenchyma was observed in cirrhotic patients with IGT. These findings suggest that the measurement of the pancreatic ECV fraction by DECT may help clarify the pathophysiology of IGT in patients with cirrhosis.
Collapse
|
25
|
Metal artifact reduction and tumor detection using photon-counting multi-energy computed tomography. PLoS One 2021; 16:e0247355. [PMID: 33667250 PMCID: PMC7935306 DOI: 10.1371/journal.pone.0247355] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Metal artifacts are considered a major challenge in computed tomography (CT) as these adversely affect the diagnosis and treatment of patients. Several approaches have been developed to address this problem. The present study explored the clinical potential of a novel photon-counting detector (PCD) CT system in reducing metal artifacts in head CT scans. In particular, we studied the recovery of an oral tumor region located under metal artifacts after correction. Three energy thresholds were used to group data into three bins (bin 1: low-energy, bin 2: middle-energy, and bin 3: high-energy) in the prototype PCD CT system. Three types of physical phantoms were scanned on the prototype PCD CT system. First, we assessed the accuracy of iodine quantification using iodine phantoms at varying concentrations. Second, we evaluated the performance of material decomposition (MD) and virtual monochromatic images (VMIs) using a multi-energy CT phantom. Third, we designed an ATOM phantom with metal insertions to verify the effect of the proposed metal artifact reduction. In particular, we placed an insertion-mimicking an iodine-enhanced oral tumor in the beam path of metallic objects. Normalized metal artifact reduction (NMAR) was performed for each energy bin image, followed by an image-based MD and VMI reconstruction. Image quality was analyzed quantitatively by contrast-to-noise ratio (CNR) measurements. The results of iodine quantification showed a good match between the true and measured iodine concentrations. Furthermore, as expected, the contrast between iodine and the surrounding material was higher in bin 1 image than in bin 3 image. On the other hand, the bin 3 image of the ATOM phantom showed fewer metal artifacts than the bin 1 image because of the higher photon energy. The result of quantitative assessment demonstrated that the 40-keV VMI (CNR: 20.6 ± 1.2) with NMAR and MD remarkably increased the contrast of the iodine-enhanced region compared with that of the conventional images (CNR: 10.4 ± 0.5) having 30 to 140 keV energy levels. The PCD-based multi-energy CT imaging has immense potential to maximize the contrast of the target tissue and reduce metal artifacts simultaneously. We believe that it would open the door to novel applications for the diagnosis and treatment of several diseases.
Collapse
|
26
|
CT severity indices derived from low monoenergetic images at dual-energy CT may improve prediction of outcome in acute pancreatitis. Eur Radiol 2021; 31:4710-4719. [PMID: 33404695 DOI: 10.1007/s00330-020-07477-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether imaging features and severity indices using low monoenergetic DECT images improve diagnostic conspicuity and outcome prediction in acute pancreatitis compared to conventional images. METHODS A retrospective study of patients with clinical and radiographic signs of acute pancreatitis who underwent 50 contrast-enhanced CT exams conducted on a single-source DECT was performed. Representative conventional and 50 keV-monoenergetic images were randomized and presented to four abdominal radiologists to determine preferred imaging for detecting fat stranding and parenchymal inflammation. Contrast and signal-to-noise ratios were constructed for necrotic, hypoattenuated, inflamed, and healthy parenchyma. These parameters and the CT severity index (CTSI) were compared between conventional and low monoenergetic images using paired t tests and correlated to clinical outcome. RESULTS Although preference for conventional images was noted for subtle peri-pancreatic fat stranding (169/200 (85%) reads), there was clear preference for low monoenergetic images among all readers for pancreatic inflammation evaluation (188/200 (94%) reads). Moreover, identification of small, hypoattenuating inflammatory foci on monoenergetic images alone in 13/50 (26%) cases resulted in upstaged CTSI from mild to moderate in 7/50 (14%), associated with longer hospitalization (16 ± 17 days vs. 5 ± 2 days; p < 0.05), ICU admission, and drainage. Quantitatively, a twofold difference between normal and inflamed parenchyma attenuation was identified for monoenergetic (44.8 ± 27.6) vs. conventional (25.1 ± 14.7) images (p < 0.05). Significant increases were seen in the monoenergetic SNR and CNR compared to the conventional images (p < 0.05). CONCLUSIONS DECT low monoenergetic images afford better tissue assessment and demarcation of inflamed pancreatic parenchyma. Additionally, they provide improved characterization of the extent parenchymal necrosis, enabling better classification that may better predict severe clinical outcomes. KEY POINTS • DECT low monoenergetic images afford better tissue assessment and demarcation of inflamed pancreatic parenchyma and provide improved characterization of the extent parenchymal necrosis. • Qualitatively, low monoenergetic images were preferred over conventional DECT images for the evaluation of pancreatic inflammation; and quantitatively, there is a twofold difference between normal and inflamed parenchyma attenuation, SNR, and CNR between monoenergetic vs. conventional images. • Monoenergetic imaging identified additional small, hypoattenuating inflammatory foci in 26% resulting in an upstaged CT severity index in 14% associated with longer hospitalization, ICU admission, and drainage, thereby enabling better classification and better prediction of severe clinical outcomes.
