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D'Angelo T, Mastrodicasa D, Lanzafame LRM, Yel I, Koch V, Gruenewald LD, Sharma SP, Ascenti V, Micari A, Blandino A, Vogl TJ, Mazziotti S, Budde RPJ, Booz C. Optimization of window settings for coronary arteries assessment using spectral CT-derived virtual monoenergetic imaging. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01835-6. [PMID: 38935247 DOI: 10.1007/s11547-024-01835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To determine the optimal window setting for virtual monoenergetic images (VMI) reconstructed from dual-layer spectral coronary computed tomography angiography (DE-CCTA) datasets. MATERIAL AND METHODS 50 patients (30 males; mean age 61.1 ± 12.4 years who underwent DE-CCTA from May 2021 to June 2022 for suspected coronary artery disease, were retrospectively included. Image quality assessment was performed on conventional images and VMI reconstructions at 70 and 40 keV. Objective image quality was assessed using contrast-to-noise ratio (CNR). Two independent observers manually identified the best window settings (B-W/L) for VMI 70 and VMI 40 visualization. B-W/L were then normalized with aortic attenuation using linear regression analysis to obtain the optimized W/L (O-W/L) settings. Additionally, subjective image quality was evaluated using a 5-point Likert scale, and vessel diameters were measured to examine any potential impact of different W/L settings. RESULTS VMI 40 demonstrated higher CNR values compared to conventional and VMI 70. B-W/L settings identified were 1180/280 HU for VMI 70 and 3290/900 HU for VMI 40. Subsequent linear regression analysis yielded O-W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40. VMI 40 O-W/L received the highest scores for each parameter compared to conventional (all p < 0.0027). Using O-W/L settings for VMI 70 and VMI 40 did not result in significant differences in vessel measurements compared to conventional images. CONCLUSION Optimization of VMI requires adjustments in W/L settings. Our results recommend W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40.
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Affiliation(s)
- Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 453 Quarry Rd, MC 5659, Palo Alto, CA 94304-5659, USA
| | - Ludovica R M Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Simran P Sharma
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Velio Ascenti
- Department of Radiology, Policlinico Universitario Ospedale Maggiore, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Antonino Micari
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Goller SS, Sutter R. Advanced Imaging of Total Knee Arthroplasty. Semin Musculoskelet Radiol 2024; 28:282-292. [PMID: 38768593 DOI: 10.1055/s-0044-1781470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The prevalence of total knee arthroplasty (TKA) is increasing with the aging population. Although long-term results are satisfactory, suspected postoperative complications often require imaging with the implant in place. Advancements in computed tomography (CT), such as tin prefiltration, metal artifact reduction algorithms, dual-energy CT with virtual monoenergetic imaging postprocessing, and the application of cone-beam CT and photon-counting detector CT, allow a better depiction of the tissues adjacent to the metal. For magnetic resonance imaging (MRI), high bandwidth (BW) optimization, the combination of view angle tilting and high BW, as well as multispectral imaging techniques with multiacquisition variable-resonance image combination or slice encoding metal artifact correction, have significantly improved imaging around metal implants, turning MRI into a useful clinical tool for patients with suspected TKA complications.
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Affiliation(s)
- Sophia Samira Goller
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Schoenbeck D, Sacha A, Niehoff JH, Moenninghoff C, Borggrefe J, Kroeger JR, Michael AE. Imaging of hypodense gliotic lesions in photon counting computed tomography using virtual monoenergetic images. Neuroradiol J 2024; 37:336-341. [PMID: 38490750 PMCID: PMC11138327 DOI: 10.1177/19714009241240056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Glioses appear as hypodense lesions in non-contrast CT examinations of the head. Photon counting CT (PCCT) enables the calculation of virtual monoenergetic images (VMI). The aim of this study is to investigate in which VMI hypodense gliotic lesions can be delineated best. MATERIALS AND METHODS 35 patients with an MRI-confirmed gliotic lesion and a non-contrast PCCT of the head were retrospectively included. All available VMI from 40 keV to 190 keV were calculated. In a quantitative analysis, conventional image quality parameters were calculated, in particular the contrast-to-noise ratio (CNR) of the hypodense lesion compared to the white matter. In a qualitative analysis, selected VMI were rated by experienced radiologists. RESULTS The absolute maximum of CNR was 8.12 ± 5.64 in the VMI 134 keV, in post hoc testing, there were significant differences in comparison to VMI with keV ≤110 and keV ≥180 (corrected p < .05). In the qualitative analysis, there were only very slight differences in the rating of the VMI with 66 keV, 80 keV, 100 keV, and 134 keV with overall low agreement between the readers. CONCLUSIONS The quantitative superiority of VMI 134 keV for the delineation of hypodense gliotic lesions did not translate into a superiority in the qualitative analysis. Therefore, it remains uncertain if the reconstruction of a high keV VMIs for the detection of hypodense gliotic lesions is useful in everyday clinical practice. However, more studies, are necessary to further assess this issue.
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Affiliation(s)
- Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Alexander Sacha
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany
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Albano D, Di Luca F, D'Angelo T, Booz C, Midiri F, Gitto S, Fusco S, Serpi F, Messina C, Sconfienza LM. Dual-energy CT in musculoskeletal imaging: technical considerations and clinical applications. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01827-6. [PMID: 38743319 DOI: 10.1007/s11547-024-01827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
Dual-energy CT stands out as a robust and innovative imaging modality, which has shown impressive advancements and increasing applications in musculoskeletal imaging. It allows to obtain detailed images with novel insights that were once the exclusive prerogative of magnetic resonance imaging. Attenuation data obtained by using different energy spectra enable to provide unique information about tissue characterization in addition to the well-established strengths of CT in the evaluation of bony structures. To understand clearly the potential of this imaging modality, radiologists must be aware of the technical complexity of this imaging tool, the different ways to acquire images and the several algorithms that can be applied in daily clinical practice and for research. Concerning musculoskeletal imaging, dual-energy CT has gained more and more space for evaluating crystal arthropathy, bone marrow edema, and soft tissue structures, including tendons and ligaments. This article aims to analyze and discuss the role of dual-energy CT in musculoskeletal imaging, exploring technical aspects, applications and clinical implications and possible perspectives of this technique.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy.
| | - Filippo Di Luca
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesca Serpi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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D'Angelo T, Lanzafame LRM, Liguori C, Mantini C, Russo V, Palumbo P, Scalera GB, Iozzelli A, Borghesi A, Matta G, Greco F, Garretto V, Danti M, Iezzi R, Francone M. Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group. Int J Cardiovasc Imaging 2024; 40:831-839. [PMID: 38263535 PMCID: PMC11052815 DOI: 10.1007/s10554-024-03052-8] [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: 11/25/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community. METHODS Between December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging. RESULTS 557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient's body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings. CONCLUSIONS This survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.
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Affiliation(s)
- Tommaso D'Angelo
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ludovica R M Lanzafame
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare, ASL NA1 Centro, Napoli, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Russo
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Radiology Department IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L'Aquila, Italy
| | - Giovanni B Scalera
- Unit of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, Brescia, I - 25123, Italy
| | - Gildo Matta
- Department of Radiology, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy
| | - Fabio Greco
- Department of Radiology, "University Hospitals Bristol and Weston Foundation Trust", Bristol, UK
| | - Valeria Garretto
- Diagnostic Radiology Unit Department, CAST - Policlinico - San Marco Hospital University, Catania, Italy
| | | | - Roberto Iezzi
- Unit of Diagnostic and Interventional Imaging, Department of Diagnostic Imaging, Radiation Therapy and Hematology, IRCCS Policlinico "A. Gemelli", Roma, Italy
- Unit of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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6
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Haag F, Hokamp NG, Overhoff D, Dasegowda G, Kuru M, Nörenberg D, Schoenberg SO, Kalra MK, Froelich MF. Potential of photon counting computed tomography derived spectral reconstructions to reduce beam-hardening artifacts in chest CT. Eur J Radiol 2024; 175:111448. [PMID: 38574510 DOI: 10.1016/j.ejrad.2024.111448] [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: 08/04/2023] [Revised: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Aim of the recent study is to point out a method to optimize quality of CT scans in oncological patients with port systems. This study investigates the potential of photon counting computed tomography (PCCT) for reduction of beam hardening artifacts caused by port-implants in chest imaging by means of spectral reconstructions. METHOD In this retrospective single-center study, 8 ROIs for 19 spectral reconstructions (polyenergetic imaging, monoenergetic reconstructions from 40 to 190 keV as well as iodine maps and virtual non contrast (VNC)) of 49 patients with pectoral port systems undergoing PCCT of the chest for staging of oncologic disease were measured. Mean values and standard deviation (SD) Hounsfield unit measurements of port-chamber associated hypo- and hyperdense artifacts, bilateral muscles and vessels has been carried out. Also, a structured assessment of artifacts and imaging findings was performed by two radiologists. RESULTS A significant association of keV with iodine contrast as well as artifact intensity was noted (all p < 0.001). In qualitative assessment, utilization of 120 keV monoenergetic reconstructions could reduce severe and pronounced artifacts completely, as compared to lower keV reconstructions (p < 0.001). Regarding imaging findings, no significant difference between monoenergetic reconstructions was noted (all p > 0.05). In cases with very high iodine concentrations in the subclavian vein, image distortions were noted at 40 keV images (p < 0.01). CONCLUSIONS The present study demonstrates that PCCT derived spectral reconstructions can be used in oncological imaging of the thorax to reduce port-derived beam-hardening artefacts. When evaluating image data sets within a staging, it can be particularly helpful to consider the 120 keV VMIs, in which the artefacts are comparatively low.
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Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Bundeswehrzentralkrankenhaus, Koblenz, Germany
| | - Giridhar Dasegowda
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mustafa Kuru
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Rippel K, Luitjens J, Habeeballah O, Scheurig-Muenkler C, Bette S, Braun F, Kroencke TJ, Schwarz F, Decker JA. Evaluation of ECG-Gated, High-Pitch Thoracoabdominal Angiographies With Dual-Source Photon-Counting Detector Computed Tomography. J Endovasc Ther 2024:15266028241230943. [PMID: 38380529 DOI: 10.1177/15266028241230943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE The aim of this study was to evaluate the radiation dose, image quality, and the potential of virtual monoenergetic imaging (VMI) reconstructions of high-pitch computed tomography angiography (CTA) of the thoracoabdominal aorta on a dual-source photon-counting detector-CT (PCD-CT) in comparison with an energy-integrating detector-CT (EID-CT), with a special focus on low-contrast attenuation. METHODS Consecutive patients being referred for an electrocardiogram (ECG)-gated, high-pitch CTA of the thoracoabdominal aorta prior to transcatheter aortic valve replacement (TAVR), and examined on the PCD-CT, were included in this prospective single-center study. For comparison, a retrospective patient group with ECG-gated, high-pitch CTA examinations of the thoracoabdominal aorta on EID-CT with a comparable scan protocol was matched for gender, body mass index, height, and age. Virtual monoenergetic imaging reconstructions from 40 to 120 keV were performed. Enhancement and noise were measured in 7 vascular segments and the surrounding air as mean and standard deviation of CT values. The radiation dose was noted and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Finally, a subgroup analysis was performed, comparing VMI reconstructions from 40 keV to 70 keV in patients with at least a 50% decrease in contrast attenuation between the ascending aorta and femoral arteries. RESULTS Fifty patients (mean age 77.0±14.5 years; 31 women) were included. The radiation dose was significantly lower on the PCD-CT (4.2±1.4 vs. 7.2±2.2 mGy; p<0.001). With increasing keV, vascular noise, SNR, and CNR decreased. Intravascular attenuation was significantly higher on VMI at levels from 40 to 65, compared with levels of 120 keV (p<0.01 and p<0.005, respectively). On the PCD-CT, SNR was significantly higher in keV levels 40 and 70 (all p<0.001), and CNR was higher at keV levels 40 and 45 (each p<0.001), compared with scans on the EID-CT. At VMI ≤60 keV, image noise was also significantly higher than that in the control group. The subgroup analysis showed a drastically improved diagnostic performance of the low-keV images in patients with low-contrast attenuation. CONCLUSION The ECG-gated CTA of the thoracoabdominal aorta in high-pitch mode on PCD-CT have significantly lower radiation dose and higher objective image quality than EID-CT. In addition, low-keV VMI can salvage suboptimal contrast studies, further reducing radiation dose by eliminating the need for repeat scans. CLINICAL IMPACT ECG-gated CT-angiographies of the thoracoabdominal aorta can be acquired with a lower radtiation dose and a better image quality by using a dual-source photon-countinge detector CT. Furthermore, the inherent spectral data offers the possiblity to improve undiagnostic images and thus saves the patient from further radiation and contrast application.
