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Pace E, Caruana CJ, Bosmans H, Cortis K, D'Anastasi M, Valentino G. An inventory of patient-image based risk/dose, image quality and body habitus/size metrics for adult abdomino-pelvic CT protocol optimisation. Phys Med 2024; 125:103434. [PMID: 39096718 DOI: 10.1016/j.ejmp.2024.103434] [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] [Received: 10/03/2023] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024] Open
Abstract
PURPOSE Patient-specific protocol optimisation in abdomino-pelvic Computed Tomography (CT) requires measurement of body habitus/size (BH), sensitivity-specificity (surrogates image quality (IQ) metrics) and risk (surrogates often dose quantities) (RD). This work provides an updated inventory of metrics available for each of these three categories of optimisation variables derivable directly from patient measurements or images. We consider objective IQ metrics mostly in the spatial domain (i.e., those related directly to sharpness, contrast, noise quantity/texture and perceived detectability as these are used by radiologists to assess the acceptability or otherwise of patient images in practice). MATERIALS AND METHODS The search engine used was PubMed with the search period being 2010-2024. The key words used were: 'comput* tomography', 'CT', 'abdom*', 'dose', 'risk', 'SSDE', 'image quality', 'water equivalent diameter', 'size', 'body composition', 'habit*', 'BMI', 'obes*', 'overweight'. Since BH is critical for patient specific optimisation, articles correlating RD vs BH, and IQ vs BH were reviewed. RESULTS The inventory includes 11 BH, 12 IQ and 6 RD metrics. 25 RD vs BH correlation studies and 9 IQ vs BH correlation studies were identified. 7 articles in the latter group correlated metrics from all three categories concurrently. CONCLUSIONS Protocol optimisation should be fine-tuned to the level of the individual patient and particular clinical query. This would require a judicious choice of metrics from each of the three categories. It is suggested that, for increased utility in clinical practice, more future optimisation studies be clinical task based and involve the three categories of metrics concurrently.
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Affiliation(s)
- Eric Pace
- Medical Physics, Faculty of Health Science, University of Malta, Msida MSD2080, Malta.
| | - Carmel J Caruana
- Medical Physics, Faculty of Health Science, University of Malta, Msida MSD2080, Malta
| | - Hilde Bosmans
- Medical Physics & Quality Assessment, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Msida MSD2090, Malta
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, Msida MSD2090, Malta
| | - Gianluca Valentino
- Communications & Computer Engineering Department, Faculty of Information and Communication Technology, University of Malta, Msida MSD2080, Malta
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Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer. Fam Cancer 2024; 23:323-339. [PMID: 38619782 PMCID: PMC11255004 DOI: 10.1007/s10689-024-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.
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Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Dawod M, Nagib P, Zaki J, Prevedello LM, Ajam AA, Nguyen XV. CT and MR utilization and morbidity metrics across Body Mass Index. PLoS One 2024; 19:e0306087. [PMID: 38941332 PMCID: PMC11213308 DOI: 10.1371/journal.pone.0306087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and same-year utilization of CT and MR imaging in a large healthcare population. METHODS In this retrospective population-based study, all patients aged ≥18 years with a documented BMI in the multi-institutional Cosmos database were included. Cohorts were identified based on ≥1 documented BMI in 2021 within pre-defined ranges. For each cohort, we assessed the percentage of patients undergoing head, neck, chest, spine, or abdomen/pelvis CT and MR during the same year. Disease severity was quantified based on emergency department (ED) visits and mortality. RESULTS In our population of 49.6 million patients, same-year CT and MR utilization was 14.5 ±0.01% and 6.0±0.01%, respectively. The underweight cohort had the highest CT (25.8±0.1%) and MR (8.01 ± 0.05) imaging utilization. At high extremes of BMI (>50 kg/m2), CT utilization mildly increased (18.4±0.1%), but MR utilization decreased (5.3±0.04%). While morbidity differences may explain some BMI-utilization relationships, lower MR utilization in the BMI>50 cohort contrasts with higher age-adjusted mortality (1.8±0.03%) and ED utilization (32.4±0.1%) in this cohort relative to normal weight (1.5±0.01% and 25.7±0.02%, respectively). CONCLUSION Underweight patients had disproportionately high CT/MR utilization, and high extremes of BMI are associated with mildly higher CT and lower MR utilization than the normal weight cohort. The elevated mortality and ED utilization in severely obese patients contrasts with their lower MR imaging utilization. Our findings may assist public health efforts to accommodate obesity trends.
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Affiliation(s)
- Mina Dawod
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Paul Nagib
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John Zaki
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Amna A. Ajam
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Dojcsák D, Farkas F, Farkas T, Papp J, Garami A, Viskolcz B, Váradi C. The Impact of Protein Glycosylation on the Identification of Patients with Pediatric Appendicitis. Int J Mol Sci 2024; 25:6432. [PMID: 38928139 PMCID: PMC11204372 DOI: 10.3390/ijms25126432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
The identification of pediatric appendicitis is challenging due to the lack of specific markers thereby several factors are included in the diagnostic process such as abdominal pain, ultrasonography and altered laboratory parameters (C reactive protein, absolute neutrophil cell number and white blood cell number). The glycosylation pattern of serum N-glycome was analyzed in this study of 38 controls and 40 patients with pediatric appendicitis. The glycans were released by enzymatic deglycosylation followed by fluorescent labeling and solid-phase extraction. The prepared samples were analyzed by hydrophilic interaction liquid chromatography with fluorescence and mass-spectrometric detection. The generated data were analyzed by multiple statistical tests involving the most important laboratory parameters as well. Significant differences associated with the examined patient groups were revealed suggesting the potential use of glycosylation analysis supporting the detection of pediatric appendicitis.
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Affiliation(s)
- Dalma Dojcsák
- Advanced Materials and Intelligent Technologies Higher Education and Industrial Cooperation Centre, University of Miskolc, 3515 Miskolc, Hungary; (D.D.); (B.V.)
| | - Flóra Farkas
- Borsod-Abaúj-Zemplén County Center Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (F.F.); (T.F.); (J.P.)
| | - Tamás Farkas
- Borsod-Abaúj-Zemplén County Center Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (F.F.); (T.F.); (J.P.)
| | - János Papp
- Borsod-Abaúj-Zemplén County Center Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (F.F.); (T.F.); (J.P.)
| | - Attila Garami
- Institute of Energy, Ceramic and Polymer Technology, University of Miskolc, 3515 Miskolc, Hungary;
| | - Béla Viskolcz
- Advanced Materials and Intelligent Technologies Higher Education and Industrial Cooperation Centre, University of Miskolc, 3515 Miskolc, Hungary; (D.D.); (B.V.)
- Institute of Chemistry, Faculty of Materials Science and Engineering, University of Miskolc, 3515 Miskolc, Hungary
| | - Csaba Váradi
- Institute of Chemistry, Faculty of Materials Science and Engineering, University of Miskolc, 3515 Miskolc, Hungary
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Luksaite-Lukste R, Gecaite I, Marcinkeviciute K, Dumskis E, Samuilis A, Zvirblis T, Jasiunas E, Bausys A, Drungilas M, Luksta M, Kryzauskas M, Petrulionis M, Beisa A, Uselis S, Valeikaite-Taugininene G, Rackauskas R, Strupas K, Poskus T. Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial. J Clin Med 2024; 13:3363. [PMID: 38929896 PMCID: PMC11203661 DOI: 10.3390/jcm13123363] [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: 04/18/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods-Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results-A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions-Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.
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Affiliation(s)
- Raminta Luksaite-Lukste
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Igne Gecaite
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | | | - Eimantas Dumskis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Arturas Samuilis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Tadas Zvirblis
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
- Department of Mechanical and Material Engineering, Vilnius Gediminas Technical University, LT-03224 Vilnius, Lithuania
| | - Eugenijus Jasiunas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Augustinas Bausys
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
| | - Mantas Drungilas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Martynas Luksta
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Petrulionis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Augustas Beisa
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Simonas Uselis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Gintare Valeikaite-Taugininene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Rokas Rackauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
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Manea E, Chitoran E, Rotaru V, Ionescu S, Luca D, Cirimbei C, Alecu M, Capsa C, Gafton B, Prutianu I, Serban D, Simion L. Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix. Bioengineering (Basel) 2024; 11:506. [PMID: 38790373 PMCID: PMC11117609 DOI: 10.3390/bioengineering11050506] [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: 04/16/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.