Collapse
|
27
|
Abstract
Dual-energy CT (DECT) overcomes several limitations of conventional single-energy CT (SECT) for the evaluation of gastrointestinal diseases. This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging. A head-to-head comparison of technical specifications among DECT scanner implementations is provided. Energy- and material-specific DECT image reconstructions enable retrospective (i.e., after examination acquisition) image quality adjustments that are not possible using SECT. Such adjustments may, for example, correct insufficient contrast bolus or metal artifacts, thereby potentially avoiding patient recalls. A combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can be included in protocols to improve lesion detection and disease characterization. Relevant literature is reviewed regarding use of DECT for evaluation of the liver, gallbladder, pancreas, and bowel. Challenges involving cost, workflow, body habitus, and variability in DECT measurements are considered. Artificial intelligence and machine-learning image reconstruction algorithms, PACS integration, photon-counting hardware, and novel contrast agents are expected to expand the multienergy capability of DECT and further augment its value.
Collapse
|
28
|
Gentili F, Guerrini S, Mazzei FG, Monteleone I, Di Meglio N, Sansotta L, Perrella A, Puglisi S, De Filippo M, Gennaro P, Volterrani L, Castagna MG, Dotta F, Mazzei MA. Dual energy CT in gland tumors: a comprehensive narrative review and differential diagnosis. Gland Surg 2020; 9:2269-2282. [PMID: 33447579 DOI: 10.21037/gs-20-543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dual energy CT (DECT)with image acquisition at two different photon X-ray levels allows the characterization of a specific tissue or material/elements, the extrapolation of virtual unenhanced and monoenergetic images, and the quantification of iodine uptake; such special capabilities make the DECT the perfect technique to support oncological imaging for tumor detection and characterization and treatment monitoring, while concurrently reducing the dose of radiation and iodine and improving the metal artifact reduction. Even though its potential in the field of oncology has not been fully explored yet, DECT is already widely used today thanks to the availability of different CT technologies, such as dual-source, single-source rapid-switching, single-source sequential, single-source twin-beam and dual-layer technologies. Moreover DECT technology represents the future of the imaging innovation and it is subject to ongoing development that increase according its clinical potentiality, in particular in the field of oncology. This review points out recent state-of-the-art in DECT applications in gland tumors, with special focus on its potential uses in the field of oncological imaging of endocrine and exocrine glands.
Collapse
Affiliation(s)
- Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Giuseppe Mazzei
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ilaria Monteleone
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Nunzia Di Meglio
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Letizia Sansotta
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Armando Perrella
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Sara Puglisi
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Massimo De Filippo
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Gennaro
- Department of Maxillofacial Surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Volterrani
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Grazia Castagna
- Unit of Endocrinology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Dotta
- Unit of Diabetology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| |
Collapse
|
29
|
Abstract
Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.