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Affiliation(s)
- K Rippel
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - J Luitjens
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - O Habeeballah
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - C Scheurig-Muenkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Franziska Braun
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - T J Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences, University of Augsburg, Augsburg, Germany
| | - F Schwarz
- DONAUISAR Klinikum Deggendorf, Deggendorf, Germany
| | - J A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
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Kazimierczak W, Kazimierczak N, Wilamowska J, Wojtowicz O, Nowak E, Serafin Z. Enhanced visualization in endoleak detection through iterative and AI-noise optimized spectral reconstructions. Sci Rep 2024; 14:3845. [PMID: 38360941 PMCID: PMC10869818 DOI: 10.1038/s41598-024-54502-1] [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: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
To assess the image quality parameters of dual-energy computed tomography angiography (DECTA) 40-, and 60 keV virtual monoenergetic images (VMIs) combined with deep learning-based image reconstruction model (DLM) and iterative reconstructions (IR). CT scans of 28 post EVAR patients were enrolled. The 60 s delayed phase of DECTA was evaluated. Objective [noise, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR)] and subjective (overall image quality and endoleak conspicuity - 3 blinded readers assessment) image quality analyses were performed. The following reconstructions were evaluated: VMI 40, 60 keV VMI; IR VMI 40, 60 keV; DLM VMI 40, 60 keV. The noise level of the DLM VMI images was approximately 50% lower than that of VMI reconstruction. The highest CNR and SNR values were measured in VMI DLM images. The mean CNR in endoleak in 40 keV was accounted for as 1.83 ± 1.2; 2.07 ± 2.02; 3.6 ± 3.26 in VMI, VMI IR, and VMI DLM, respectively. The DLM algorithm significantly reduced noise and increased lesion conspicuity, resulting in higher objective and subjective image quality compared to other reconstruction techniques. The application of DLM algorithms to low-energy VMIs significantly enhances the diagnostic value of DECTA in evaluating endoleaks. DLM reconstructions surpass traditional VMIs and IR in terms of image quality.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland.
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland.
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland.
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Justyna Wilamowska
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Olaf Wojtowicz
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Ewa Nowak
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
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Layer YC, Mesropyan N, Kupczyk PA, Luetkens JA, Isaak A, Dell T, Ernst BP, Attenberger UI, Kuetting D. Use of virtual monoenergetic images for reduction of extensive dental implant associated artifacts in photon-counting detector CT. Sci Rep 2024; 14:497. [PMID: 38177651 PMCID: PMC10766624 DOI: 10.1038/s41598-023-50926-3] [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: 04/05/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
Aim of this study was to assess the impact of virtual monoenergetic images (VMI) on dental implant artifacts in photon-counting detector computed tomography (PCD-CT) compared to standard reconstructed polychromatic images (PI). 30 scans with extensive (≥ 5 dental implants) dental implant-associated artifacts were retrospectively analyzed. Scans were acquired during clinical routine on a PCD-CT. VMI were reconstructed for 100-190 keV (10 keV steps) and compared to PI. Artifact extent and assessment of adjacent soft tissue were rated using a 5-point Likert grading scale for qualitative assessment. Quantitative assessment was performed using ROIs in most pronounced hypodense and hyperdense artifacts, artifact-impaired soft tissue, artifact-free fat and muscle tissue. A corrected attenuation was calculated as difference between artifact-impaired tissue and tissue without artifacts. Qualitative assessment of soft palate and cheeks improved for all VMI compared to PI (Median PI: 1 (Range: 1-3) and 1 (1-3); e.g. VMI130 keV 2 (1-5); p < 0.0001 and 2 (1-4); p < 0.0001). In quantitative assessment, VMI130 keV showed best results with a corrected attenuation closest to 0 (PI: 30.48 ± 98.16; VMI130 keV: - 0.55 ± 73.38; p = 0.0026). Overall, photon-counting deducted VMI reduce the extent of dental implant-associated artifacts. VMI of 130 keV showed best results and are recommended to support head and neck CT scans.
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Affiliation(s)
- Yannik C Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Benjamin P Ernst
- Department of Otorhinolaryngology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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10
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Decker JA, Becker J, Härting M, Jehs B, Risch F, Canalini L, Wollny C, Scheurig-Muenkler C, Kroencke T, Schwarz F, Bette S. Optimal conspicuity of pancreatic ductal adenocarcinoma in virtual monochromatic imaging reconstructions on a photon-counting detector CT: comparison to conventional MDCT. Abdom Radiol (NY) 2024; 49:103-116. [PMID: 37796327 PMCID: PMC10789688 DOI: 10.1007/s00261-023-04042-5] [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: 06/09/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE To analyze the conspicuity of pancreatic ductal adenocarcinoma (PDAC) in virtual monoenergetic images (VMI) on a novel photon-counting detector CT (PCD-CT) in comparison to energy-integrating CT (EID-CT). METHODS Inclusion criteria comprised initial diagnosis of PDAC (reference standard: histopathological analysis) and standardized contrast-enhanced CT imaging either on an EID-CT or a PCD-CT. Patients were excluded due to different histopathological diagnosis or missing tumor delineation on CT. On the PCD-CT, 40-190 keV VMI reconstructions were generated. Image noise, tumor-to-pancreas ratio (TPR) and contrast-to-noise ratio (CNR) were analyzed by ROI-based measurements in arterial and portal venous contrast phase. Two board-certified radiologist evaluated image quality and tumor delineation at both, EID-CT and PCD-CT (40 and 70 keV). RESULTS Thirty-eight patients (mean age 70.4 years ± 10.3 [range 45-91], 27 males; PCD-CT: n=19, EID-CT: n=19) were retrospectively included. On the PCD-CT, tumor conspicuity (reflected by low TPR and high CNR) was significantly improved at low-energy VMI series (≤ 70 keV compared to > 70 keV), both in arterial and in portal venous contrast phase (P < 0.001), reaching the maximum at 40 keV. Comparison between PCD-CT and EID-CT showed significantly higher CNR on the PCD-CT in portal venous contrast phase at < 70 keV (P < 0.016). On the PCD-CT, tumor conspicuity was improved in portal venous contrast phase compared to arterial contrast phase especially at the lower end of the VMI spectrum (≤ 70 keV). Qualitative analysis revealed that tumor delineation is improved in 40 keV reconstructions compared to 70 keV reconstructions on a PCD-CT. CONCLUSION PCD-CT VMI reconstructions (≤ 70 keV) showed significantly improved conspicuity of PDAC in quantitative and qualitative analysis in both, arterial and portal venous contrast phase, compared to EID-CT, which may be important for early detection of tumor tissue in clinical routine. Tumor delineation was superior in portal venous contrast phase compared to arterial contrast phase.
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Affiliation(s)
- Josua A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Judith Becker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Mark Härting
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Bertram Jehs
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Franka Risch
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Luca Canalini
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Claudia Wollny
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Thomas Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
| | - Florian Schwarz
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
- Medical Faculty, Ludwig Maximilian University Munich, Bavariaring 19, 80336, Munich, Germany
- Institute for Radiology, DONAUISAR Hospital Deggendorf-Dingolfing-Landau, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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11
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Dar G, Goldberg SN, Levy S, Nevo A, Daud M, Sosna J, Lev-Cohain N. Optimal CT windowing on low-monoenergetic images using a simplex algorithm-based approach for abdominal inflammatory processes. Eur J Radiol 2024; 170:111262. [PMID: 38141262 DOI: 10.1016/j.ejrad.2023.111262] [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: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND OBJECTIVES: To determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy spectral CT (DECT). METHODS A retrospective study of 30 patients with clinically proven pancreatitis (15/30) or pyelonephritis (15/30) with inflammatory lesions visible on DECT scans were selected to serve as reference populations. 50 keV low-monoenergetic images in the portal venous phase were iteratively evaluated by 6 abdominal radiologists in twenty-one different windows (7-350HU center; 120-580HU width), selected using a simplex optimization algorithm. Each reader graded the conspicuity of the parenchymal hypodense lesions and image background quality. Three-dimensional contour maps expressing the relationship between overall reader grade and window center and width were constructed and used to find the ideal window for inflammatory pancreatic and renal processes and the image background quality. Finally, 15 appendicitis cases were reviewed on optimal pancreas and kidney windows and the manufacturer recommended conventional abdominal window settings for conventional imaging. RESULTS Convergence to optimal windowing was achieved based upon a total of 3,780 reads (21 window settings × 6 readers × 15 cases for pancreas and kidney). Highest conspicuity grade (>4.5 ± 0.0) for pancreas inflammatory lesions was seen at 116HU/430HU, whereas hypodense pyelonephritis had highest conspicuity at 290HU/570HU. This rendered an ideal "compromise" window (>4 ± 0.2) of 150HU/450HU which differed substantially from conventional manufacturer recommended settings of 50HU/380HU (2.1 ± 1.0, p = 0.00001). Appendix mucosal enhancement was best visualized at manufacturer settings. CONCLUSIONS Optimal visualization of inflammatory processes in abdominal organs on 50 keV low-monoenergetic images may require tailored refinement of window settings.
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Affiliation(s)
- Gili Dar
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Shiran Levy
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Adam Nevo
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Marron Daud
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel.