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Affiliation(s)
- Elena Manea
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Sinziana Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihnea Alecu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Cristina Capsa
- Radiology and Medical Imaging Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Bogdan Gafton
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iulian Prutianu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences I—Histology, University of Medicine and Pharmacy “Gr. T. Popa”, 700483 Iasi, Romania
| | - Dragos Serban
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- Surgery Department IV, Bucharest Clinical Emergency Hospital, 050098 Bucharest, Romania
| | - Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Salyapongse AM, Kanne JP, Nagpal P, Laucis NC, Markhardt BK, Yin Z, Slavic S, Lubner MG, Szczykutowicz TP. Spatial Resolution Fidelity Comparison Between Energy Integrating and Deep Silicon Photon Counting CT: Implications for Pulmonary Imaging. J Thorac Imaging 2024:00005382-990000000-00137. [PMID: 38712920 DOI: 10.1097/rti.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE We investigated spatial resolution loss away from isocenter for a prototype deep silicon photon-counting detector (PCD) CT scanner and compare with a clinical energy-integrating detector (EID) CT scanner. MATERIALS AND METHODS We performed three scans on a wire phantom at four positions (isocenter, 6.7, 11.8, and 17.1 cm off isocenter). The acquisition modes were 120 kV EID CT, 120 kV high-definition (HD) EID CT, and 120 kV PCD CT. HD mode used double the projection view angles per rotation as the "regular" EID scan mode. The diameter of the wire was calculated by taking the full width of half max (FWHM) of a profile drawn over the radial and azimuthal directions of the wire. Change in wire diameter appearance was assessed by calculating the ratio of the radial and azimuthal diameter relative to isocenter. t tests were used to make pairwise comparisons of the wire diameter ratio with each acquisition and mean ratios' difference from unity. RESULTS Deep silicon PCD CT had statistically smaller (P<0.05) changes in diameter ratio for both radial and azimuthal directions compared with both regular and HD EID modes and was not statistically different from unity (P<0.05). Maximum increases in FWMH relative to isocenter were 36%, 12%, and 1% for regular EID, HD EID, and deep silicon PCD, respectively. CONCLUSION Deep silicon PCD CT exhibits less change in spatial resolution in both the radial and azimuthal directions compared with EID CT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Timothy P Szczykutowicz
- Departments of Radiology, Medical Physics, and Biomedical Engineering, University of Wisconsin Madison, Madison, WI
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Goyal A, Crabtree CD, Lee BC, Harfi TT, Rajpal S, Yildiz VO, Simonetti OP, Tong MS. The impact of severe obesity on image quality and ventricular function assessment in echocardiography and cardiac MRI. Int J Cardiovasc Imaging 2024; 40:1081-1094. [PMID: 38625629 PMCID: PMC11147879 DOI: 10.1007/s10554-024-03078-y] [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: 10/04/2023] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
This study sought to evaluate the impact of severe obesity on image quality and ventricular function assessment in cardiovascular magnetic resonance (MRI) and trans-thoracic echocardiography (TTE). We studied 100 consecutive patients who underwent clinically indicated cardiac MRI and TTE studies within 12 months between July 2017 and December 2020; 50 (28 females and 22 males; 54.5 ± 18.7 years) with normal body mass index (BMI) (18.5-25 kg/m2) and 50 (21 females and 29 males; 47.2 ± 13.3 years) with severe obesity (BMI ≥ 40 kg/m2). MRI and TTE image quality scores were compared within and across cohorts using a linear mixed model. Categorical left (LVF) and right (RVF) ventricular function were compared using Cohens Kappa statistic. Mean BMI for normal weight and obese cohorts were 22.2 ± 1.7 kg/m2 and 50.3 ± 5.9 kg/m2, respectively. Out of a possible 93 points, mean MRI image quality score was 91.5 ± 2.5 for patients with normal BMI, and 88.4 ± 5.5 for patients with severe obesity; least square (LS) mean difference 3.1, p = 0.460. TTE scores were 64.2 ± 13.6 for patients with normal BMI and 46.0 ± 12.9 for patients with severe obesity, LS mean difference 18.2, p < 0.001. Ventricular function agreement between modalities was worse in the obese cohort for both LVF (72% vs 80% agreement; kappa 0.53 vs 0.70, obese vs. normal BMI), and RVF (58% vs 72% agreement, kappa 0.18 vs 0.34, obese vs. normal BMI). Severe obesity had limited impact on cardiac MRI image quality, while obesity significantly degraded TTE image quality and ventricular function agreement with MRI.
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Affiliation(s)
- Akash Goyal
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | | | - Bryan C Lee
- OhioHealth Systems, Heart and Vascular Institute, Columbus, OH, USA
| | - Thura T Harfi
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Saurabh Rajpal
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, OH, USA
- Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Matthew S Tong
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA.
- Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA.
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Feng S, Wang B, Chen S, Xie Q, Yu L, Xiong C, Wang S, Huang Z, Xing G, Li K, Lu C, Zhao Y, Li Z, Wu Q, Huang J. Association between proliferative-to-secretory endometrial compaction and pregnancy outcomes after embryo transfer: a systematic review and meta-analysis. Hum Reprod 2024; 39:749-759. [PMID: 38323525 DOI: 10.1093/humrep/deae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
STUDY QUESTION Does the change in endometrial thickness (EMT) from the end of the follicular/estrogen phase to the day of embryo transfer (ET) determine subsequent pregnancy outcomes? SUMMARY ANSWER Endometrial compaction from the late-proliferative to secretory phase is not associated with live birth rate (LBR) and other pregnancy outcomes. WHAT IS KNOWN ALREADY Endometrial compaction has been suggested to be indicative of endometrial responsiveness to progesterone, and its association with ET outcome has been investigated but is controversial. STUDY DESIGN, SIZE, DURATION A systematic review with meta-analysis was carried out. PubMed, EMBASE, and Web of Science were searched to identify relevant studies from inception to 18 November 2022. The reference lists of included studies were also manually screened for any additional publications. PARTICIPANTS/MATERIALS, SETTING, METHODS Cohort studies comparing ET pregnancy outcomes between patients with and without endometrial compaction were included. A review of the studies for inclusion, data extraction, and quality assessment was performed by two independent reviewers. The effect size was synthesized as odds ratio (OR) with 95% CI using a random-effects model. Heterogeneity and publication bias were assessed by the I2 statistic and Egger's test, respectively. The primary outcome was LBR. Secondary outcomes included biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), miscarriage rate (MR), ongoing pregnancy rate (OPR), and ectopic pregnancy rate (EPR). MAIN RESULTS AND THE ROLE OF CHANCE Seventeen cohort studies involving 18 973 ET cycles fulfilled the eligibility criteria. The pooled results revealed that there were no significant differences between endometrial compaction and non-compaction groups in LBR (crude OR (cOR) = 0.95, 95% CI 0.87-1.04; I2 = 0%; adjusted OR (aOR) = 1.02, 95% CI 0.87-1.19, I2 = 79%), BPR (cOR = 0.93, 95% CI 0.81-1.06; I2 = 0%; aOR = 0.88, 95% CI 0.75-1.03, I2 = 0%), CPR (cOR = 0.98, 95% CI 0.81-1.18; I2 = 70%; aOR = 0.86, 95% CI 0.72-1.02, I2 = 13%), MR (cOR = 1.09, 95% CI 0.90-1.32; I2 = 0%; aOR = 0.91, 95% CI 0.64-1.31; I2 = 0%), and EPR (cOR = 0.70, 95% CI 0.31-1.61; I2 = 61%). The OPR was marginally higher in crude analysis (cOR = 1.48, 95% CI 1.01-2.16; I2 = 81%) among women with compacted endometrium, but was not evident in adjusted results (aOR = 1.36, 95% CI 0.86-2.14; I2 = 84%). Consistently, the pooled estimate of LBR remained comparable in further subgroup and sensitivity analyses according to the degree of compaction (0%, 5%, 10%, 15%, or 20%), type of ET (fresh, frozen, or euploid only), and endometrial preparation protocol (natural or artificial). No publication bias was observed based on Egger's test. LIMITATIONS, REASONS FOR CAUTION Although the number of included studies is sufficient, data on certain measures, such as EPR, are limited. The inherent bias and residual confounding were also inevitable owing to the observational study design. Furthermore, inconsistent definitions of pregnancy outcomes may affect the accuracy of our pooled analysis. WIDER IMPLICATIONS OF THE FINDINGS Given the lack of prognostic value, assessing endometrial compaction or repeated EMT measurement on the day of ET may not be necessary or warranted. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Natural Science Foundation of Jiangxi Province (20224BAB216025), National Natural Science Foundation of China (82260315), and Central Funds Guiding the Local Science and Technology Development (20221ZDG020071). The authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42022384539 (PROSPERO).