Collapse
Affiliation(s)
- Samuel J Galgano
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA; Department of Radiology, Section of Molecular Imaging & Therapeutics, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA.
| | - Kedar Sharbidre
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA
| | - Desiree E Morgan
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA
| |
Collapse
|
30
|
Dual energy CT in clinical routine: how it works and how it adds value. Emerg Radiol 2020; 28:103-117. [PMID: 32483665 DOI: 10.1007/s10140-020-01785-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
Dual energy computed tomography (DECT), also known as spectral CT, refers to advanced CT technology that separately acquires high and low energy X-ray data to enable material characterization applications for substances that exhibit different energy-dependent x-ray absorption behavior. DECT supports a variety of post-processing applications that add value in routine clinical CT imaging, including material selective and virtual non-contrast images using two- and three-material decomposition algorithms, virtual monoenergetic imaging, and other material characterization techniques. Following a review of acquisition and post-processing techniques, we present a case-based approach to highlight the added value of DECT in common clinical scenarios. These scenarios include improved lesion detection, improved lesion characterization, improved ease of interpretation, improved prognostication, inherently more robust imaging protocols to account for unexpected pathology or suboptimal contrast opacification, length of stay reduction, reduced utilization by avoiding unnecessary follow-up examinations, and radiation dose reduction. A brief discussion of post-processing workflow approaches, challenges, and solutions is also included.
Collapse
|
31
|
Maldonado I, Shetty A, Estay MC, Siña E, Rojas A, Narra V, Varela C. Acute Pancreatitis Imaging in MDCT: State of the Art of Usual and Unusual Local Complications. 2012 Atlanta Classification Revisited. Curr Probl Diagn Radiol 2020; 50:186-199. [PMID: 32553440 DOI: 10.1067/j.cpradiol.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/15/2019] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Abstract
Acute pancreatitis is an inflammatory disease in which most common etiologies are biliary lithiasis and alcoholism. Acute pancreatitis can be classified into 2 groups according to its morphologic features: interstitial edematous pancreatitis and necrotizing acute pancreatitis. The prognosis of this group of diseases and its complications varies significantly and contrast-enhanced computed tomography is the imaging study of choice for the diagnosis and detection of complications. . In this review, we aim to summarize the changes introduced in the revised Atlanta classification and describe other usual and unusual local complications of acute pancreatitis that are not analyzed in that classification. We will also describe early detection signs and provide an accurate interpretation of complications on contrast-enhanced computed tomography that will lead to prompt management decisions which can reduce the morbidity and mortality of these patients.
Collapse
Affiliation(s)
- Ignacio Maldonado
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile.
| | - Anup Shetty
- Mallinckdrodt Institute of Radiology (MIR), Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - María Catalina Estay
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile
| | - Eduardo Siña
- Universidad de los Andes, Facultad de Medicina, Santiago, Chile
| | - Alberto Rojas
- Universidad de los Andes, Facultad de Medicina, Santiago, Chile
| | - Vampsi Narra
- Mallinckdrodt Institute of Radiology (MIR), Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Cristian Varela
- Departamento Imagenología, Clínica Dávila, Facultad de Medicina Universidad de los Andes y Universidad Mayor, Santiago, Chile
| |
Collapse
|
32
|
Dual-Energy CT of Pediatric Abdominal Oncology Imaging: Private Tour of New Applications of CT Technology. AJR Am J Roentgenol 2020; 214:967-975. [DOI: 10.2214/ajr.19.22242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
33
|
Patel BN, Brooke Jeffrey R, Olcott EW, Zaheer A. Groove pancreatitis: a clinical and imaging overview. Abdom Radiol (NY) 2020; 45:1439-1446. [PMID: 31559471 DOI: 10.1007/s00261-019-02239-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Groove or paraduodenal pancreatitis is an uncommon fibroinflammatory form of pancreatitis involving the anatomic space of the pancreatic groove located between the C-loop of the duodenum and the head of the pancreas. Although in some patients there are distinctive clinical and imaging features of groove pancreatitis (GP), there is often significant overlap with other infiltrative processes involving the pancreatic groove such as pancreatic ductal adenocarcinoma or duodenal carcinoma. In this review, we summarize the most distinctive clinical and imaging aspects of GP and highlight some important distinguishing features that may aid in differentiating malignant lesions involving the pancreatic groove.