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12
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Schreck J, Laukamp KR, Niehoff JH, Michael AE, Boriesosdick J, Wöltjen MM, Kröger JR, Reimer RP, Grunz JP, Borggrefe J, Lennartz S. Metal artifact reduction in patients with total hip replacements: evaluation of clinical photon counting CT using virtual monoenergetic images. Eur Radiol 2023; 33:9286-9295. [PMID: 37436505 PMCID: PMC10667386 DOI: 10.1007/s00330-023-09879-4] [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: 10/04/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES To investigate photon-counting CT (PCCT)-derived virtual monoenergetic images (VMI) for artifact reduction in patients with unilateral total hip replacements (THR). METHODS Forty-two patients with THR and portal-venous phase PCCT of the abdomen and pelvis were retrospectively included. For the quantitative analysis, region of interest (ROI)-based measurements of hypodense and hyperdense artifacts, as well as of artifact-impaired bone and the urinary bladder, were conducted, and corrected attenuation and image noise were calculated as the difference of attenuation and noise between artifact-impaired and normal tissue. Two radiologists qualitatively evaluated artifact extent, bone assessment, organ assessment, and iliac vessel assessment using 5-point Likert scales. RESULTS VMI110keV yielded a significant reduction of hypo- and hyperdense artifacts compared to conventional polyenergetic images (CI) and the corrected attenuation closest to 0, indicating best possible artifact reduction (hypodense artifacts: CI: 237.8 ± 71.4 HU, VMI110keV: 8.5 ± 122.5 HU; p < 0.05; hyperdense artifacts: CI: 240.6 ± 40.8 HU vs. VMI110keV: 13.0 ± 110.4 HU; p < 0.05). VMI110keV concordantly provided best artifact reduction in the bone and bladder as well as the lowest corrected image noise. In the qualitative assessment, VMI110keV received the best ratings for artifact extent (CI: 2 (1-3), VMI110keV: 3 (2-4); p < 0.05) and bone assessment (CI: 3 (1-4), VMI110keV: 4 (2-5); p < 0.05), whereas organ and iliac vessel assessments were rated highest in CI and VMI70keV. CONCLUSIONS PCCT-derived VMI effectively reduce artifacts from THR and thereby improve assessability of circumjacent bone tissue. VMI110keV yielded optimal artifact reduction without overcorrection, yet organ and vessel assessments at that energy level and higher were impaired by loss of contrast. CLINICAL RELEVANCE STATEMENT PCCT-enabled artifact reduction is a feasible method for improving assessability of the pelvis in patients with total hip replacements at clinical routine imaging. KEY POINTS • Photon-counting CT-derived virtual monoenergetic images at 110 keV yielded best reduction of hyper- and hypodense artifacts, whereas higher energy levels resulted in artifact overcorrection. • The qualitative artifact extent was reduced best in virtual monoenergetic images at 110 keV, facilitating an improved assessment of the circumjacent bone. • Despite significant artifact reduction, assessment of pelvic organs as well as vessels did not profit from energy levels higher than 70 keV, due to the decline in image contrast.
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Affiliation(s)
- Julian Schreck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Matthias Michael Wöltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Jan Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Robert P Reimer
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801, Bochum, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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13
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Chakravarti S, Uyeda JW. Expanding Role of Dual-Energy CT for Genitourinary Tract Assessment in the Emergency Department, From the AJR Special Series on Emergency Radiology. AJR Am J Roentgenol 2023; 221:720-730. [PMID: 37073900 DOI: 10.2214/ajr.22.27864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Among explored applications of dual-energy CT (DECT) in the abdomen and pelvis, the genitourinary (GU) tract represents an area where accumulated evidence has established the role of DECT to provide useful information that may change management. This review discusses established applications of DECT for GU tract assessment in the emergency department (ED) setting, including characterization of renal stones, evaluation of traumatic injuries and hemorrhage, and characterization of incidental renal and adrenal findings. Use of DECT for such applications can reduce the need for additional multiphase CT or MRI examinations and reduce follow-up imaging recommendations. Emerging applications are also highlighted, including use of low-energy virtual monoenergetic images (VMIs) to improve image quality and potentially reduce contrast media doses and use of high-energy VMIs to mitigate renal mass pseudoenhancement. Finally, implementation of DECT into busy ED radiology practices is presented, weighing the trade-off of additional image acquisition, processing time, and interpretation time against potential additional useful clinical information. Automatic generation of DECT-derived images with direct PACS transfer can facilitate radiologists' adoption of DECT in busy ED environments and minimize impact on interpretation times. Using the described approaches, radiologists can apply DECT technology to improve the quality and efficiency of care in the ED.
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Affiliation(s)
| | - Jennifer W Uyeda
- Department of Emergency Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA 02115
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14
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Sauter AP, Proksa R, Knipfer A, Reischl S, Braren RF, Nadjiri J, Kopp F, Noël PB, Makowski MR, Rummeny EJ, Fingerle AA. CT-Guided Liver Biopsy: Evaluation of Spectral Data From Dual-Layer Detector CT for Improved Lesion Detection. Cardiovasc Intervent Radiol 2023; 46:1621-1631. [PMID: 37759090 PMCID: PMC10615904 DOI: 10.1007/s00270-023-03550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Evaluation of dual-layer spectral computed tomography (CT) for contrast enhancement during image-guided biopsy of liver lesions using virtual monoenergetic images (VMI) and virtual non-contrast (VNC) images. METHODS Spectral CT data of 20 patients receiving CT-guided needle biopsy of focal liver lesions were used to generate VMI at energy levels from 40 to 200 keV and VNC images. Images were analyzed objectively regarding contrast-to-noise ratio between lesion center (CNRcent) or periphery (CNRperi) and normal liver parenchyma. Lesion visibility and image quality were evaluated on a 4-point Likert scale by two radiologists. RESULTS Using VMI/VNC images, readers reported an increased visibility of the lesion compared to the conventional CT images in 18/20 cases. In 75% of cases, the highest visibility was derived by VMI-40. Showing all reconstructions simultaneously, VMI-40 offered the highest visibility in 75% of cases, followed by VNC in 12.5% of cases. Either CNRcent (17/20) or/and CNRperi (17/20) was higher (CNR increase > 50%) in 19/20 cases for VMI-40 or VNC images compared to conventional CT images. VMI-40 showed the highest CNRcent in 14 cases and the highest CNRperi in 12 cases. High image quality was present for all reconstructions with a minimum median of 3.5 for VMI-40 and VMI-50. CONCLUSIONS When implemented in the CT scanner software, automated contrast enhancement of liver lesions during image-guided biopsy may facilitate the procedure.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | | | - Andreas Knipfer
- Department of Radiology, Helios Klinikum München West, Munich, Germany
| | - Stefan Reischl
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jonathan Nadjiri
- Department of Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Markus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Kantonsspital Münsterlingen, Muensterlingen, Switzerland
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Kazimierczak W, Nowak E, Kazimierczak N, Jankowski T, Jankowska A, Serafin Z. The value of metal artifact reduction and iterative algorithms in dual energy CT angiography in patients after complex endovascular aortic aneurysm repair. Heliyon 2023; 9:e20700. [PMID: 37876478 PMCID: PMC10590777 DOI: 10.1016/j.heliyon.2023.e20700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023] Open
Abstract
Rationale and objectives Evaluation of the diagnostic value of linearly blended (LB) and virtual monoenergetic images (VMI) reconstruction techniques with and without metal artifacts reduction (MAR) and of adaptive statistical iterative reconstructions (ASIR) in the assessment of target vessels after branched/fenestrated endovascular aortic repair (f/brEVAR) procedures. Materials and methods CT scans of 28 patients were used in this study. Arterial phase of examination was obtained using a dual-energy fast-kVp switching scanner. CT numbers in the aorta, celiac trunk, superior mesenteric artery, and renal arteries were measured in the following reconstructions: LB, VMI 60 keV, VMI MAR 60 keV, VMI ASIR 60 % 60 keV. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated for each reconstruction. Luminal diameters (measurements at 2 levels of stent) and subjective image quality (5-point Likert scale) were assessed (2 readers, blinded to the type of reconstruction). Results The highest mean values of CNR and SNR in vascular structures were obtained in VMI MAR 60 keV (CNR 12.526 ± 2.46, SNR 17.398 ± 2.52), lower in VMI 60 keV (CNR 11.508 ± 2.01, SNR 16.524 ± 2.07) and VMI ASIR (CNR 11.086 ± 1.78, SNR 15.928 ± 1.82), and the lowest in LB (CNR 6.808 ± 0.79, SNR 11.492 ± 0.79) reconstructions. There were no statistically significant differences in the measurements of the stent width between reconstructions (p > 0.05). The highest subjective image quality was obtained in the ASIR VMI (4.25 ± 0.44) and the lowest in the MAR VMI (1.57 ± 0.5) reconstruction. Conclusion Despite obtaining the highest values of SNR and CNR in the MAR VMI reconstruction, the subjective diagnostic value was the lowest for this technique due to significant artifacts. The type of reconstruction did not significantly affect vessel diameter measurements (p > 0.05). Iterative reconstructions raised both objective and subjective image quality.
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Affiliation(s)
- Wojciech Kazimierczak
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Ewa Nowak
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009, Bydgoszcz, Poland
| | - Tomasz Jankowski
- Jankowscy Private Dental Practice, Czerwonego Krzyża 24, 68-200, Żary, Poland
| | - Agnieszka Jankowska
- Jankowscy Private Dental Practice, Czerwonego Krzyża 24, 68-200, Żary, Poland
| | - Zbigniew Serafin
- Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067, Bydgoszcz, Poland
- University Hospital No 1 in Bydgoszcz, Marii Skłodowskiej – Curie 9, 85-094, Bydgoszcz, Poland
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16
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Näsmark T, Andersson J. The influence of dual-energy computed tomography image noise in proton therapy treatment planning. Phys Imaging Radiat Oncol 2023; 28:100493. [PMID: 37789872 PMCID: PMC10544042 DOI: 10.1016/j.phro.2023.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose In proton therapy, a 3.5% margin is often used to account for proton range uncertainties, of which computed tomography (CT) image noise is assumed to contribute 0.5%. This work evaluates the noise-sensitivity of three dual-energy computed tomography (DECT)-based methods for mapping proton stopping power relative to water (SPR): Näsmark & Andersson (N&A), Landry-Saito (L-S), and the commercial application DirectSPR. Methods and materials DECT image data of a CIRS-062M phantom was acquired with CT scanners from two different vendors. Acquisitions were repeated 30 times to account for intra- and inter-scan variations. SPR maps were generated with the three DECT-based methods and range simulated in a commercial treatment planning system. Results Noise in input data was amplified in L-S SPR maps, kept level with DirectSPR, while N&A compressed noise overall but displayed sensitivity to the choice of input data, potentially leading to increased noise levels. In our simulations, only N&A improved upon the assumed 0.5% noise contribution to range uncertainty on one scanner. On the other scanner, uncertainties exceeded 0.5% for all three methods. Mitigation of this issue was demonstrated by using a method employing virtual mono-energetic images as input. Increasing imaging radiation dose, as expected, alleviates the problem, while applying noise reduction only helped to a lesser extent. Conclusions While range uncertainty due to noise is small compared to other contributions, it becomes more important as we move towards smaller treatment margins and the noise-sensitivity of SPR mapping methods should be carefully estimated and considered before clinical implementation.