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Affiliation(s)
- Shenghui Feng
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Bangqi Wang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Shen Chen
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Qiqi Xie
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Lamei Yu
- Department of Obstetrics, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Chaoyi Xiong
- Department of Pathology, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Shuang Wang
- Department of Gynecology, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Zhihui Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Gengbao Xing
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Ke Li
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Chuming Lu
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Yan Zhao
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Zengming Li
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Qiongfang Wu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
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Steinhardt M, Marka AW, Ziegelmayer S, Makowski M, Braren R, Graf M, Gawlitza J. Comparison of Virtual Non-Contrast and True Non-Contrast CT Images Obtained by Dual-Layer Spectral CT in COPD Patients. Bioengineering (Basel) 2024; 11:301. [PMID: 38671723 PMCID: PMC11047621 DOI: 10.3390/bioengineering11040301] [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: 02/20/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. Recent studies have underlined the importance of non-contrast-enhanced chest CT scans not only for emphysema progression quantification, but for correlation with clinical outcomes as well. As about 40 percent of the 300 million CT scans per year are contrast-enhanced, no proper emphysema quantification is available in a one-stop-shop approach for patients with known or newly diagnosed COPD. Since the introduction of spectral imaging (e.g., dual-energy CT scanners), it has been possible to create virtual non-contrast-enhanced images (VNC) from contrast-enhanced images, making it theoretically possible to offer proper COPD imaging despite contrast enhancing. This study is aimed towards investigating whether these VNC images are comparable to true non-contrast-enhanced images (TNC), thereby reducing the radiation exposure of patients and usage of resources in hospitals. In total, 100 COPD patients with two scans, one with (VNC) and one without contrast media (TNC), within 8 weeks or less obtained by a spectral CT using dual-layer technology, were included in this retrospective study. TNC and VNC were compared according to their voxel-density histograms. While the comparison showed significant differences in the low attenuated volumes (LAVs) of TNC and VNC regarding the emphysema threshold of -950 Houndsfield Units (HU), the 15th and 10th percentiles of the LAVs used as a proxy for pre-emphysema were comparable. Upon further investigation, the threshold-based LAVs (-950 HU) of TNC and VNC were comparable in patients with a water equivalent diameter (DW) below 270 mm. The study concludes that VNC imaging may be a viable option for assessing emphysema progression in COPD patients, particularly those with a normal body mass index (BMI). Further, pre-emphysema was generally comparable between TNC and VNC. This approach could potentially reduce radiation exposure and hospital resources by making additional TNC scans obsolete.
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Affiliation(s)
- Manuel Steinhardt
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.W.M.); (S.Z.); (M.M.); (R.B.); (M.G.)
| | | | | | | | | | | | - Joshua Gawlitza
- Correspondence: (M.S.); (J.G.); Tel.: +49-176-24498226 (M.S.); +49-89-4140-8834 (J.G.)
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11
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Flechas Becerra C, Barrios Silva LV, Ahmed E, Bear JC, Feng Z, Chau DY, Parker SG, Halligan S, Lythgoe MF, Stuckey DJ, Patrick PS. X-Ray Visible Protein Scaffolds by Bulk Iodination. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306246. [PMID: 38145968 PMCID: PMC10933627 DOI: 10.1002/advs.202306246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/18/2023] [Indexed: 12/27/2023]
Abstract
Protein-based biomaterial use is expanding within medicine, together with the demand to visualize their placement and behavior in vivo. However, current medical imaging techniques struggle to differentiate between protein-based implants and surrounding tissue. Here a fast, simple, and translational solution for tracking transplanted protein-based scaffolds is presented using X-ray CT-facilitating long-term, non-invasive, and high-resolution imaging. X-ray visible scaffolds are engineered by selectively iodinating tyrosine residues under mild conditions using readily available reagents. To illustrate translatability, a clinically approved hernia repair mesh (based on decellularized porcine dermis) is labeled, preserving morphological and mechanical properties. In a mouse model of mesh implantation, implants retain marked X-ray contrast up to 3 months, together with an unchanged degradation rate and inflammatory response. The technique's compatibility is demonstrated with a range of therapeutically relevant protein formats including bovine, porcine, and jellyfish collagen, as well as silk sutures, enabling a wide range of surgical and regenerative medicine uses. This solution tackles the challenge of visualizing implanted protein-based biomaterials, which conventional imaging methods fail to differentiate from endogenous tissue. This will address previously unanswered questions regarding the accuracy of implantation, degradation rate, migration, and structural integrity, thereby accelerating optimization and safe translation of therapeutic biomaterials.
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Affiliation(s)
- Carlos Flechas Becerra
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Lady V. Barrios Silva
- Division of Biomaterials and Tissue EngineeringEastman Dental InstituteUniversity College LondonRoyal Free HospitalRowland Hill StreetLondonNW3 2PFUK
| | - Ebtehal Ahmed
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Joseph C. Bear
- School of Life SciencePharmacy & ChemistryKingston UniversityPenrhyn RoadKingston upon ThamesKT1 2EEUK
| | - Zhiping Feng
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - David Y.S. Chau
- Division of Biomaterials and Tissue EngineeringEastman Dental InstituteUniversity College LondonRoyal Free HospitalRowland Hill StreetLondonNW3 2PFUK
| | - Samuel G. Parker
- Centre for Medical Imaging, Division of MedicineUniversity College London UCLCharles Bell House, 43–45 Foley StreetLondonW1W 7TSUK
| | - Steve Halligan
- Centre for Medical Imaging, Division of MedicineUniversity College London UCLCharles Bell House, 43–45 Foley StreetLondonW1W 7TSUK
| | - Mark F. Lythgoe
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Daniel J. Stuckey
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - P. Stephen Patrick
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
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12
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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13
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Lee IT, Chaili S, Ocran C, Bond JB, Longmuir RA, Barahimi B, Sobel RK. Barriers to Care for the Super-super Obese Patient With Clinically Suspected Idiopathic Intracranial Hypertension. J Neuroophthalmol 2023; 43:e149-e150. [PMID: 34924529 DOI: 10.1097/wno.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Irene T Lee
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Vasileiadis K, Antza C, Kotsis V. The Depiction of Hypertension in Heart Imaging Examinations: An Up-to-Date Review of the Evidence. Vasc Health Risk Manag 2023; 19:789-796. [PMID: 38045022 PMCID: PMC10693270 DOI: 10.2147/vhrm.s436133] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
Hypertension is one of the main preventable cardiovascular (CV) risk factors all over the years, closely related to CV morbidity and mortality. One of the most common hypertensive target organ damages is hypertensive heart disease (HHD), including left ventricular hypertrophy, which progresses gradually and leads to systolic or diastolic dysfunction of the left ventricular, and finally to end-stage heart failure. Regarding its prevalence and the need for early diagnosis, assessment of heart imaging examination is of major importance. Echocardiography has been used as the standard imaging technique to evaluate HHD for years, providing an accurate evaluation of the left ventricular geometry, along with the systolic and diastolic function. However, nowadays there is a growing interest in cardiovascular magnetic resonance (CMR). Despite the importance of the use of echocardiography in everyday clinical practice, numerous studies have shown the superiority of CMR as an imaging technique for clinical and research purposes, mainly due to its strength to provide an unlimited area of view, as well as the identification and quantification of the type and extent of myocardial fibrosis. Hence, this review aims to analyze the importance of heart imaging in the hypertensive population, with a special interest in CMR imaging.
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Affiliation(s)
- Konstantinos Vasileiadis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Bafna KR, Kalra-Lall A, Gurajala RK, Karuppasamy K. Computed Tomography-Guided Pericardiocentesis: A Practical Guide. Curr Cardiol Rep 2023; 25:1433-1441. [PMID: 37856032 DOI: 10.1007/s11886-023-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage. RECENT FINDINGS Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.
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Affiliation(s)
- Kunaal R Bafna
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Anouva Kalra-Lall
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Ram Kishore Gurajala
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Karunakaravel Karuppasamy
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA.
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16
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Kamiński M, Kaczmarek A, Wieczorek T, Kierzek M, Kręgielska-Narożna M, Bogdański P. Availability of CT, MRI, and endoscopy procedures for Polish individuals with morbid obesity: cross-sectional telephone survey study. Pol J Radiol 2023; 88:e467-e471. [PMID: 38020502 PMCID: PMC10660139 DOI: 10.5114/pjr.2023.132171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The rise in morbid obesity presents diagnostic challenges in computed tomography (CT), magnetic resonance imaging (MRI), and endoscopy. Research on the availability of these procedures for people with extreme obesity is limited. We aimed to analyse the accessibility of CT, MRI, and endoscopy procedures for people with extreme obesity in a significant sample of facilities serving in the Polish public healthcare system. Material and methods A telephone-based survey was conducted on healthcare facilities offering CT, MRI, or endoscopy procedures, identified using the Polish National Health Fund (NFZ) API. A refined questionnaire was utilized after a pilot study to collect details on the equipment's weight and diameter capacities, among other parameters. Of the initial 312 facilities sampled, 195 were eligible and successfully contacted, representing 9.4% of the facilities offering the procedures in the NFZ database. Results Of the 195 facilities, 86.4% of CT departments knew their scanner's maximum weight, 57.6% its diameter; 76.5% of MRI departments recognized their scanner's weight, and 59.2% its diameter, while 77.3% of endoscopy departments were aware of their maximum weight capacity. Approximately 28% of CT, 5% of MRI, and 39% of endoscopy departments could perform the procedure if the patient's weight was over 200 kg. Facilities knowledgeable about CT's maximum diameter and MRI's maximum weight often provided private CT/MRI services. Conclusions A significant proportion of Polish facilities providing CT, MRI, and endoscopic examinations in the Polish public healthcare system were unaware of their equipment's weight and diameter limits. Merely 5% of the surveyed MRI facilities could potentially accommodate a patient weighing over 200 kg.
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Affiliation(s)
- Mikołaj Kamiński
- Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Ada Kaczmarek
- Student Scientific Club of Clinical Dietetics, Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Tobiasz Wieczorek
- Student Scientific Club of Clinical Dietetics, Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Michalina Kierzek
- Student Scientific Club of Clinical Dietetics, Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Matylda Kręgielska-Narożna
- Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Paweł Bogdański
- Department of the Treatment of Obesity and Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
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17
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Gottlieb M, Patel D, Kayarian F, Peksa GD, Bailitz J. Effect of pleural depth and width on the accuracy of lung ultrasound for detecting pulmonary edema. Am J Emerg Med 2023; 72:210-212. [PMID: 37558511 DOI: 10.1016/j.ajem.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Fae Kayarian
- Rush Medical College of Rush University Medical Center, Chicago, IL, United States of America.