Collapse
Affiliation(s)
- Bhavik N Patel
- Division of Abdominal Imaging, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA.
| | - R Brooke Jeffrey
- Division of Abdominal Imaging, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA
| | - Eric W Olcott
- Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, 21287, USA
| |
Collapse
|
34
|
Abstract
In patients with acute pancreatitis (AP), diagnostic imaging is performed for various reasons, including the detection of the etiology (e.g., biliary obstruction caused by gallstones), diagnosis of pancreatitis in an unclear clinical setting, assessment of the severity of the process, and evaluation of its complications. In spite of the potential benefits of these imaging studies in the setting of AP, especially economic consequences but also medical risks are associated with diagnostic imaging, including increase of the effective radiation dose received by patients with AP and rising health care costs, frequently without impact on management. The rising incidence of acute pancreatitis in the Western world is escalating its financial burden with national health care expenses of over 2.5 billion dollars annually. Despite evidence-based national recommendations on utilization of diagnostic imaging in patients with AP, unnecessary imaging studies are still frequently performed, especially in the early hospital course. The purpose of this article is, therefore, to review the imaging guidelines for acute pancreatitis with regards to when and when not to image, with the aim to minimize inappropriate utilization.
Collapse
|
35
|
Abstract
Acute pancreatitis is an increasingly common condition and can result in significant morbidity and mortality. Contrast enhanced computed tomography (CECT) is the primary initial imaging modality in the characterization of acute pancreatitis. In this article, we provide sample CECT technical acquisition parameters for pancreatic imaging. We also review the classification systems for acute pancreatitis and give examples of common and uncommon complications of acute pancreatitis.
Collapse
|
36
|
Elsherif SB, Zheng S, Ganeshan D, Iyer R, Wei W, Bhosale PR. Does dual-energy CT differentiate benign and malignant ovarian tumours? Clin Radiol 2020; 75:606-614. [PMID: 32252992 DOI: 10.1016/j.crad.2020.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/09/2020] [Indexed: 01/19/2023]
Abstract
AIM To assess the ability of dual-energy computed tomography (DECT) to distinguish benign from malignant ovarian tumours (OTs). MATERIALS AND METHODS Following approval of the institutional review board, the institutional database was mined for treatment-naive patients who underwent primary cytoreduction for OT. Thirty-seven patients were included and divided into those with benign OTs (n = 11) and malignant OTs (n = 26), including high-grade (n = 20) and low-grade (n = 6) malignant OTs. Advanced processing and region of interest delineation on the ovarian mass were performed using the preoperative staging DECT examination using the Advantage Workstation. The pixel-level data of the CT attenuation values at 50, 70, and 120 keV and the effective atomic number (Zeff), water content (WC), and iodine content (IC) in the ovarian mass were recorded. The Wilcoxon rank-sum test was used to compare CT attenuation data at different voltages, Zeff, and WC and IC levels between benign and malignant OTs and between high- and low-grade malignant OTs. Simple logistic regression was used to correlate the imaging characteristics with malignant status and grade. RESULTS Malignant OTs had significantly higher Zeff and IC compared with benign OTs. The threshold values for the diagnosis of malignant OT were IC≥9.74 (100 μg/cm3) with 81% sensitivity and 73% specificity and Zeff ≥8.16 with 85% sensitivity and 73% specificity. High-grade OTs had significantly higher WC compared with low-grade OTs, and a threshold of ≥1,013.92 mg/cm3 differentiated them with 80% sensitivity and 83% specificity. CONCLUSION DECT may be a tool to help distinguish malignant and benign OTs and predict tumour grade.
Collapse
Affiliation(s)
- S B Elsherif
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA.
| | - S Zheng
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston McGovern Medical School, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030 Houston, Texas, USA
| | - D Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - R Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - W Wei
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - P R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| |
Collapse
|
37
|
The multidisciplinary team for gastroenteropancreatic neuroendocrine tumours: the radiologist's challenge. Radiol Oncol 2019; 53:373-387. [PMID: 31652122 PMCID: PMC6884929 DOI: 10.2478/raon-2019-0040] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a heterogeneous group of tumours. An effective diagnosis requires a multimodal approach that combines evaluation of clinical symptoms, hormonelevels, radiological and nuclear imaging, and histological confirmation. Imaging plays a critical role in NETs diagnosis, prognosis and management, so the radiologists are important members of the multidisciplinary team. During diagnostic work-up two critical issues are present: firstly the need to identify tumor presence and secondly to define the primary site and assess regional and distant metastases. Conclusions The most appropriate imaging technique depends on the type of neuroendocrine tumour and the availability of specialized imaging techniques and expertise. There is no general consensus on the most efficient imaging pathway, reflecting the challenge in reliably detection of these tumours.