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Affiliation(s)
- Torbjörn Näsmark
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85 UMEÅ, Sweden
| | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85 UMEÅ, Sweden
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Abstract
Dual-energy CT has expanded the potential of thoracic imaging in both children and adults. Data processing allows material- and energy-specific reconstructions, which improve material differentiation and tissue characterization compared with single-energy CT. Material-specific reconstructions include iodine, virtual unenhanced, perfusion blood volume, and lung vessel images, which can improve assessment of vascular, mediastinal, and parenchymal abnormalities. The energy-specific reconstruction algorithm allows virtual monoenergetic reconstructions, including low-energy images to increase iodine conspicuity and high-energy images to reduce beam-hardening and metal artifacts. This review highlights dual-energy CT principles, hardware, and postprocessing algorithms; the clinical applications of dual-energy CT; and the potential benefits of photon counting (the most recently introduced iteration of spectral imaging) in pediatric thoracic imaging.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marilyn J Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110
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Kraft J, Lutyj P, Grabenbauer F, Ströhle SP, Tamihardja J, Razinskas G, Weick S, Richter A, Huflage H, Wittig A, Flentje M, Lisowski D. Assessment of dual-energy computed tomography derived virtual monoenergetic imaging for target volume delineation of brain metastases. Radiother Oncol 2023; 187:109840. [PMID: 37536377 DOI: 10.1016/j.radonc.2023.109840] [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: 02/20/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Objective and subjective assessment of image quality of brain metastases on dual-energy computed tomography (DECT) virtual monoenergetic imaging (VMI) and its impact on target volume delineation. MATERIALS AND METHODS 26 patients with 37 brain metastases receiving Magnetic Resonance Imaging (MRI) and DECT for stereotactic radiotherapy planning were included in this retrospective analysis. Lesion contrast (LC), contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were assessed for reconstructed VMI at 63 keV and artificial 120 kV Computed Tomography (CT). Image contrast and demarcation of metastases between 120 kV CT, VMI and MRI were subjectively assessed. Brain metastases were delineated by four radiation oncologists on VMI with a fixed or free brain window and contours were compared to solely MRI-based delineation using the Dice similarity coefficient. RESULTS LC, CNR and SNR were significantly higher in VMI than in 120 kV CT (p < 0.0001). Image contrast and lesion demarcation were significantly better on VMI compared to 120 kV CT (p < 0.0001). Mean gross tumor volume (GTV)/planning target volume (PTV) Dice similarity coefficients were 0.87/0.9 for metastases without imaging uncertainties (no artifacts, calcification or impaired visibility with MRI) but worse for metastases with imaging uncertainties (0.71/0.74). Target volumes delineated on VMI were around 5-10% smaller compared to MRI. CONCLUSION Image quality of VMI is objectively and subjectively superior to conventional CT. VMI provides significant advantages in stereotactic radiotherapy planning with improved visibility of brain metastases and geometrically distortion-free representation of brain metastases. Beside a plausibility check of MRI-based target volume delineation, VMI might improve reliability and accuracy in target volume definition particularly in cases with imaging uncertainties with MRI.
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Affiliation(s)
- Johannes Kraft
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Paul Lutyj
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Felix Grabenbauer
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Serge-Peer Ströhle
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Jörg Tamihardja
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gary Razinskas
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Anne Richter
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andrea Wittig
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Dominik Lisowski
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
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Mantini C, Corradi F, Ricci F, Jensen B, Tana C, Di Mascio V, Mastrodicasa D, Bucciarelli B, Procaccini L, Saba L, Marco Tana, Cademartiri F, De Caterina R. A highly-detailed anatomical study of left atrial auricle as revealed by in-vivo computed tomography. Heliyon 2023; 9:e20575. [PMID: 37842578 PMCID: PMC10568352 DOI: 10.1016/j.heliyon.2023.e20575] [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: 03/09/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
The left atrial auricle (LAA) is the main source of intracardiac thrombi, which contribute significantly to the total number of stroke cases. It is also considered a major site of origin for atrial fibrillation in patients undergoing ablation procedures. The LAA is known to have a high degree of morphological variability, with shape and structure identified as important contributors to thrombus formation. A detailed understanding of LAA form, dimension, and function is crucial for radiologists, cardiologists, and cardiac surgeons. This review describes the normal anatomy of the LAA as visualized through multiple imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography. Special emphasis is devoted to a discussion on how the morphological characteristics of the LAA are closely related to the likelihood of developing LAA thrombi, including insights into LAA embryology.
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Affiliation(s)
- Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Claudio Tana
- Geriatrics Clinic, SS. Annunziata Hospital of Chieti, 66100, Chieti, Italy
| | - Valeria Di Mascio
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
| | | | - Benedetta Bucciarelli
- Department of Pediatrics, Politechnic University of Marche, G. Salesi Children's Hospital, Ancona, Italy
| | | | - Luca Saba
- Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Marco Tana
- Internal Medicine Unit and Department of Vascular Medicine and Cardiovascular Ultrasound, SS. Annunziata Hospital of Chieti, Italy
| | | | - Raffaele De Caterina
- Cardiology, University of Pisa and University Cardiology Division, Pisa University Hospital, Pisa, Italy
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo-Pescara, Italy
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Inserra MC, Cannizzaro MT, Passaniti G, Celona A, Secinaro A, Curione D, D'Angelo T, Garretto O, Romeo P. MR imaging of primary benign cardiac tumors in the pediatric population. Heliyon 2023; 9:e19932. [PMID: 37809686 PMCID: PMC10559362 DOI: 10.1016/j.heliyon.2023.e19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.
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Affiliation(s)
| | | | - Giulia Passaniti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Orazio Garretto
- UOSD Radiologia 2 CAST, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
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21
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Grkovski R, Acu L, Ahmadli U, Nakhostin D, Thurner P, Wacht L, Kulcsár Z, Alkadhi H, Winklhofer S. Dual-Energy Computed Tomography in Stroke Imaging : Value of a New Image Acquisition Technique for Ischemia Detection after Mechanical Thrombectomy. Clin Neuroradiol 2023; 33:747-754. [PMID: 36862231 PMCID: PMC10450017 DOI: 10.1007/s00062-023-01270-6] [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: 10/07/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To assess if a new dual-energy computed tomography (DECT) technique enables an improved visualization of ischemic brain tissue after mechanical thrombectomy in acute stroke patients. MATERIAL AND METHODS The DECT head scans with a new sequential technique (TwinSpiral DECT) were performed in 41 patients with ischemic stroke after endovascular thrombectomy and were retrospectively included. Standard mixed and virtual non-contrast (VNC) images were reconstructed. Infarct visibility and image noise were assessed qualitatively by two readers using a 4-point Likert scale. Quantitative Hounsfield units (HU) were used to assess density differences of ischemic brain tissue versus healthy tissue on the non-affected contralateral hemisphere. RESULTS Infarct visibility was significantly better in VNC compared to mixed images for both readers R1 (VNC: median 1 (range 1-3), mixed: median 2 (range 1-4), p < 0.05) and R2 (VNC: median 2 (range 1-3), mixed: 2 (range 1-4), p < 0.05). Qualitative image noise was significantly higher in VNC compared to mixed images for both readers R1 (VNC: median 3, mixed: 2) and R2 (VNC: median 2, mixed: 1, p < 0.05, each). Mean HU were significantly different between the infarcted tissue and the reference healthy brain tissue on the contralateral hemisphere in VNC (infarct 24 ± 3) and mixed images (infarct 33 ± 5, p < 0.05, each). The mean HU difference between ischemia and reference in VNC images (mean 8 ± 3) was significantly higher (p < 0.05) compared to the mean HU difference in mixed images (mean 5 ± 4). CONCLUSION TwinSpiral DECT allows an improved qualitative and quantitative visualization of ischemic brain tissue in ischemic stroke patients after endovascular treatment.
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Affiliation(s)
- Risto Grkovski
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
- Department of Radiology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Leyla Acu
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Uzeyir Ahmadli
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Nakhostin
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Lorenz Wacht
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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22
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Zheng Y, Han X, Jia X, Ding C, Zhang K, Li H, Cao X, Zhang X, Zhang X, Shi H. Dual-energy CT-based radiomics for predicting invasiveness of lung adenocarcinoma appearing as ground-glass nodules. Front Oncol 2023; 13:1208758. [PMID: 37637058 PMCID: PMC10449576 DOI: 10.3389/fonc.2023.1208758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives To explore the value of radiomics based on Dual-energy CT (DECT) for discriminating preinvasive or MIA from IA appearing as GGNs before surgery. Methods The retrospective study included 92 patients with lung adenocarcinoma comprising 30 IA and 62 preinvasive-MIA, which were further divided into a training (n=64) and a test set (n=28). Clinical and radiographic features along with quantitative parameters were recorded. Radiomics features were derived from virtual monoenergetic images (VMI), including 50kev and 150kev images. Intraclass correlation coefficients (ICCs), Pearson's correlation analysis and least absolute shrinkage and selection operator (LASSO) penalized logistic regression were conducted to eliminate unstable and redundant features. The performance of the models was evaluated by area under the curve (AUC) and the clinical utility was assessed using decision curve analysis (DCA). Results The DECT-based radiomics model performed well with an AUC of 0.957 and 0.865 in the training and test set. The clinical-DECT model, comprising sex, age, tumor size, density, smoking, alcohol, effective atomic number, and normalized iodine concentration, had an AUC of 0.929 in the training and 0.719 in the test set. In addition, the radiomics model revealed a higher AUC value and a greater net benefit to patients than the clinical-DECT model. Conclusion DECT-based radiomics features were valuable in predicting the invasiveness of GGNs, yielding a better predictive performance than the clinical-DECT model.