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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18
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Schwartz FR, Clark DP, Rigiroli F, Kalisz K, Wildman-Tobriner B, Thomas S, Wilson J, Badea CT, Marin D. Evaluation of the impact of a novel denoising algorithm on image quality in dual-energy abdominal CT of obese patients. Eur Radiol 2023; 33:7056-7065. [PMID: 37083742 PMCID: PMC10902821 DOI: 10.1007/s00330-023-09644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Evaluate a novel algorithm for noise reduction in obese patients using dual-source dual-energy (DE) CT imaging. METHODS Seventy-nine patients with contrast-enhanced abdominal imaging (54 women; age: 58 ± 14 years; BMI: 39 ± 5 kg/m2, range: 35-62 kg/m2) from seven DECT (SOMATOM Flash or Force) were retrospectively included (01/2019-12/2020). Image domain data were reconstructed with the standard clinical algorithm (ADMIRE/SAFIRE 2), and denoised with a comparison (ME-NLM) and a test algorithm (rank-sparse kernel regression). Contrast-to-noise ratio (CNR) was calculated. Four blinded readers evaluated the same original and denoised images (0 (worst)-100 (best)) in randomized order for perceived image noise, quality, and their comfort making a diagnosis from a table of 80 options. Comparisons between algorithms were performed using paired t-tests and mixed-effects linear modeling. RESULTS Average CNR was 5.0 ± 1.9 (original), 31.1 ± 10.3 (comparison; p < 0.001), and 8.9 ± 2.9 (test; p < 0.001). Readers were in good to moderate agreement over perceived image noise (ICC: 0.83), image quality (ICC: 0.71), and diagnostic comfort (ICC: 0.6). Diagnostic accuracy was low across algorithms (accuracy: 66, 63, and 67% (original, comparison, test)). The noise received a mean score of 54, 84, and 66 (p < 0.05); image quality 59, 61, and 65; and the diagnostic comfort 63, 68, and 68, respectively. Quality and comfort scores were not statistically significantly different between algorithms. CONCLUSIONS The test algorithm produces quantitatively higher image quality than current standard and existing denoising algorithms in obese patients imaged with DECT and readers show a preference for it. CLINICAL RELEVANCE STATEMENT Accurate diagnosis on CT imaging of obese patients is challenging and denoising algorithms can increase the diagnostic comfort and quantitative image quality. This could lead to better clinical reads. KEY POINTS • Improving image quality in DECT imaging of obese patients is important for accurate and confident clinical reads, which may be aided by novel denoising algorithms using image domain data. • Accurate diagnosis on CT imaging of obese patients is especially challenging and denoising algorithms can increase quantitative and qualitative image quality. • Image domain algorithms can generalize well and can be implemented at other institutions.
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Affiliation(s)
- Fides R Schwartz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Darin P Clark
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, NC, USA
| | - Francesca Rigiroli
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Kevin Kalisz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Benjamin Wildman-Tobriner
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Sarah Thomas
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | | | - Cristian T Badea
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, NC, USA
| | - Daniele Marin
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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Heinitz S, Müller J, Jenderka KV, Schlögl H, Stumvoll M, Blüher M, Blank V, Karlas T. The application of high-performance ultrasound probes increases anatomic depiction in obese patients. Sci Rep 2023; 13:16297. [PMID: 37770538 PMCID: PMC10539468 DOI: 10.1038/s41598-023-43509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
This study evaluated the impact of obesity on abdominal ultrasound diagnostics and assessed effect of high-performance ultrasound probes increased imaging quality. Lean and obese subjects (n = 40; 58% female) were categorized according to body mass index (BMI, 21 to 48 kg/m2). A highly standardized ultrasound examination of the abdomen was performed by trained examiners using three different probes in randomized order (standard probe versus two high-performance probes). Quality of B-mode and duplex ultrasound were assessed using a custom scoring approach for depiction of liver and kidney anatomy and vascularization. Across probes, imaging quality of hepatic and kidney anatomy was inversely related with BMI (P < 0.03, r < - 0.35). Age, sex, and BMI explained 51% of the variance within the ultrasound quality score, with β = - 0.35, P < 0.0001 for BMI. Compared to the standard probe, high-performance probes allowed for a better depiction of kidney and liver anatomy in subjects above BMI 35 kg/m2 (n = 20, all P < 0.05), resulting in a less pronounced deterioration of imaging quality with increased BMI (all P < 0.05). In conclusion the study shows that obesity impairs ultrasound imaging quality of abdominal anatomy. The application of high-performance probes can increase anatomic depiction in obese patients.Registration number of the German Registry of Clinical Studies: DRKS00023498.
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Affiliation(s)
- Sascha Heinitz
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Jürgen Müller
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Klaus-Vitold Jenderka
- Department of Physics, Sensor and Ultrasound Technology, University of Applied Sciences Merseburg, Eberhard-Leibnitz-Strasse 2, 06217, Merseburg, Germany
| | - Haiko Schlögl
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Michael Stumvoll
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Matthias Blüher
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Valentin Blank
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Internal Medicine I, Halle University Medical Center, 06120, Halle (Saale), Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany.
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20
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Perez D, Neeman BB, Dotan D, Raisin G, Chertin B, Kafka I. Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: a comparative study. Urolithiasis 2023; 51:111. [PMID: 37688633 DOI: 10.1007/s00240-023-01485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
Percutaneous nephrolithotomy (PCNL) is considered gold standard treatment of renal stones larger than 20 mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than fluoroscopy. A higher body mass index (BMI) can make ultrasound-guided renal access more difficult and unsuccessful. We present a prospective analysis and comparison of ultrasound-guided PCNL in patients with normal and increased body mass index. We performed a prospective comparison of patients who underwent ultrasound-guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-obese) were compared to those with BMIs less than 30 (mean 25.69-non-obese). Demographic, perioperative, and follow-up data were collected, analyzed, and included in this study. Total of 98 consecutive patients, with 49 patients in each group were analyzed. No statistically significant differences were observed in terms of stone volume (P = 0.085), stone density (P = 0.5590), location of renal access (P = 0.108), surgery duration (P = 0.38), blood loss (P = 0.54), or laboratory changes after surgery (P = 0.60). 87.76% of obese patients were stone free per CT scan at follow-up, compared to 73.47% of normal-weight patients (P = 0.1238). According to Clavien-Dindo classification, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to six patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications. There was no significant correlation between body mass index and the success or safety of ultrasound-guided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone-free status postoperatively and can diminish or avoid both patient's and medical team's exposure to ionizing radiation.
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Affiliation(s)
- Dolev Perez
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel.
| | - Binyamin B Neeman
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - David Dotan
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Galiya Raisin
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Ilan Kafka
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
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21
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Boakye E, Grandhi GR, Dardari Z, Adhikari R, Soroosh G, Jha K, Dzaye O, Tasdighi E, Erhabor J, Kumar SJ, Whelton S, Blumenthal RS, Albert M, Rozanski A, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Blaha M. Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium. Obesity (Silver Spring) 2023; 31:2240-2248. [PMID: 37534563 PMCID: PMC10524261 DOI: 10.1002/oby.23832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. METHODS Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. RESULTS Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. CONCLUSIONS Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gowtham R Grandhi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rishav Adhikari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunal Jha
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sant J Kumar
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Seamus Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Albert
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St. Luke's Hospital, New York, New York, USA
| | - Daniel S Berman
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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22
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Nigatu AM, Yilma TM, Gezie LD, Gebrewold Y, Gullslett MK, Mengiste SA, Tilahun B. Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: a descriptive phenomenological study. BMC Health Serv Res 2023; 23:787. [PMID: 37488569 PMCID: PMC10367423 DOI: 10.1186/s12913-023-09652-9] [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: 11/07/2022] [Accepted: 06/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists' services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system. METHODS Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software. RESULTS Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service. CONCLUSIONS This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians' ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians' competence through long-term and short-term trainings are recommended to improve the referral consultation practice.
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Affiliation(s)
- Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Tesfahun Melese Yilma
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yonathan Gebrewold
- Department of Radiology, College of Medicine, Author's Information, University of Gondar, Gondar, Ethiopia
| | | | | | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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23
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Halpern SA, Patrizio HA, Brace EJ, Wang S, Yuh JY, Patel DV, Morrison RG, Hall AJ, Falciani A, Deiling KA, Brolis NV. Anatomical Considerations for Gallbladder Sonography: A Cross-Sectional Study of CT Imaging by BMI Group. Cureus 2023; 15:e40557. [PMID: 37465802 PMCID: PMC10351329 DOI: 10.7759/cureus.40557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Objective The purpose of this study was to establish an association between the body mass index (BMI) group and anatomical gallbladder position to aid novices in gallbladder sonography. Methods This was a cross-sectional, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-compliant study that examined the association between gender and the BMI group with quantitative gallbladder position measurements from computed tomography (CT) scans. Results A quantitative analysis determined that the gallbladder was positioned relatively higher and oriented more horizontally within the abdomen of individuals with obese BMI than those with normal BMI (p < 0.001), irrespective of gender. Additionally, the gallbladder was more obstructed by the rib cage in individuals with obese BMI than those with normal BMI (p = 0.007 for females and p < 0.001 for males). The gallbladder was significantly more horizontal in overweight males than females (p < 0.001) and more obstructed by the rib cage in obese males than females (p = 0.013). Conclusion This association provides ultrasound novices knowledge for a more targeted approach in localizing the gallbladder and evidence to recommend an intercostal approach for gallbladder sonography in obese patients.