Collapse
|
38
|
Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma. Eur Radiol 2019; 29:3617-3625. [PMID: 30888484 PMCID: PMC6554239 DOI: 10.1007/s00330-019-06116-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/15/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to assess the objective and subjective image characteristics of monoenergetic images (MEI[+]), using a noise-optimized algorithm at different kiloelectron volts (keV) compared to polyenergetic images (PEI), in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS This retrospective, institutional review board-approved study included 45 patients (18 male, 27 female; mean age 66 years; range, 42-96 years) with PDAC who had undergone a dual-energy CT (DECT) of the abdomen for staging. One standard polyenergetic image (PEI) and five MEI(+) images in 10-keV intervals, ranging from 40 to 80 keV, were reconstructed. Line-density profile analysis, as well as the contrast-to-noise ratio (CNR) of the tumor, the signal-to-noise ratio (SNR) of the regular pancreas parenchyma and the tumor, and the CNR of the three main peripancreatic vessels, was calculated. For subjective quality assessment, two readers independently assessed the images using a 5-point Likert scale. Reader reliability was evaluated using an intraclass correlation coefficient. RESULTS Line-density profile analysis revealed the largest gradient in attenuation between PDAC and regular tissue in MEI(+) at 40 keV. Low-keV MEI(+)reconstructions at 40 and 50 keV increased CNR and SNR compared to PEI (40 keV: CNR 46.8 vs. 7.5; SNRPankreas 32.5 vs. 15.7; SNRLesion 13.5 vs. 8.6; p < 0.001). MEI(+) at 40 keV and 50 keV were consistently preferred by the observers (p < 0.05), showing a high intra-observer 0.937 (0.92-0.95) and inter-observer 0.911 (0.89-0.93) agreement. CONCLUSION MEI(+) reconstructions at 40 keV and 50 keV provide better objective and subjective image quality compared to conventional PEI of DECT in patients with PDAC. KEY POINTS • Low-keV MEI(+) reconstructions at 40 and 50 keV increase tumor-to-pancreas contrast compared to PEI. • Low-keV MEI(+) reconstructions improve objective and subjective image quality parameters compared to PEI. • Dual-energy post-processing might be a valuable tool in the diagnostic workup of patients with PDAC.
Collapse
|
39
|
High-Pitch Wide-Coverage Fast-Kilovoltage-Switching Dual-Energy CT: Impact of Pitch on Noise, Spatial Resolution, and Iodine Quantification in a Phantom Study. AJR Am J Roentgenol 2019; 212:W64-W72. [PMID: 30645160 DOI: 10.2214/ajr.18.19851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of high pitch values on image noise, spatial resolution, and iodine quantification in single-source wide-coverage fast-kilovoltage-switching dual-energy CT (DECT). MATERIALS AND METHODS Two phantom experiments were conducted. First, image noise and spatial resolution in the x-, y-, and z-directions were assessed. Second, the accuracy of iodine quantification was investigated with multiple-size phantoms with pure iodine and blood-iodine inserts. Both phantoms were scanned repeatedly with a third-generation fast-kilovoltage-switching DECT scanner with a collimation width of 80 mm at four different pitch values (0.5, 0.99, 1.375, 1.53) and three different gantry rotation times (0.6, 0.8, 1.0 second). Image noise, spatial resolution, and absolute error of iodine concentration (E) were measured. A linear mixed effects model was used to determine the effect of pitch, rotation time, and size on the error of iodine concentration. RESULTS Image noise and xy spatial resolution were comparable among the four pitch values. Spatial resolution in the z-direction was inferior and had higher variance at a low pitch of 0.5 compared with pitches of 0.99, 1.375, and 1.53. Error of iodine concentration was significantly affected by pitch and rotation time (p < 0.001). E decreased with increasing pitch and decreasing rotation time. In detail, mean E was 0.91 ± 0.47 mg I/mL for a pitch of 0.5, 0.52 ± 0.29 mg I/mL for 0.99, 0.44 ± 0.25 mg I/mL for 1.375, and 0.40 ± 0.25 mg I/mL for 1.53. CONCLUSION High-pitch wide-coverage fast-kilovoltage-switching DECT can be performed without impairing image quality or iodine quantification, and the results are superior to those of imaging at a low pitch of 0.5.