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Affiliation(s)
- Yuting Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoyu Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chengyu Ding
- ShuKun (BeiJing) Technology Co., Ltd., Beijing, China
| | - Kailu Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hanting Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuexiang Cao
- Clinical Solution, Philips Healthcare, Shanghai, China
| | - Xiaohui Zhang
- Clinical Solution, Philips Healthcare, Shanghai, China
| | - Xin Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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23
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Zhong J, Wang L, Shen H, Li J, Lu W, Shi X, Xing Y, Hu Y, Ge X, Ding D, Yan F, Du L, Yao W, Zhang H. Improving lesion conspicuity in abdominal dual-energy CT with deep learning image reconstruction: a prospective study with five readers. Eur Radiol 2023; 33:5331-5343. [PMID: 36976337 DOI: 10.1007/s00330-023-09556-6] [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: 10/08/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To evaluate image quality, diagnostic acceptability, and lesion conspicuity in abdominal dual-energy CT (DECT) using deep learning image reconstruction (DLIR) compared to those using adaptive statistical iterative reconstruction-V (Asir-V) at 50% blending (AV-50), and to identify potential factors impacting lesion conspicuity. METHODS The portal-venous phase scans in abdominal DECT of 47 participants with 84 lesions were prospectively included. The raw data were reconstructed to virtual monoenergetic image (VMI) at 50 keV using filtered back-projection (FBP), AV-50, and DLIR at low (DLIR-L), medium (DLIR-M), and high strength (DLIR-H). A noise power spectrum (NPS) was generated. CT number and standard deviation values of eight anatomical sites were measured. Signal-to-noise (SNR), and contrast-to-noise ratio (CNR) values were calculated. Five radiologists assessed image quality in terms of image contrast, image noise, image sharpness, artificial sensation, and diagnostic acceptability, and evaluated the lesion conspicuity. RESULTS DLIR further reduced image noise (p < 0.001) compared to AV-50 while better preserved the average NPS frequency (p < 0.001). DLIR maintained CT number values (p > 0.99) and improved SNR and CNR values compared to AV-50 (p < 0.001). DLIR-H and DLIR-M showed higher ratings in all image quality analyses than AV-50 (p < 0.001). DLIR-H provided significantly better lesion conspicuity than AV-50 and DLIR-M regardless of lesion size, relative CT attenuation to surrounding tissue, or clinical purpose (p < 0.05). CONCLUSIONS DLIR-H could be safely recommended for routine low-keV VMI reconstruction in daily contrast-enhanced abdominal DECT to improve image quality, diagnostic acceptability, and lesion conspicuity. KEY POINTS • DLIR is superior to AV-50 in noise reduction, with less shifts of the average spatial frequency of NPS towards low frequency, and larger improvements of NPS noise, noise peak, SNR, and CNR values. • DLIR-M and DLIR-H generate better image quality in terms of image contrast, noise, sharpness, artificial sensation, and diagnostic acceptability than AV-50, while DLIR-H provides better lesion conspicuity than AV-50 and DLIR-M. • DLIR-H could be safely recommended as a new standard for routine low-keV VMI reconstruction in contrast-enhanced abdominal DECT to provide better lesion conspicuity and better image quality than the standard AV-50.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lingyun Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, 215028, China
| | - Jianying Li
- Computed Tomography Research Center, GE Healthcare, Beijing, 100176, China
| | - Wei Lu
- Computed Tomography Research Center, GE Healthcare, Shanghai, 201203, China
| | - Xiaomeng Shi
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Xiang Ge
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Defang Ding
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lianjun Du
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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24
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Arico' FM, Trimarchi R, Portaluri A, Barilla' C, Migliaccio N, Bucolo GM, Cicero G, Sofia C, Booz C, Vogl TJ, Marino MA, Ascenti V, D'Angelo T, Mazziotti S, Ascenti G. Virtual monoenergetic dual-layer dual-energy CT images in colorectal cancer: CT diagnosis could be improved? LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01663-0. [PMID: 37310558 DOI: 10.1007/s11547-023-01663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare conventional CT images and virtual monoenergetic images (VMI) at dual-layer dual-energy CT (dlDECT) in patients with colorectal cancer (CRC) through quantitative analysis and to investigate the added value of VMI. MATERIAL AND METHODS Sixty-six consecutive patients with histologically documented CRC and available VMI reconstructions were retrospectively investigated. Subsequently, forty-two patients, without any colonic disease at colonoscopy, were selected as control group. Conventional CT images and VMI reconstructions at energy levels ranging from 40 (VMI40) to 100 keV (VMI100) in 10 keV increments, were obtained from the late arterial phase. First, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were obtained to select the best VMI reconstruction. Finally, the diagnostic accuracy of conventional CT and VMI40 in late arterial phase was evaluated. RESULTS On quantitative analysis, SNR and CNR were higher for VMI40 (19.5 ± 7.7 and 11.8 ± 6.2, respectively) with statistically significant differences compared to conventional CT (P < 0.05) and all the other VMI reconstructions (P < 0.05), except for VMI50 (P > 0.05). The addition of VMI40 to conventional CT images significantly improved the area under the curve (AUC) for the diagnosis of CRC, increasing it from 0.875 to 0.943 for reader 1 (P < 0.05) and from 0.916 to 0.954 for reader 2 (P < 0.05). The improvement was greater in the less experienced radiologist (0.068) compared to the more experienced one (0.037). CONCLUSION VMI40 has showed the highest quantitative image parameters. Furthermore, the use of VMI40 can lead to a significant improvement in the diagnostic performance for detecting CRC.
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Affiliation(s)
- Francesco Marcello Arico'
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Renato Trimarchi
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy.
| | - Antonio Portaluri
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Claudia Barilla'
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Nicola Migliaccio
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Giuseppe Mauro Bucolo
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, Milan, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Via Consolare Valeria 1, 98123, Messina, Italy
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Zhong J, Pan Z, Chen Y, Wang L, Xia Y, Wang L, Li J, Lu W, Shi X, Feng J, Yan F, Zhang H, Yao W. Robustness of radiomics features of virtual unenhanced and virtual monoenergetic images in dual-energy CT among different imaging platforms and potential role of CT number variability. Insights Imaging 2023; 14:79. [PMID: 37166511 PMCID: PMC10175529 DOI: 10.1186/s13244-023-01426-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/05/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To evaluate robustness of dual-energy CT (DECT) radiomics features of virtual unenhanced (VUE) image and virtual monoenergetic image (VMI) among different imaging platforms. METHODS A phantom with sixteen clinical-relevant densities was scanned on ten DECT platforms with comparable scan parameters. Ninety-four radiomic features were extracted via Pyradiomics from VUE images and VMIs at energy level of 70 keV (VMI70keV). Test-retest repeatability was assessed by Bland-Altman analysis. Inter-platform reproducibility of VUE images and VMI70keV was evaluated by coefficient of variation (CV) and quartile coefficient of dispersion (QCD) among platforms, and by intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) between platform pairs. The correlation between variability of CT number radiomics reproducibility was estimated. RESULTS 92.02% and 92.87% of features were repeatable between scan-rescans for VUE images and VMI70keV, respectively. Among platforms, 11.30% and 28.39% features of VUE images, and 15.16% and 28.99% features of VMI70keV were with CV < 10% and QCD < 10%. The average percentages of radiomics features with ICC > 0.90 and CCC > 0.90 between platform pairs were 10.00% and 9.86% in VUE images and 11.23% and 11.23% in VMI70keV. The CT number inter-platform reproducibility using CV and QCD showed negative correlations with percentage of the first-order radiomics features with CV < 10% and QCD < 10%, in both VUE images and VMI70keV (r2 0.3870-0.6178, all p < 0.001). CONCLUSIONS The majority of DECT radiomics features were non-reproducible. The differences in CT number were considered as an indicator of inter-platform DECT radiomics variation. Critical relevance statement: The majority of radiomics features extracted from the VUE images and the VMI70keV were non-reproducible among platforms, while synchronizing energy levels of VMI to reduce the CT number value variability may be a potential way to mitigate radiomics instability.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lingyun Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yihan Xia
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lan Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jianying Li
- Computed Tomography Research Center, GE Healthcare, Beijing, 100176, China
| | - Wei Lu
- Computed Tomography Research Center, GE Healthcare, Shanghai, 201203, China
| | - Xiaomeng Shi
- Department of Materials, Imperial College London, London, SW7 2AZ, UK
| | - Jianxing Feng
- Haohua Technology Co., Ltd., Shanghai, 201100, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Ascenti G, Cicero G, Cardone G, Bertelli E, Papa M, Ciccone V, Manetta R, Gentili F, Francioso AP, Mazzei MA, Floridi C, Di Cesare E, Gandolfo N, De Filippo M, Miele V, Giovagnoni A. Cornerstones of CT urography: a shared document by the Italian board of urogenital radiology. LA RADIOLOGIA MEDICA 2023; 128:601-611. [PMID: 37027091 DOI: 10.1007/s11547-023-01623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023]
Abstract
CT urography is a single term used to refer to different scanning protocols that can be applied for a number of clinical indications. If, on the one hand, this highlights the role of the radiologist in deciding the most suitable technique to perform according to the patient's needs, on the other hand, a certain confusion may arise due to the different technical and clinical variables that have to be taken into account. This has been well demonstrated by a previous work based on an online questionnaire administered to a population of Italian radiologists that brought out similarities as well as differences across the national country. Defining precise guidelines for each clinical scenario, although desirable, is a difficult task to accomplish, if not even unfeasible. According to the prementioned survey, five relevant topics concerning CT urography have been identified: definition and clinical indications, opacification of the excretory system, techniques, post-processing reconstructions, and radiation dose and utility of dual-energy CT. The aim of this work is to deepen and share knowledge about these main points in order to assist the radiology in the daily practice. Moreover, a synopsis of recommendations agreed by the Italian board of genitourinary imaging is provided.
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Affiliation(s)
- Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy
| | - Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria, 1, 98100, Messina, Italy.
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Papa
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Vincenzo Ciccone
- Radiology Department, San Giovanni Di Dio E Ruggi D'Aragona Hospital, Salerno, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, "Santa Maria Alle Scotte" General Hospital, Viale Mario Bracci, 16, Siena, 53100, Italy
| | - Antonio Pio Francioso
- Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Azienda Socio Sanitaria Territoriale (ASST) Lodi, Lodi, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Chiara Floridi
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Massimo De Filippo
- University of Parma, Parma Hospital, Via Gramsci 14, 43126, Parma, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Ospedali Riuniti Ancona, Università Politecnica Delle Marche - University Hospital, Via Tronto 10, 60126, Ancona, Italy
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27
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Zsarnoczay E, Fink N, Schoepf UJ, O'Doherty J, Allmendinger T, Hagenauer J, Wolf EV, Griffith JP, Maurovich-Horvat P, Varga-Szemes A, Emrich T. Ultra-high resolution photon-counting coronary CT angiography improves coronary stenosis quantification over a wide range of heart rates - A dynamic phantom study. Eur J Radiol 2023; 161:110746. [PMID: 36821957 DOI: 10.1016/j.ejrad.2023.110746] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To investigate the effect of using photon-counting detector (PCD)-CT with ultra-high resolution (UHR) on stenosis quantification accuracy and blooming artifacts from low to high heart rates in a dynamic motion phantom. METHOD Two vessel phantoms (diameter: 4 mm) containing solid calcified lesions (25%, 50% stenoses), filled with different concentrations of iodine, inside an anthropomorphic thorax phantom attached to a coronary motion simulator were used. Scanning was performed on a PCD-CT system using an ECG-gated mode at UHR and standard resolution (SR) (0.2, 0.6 mm slice thickness, respectively). Images were reconstructed at 60, 80 and 100 beats per minute (bpm) (UHR: Bv56 kernel, quantum iterative reconstruction (QIR) level 3; SR: 55 keV, Bv40 kernel, QIR3). Percent diameter stenosis (PDS) and blooming artifacts were measured by two readers. RESULTS PDS measurements derived from UHR were more accurate than SR for both lesions at every heart rate (p ≤ 0.005 for all, e.g. 50% lesion SR vs. UHR: at 60 bpm 57.1% [55.2-59.2] vs. 50.0% [48.5-51.2], at 100 bpm 61.0% [58.6-64.3] vs. 52.4% [51.3-54.3]). Overall mean difference across heart rates and lesions compared to the nominal stenoses was 9.2% (Limit of Agreement (LoA), 2.4%/16.0%) for SR vs. 2.4% (LoA, -2.8%/7.5%) for UHR. Blooming artifacts decreased with UHR compared to SR for both lesions at every heart rate (p < 0.001 for all, e.g. 50% lesion SR vs. UHR: at 60 bpm 63.8% [60.6-69.5] vs. 52.5% [50.0-57.5], at 100 bpm 70.2% [64.8-78.1] vs. 56.1% [51.2-60.8]). CONCLUSIONS This motion phantom study demonstrates improved stenosis quantification accuracy and reduced blooming artifacts with UHR-PCD-CT compared to SR, independent of heart rate.
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Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest 1083, Hungary.
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, Munich 81377, Germany.
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Siemens Medical Solutions USA Inc, 40 Liberty Boulevard, Malvern, PA 19355, United States.
| | | | - Junia Hagenauer
- Siemens Healthcare GmbH, Siemensstraße 1, Forchheim 91301, Germany; Faculty of Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstraße 12, Erlangen 91054, Germany.
| | - Elias V Wolf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany.