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Affiliation(s)
- Sophie A Halpern
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Harrison A Patrizio
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Eamonn J Brace
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Shiyuan Wang
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Jonathan Y Yuh
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Dip V Patel
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Ryan G Morrison
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Arielle J Hall
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Amerigo Falciani
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Kathleen A Deiling
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Nils V Brolis
- Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
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24
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Gottlieb M, Patel D, Viars M, Tsintolas J, Peksa GD, Bailitz J. Comparison of artificial intelligence versus real-time physician assessment of pulmonary edema with lung ultrasound. Am J Emerg Med 2023; 70:109-112. [PMID: 37269797 DOI: 10.1016/j.ajem.2023.05.029] [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: 04/13/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Lung ultrasound can evaluate for pulmonary edema, but data suggest moderate inter-rater reliability among users. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of B line interpretation. Early data suggest a benefit among more novice users, but data are limited among average residency-trained physicians. The objective of this study was to compare the accuracy of AI versus real-time physician assessment for B lines. METHODS This was a prospective, observational study of adult Emergency Department patients presenting with suspected pulmonary edema. We excluded patients with active COVID-19 or interstitial lung disease. A physician performed thoracic ultrasound using the 12-zone technique. The physician recorded a video clip in each zone and provided an interpretation of positive (≥3 B lines or a wide, dense B line) or negative (<3 B lines and the absence of a wide, dense B line) for pulmonary edema based upon the real-time assessment. A research assistant then utilized the AI program to analyze the same saved clip to determine if it was positive versus negative for pulmonary edema. The physician sonographer was blinded to this assessment. The video clips were then reviewed independently by two expert physician sonographers (ultrasound leaders with >10,000 prior ultrasound image reviews) who were blinded to the AI and initial determinations. The experts reviewed all discordant values and reached consensus on whether the field (i.e., the area of lung between two adjacent ribs) was positive or negative using the same criteria as defined above, which served as the gold standard. RESULTS 71 patients were included in the study (56.3% female; mean BMI: 33.4 [95% CI 30.6-36.2]), with 88.3% (752/852) of lung fields being of adequate quality for assessment. Overall, 36.1% of lung fields were positive for pulmonary edema. The physician was 96.7% (95% CI 93.8%-98.5%) sensitive and 79.1% (95% CI 75.1%-82.6%) specific. The AI software was 95.6% (95% CI 92.4%-97.7%) sensitive and 64.1% (95% CI 59.8%-68.5%) specific. CONCLUSION Both the physician and AI software were highly sensitive, though the physician was more specific. Future research should identify which factors are associated with increased diagnostic accuracy.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Miranda Viars
- Rush Medical College, Chicago, IL, United States of America.
| | - Jack Tsintolas
- Rush Medical College, Chicago, IL, United States of America.
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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25
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Counseller Q, Aboelkassem Y. Recent technologies in cardiac imaging. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:984492. [PMID: 36704232 PMCID: PMC9872125 DOI: 10.3389/fmedt.2022.984492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac imaging allows physicians to view the structure and function of the heart to detect various heart abnormalities, ranging from inefficiencies in contraction, regulation of volumetric input and output of blood, deficits in valve function and structure, accumulation of plaque in arteries, and more. Commonly used cardiovascular imaging techniques include x-ray, computed tomography (CT), magnetic resonance imaging (MRI), echocardiogram, and positron emission tomography (PET)/single-photon emission computed tomography (SPECT). More recently, even more tools are at our disposal for investigating the heart's physiology, performance, structure, and function due to technological advancements. This review study summarizes cardiac imaging techniques with a particular interest in MRI and CT, noting each tool's origin, benefits, downfalls, clinical application, and advancement of cardiac imaging in the near future.
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Affiliation(s)
- Quinn Counseller
- College of Health Sciences, University of Michigan, Flint, MI, United States
| | - Yasser Aboelkassem
- College of Innovation and Technology, University of Michigan, Flint, MI, United States,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States,Correspondence: Yasser Aboelkassem
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26
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Oliveira R, Figueiredo L, Costa P. Modification of [18F]-FDG PET/CT imaging protocols in obese oncology patients: A nationwide survey. Radiography (Lond) 2023; 29:145-151. [PMID: 36370640 DOI: 10.1016/j.radi.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The use of medical imaging for diagnosis, staging and follow-up in Oncology context is incredibly important, being the use of [18F]-FDG PET/CT particularly advantageous in specific contexts like the case of obese patients. However, imaging the latter can be challenging sometimes, since their own body size may affect overall image quality and adds technical difficulties for the operator(s) performing the examination. METHODS This research project was developed with the aim of analysing the current personal practices of Portuguese Nuclear Medicine Technologists (NMTs) in the adaptation of 18F-FDG PET/CT oncological protocols for obese patients and comparing the results with parameters referenced in literature. A non-experimental research study was conducted using a survey delivered online to NMTs through social media platforms (Facebook® and LinkedIn®) and by sending the link directly to contacts within the research team professional and personal networks. RESULTS Answers from a total of 26 participants were obtained, with 88.5% of participants admitting modifying technical protocols in examinations for obese patients. Changes in PET protocols included an increase in the administered activity (60.9%), an increase in scan time per individual bed position (69.6%) and the use of Time-of-Flight (TOF) technology whenever available. Protocol changes in CT included increasing the mA (82.6%), raising the KVp (47.8%), the application of iterative reconstruction (69.6%) and the use of automatic exposure control (AEC) (52.2%). The remaining parameters (pitch, algorithm, slice thickness, display FOV, gantry rotation time and energy acceptance window) were claimed not to be modified by around 90% of professionals. CONCLUSION Portuguese NMTs tend to change the [18F]-FDG PET/CT protocols for obese patients. However, while some of the parameters appear to be contradictory or redundant, others require further optimisation, especially in the CT component. IMPLICATIONS FOR PRACTICE Efforts should be made to optimize acquisition protocols used in [18F]-FDG PET/CT scans for obese patients.
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Affiliation(s)
- R Oliveira
- Medical Imaging and Radiotherapy Graduation Programme, School of Health - Polytechnic Institute of Porto, Portugal
| | - L Figueiredo
- Radiology Department, School of Health - Polytechnic Institute of Porto, Portugal
| | - P Costa
- Nuclear Medicine Department, School of Health - Polytechnic Institute of Porto, Portugal.
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27
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Bozorgmanesh M, Latifi R, Hassannejad N. Innovative Technique for Posterior Fixation of Vertically Unstable Pelvic Ring Fracture: A Case Report. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:658-661. [PMID: 37873524 PMCID: PMC10590491 DOI: 10.22038/abjs.2023.70015.3286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/18/2023] [Indexed: 10/25/2023]
Abstract
An obese 57-year-old woman with known hypertension and diabetes mellitus sustained multiple injuries during an accident, which caused anterior-posterior fracture-dislocation of the pelvic ring. Due to the drawbacks of conventional stabilizing methods for anterior-posterior fracture-dislocations of the hip in this setting, such as the inability to visualize anatomical landmarks fluoroscopically for the iliosacral screw technique and the compromised L5 pedicle preventing lumbopelvic fixation, the patient underwent an innovative Hula Hoop technique described here. Using the Hula Hoop technique, a technique that has rarely been studied in humans, we avoided an invasive open procedure, decreased anesthesia time, reduced the size and number of incisions, and minimized bleeding. After three months of routine physiotherapy and occupational therapy, the patient was able to walk with a walker and an ankle-foot orthosis.
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Affiliation(s)
| | - Reza Latifi
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
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28
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Hasenberg T, König B. [Obesity from the Perspective of Surgical Oncology]. Zentralbl Chir 2022; 147:574-583. [PMID: 36479653 DOI: 10.1055/a-1957-5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Up to 40% of all adults worldwide are overweight or obese. Besides the established obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension or NAFLD (non-alcoholic fatty liver disease), the focus of interest is shifting towards the influence of increased body weight as a risk factor for the development of malignant diseases. For more than 20 different types of malignancies, interactions between increased body weight and cancer risk have been established. Pathophysiological influences of obesity on carcinogenesis are diverse, including factors such as chronic inflammation, hyperinsulinaemia and insulin resistance, various changes in growth factor and changes in sex hormones. In cohorts of visceral oncology patients, malignancies such as colorectal carcinomas, hepatocellular carcinomas, adenocarcinomas of the pancreas, oesophageal and gastric carcinomas are also linked to an increased disease risk with increasing body weight. Since obesity must be considered a preventable or at least treatable cause of cancer, this review examines the influence of obesity in the field of visceral oncology, examining the effects of obesity on tumour prevalence, prevention and diagnostic testing, as well as its influence on treatment and prognosis. Furthermore, this review explores the current evidence on the influence of bariatric surgery on the prevalence of these obesity associated tumours. For example, in the case of colorectal carcinomas, the evidence base following bariatric surgery is mixed, painting an inhomogeneous picture. On the other hand, significantly lower prevalence of pancreatic adenocarcinoma and hepatocellular carcinomas is to be noted. The latter effect can be explained by the decrease in non-alcoholic fatty liver disease (NAFLD) associated with weight loss. Despite the justified concern that bariatric procedures (especially gastric sleeve resection) lead to increased prevalence of malignancies of the oesophageal junction, the currently available epidemiological data does not seem to identify a relevant increase in the incidence of these malignancies.