Collapse
|
40
|
Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S. Dual-Energy CT in Evaluation of the Acute Abdomen. Radiographics 2019; 39:264-286. [DOI: 10.1148/rg.2019180087] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicolas Murray
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Kathryn E. Darras
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Frances E. Walstra
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Mohammed F. Mohammed
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Patrick D. McLaughlin
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| | - Savvas Nicolaou
- From the Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9 (N.M., K.E.D., F.E.W., P.D.M., S.N.); and the Medical Imaging Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia (M.F.M.)
| |
Collapse
|
41
|
Tirosh A, Journy N, Folio LR, Lee C, Leite C, Yao J, Kovacs W, Linehan WM, Malayeri A, Kebebew E, Berrington de González A. Cumulative Radiation Exposures from CT Screening and Surveillance Strategies for von Hippel-Lindau-associated Solid Pancreatic Tumors. Radiology 2018; 290:116-124. [PMID: 30299237 DOI: 10.1148/radiol.2018180687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To assess the potential ionizing radiation exposure from CT scans for both screening and surveillance of patients with von Hippel-Lindau (VHL) syndrome. Materials and Methods For this retrospective study, abdomen-pelvic (AP) and chest-abdomen-pelvic (CAP) CT scans were performed with either a three-phase (n = 1242) or a dual-energy virtual noncontrast protocol (VNC; n = 149) in 747 patients with VHL syndrome in the National Institutes of Health Clinical Center between 2009 and 2015 (mean age, 47.6 years ± 14.6 [standard deviation]; age range, 12-83 years; 320 women [42.8%]). CT scanning parameters for patients with pancreatic neuroendocrine tumors (PNETs; 124 patients and 381 scans) were compared between a tumor diameter-based surveillance protocol and a VHL genotype and tumor diameter-based algorithm (a tailored algorithm) developed by three VHL clinicians. Organ and lifetime radiation doses were estimated by two radiologists and five radiation scientists. Cumulative radiation doses were compared between the PNET surveillance algorithms by analyses of variance, and a two-tailed P value less than .05 indicated statistical significance. Results Median cumulative colon doses for annual CAP and AP CT scans from age 15 to 40 years ranged from 0.34 Gy (5th-95th percentiles, 0.18-0.75; dual-energy VNC CT) to 0.89 Gy (5th-95th percentiles, 0.42-1.0; three-phase CT). For the current PNET surveillance protocol, the cumulative effective radiation dose from age 40 to 65 years was 682 mSv (tumors < 1.2 cm) and 2125 mSv (tumors > 3 cm). The tailored algorithm could halve these doses for patients with initial tumor diameter less than 1.2 cm (P < .001). Conclusion CT screening of patients with von Hippel-Lindau syndrome can lead to substantial radiation exposures, even with dual-energy virtual noncontrast CT. A genome and tumor diameter-based algorithm for pancreatic neuroendocrine tumor surveillance may potentially reduce lifetime radiation exposure. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Amit Tirosh
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Neige Journy
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Les R Folio
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Choonsik Lee
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Christiane Leite
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Jianhua Yao
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - William Kovacs
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - W Marston Linehan
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Ashkan Malayeri
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Electron Kebebew
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| | - Amy Berrington de González
- From the Neuroendocrine Tumors Service, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621 (A.T.); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.T.); Division of Cancer Epidemiology and Genetics (N.J., C. Lee, A.B.d.G.), Department of Radiology and Imaging Sciences (L.R.F., J.Y., W.K., A.M.), and Urologic Oncology Branch (C. Leite, W.M.L.), National Cancer Institute, National Institutes of Health, Bethesda, Md; Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France (N.J.); and Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, Calif (E.K.)
| |
Collapse
|
42
|
Mohammed MF, Elbanna KY, Mohammed AME, Murray N, Azzumea F, Almazied G, Nicolaou S. Practical Applications of Dual-Energy Computed Tomography in the Acute Abdomen. Radiol Clin North Am 2018; 56:549-563. [PMID: 29936947 DOI: 10.1016/j.rcl.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.
Collapse
Affiliation(s)
- Mohammed F Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia.
| | - Khaled Y Elbanna
- Department of Medical Imaging, Emergency and Trauma Radiology Division, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Abdelazim M E Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Nicolas Murray
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| | - Fahad Azzumea
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Ghassan Almazied
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| |
Collapse
|