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest 1083, Hungary.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz 55131, Germany.
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28
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Hunter JG, Prajapati P, Bera K, Gupta A, Gupta A. Imaging Depiction of Hypoxic Pulmonary Vasoconstriction Using Dual-Energy CT. Cureus 2023; 15:e36551. [PMID: 37102002 PMCID: PMC10123221 DOI: 10.7759/cureus.36551] [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: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
In this article, we aim to highlight the utility of dual-energy computed tomography (DECT) in demonstrating imaging changes due to hypoxic pulmonary vasoconstriction (HPV). DECT allows detailed image reconstructions that have been shown to better characterize cardiothoracic pathologies, as compared to conventional CT techniques. DECT simultaneously detects two different X-ray energies, which enables generation of iodine density maps, virtual monoenergetic images, and effective atomic number maps (Zeff), among others. DECT has been shown to have utility in the assessment of benign versus malignant pulmonary nodules, pulmonary embolism, myocardial perfusion defects, and other conditions. Herein, we describe four cases of indeterminate pulmonary pathology when imaged with conventional CT in which subsequent use of DECT-derived image reconstructions demonstrated HPV as the underlying pathophysiological mechanism. The goal of this article is to understand the imaging appearance of HPV on DECT and discuss how HPV may mimic other causes of perfusion defects.
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Affiliation(s)
- Joshua G Hunter
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Priyanka Prajapati
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Kaustav Bera
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Aekta Gupta
- Internal Medicine, Mercy Health - St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Amit Gupta
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
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29
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Meyer S, Liu LP, Litt HI, Halliburton SS, Shapira N, Noël PB. Phantom-based quantification of the spectral accuracy in dual-layer spectral CT for pediatric imaging at 100 kVp. Quant Imaging Med Surg 2023; 13:924-934. [PMID: 36819257 PMCID: PMC9929380 DOI: 10.21037/qims-22-552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/07/2022] [Indexed: 01/05/2023]
Abstract
Background To determine the spectral accuracy in detector-based dual-energy CT (DECT) at 100 kVp and wide (8 cm) collimation width for dose levels and object sizes relevant to pediatric imaging. Methods A spectral CT phantom containing tissue-equivalent materials and iodine inserts of varying concentrations was scanned on the latest generation detector-based DECT system. Two 3D-printed extension rings were used to mimic varying pediatric patient sizes. Scans were performed at 100 and 120 kVp, 4 and 8 cm collimation widths, and progressively reduced radiation dose levels, down to 0.9 mGy CTDIvol. Virtual mono-energetic, iodine density, effective atomic number, and electron density results were quantified and compared to their expected values for all acquisition settings and phantom sizes. Results DECT scans at 100 kVp provided highly accurate spectral results; however, a size dependence was observed for iodine quantification. For the medium phantom configuration (15 cm diameter), measurement errors in iodine density, effective atomic number, and electron density (ED) were below 0.3 mg/mL, 0.2 and 1.8 %EDwater, respectively. The average accuracy was slightly different from scans at 120 kVp; however, not statistically significant for all configurations. Collimation width had no substantial impact. Spectral results were accurate and reliable for radiation exposures down to 0.9 mGy CTDIvol. Conclusions Detector-based DECT at 100 kVp can provide on-demand or retrospective spectral information with high accuracy even at extremely low doses, thereby making it an attractive solution for pediatric imaging.
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Affiliation(s)
- Sebastian Meyer
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leening P. Liu
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harold I. Litt
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nadav Shapira
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter B. Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;,Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
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30
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Taphorn K, Kaster L, Sellerer T, Hötger A, Herzen J. Spectral X-ray dark-field signal characterization from dual-energy projection phase-stepping data with a Talbot-Lau interferometer. Sci Rep 2023; 13:767. [PMID: 36641492 PMCID: PMC9840630 DOI: 10.1038/s41598-022-27155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/27/2022] [Indexed: 01/16/2023] Open
Abstract
Material-selective analysis of spectral X-ray imaging data requires prior knowledge of the energy dependence of the observed signal. Contrary to conventional X-ray imaging, where the material-specific attenuation coefficient is usually precisely known, the linear diffusion coefficient of the X-ray dark-field contrast does not only depend on the material and its microstructure, but also on the setup geometry and is difficult to access. Here, we present an optimization approach to retrieve the energy dependence of the X-ray dark-field signal quantitatively on the example of closed-cell foams from projection data without the need for additional hardware to a standard grating-based X-ray dark-field imaging setup. A model for the visibility is used to determine the linear diffusion coefficient with a least-squares optimization. The comparison of the results to spectrometer measurements of the linear diffusion coefficient suggests the proposed method to provide a good estimate for the energydependent dark-field signal.
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Affiliation(s)
- Kirsten Taphorn
- grid.6936.a0000000123222966Research Group Biomedical imaging Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany ,grid.6936.a0000000123222966Munich Institute of Biomedical Engineering (MIBE), Technical University of Munich, 85748 Garching, Germany
| | - Lennard Kaster
- grid.6936.a0000000123222966Research Group Biomedical imaging Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany ,grid.6936.a0000000123222966Munich Institute of Biomedical Engineering (MIBE), Technical University of Munich, 85748 Garching, Germany
| | - Thorsten Sellerer
- grid.6936.a0000000123222966Research Group Biomedical imaging Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany ,grid.6936.a0000000123222966Munich Institute of Biomedical Engineering (MIBE), Technical University of Munich, 85748 Garching, Germany
| | - Alexander Hötger
- grid.6936.a0000000123222966Walter Schottky Institute and Physics Department, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany ,grid.510972.80000 0005 0774 4499Munich Center for Quantum Science and Technology (MCQST), 80799 Munich, Germany
| | - Julia Herzen
- grid.6936.a0000000123222966Research Group Biomedical imaging Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany ,grid.6936.a0000000123222966Munich Institute of Biomedical Engineering (MIBE), Technical University of Munich, 85748 Garching, Germany
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31
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Dumitriu LaGrange D, Reymond P, Brina O, Zboray R, Neels A, Wanke I, Lövblad KO. Spatial heterogeneity of occlusive thrombus in acute ischemic stroke: A systematic review. J Neuroradiol 2023; 50:352-360. [PMID: 36649796 DOI: 10.1016/j.neurad.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Following the advent of mechanical thrombectomy, occlusive clots in ischemic stroke have been amply characterized using conventional histopathology. Many studies have investigated the compositional variability of thrombi and the consequences of thrombus composition on treatment response. More recent evidence has emerged about the spatial heterogeneity of the clot or the preferential distribution of its components and compact nature. Here we review this emerging body of evidence, discuss its potential clinical implications, and propose the development of adequate characterization techniques.
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Affiliation(s)
- Daniela Dumitriu LaGrange
- Neurodiagnostic and Neurointerventional Division, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Philippe Reymond
- Neurodiagnostic and Neurointerventional Division, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Diagnostic and Interventional Neuroradiology, HUG Geneva University Hospitals, Geneva, Switzerland
| | - Robert Zboray
- Center for X-Ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf 8600, Switzerland
| | - Antonia Neels
- Center for X-Ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf 8600, Switzerland
| | - Isabel Wanke
- Division of Neuroradiology, Klinik Hirslanden, Zurich, Switzerland; Swiss Neuroradiology Institute, Zurich, Switzerland; Division of Neuroradiology, University of Essen, Essen, Germany
| | - Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, HUG Geneva University Hospitals, Geneva, Switzerland; Neurodiagnostic and Neurointerventional Division, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Dabli D, Loisy M, Frandon J, de Oliveira F, Meerun AM, Guiu B, Beregi JP, Greffier J. Comparison of image quality of two versions of deep-learning image reconstruction algorithm on a rapid kV-switching CT: a phantom study. Eur Radiol Exp 2023; 7:1. [PMID: 36617620 PMCID: PMC9826773 DOI: 10.1186/s41747-022-00314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/05/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To assess the impact of the new version of a deep learning (DL) spectral reconstruction on image quality of virtual monoenergetic images (VMIs) for contrast-enhanced abdominal computed tomography in the rapid kV-switching platform. METHODS Two phantoms were scanned with a rapid kV-switching CT using abdomen-pelvic CT examination parameters at dose of 12.6 mGy. Images were reconstructed using two versions of DL spectral reconstruction algorithms (DLSR V1 and V2) for three reconstruction levels. The noise power spectrum (NSP) and task-based transfer function at 50% (TTF50) were computed at 40/50/60/70 keV. A detectability index (d') was calculated for enhanced lesions at low iodine concentrations: 2, 1, and 0.5 mg/mL. RESULTS The noise magnitude was significantly lower with DLSR V2 compared to DLSR V1 for energy levels between 40 and 60 keV by -36.5% ± 1.4% (mean ± standard deviation) for the standard level. The average NPS frequencies increased significantly with DLSR V2 by 23.7% ± 4.2% for the standard level. The highest difference in TTF50 was observed at the mild level with a significant increase of 61.7% ± 11.8% over 40-60 keV energy with DLSR V2. The d' values were significantly higher for DLSR V2 versus DLSR V1. CONCLUSIONS The DLSR V2 improves image quality and detectability of low iodine concentrations in VMIs compared to DLSR V1. This suggests a great potential of DLSR V2 to reduce iodined contrast doses.
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Affiliation(s)
- Djamel Dabli
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029, Nîmes Cedex 9, France.
| | - Maeliss Loisy
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex 9, France
| | - Julien Frandon
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex 9, France
| | - Fabien de Oliveira
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex 9, France
| | - Azhar Mohamad Meerun
- grid.157868.50000 0000 9961 060XSaint-Eloi University Hospital, Montpellier, France
| | - Boris Guiu
- grid.157868.50000 0000 9961 060XSaint-Eloi University Hospital, Montpellier, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex 9, France
| | - Joël Greffier
- Department of Medical Imaging, IMAGINE UR UM 103, Montpellier University, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex 9, France
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Sauerbeck J, Adam G, Meyer M. Spectral CT in Oncology. ROFO-FORTSCHR RONTG 2023; 195:21-29. [PMID: 36167316 DOI: 10.1055/a-1902-9949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Spectral CT is gaining increasing clinical importance with multiple potential applications, including oncological imaging. Spectral CT-specific image data offers multiple advantages over conventional CT image data through various post-processing algorithms, which will be highlighted in the following review. METHODOLOGY The purpose of this review article is to provide an overview of potential useful oncologic applications of spectral CT and to highlight specific spectral CT pitfalls. The technical background, clinical advantages of primary and follow-up spectral CT exams in oncology, and the application of appropriate spectral tools will be highlighted. RESULTS/CONCLUSIONS Spectral CT imaging offers multiple advantages over conventional CT imaging, particularly in the field of oncology. The combination of virtual native and low monoenergetic images leads to improved detection and characterization of oncologic lesions. Iodine-map images may provide a potential imaging biomarker for assessing treatment response. KEY POINTS · The most important spectral CT reconstructions for oncology imaging are virtual unenhanced, iodine map, and virtual monochromatic reconstructions.. · The combination of virtual unenhanced and low monoenergetic reconstructions leads to better detection and characterization of the vascularization of solid tumors.. · Iodine maps can be a surrogate parameter for tumor perfusion and potentially used as a therapy monitoring parameter.. · For radiotherapy planning, the relative electron density and the effective atomic number of a tissue can be calculated.. CITATION FORMAT · Sauerbeck J, Adam G, Meyer M. Onkologische Bildgebung mittels Spektral-CT. Fortschr Röntgenstr 2023; 195: 21 - 29.