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Affiliation(s)
- Till Hasenberg
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
| | - Barbara König
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
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29
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Kuoy E, Glavis-Bloom J, Hovis G, Yep B, Biswas A, Masudathaya LA, Norrick LA, Limfueco J, Soun JE, Chang PD, Chu E, Akbari Y, Yaghmai V, Fox JC, Yu W, Chow DS. Point-of-Care Brain MRI: Preliminary Results from a Single-Center Retrospective Study. Radiology 2022; 305:666-671. [PMID: 35916678 PMCID: PMC9713449 DOI: 10.1148/radiol.211721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 11/11/2022]
Abstract
Background Point-of-care (POC) MRI is a bedside imaging technology with fewer than five units in clinical use in the United States and a paucity of scientific studies on clinical applications. Purpose To evaluate the clinical and operational impacts of deploying POC MRI in emergency department (ED) and intensive care unit (ICU) patient settings for bedside neuroimaging, including the turnaround time. Materials and Methods In this preliminary retrospective study, all patients in the ED and ICU at a single academic medical center who underwent noncontrast brain MRI from January 2021 to June 2021 were investigated to determine the number of patients who underwent bedside POC MRI. Turnaround time, examination limitations, relevant findings, and potential CT and fixed MRI findings were recorded for patients who underwent POC MRI. Descriptive statistics were used to describe clinical variables. The Mann-Whitney U test was used to compare the turnaround time between POC MRI and fixed MRI examinations. Results Of 638 noncontrast brain MRI examinations, 36 POC MRI examinations were performed in 35 patients (median age, 66 years [IQR, 57-77 years]; 21 women), with one patient undergoing two POC MRI examinations. Of the 36 POC MRI examinations, 13 (36%) occurred in the ED and 23 (64%) in the ICU. There were 12 of 36 (33%) POC MRI examinations interpreted as negative, 14 of 36 (39%) with clinically significant imaging findings, and 10 of 36 (28%) deemed nondiagnostic for reasons such as patient motion. Of 23 diagnostic POC MRI examinations with comparison CT available, three (13%) demonstrated acute infarctions not apparent on CT scans. Of seven diagnostic POC MRI examinations with subsequent fixed MRI examinations, two (29%) demonstrated missed versus interval subcentimeter infarctions, while the remaining demonstrated no change. The median turnaround time of POC MRI was 3.4 hours in the ED and 5.3 hours in the ICU. Conclusion Point-of-care (POC) MRI was performed rapidly in the emergency department and intensive care unit. A few POC MRI examinations demonstrated acute infarctions not apparent at standard-of-care CT examinations. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Anzai and Moy in this issue.
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Affiliation(s)
- Edward Kuoy
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Justin Glavis-Bloom
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Gabrielle Hovis
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Brian Yep
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Arabdha Biswas
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Lu-Aung Masudathaya
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Lori A. Norrick
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Julie Limfueco
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Jennifer E. Soun
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Peter D. Chang
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Eleanor Chu
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Yama Akbari
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Vahid Yaghmai
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - John C. Fox
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Wengui Yu
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Daniel S. Chow
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
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Petrou NA, Rafique H, Rasheed S, Tekkis P, Kontovounisios C. Colorectal Cancer and the Obese Patient: A Call for Guidelines. Cancers (Basel) 2022; 14:5255. [PMID: 36358674 PMCID: PMC9657704 DOI: 10.3390/cancers14215255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 07/30/2023] Open
Abstract
The link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients.
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Affiliation(s)
- Nikoletta A. Petrou
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Henna Rafique
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
| | - Shahnawaz Rasheed
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Paris Tekkis
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Christos Kontovounisios
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
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31
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Illg C, Krauss S, Rachunek K, Thiel JT, Daigeler A, Schäfer RC. Thermography Supported Color Duplex Ultrasound Accelerates ALT Perforator Imaging. J Reconstr Microsurg 2022; 39:295-300. [PMID: 36150693 DOI: 10.1055/s-0042-1755614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The anterolateral thigh flap is a versatile and dependable perforator flap and is a popular choice in the reconstruction of various body sites. The variable perforator anatomy suggests preoperative perforator imaging to improve safety and speed of dissection. An innovative perforator imaging technique is thermography, which lately gained attention in plastic surgery. METHODS Thirty-two healthy participants were included in this randomized study. One thigh was examined with dynamic infrared thermography and consecutively with ultrasound, while the contralateral thigh was examined with ultrasound as standalone technology. RESULTS The application of dynamic infrared thermography prior to ultrasound perforator identification significantly accelerated the ultrasound examination duration by 90 to 130 seconds. The mean duplex ultrasound examination duration correlated positively with the hotspot and perforator quantity per thigh. CONCLUSION The addition of thermographic perforator mapping can accelerate color duplex ultrasound anterolateral thigh perforator imaging. Furthermore, thermography supplements color duplex ultrasound with crucial information on angiosome location.
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Affiliation(s)
- Claudius Illg
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Sabrina Krauss
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Tobias Thiel
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ruth Christine Schäfer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Maar M, Lee J, Tardi A, Zheng YY, Wong C, Gao J. Inter-transducer variability of ultrasound image quality in obese adults: Qualitative and quantitative comparisons. Clin Imaging 2022; 92:63-71. [DOI: 10.1016/j.clinimag.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
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Lazarus E, Bays HE. Cancer and Obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 3:100026. [PMID: 37990728 PMCID: PMC10661911 DOI: 10.1016/j.obpill.2022.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of cancer and increased body fat. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics include the increased risk of cancers among patients with obesity, cancer risk factor population-attributable fractions, genetic and epigenetic links between obesity and cancer, adiposopathic and mechanistic processes accounting for increased cancer risk among patients with obesity, the role of oxidative stress, and obesity-related cancers based upon Mendelian randomization and observational studies. Other topics include nutritional and physical activity principles for patients with obesity who either have cancer or are at risk for cancer, and preventive care as it relates to cancer and obesity. Conclusions Obesity is the second most common preventable cause of cancer and may be the most common preventable cause of cancer among nonsmokers. This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on cancer is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Patients with obesity are at greater risk of developing certain types of cancers, and treatment of obesity may influence the risk, onset, progression, and recurrence of cancer in patients with obesity.
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Affiliation(s)
- Ethan Lazarus
- Diplomate American Board of Obesity Medicine, Diplomate American Board of Family Medicine, President Obesity Medicine Association (2021- 2022); Delegate American Medical Association, Clinical Nutrition Center 5995 Greenwood Plaza Blvd, Ste 150, Greenwood Village, CO 80111
| | - Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, Medical Director/President Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor/University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Alenezi S, Dannoon S, Alnafisi N, Alshammari J, H. Elgazzar A. Potential Pitfalls of Steatopygia on Bone Scintigraphy and the Added Value of Single Photon Emission Computed Tomography and Single Photon Emission Computed Tomography/Computed Tomography. Med Princ Pract 2022; 32:343-350. [PMID: 35940136 PMCID: PMC10727687 DOI: 10.1159/000526372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aims of the study were to assess the prevalence of steatopygia on bone scintigraphy of obese patients and to evaluate its effect on the appearance of the lumbar spine, and the added benefit of single photon emission computed tomography (SPECT) and SPECT/computed tomography (SPECT/CT) in overcoming possible artifacts. METHODS Patients with BMI ≥30 who underwent bone scintigraphy between 2016 and 2019 were included. Three nuclear medicine consultants reviewed the studies to determine whether significant steatopygia was present, and whether it resulted in attenuation of underlying lumber spine and crease edge artifact. SPECT or SPECT/CT images were reviewed to evaluate their impact on diagnosis. RESULTS 56 out of the 100 patients were noted to have steatopygia on planar images. Among the group of 80 obese patients, 50% showed steatopygia, while in the group of 20 morbidly obese patients, 80% showed steatopygia. 32 of the 56 patients with steatopygia had significant attenuation at the lower lumber vertebrae. Nine of these patients showed crease edge artifact. SPECT and SPECT/CT clarified the scintigraphic abnormalities noted in all patients including those with edge artifact alleviating diagnostic difficulty. Among the 9 patients with edge artifact, 6 patients showed normal appearance on SPECT/CT images while three showed true abnormalities. CONCLUSIONS Steatopygia is common on bone scintigraphy of obese patients, higher in females and morbidly obese patients. Obesity-related artifacts in bone scintigraphy, including attenuation effect and edge artifact, are common in this patient group. SPECT or SPECT/CT improves the diagnostic accuracy by overcoming the effects of steatopygia seen on planar images.