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Affiliation(s)
- Julia Sauerbeck
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Hamburg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Hamburg, Germany
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Lanzafame LRM, Carerj ML, Rizzo G, Minutoli F, Bucolo GM, Irrera N, Muscogiuri G, Sironi S, Blandino A, D’Angelo T. Multimodality Imaging Evaluation of Coronary IgG4-Related Disease: A "Tumor-Like" Cardiac Lesion. Diagnostics (Basel) 2022; 12:diagnostics12112814. [PMID: 36428873 PMCID: PMC9689228 DOI: 10.3390/diagnostics12112814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory disorder. Coronary IgG4-RD has been scarcely reported and may present as "tumor-like" lesions. These pseudo-masses may be underdiagnosed mainly due to a vague clinical picture that can vary from complete lack of symptoms to acute coronary syndrome or sudden cardiac death. Early recognition of coronary IgG4-RD is essential to monitor disease activity and prevent life-threatening complications. We report a comprehensive non-invasive imaging evaluation of a patient affected by coronary IgG4-RD, which was diagnosed as an incidental finding during routine pre-laparoscopic cholecystectomy checkup. Non-invasive imaging revealed the presence of a peri-coronary soft-tissue mass that was stable at 12 months follow-up.
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Affiliation(s)
- Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Maria Ludovica Carerj
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giovanna Rizzo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Fabio Minutoli
- Nuclear Medicine Unit, BIOMORF Department, University of Messina, 98124 Messina, Italy
| | - Giuseppe M. Bucolo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Natasha Irrera
- Pharmacology Unit, DIMED Department, University Hospital Messina, 98124 Messina, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 Rotterdam, The Netherlands
- Correspondence:
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Yalynska T, Polacin M, Frauenfelder T, Martini K. Impact of Photon Counting Detector CT Derived Virtual Monoenergetic Images on the Diagnosis of Pulmonary Embolism. Diagnostics (Basel) 2022; 12:diagnostics12112715. [PMID: 36359558 PMCID: PMC9689164 DOI: 10.3390/diagnostics12112715] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose: To assess the impact of virtual-monoenergetic-image (VMI) energies on the diagnosis of pulmonary embolism (PE) in photon-counting-detector computed-tomography (PCD-CT). Methods: Eighty patients (median age 60.4 years) with suspected PE were retrospectively included. Scans were performed on PCD-CT in the multi-energy mode at 120 kV. VMIs from 40−70 keV in 10 keV intervals were reconstructed. CT-attenuation was measured in the pulmonary trunk and the main branches of the pulmonary artery. Signal-to-noise (SNR) ratio was calculated. Two radiologists evaluated subjective-image-quality (noise, vessel-attenuation and sharpness; five-point-Likert-scale, non-diagnostic−excellent), the presence of hardening artefacts and presence/visibility of PE. Results: Signal was highest at the lowest evaluated VMI (40 keV; 1053.50 HU); image noise was lowest at the highest VMI (70 keV; 15.60 HU). Highest SNR was achieved at the lowest VMI (p < 0.05). Inter-reader-agreement for subjective analysis was fair to excellent (k = 0.373−1.000; p < 0.001). Scores for vessel-attenuation and sharpness were highest at 40 keV (both:5, range 4/3−5; k = 1.000); scores for image-noise were highest at 70 keV (4, range 3−5). The highest number of hardening artifacts were reported at 40 keV (n = 22; 28%). PE-visualization was rated best at 50 keV (4.7; range 4−5) and decreased with increasing VMI-energy (r = −0.558; p < 0.001). Conclusions: While SNR was best at 40 keV, subjective PE visibility was rated highest at 50 keV, potentially owing to the lower image noise and hardening artefacts.
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Virtual monochromatic spectral attenuation curve analysis for evaluation of incidentally detected small renal lesions using rapid kilovoltage-switching dual-energy computed tomography. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3817-3827. [PMID: 35945346 DOI: 10.1007/s00261-022-03634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine whether the spectral attenuation curve on a rapid kilovoltage-switching dual-energy computed tomography (DECT) scan can distinguish enhancing from nonenhancing incidental small (1-4 cm) renal lesions compared with conventional single-energy attenuation changes. METHODS This retrospective study enrolled 46 patients with 78 renal lesions (24 enhancing; 54 nonenhancing) who underwent DECT with DE mode performed during the portovenous or nephrographic phase. Final diagnosis of enhancing and nonenhancing masses was confirmed by pathology or imaging following the established criteria. Virtual monochromatic images (VMI) were reconstructed, and the slopes between the VMI dataset at 40-70 keV (Slope HU40-70), 40-100 keV (Slope HU40-100), and 40-140 keV (Slope HU40-140) were measured. Visual assessment of the curve pattern was recorded. Diagnostic accuracies were calculated with a cross-validated Mann-Whitney U test, and correlations of quantitative spectral parameters and intraclass correlation coefficient (ICC) were calculated using Spearman's rho correlation. RESULTS All quantitative and qualitative spectral analysis parameters significantly differentiated the enhancing and nonenhancing lesions (P < 0.001). The optimal slope thresholds calculated by cross-validation for Slope HU40-70, Slope HU40-100, and Slope HU40-140 were 3.0, 1.8 and 1.2, respectively for reader 1 and 3.0, 1.9 and 1.15, respectively for reader 2. Using a slope threshold at all datasets yielded a high diagnostic accuracy of 96 for reader 1 and 95 for reader 2. Using a ∆HU threshold of 20 HU yielded an accuracy of 100. Visual analysis of the curve pattern also yielded high accuracy of 94. CONCLUSIONS The spectral attenuation curve on rapid kilovoltage-switching DECT gives excellent diagnostic accuracy differentiating between incidental enhancing and nonenhancing renal lesions. This benefit of DECT will be most helpful when the true unenhanced phase is not performed.
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Zorzetto G, Coppola A, Molinelli V, Angeretti MG, Casarin J, Fontana F, Piacentino F, Carcano G, Ghezzi F, Venturini M. Spectral CT in peritoneal carcinomatosis from ovarian cancer: a tool for differential diagnosis of small nodules? Eur Radiol Exp 2022; 6:45. [PMID: 36245001 PMCID: PMC9573836 DOI: 10.1186/s41747-022-00302-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/04/2022] [Indexed: 01/17/2023] Open
Abstract
The detection of peritoneal carcinomatosis in patients with ovarian cancer is crucial to establish the correct therapeutic planning (debulking surgery versus neoadjuvant chemotherapy). Often, however, the nodules of peritoneal carcinomatosis are very small in size or have a reticular appearance that can mimic the fat stranding that is typical of acute inflammation conditions. Our hypothesis is that the use of dual-layer spectral computed tomography with its applications, such as virtual monoenergetic imaging and Z-effective imaging, might improve the detection and the characterisation of peritoneal nodules, increasing sensitivity and diagnostic accuracy, as recently described for other oncological diseases.
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Velangi PS, Agdamag AC, Nijjar PS, Pogatchnik B, Nijjar PS. Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhou PX, Zhang SX. Functional lung imaging in thoracic tumor radiotherapy: Application and progress. Front Oncol 2022; 12:908345. [PMID: 36212454 PMCID: PMC9544588 DOI: 10.3389/fonc.2022.908345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/17/2022] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy plays an irreplaceable and unique role in treating thoracic tumors, but the occurrence of radiation-induced lung injury has limited the increase in tumor target doses and has influenced patients’ quality of life. However, the introduction of functional lung imaging has been incorporating functional lungs into radiotherapy planning. The design of the functional lung protection plan, while meeting the target dose requirements and dose limitations of the organs at risk (OARs), minimizes the radiation dose to the functional lung, thus reducing the occurrence of radiation-induced lung injury. In this manuscript, we mainly reviewed the lung ventilation or/and perfusion functional imaging modalities, application, and progress, as well as the results based on the functional lung protection planning in thoracic tumors. In addition, we also discussed the problems that should be explored and further studied in the practical application based on functional lung radiotherapy planning.
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Affiliation(s)
- Pi-Xiao Zhou
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
- Department of Oncology, The First People's Hospital of Changde City, Changde, China
| | - Shu-Xu Zhang
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Shu-Xu Zhang,
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Toia GV, Mileto A, Wang CL, Sahani DV. Quantitative dual-energy CT techniques in the abdomen. Abdom Radiol (NY) 2022; 47:3003-3018. [PMID: 34468796 DOI: 10.1007/s00261-021-03266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Advances in dual-energy CT (DECT) technology and spectral techniques are catalyzing the widespread implementation of this technology across multiple radiology subspecialties. The inclusion of energy- and material-specific datasets has ushered overall improvements in CT image contrast and noise as well as artifacts reduction, leading to considerable progress in radiologists' ability to detect and characterize pathologies in the abdomen. The scope of this article is to provide an overview of various quantitative clinical DECT applications in the abdomen and pelvis. Several of the reviewed applications have not reached mainstream clinical use and are considered investigational. Nonetheless awareness of such applications is critical to having a fully comprehensive knowledge base to DECT and fostering future clinical implementation.
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Affiliation(s)
- Giuseppe V Toia
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Mailbox 3252, Madison, WI, 53792, USA.
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Carolyn L Wang
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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Fernández-Pérez G, Fraga Piñeiro C, Oñate Miranda M, Díez Blanco M, Mato Chaín J, Collazos Martínez M. Energía Dual en TC. Consideraciones técnicas y aplicaciones clínicas. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu C, Kong L, Deng X. Dual-Energy Computed Tomography For Differentiation Between Osteoblastic Metastases and Bone Islands. Front Oncol 2022; 12:815955. [PMID: 35903682 PMCID: PMC9315104 DOI: 10.3389/fonc.2022.815955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of our study was to evaluate the utility of Rho/Z on dual-energy computed tomography (DECT) for the differentiation of osteoblastic metastases (OBMs) from bone islands (BIs). Methods DECT images of 110 patients with malignancies were collected. The effective atomic number (Z), electron density (Rho), dual energy index (DEI), and regular CT (rCT) values were measured by two observers. Independent-sample t-test was used to compare these values between OBMs and BIs. The diagnostic performance was assessed by receiver operating characteristic (ROC) analysis and the cutoff values were evaluated according to ROC curves. Results A total of 205 OBMs and 120 BIs were included. The mean values of Z, Rho, DEI, and rCT of OBMs were significantly lower than those of BIs, whereas the standard deviation values were higher than those of BIs (all p ≤ 0.05). ROC analysis showed that 11.86 was the optimal cutoff value for Z, rendering an area under the ROC curve (AUC) of 0.91, with a sensitivity of 91.2% and a specificity of 82.5%. Conclusion DECT can provide quantitative values of Z, Rho, and DEI and has good performance in differentiating between OBMs and BIs.