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Affiliation(s)
- Saud Alenezi
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Farwania Hospital, Ministry of Health, Kuwait, Kuwait
| | - Shorouk Dannoon
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Naheel Alnafisi
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Jehan Alshammari
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Abdelhamid H. Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
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Abrishami Kashani M, Campbell-Washburn AE, Murphy MC, Catalano OA, McDermott S, Fintelmann FJ. Magnetic Resonance Imaging for Guidance and Follow-up of Thoracic Needle Biopsies and Thermal Ablations. J Thorac Imaging 2022; 37:201-216. [PMID: 35426857 PMCID: PMC10441002 DOI: 10.1097/rti.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI) is used for the guidance and follow-up of percutaneous minimally invasive interventions in many body parts. In the thorax, computed tomography (CT) is currently the most used imaging modality for the guidance and follow-up of needle biopsies and thermal ablations. Compared with CT, MRI provides excellent soft tissue contrast, lacks ionizing radiation, and allows functional imaging. The role of MRI is limited in the thorax due to the low hydrogen proton density and many air-tissue interfaces of the lung, as well as respiratory and cardiac motion. Here, we review the current experience of MR-guided thoracic needle biopsies and of MR-guided thermal ablations targeting lesions in the lung, mediastinum, and the chest wall. We provide an overview of MR-compatible biopsy needles and ablation devices. We detail relevant MRI sequences and their relative advantages and disadvantages for procedural guidance, assessment of complications, and long-term follow-up. We compare the advantages and disadvantages of CT and MR for thoracic interventions and identify areas in need of improvement and additional research.
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Affiliation(s)
| | - Adrienne E Campbell-Washburn
- Division of Intramural Research, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mark C Murphy
- Division of Thoracic Imaging and Intervention, Department of Radiology
| | - Onofrio A Catalano
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Morales MA, Snel GJH, van den Boomen M, Borra RJH, van Deursen VM, Slart RHJA, Izquierdo-Garcia D, Prakken NHJ, Catana C. DeepStrain Evidence of Asymptomatic Left Ventricular Diastolic and Systolic Dysfunction in Young Adults With Cardiac Risk Factors. Front Cardiovasc Med 2022; 9:831080. [PMID: 35479280 PMCID: PMC9035693 DOI: 10.3389/fcvm.2022.831080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate if a fully-automatic deep learning method for myocardial strain analysis based on magnetic resonance imaging (MRI) cine images can detect asymptomatic dysfunction in young adults with cardiac risk factors. Methods An automated workflow termed DeepStrain was implemented using two U-Net models for segmentation and motion tracking. DeepStrain was trained and tested using short-axis cine-MRI images from healthy subjects and patients with cardiac disease. Subsequently, subjects aged 18–45 years were prospectively recruited and classified among age- and gender-matched groups: risk factor group (RFG) 1 including overweight without hypertension or type 2 diabetes; RFG2 including hypertension without type 2 diabetes, regardless of overweight; RFG3 including type 2 diabetes, regardless of overweight or hypertension. Subjects underwent cardiac short-axis cine-MRI image acquisition. Differences in DeepStrain-based left ventricular global circumferential and radial strain and strain rate among groups were evaluated. Results The cohort consisted of 119 participants: 30 controls, 39 in RFG1, 30 in RFG2, and 20 in RFG3. Despite comparable (>0.05) left-ventricular mass, volumes, and ejection fraction, all groups (RFG1, RFG2, RFG3) showed signs of asymptomatic left ventricular diastolic and systolic dysfunction, evidenced by lower circumferential early-diastolic strain rate (<0.05, <0.001, <0.01), and lower septal circumferential end-systolic strain (<0.001, <0.05, <0.001) compared with controls. Multivariate linear regression showed that body surface area correlated negatively with all strain measures (<0.01), and mean arterial pressure correlated negatively with early-diastolic strain rate (<0.01). Conclusion DeepStrain fully-automatically provided evidence of asymptomatic left ventricular diastolic and systolic dysfunction in asymptomatic young adults with overweight, hypertension, and type 2 diabetes risk factors.
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Affiliation(s)
- Manuel A. Morales
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- *Correspondence: Manuel A. Morales
| | - Gert J. H. Snel
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maaike van den Boomen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ronald J. H. Borra
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Vincent M. van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - David Izquierdo-Garcia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Niek H. J. Prakken
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ciprian Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Ciprian Catana
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Brendlin AS, Estler A, Plajer D, Lutz A, Grözinger G, Bongers MN, Tsiflikas I, Afat S, Artzner CP. AI Denoising Significantly Enhances Image Quality and Diagnostic Confidence in Interventional Cone-Beam Computed Tomography. Tomography 2022; 8:933-947. [PMID: 35448709 PMCID: PMC9031402 DOI: 10.3390/tomography8020075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
(1) To investigate whether interventional cone-beam computed tomography (cbCT) could benefit from AI denoising, particularly with respect to patient body mass index (BMI); (2) From 1 January 2016 to 1 January 2022, 100 patients with liver-directed interventions and peri-procedural cbCT were included. The unenhanced mask run and the contrast-enhanced fill run of the cbCT were reconstructed using weighted filtered back projection. Additionally, each dataset was post-processed using a novel denoising software solution. Place-consistent regions of interest measured signal-to-noise ratio (SNR) per dataset. Corrected mixed-effects analysis with BMI subgroup analyses compared objective image quality. Multiple linear regression measured the contribution of “Radiation Dose”, “Body-Mass-Index”, and “Mode” to SNR. Two radiologists independently rated diagnostic confidence. Inter-rater agreement was measured using Spearman correlation (r); (3) SNR was significantly higher in the denoised datasets than in the regular datasets (p < 0.001). Furthermore, BMI subgroup analysis showed significant SNR deteriorations in the regular datasets for higher patient BMI (p < 0.001), but stable results for denoising (p > 0.999). In regression, only denoising contributed positively towards SNR (0.6191; 95%CI 0.6096 to 0.6286; p < 0.001). The denoised datasets received overall significantly higher diagnostic confidence grades (p = 0.010), with good inter-rater agreement (r ≥ 0.795, p < 0.001). In a subgroup analysis, diagnostic confidence deteriorated significantly for higher patient BMI (p < 0.001) in the regular datasets but was stable in the denoised datasets (p ≥ 0.103).; (4) AI denoising can significantly enhance image quality in interventional cone-beam CT and effectively mitigate diagnostic confidence deterioration for rising patient BMI.
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Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
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Syan SK, McIntyre-Wood C, Minuzzi L, Hall G, McCabe RE, MacKillop J. Dysregulated resting state functional connectivity and obesity: A systematic review. Neurosci Biobehav Rev 2021; 131:270-292. [PMID: 34425125 DOI: 10.1016/j.neubiorev.2021.08.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
Obesity has been variously linked to differences in brain functional connectivity in regions associated with reward, emotional regulation and cognition, potentially revealing neural mechanisms contributing to its development and maintenance. This systematic review summarizes and critically appraises the existing literature on differences in resting state functional connectivity (Rs-FC) between overweight and individuals with obesity in relation healthy-BMI controls. Twenty-nine studies were identified and the results consistently support the hypothesis that obesity is associated with differences in Rs-FC. Specifically, obesity/overweight was consistently associated with (i) DMN hypoconnectivity and salience network hyperconnectivity; (ii) increased Rs-FC between the hypothalamus and reward, limbic and salience networks, and decreased Rs-FC between the hypothalamus and cognitive regions; (iii) increased power within regions associated with inhibition/emotional reasoning; (iv) decreased nodal efficiency, degree centrality, and global efficiency. Collectively, the results suggest obesity is associated with disrupted connectivity of brain networks responsible for cognition, reward, self-referential processing and emotional regulation.
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Affiliation(s)
- Sabrina K Syan
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada; Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.
| | - Carly McIntyre-Wood
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Geoffrey Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada; Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
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Hegemann N, Primessnig U, Bode D, Wakula P, Beindorff N, Klopfleisch R, Michalick L, Grune J, Hohendanner F, Messroghli D, Pieske B, Kuebler WM, Heinzel FR. Right-ventricular dysfunction in HFpEF is linked to altered cardiomyocyte Ca 2+ homeostasis and myofilament sensitivity. ESC Heart Fail 2021; 8:3130-3144. [PMID: 34002482 PMCID: PMC8318431 DOI: 10.1002/ehf2.13419] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/17/2022] Open
Abstract
Aims Heart failure with preserved ejection fraction (HFpEF) is frequently (30%) associated with right ventricular (RV) dysfunction, which increases morbidity and mortality in these patients. Yet cellular mechanisms of RV remodelling and RV dysfunction in HFpEF are not well understood. Here, we evaluated RV cardiomyocyte function in a rat model of metabolically induced HFpEF. Methods and results Heart failure with preserved ejection fraction‐prone animals (ZSF‐1 obese) and control rats (Wistar Kyoto) were fed a high‐caloric diet for 13 weeks. Haemodynamic characterization by echocardiography and invasive catheterization was performed at 22 and 23 weeks of age, respectively. After sacrifice, organ morphometry, RV histology, isolated RV cardiomyocyte function, and calcium (Ca2+) transients were assessed. ZSF‐1 obese rats showed a HFpEF phenotype with left ventricular (LV) hypertrophy, LV diastolic dysfunction (including increased LV end‐diastolic pressures and E/e′ ratio), and preserved LV ejection fraction. ZSF‐1 obese animals developed RV dilatation (50% increased end‐diastolic area) and mildly impaired RV ejection fraction (42%) with evidence of RV hypertrophy. In isolated RV cardiomyocytes from ZSF‐1 obese rats, cell shortening amplitude was preserved, but cytosolic Ca2+ transient amplitude was reduced. In addition, augmentation of cytosolic Ca2+ release with increased stimulation frequency was lost in ZSF‐1 obese rats. Myofilament sensitivity was increased, while contractile kinetics were largely unaffected in intact isolated RV cardiomyocytes from ZSF‐1 obese rats. Western blot analysis revealed significantly increased phosphorylation of cardiac myosin‐binding protein C (Ser282 cMyBP‐C) but no change in phosphorylation of troponin I (Ser23, 24 TnI) in RV myocardium from ZSF‐1 obese rats. Conclusions Right ventricular dysfunction in obese ZSF‐1 rats with HFpEF is associated with intrinsic RV cardiomyocyte remodelling including reduced cytosolic Ca2+ amplitudes, loss of frequency‐dependent augmentation of Ca2+ release, and increased myofilament Ca2+ sensitivity.
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Affiliation(s)
- Niklas Hegemann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Primessnig
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - David Bode
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Paulina Wakula
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Department of Veterinary Pathology, Free University of Berlin, Berlin, Germany
| | - Laura Michalick
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Grune
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Hohendanner
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center, Berlin, Germany
| | - Wolfgang M Kuebler
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Yeni YN, Oravec D, Drost J, Bevins N, Morrison C, Flynn MJ. Bone health assessment via digital wrist tomosynthesis in the mammography setting. Bone 2021; 144:115804. [PMID: 33321264 DOI: 10.1016/j.bone.2020.115804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
Bone fractures attributable to osteoporosis are a significant problem. Though preventative treatment options are available for individuals who are at risk of a fracture, a substantial number of these individuals are not identified due to lack of adherence to bone screening recommendations. The issue is further complicated as standard diagnosis of osteoporosis is based on bone mineral density (BMD) derived from dual energy x-ray absorptiometry (DXA), which, while helpful in identifying many at risk, is limited in fully predicting risk of fracture. It is reasonable to expect that bone screening would become more prevalent and efficacious if offered in coordination with digital breast tomosynthesis (DBT) exams, provided that osteoporosis can be assessed using a DBT modality. Therefore, the objective of the current study was to explore the feasibility of using digital tomosynthesis imaging in a mammography setting. To this end, we measured density, cortical thickness and microstructural properties of the wrist bone, correlated these to reference measurements from microcomputed tomography and DXA, demonstrated the application in vivo in a small group of participants, and determined the repeatability of the measurements. We found that measurements from digital wrist tomosynthesis (DWT) imaging with a DBT scanner were highly repeatable ex vivo (error = 0.05%-9.62%) and in vivo (error = 0.06%-10.2%). In ex vivo trials, DWT derived BMDs were strongly correlated with reference measurements (R = 0.841-0.980), as were cortical thickness measured at lateral and medial cortices (R = 0.991 and R = 0.959, respectively) and the majority of microstructural measures (R = 0.736-0.991). The measurements were quick and tolerated by human patients with no discomfort, and appeared to be different between young and old participants in a preliminary comparison. In conclusion, DWT is feasible in a mammography setting, and informative on bone mass, cortical thickness, and microstructural qualities that are known to deteriorate in osteoporosis. To our knowledge, this study represents the first application of DBT for imaging bone. Future clinical studies are needed to further establish the efficacy for diagnosing osteoporosis and predicting risk of fragility fracture using DWT.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA.
| | - Daniel Oravec
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Joshua Drost
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Nicholas Bevins
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Michael J Flynn
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
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Usher-Smith J, Simmons RK, Rossi SH, Stewart GD. Current evidence on screening for renal cancer. Nat Rev Urol 2020; 17:637-642. [PMID: 32860009 PMCID: PMC7610655 DOI: 10.1038/s41585-020-0363-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Renal cell carcinoma (RCC) incidence is increasing worldwide. A high proportion of individuals are asymptomatic at diagnosis, but RCC has a high mortality rate. These facts suggest that RCC meets some of the criteria for screening, and a new analysis shows that screening for RCC could potentially be cost-effective. Targeted screening of high-risk individuals is likely to be the most cost-effective strategy to maximize the benefits and reduce the harms of screening. However, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness of screening remains uncertain. The optimal screening modality and target population is also unclear, and uncertainties exist regarding the specification and implementation of a screening programme. Before moving to a fully powered trial of screening, future work should focus on the following: developing and validating accurate risk prediction models; developing non-invasive methods of early RCC detection; establishing the feasibility, public acceptability and potential uptake of screening; establishing the prevalence of RCC and stage distribution of RCC detected by screening; and evaluating the potential harms of screening, including the impact on quality of life, overdiagnosis and over-treatment.
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Affiliation(s)
- Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rebecca K Simmons
- Department of Public Health, Bartolins Allé 2, University of Aarhus, Aarhus C, Denmark
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
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Effect of obesity on radiation exposure, quality of life scores, and outcomes of fenestrated-branched endovascular aortic repair of pararenal and thoracoabdominal aortic aneurysms. J Vasc Surg 2020; 73:1156-1166.e2. [PMID: 32853700 DOI: 10.1016/j.jvs.2020.07.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of the present study was to assess the effect of obesity on procedural metrics, radiation exposure, quality of life (QOL), and clinical outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of pararenal and thoracoabdominal aortic aneurysms. METHODS We reviewed the clinical data from 334 patients (236 men; mean age, 75 ± 8 years) enrolled in a prospective nonrandomized study to evaluate FB-EVAR from 2013 to 2019. The patients were classified using the body mass index (BMI) as obese (BMI ≥30 kg/m2) or nonobese (BMI <30 kg/m2). QOL questionnaires (short-form 36-item questionnaire) and imaging studies were obtained preoperatively and at 2 months and 6 months postoperatively, and annually thereafter. The procedures were performed using two different fixed imaging systems. The end points included procedural metrics (ie, total operative time, fluoroscopic time, contrast volume), radiation exposure, technical success, 30-day mortality, and major adverse events, QOL changes, freedom from target vessel instability, freedom from reintervention, and patient survival. RESULTS The aneurysm extent was a pararenal aortic aneurysm in 117 patients (35%) and a thoracoabdominal aortic aneurysm in 217 patients (65%). Both groups had similar demographics, cardiovascular risk factors, and aneurysm extent, except for a greater incidence of hyperlipidemia and diabetes among the obese patients (P < .05). No significant differences were found in the procedural metrics or intraprocedural complications between the groups, except that the obese patients had greater radiation exposure than the nonobese patients (mean, 2.5 vs 1.6 Gy; P < .001), with the highest radiation exposure in those obese patients who had undergone the procedure using system 1 (fusion alone) instead of system 2 (fusion and digital zoom; mean, 4.1 vs 1.5 Gy; P < .001). Three patients had died within 30 days (0.8%), with no difference in mortality or major adverse events between the groups. The mental QOL scores had improved in the obese group at 2 and 12 months compared with the nonobese patients, with persistently higher scores up to 3 years. At 3 years, the obese and nonobese patients had a similar incidence of freedom from target vessel instability (74% ± 6% vs 80% ± 3%; P = .99, log-rank test), freedom from reintervention (66% ± 6% vs 73% ± 4%; P = .77, log-rank test), and patient survival (83% ± 5% vs 75% ± 4%; P = .16, log-rank test). CONCLUSIONS FB-EVAR was performed with high technical success and low mortality and morbidity, with no significant differences between the obese and nonobese patients. The procedural metrics and outcomes were similar, with the exception of greater radiation exposure among obese patients, especially for the procedures performed using system 1 with fusion alone compared with system 2 (fusion and digital zoom). Obese patients had higher QOL mental scores at 2 and 12 months, with a similar reintervention rate, target vessel outcomes, and survival compared with nonobese patients.
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Finer N, Garnett SP, Bruun JM. COVID-19 and obesity. Clin Obes 2020; 10:e12365. [PMID: 32342637 PMCID: PMC7267455 DOI: 10.1111/cob.12365] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Nick Finer
- National Centre for Cardiovascular Prevention and OutcomesUCL Institute of Cardiovascular ScienceLondonUK
| | - Sarah P. Garnett
- Discipline of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Jens M. Bruun
- Steno Diabetes Center AarhusAarhus University Hospital and University of AarhusAarhusDenmark
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Affiliation(s)
- Stuart A Taylor
- 1 UCL Centre for Medical Imaging, Division of Medicine, University College London , London , UK
| | - Laura R Carucci
- 2 Department of Radiology, VCU Health System , Richmond, VA , United States
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