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Seo JY, Joo I, Yoon JH, Kang HJ, Kim S, Kim JH, Ahn C, Lee JM. Deep learning-based reconstruction of virtual monoenergetic images of kVp-switching dual energy CT for evaluation of hypervascular liver lesions: Comparison with standard reconstruction technique. Eur J Radiol 2022; 154:110390. [PMID: 35724579 DOI: 10.1016/j.ejrad.2022.110390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/12/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate clinical applicability of deep learning(DL)-based reconstruction of virtual monoenergetic images(VMIs) of arterial phase liver CT obtained by rapid kVp-switching dual-energy CT for evaluation of hypervascular liver lesions. MATERIALS AND METHODS We retrospectively included 109 patients who had available late arterial phase liver CT images of the liver obtained with a rapid switching kVp DECT scanner for suspicious intra-abdominal malignancies. Two VMIs of 70 keV and 40 keV were reconstructed using adaptive statistical iterative reconstruction (ASiR-V) for arterial phase scans. VMIs at 40 keV were additionally reconstructed with a vendor-agnostic DL-based reconstruction technique (ClariCT.AI, ClariPi, DL 40 keV). Qualitative, quantitative image quality and subjective diagnostic acceptability were compared according to reconstruction techniques. RESULTS In qualitative analysis, DL 40 keV images showed less image noise (4.55 vs 3.11 vs 3.95, p < 0.001), better image sharpness (4.75 vs 4.16 vs 4.3, p < 0.001), better image contrast (4.98 vs 4.72 vs 4.19, p < 0.017), better lesion conspicuity (4.61 vs 4.23 vs 3.4, p < 0.001) and diagnostic acceptability (4.59 vs 3.88 vs 4.09, p < 0.001) compared with ASiR-V 40 keV or 70 keV image sets. In quantitative analysis, DL 40 keV significantly reduced image noise relative to ASiR-V 40 keV images (49.9%, p < 0.001) and ASiR-V 70 keV images (85.2%, p = 0.012). DL 40 keV images showed significantly higher CNRlesion to the liver and SNRliver than ASiR-V 40 keV image and 70 keV images (p < 0.001). CONCLUSION DL-based reconstruction of 40 keV images using vendor-agnostic software showed greater noise reduction, better lesion conspicuity, image contrast, image sharpness, and higher overall image diagnostic acceptability than ASiR for 40 keV or 70 keV images in patients with hypervascular liver lesions.
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Affiliation(s)
- June Young Seo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sewoo Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea; Center for Medical-IT Convergence Technology Research, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea; Research Institute, ClariPi, Seoul, Republic of Korea
| | - Chulkyun Ahn
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea; Research Institute, ClariPi, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Michael AE, Boriesosdick J, Schoenbeck D, Lopez-Schmidt I, Kroeger JR, Moenninghoff C, Horstmeier S, Pennig L, Borggrefe J, Niehoff JH. Photon Counting CT Angiography of the Head and Neck: Image Quality Assessment of Polyenergetic and Virtual Monoenergetic Reconstructions. Diagnostics (Basel) 2022; 12:diagnostics12061306. [PMID: 35741116 PMCID: PMC9222087 DOI: 10.3390/diagnostics12061306] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of the present study was the evaluation of the image quality of polyenergetic and monoenergetic reconstructions (PERs and MERs) of CT angiographies (CTAs) of the head and neck acquired with the novel photon counting CT (PCCT) method in clinical routine. Methods: Thirty-seven patients were enrolled in this retrospective study. Quantitative image parameters of the extracranial, intracranial and cerebral arteries were evaluated for the PER and MER (40–120 keV). Additionally, two radiologists rated the perceived image quality. Results: The mean CTDIvol used in the PCCT was 8.31 ± 1.19 mGy. The highest signal within the vessels was detected in the 40 keV MER, whereas the lowest noise was detected in the 115 keV MER. The most favorable contrast-to-noise-ratio (CNR) and signal-to-noise-ratio (SNR) were detected in the PER and low keV MER. In the qualitative image analysis, the PER was superior to the MER in all rated criteria. For MER, 60–65 keV was rated as best image quality. Conclusion: Overall, PCCT offers excellent image quality for CTAs of the head and neck. At the current state, the PER of the PCCT seems to be the most favorable reconstruction for diagnostic reporting.
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Affiliation(s)
- Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
- Correspondence: ; Tel.: +49-571-790-4601
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Ingo Lopez-Schmidt
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Sebastian Horstmeier
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Lenhard Pennig
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 32429 Minden, Germany; (J.B.); (D.S.); (I.L.-S.); (J.R.K.); (C.M.); (S.H.); (J.B.); (J.H.N.)
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Mahmoudi S, Lange M, Lenga L, Yel I, Koch V, Booz C, Martin S, Bernatz S, Vogl T, Albrecht M, Scholtz JE. Salvaging low contrast abdominal CT studies using noise-optimised virtual monoenergetic image reconstruction. BJR Open 2022; 4:20220006. [PMID: 36105416 PMCID: PMC9446156 DOI: 10.1259/bjro.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess the impact of noise-optimised virtual monoenergetic imaging (VMI+) on image quality and diagnostic evaluation in abdominal dual-energy CT scans with impaired portal-venous contrast. Methods We screened 11,746 patients who underwent portal-venous abdominal dual-energy CT for cancer staging between 08/2014 and 11/2019 and identified those with poor portal-venous contrast.Standard linearly-blended image series and VMI+ image series at 40, 50, and 60 keV were reconstructed. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of abdominal organs and vascular structures were calculated. Image noise, image contrast and overall image quality were rated by three radiologists using 5-point Likert scale. Results 452 of 11,746 (4%) exams were poorly opacified. We excluded 190 cases due to incomplete datasets or multiple exams of the same patient with a final study group of 262. Highest CNR values in all abdominal organs (liver, 6.4 ± 3.0; kidney, 17.4 ± 7.5; spleen, 8.0 ± 3.5) and vascular structures (aorta, 16.0 ± 7.3; intrahepatic vein, 11.3 ± 4.7; portal vein, 15.5 ± 6.7) were measured at 40 keV VMI+ with significantly superior values compared to all other series. In subjective analysis, highest image contrast was seen at 40 keV VMI+ (4.8 ± 0.4), whereas overall image quality peaked at 50 keV VMI+ (4.2 ± 0.5) with significantly superior results compared to all other series (p < 0.001). Conclusions Image reconstruction using VMI+ algorithm at 50 keV significantly improves image contrast and image quality of originally poorly opacified abdominal CT scans and reduces the number of non-diagnostic scans. Advances in knowledge We validated the impact of VMI+ reconstructions in poorly attenuated DECT studies of the abdomen in a big data cohort.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Marvin Lange
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Simon Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Moritz Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai, Frankfurt, Germany
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Bicci E, Mastrorosato M, Danti G, Lattavo L, Bertelli E, Cozzi D, Pradella S, Agostini S, Miele V. Dual-Energy CT applications in urinary tract cancers: an update. TUMORI JOURNAL 2022; 109:148-156. [PMID: 35442120 DOI: 10.1177/03008916221088883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urothelial tumours are the fourth most common cancer in the world and account for the majority of tumours involving the bladder. The symptom that often leads to diagnosis is the presence of haematuria. Diagnosis is made by cystoscopy, which is currently the gold standard in bladder cancer. Computed tomography (CT) performed with pre- and post-contrastographic phases is essential in order to assess the loco-regional and distant extension of disease. The diagnosis and staging of upper tract urothelial cancer (UTUC) are best done with computed tomography urography and flexible ureteroscopy (URS). In the acquisition protocol of this type of tumour, a urographic phase is mandatory, which allows for an accurate diagnostic assessment of the renal pelvis, ureter and bladder, especially in papillary forms. The use of multiple acquisition phases, especially in this type of patient who will have to perform follow-up CTs, leads to the problem of overexposure to ionising radiation, as well as the frequent administration of iodinated contrast medium. For this reason, in recent year, the focus has been put on advanced technologies such as dual-energy CT (DECT), that is a method that can offer some advantages for both radiologist and patient, in the diagnosis of cancer and, in particular, urinary tract disease.
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Affiliation(s)
- Eleonora Bicci
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | | | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Lattavo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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Muscogiuri G, Guglielmo M, Serra A, Gatti M, Volpato V, Schoepf UJ, Saba L, Cau R, Faletti R, McGill LJ, De Cecco CN, Pontone G, Dell’Aversana S, Sironi S. Multimodality Imaging in Ischemic Chronic Cardiomyopathy. J Imaging 2022; 8:jimaging8020035. [PMID: 35200737 PMCID: PMC8877428 DOI: 10.3390/jimaging8020035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ischemic chronic cardiomyopathy (ICC) is still one of the most common cardiac diseases leading to the development of myocardial ischemia, infarction, or heart failure. The application of several imaging modalities can provide information regarding coronary anatomy, coronary artery disease, myocardial ischemia and tissue characterization. In particular, coronary computed tomography angiography (CCTA) can provide information regarding coronary plaque stenosis, its composition, and the possible evaluation of myocardial ischemia using fractional flow reserve CT or CT perfusion. Cardiac magnetic resonance (CMR) can be used to evaluate cardiac function as well as the presence of ischemia. In addition, CMR can be used to characterize the myocardial tissue of hibernated or infarcted myocardium. Echocardiography is the most widely used technique to achieve information regarding function and myocardial wall motion abnormalities during myocardial ischemia. Nuclear medicine can be used to evaluate perfusion in both qualitative and quantitative assessment. In this review we aim to provide an overview regarding the different noninvasive imaging techniques for the evaluation of ICC, providing information ranging from the anatomical assessment of coronary artery arteries to the assessment of ischemic myocardium and myocardial infarction. In particular this review is going to show the different noninvasive approaches based on the specific clinical history of patients with ICC.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
- Correspondence: ; Tel.: +39-329-404-9840
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, 3584 Utrecht, The Netherlands;
| | - Alessandra Serra
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Valentina Volpato
- Department of Cardiac, Neurological and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy;
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Liam J. McGill
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Carlo Nicola De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
| | | | - Serena Dell’Aversana
- Department of Radiology, Ospedale S. Maria Delle Grazie—ASL Napoli 2 Nord, 80078 Pozzuoli, Italy;
| | - Sandro Sironi
- School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 20126 Milan, Italy;
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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Image-Quality Assessment of Polyenergetic and Virtual Monoenergetic Reconstructions of Unenhanced CT Scans of the Head: Initial Experiences with the First Photon-Counting CT Approved for Clinical Use. Diagnostics (Basel) 2022; 12:diagnostics12020265. [PMID: 35204356 PMCID: PMC8871064 DOI: 10.3390/diagnostics12020265] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/31/2023] Open
Abstract
In 2021, the first clinical photon-counting CT (PCCT) was introduced. The purpose of this study is to evaluate the image quality of polyenergetic and virtual monoenergetic reconstructions in unenhanced PCCTs of the head. A total of 49 consecutive patients with unenhanced PCCTs of the head were retrospectively included. The signals ± standard deviations of the gray and white matter were measured at three different locations in axial slices, and a measure of the artifacts below the cranial calvaria and in the posterior fossa between the petrous bones was also obtained. The signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated for all reconstructions. In terms of the SNRs and CNRs, the polyenergetic reconstruction is superior to all virtual monoenergetic reconstructions (p < 0.001). In the MERs, the highest SNR is found in the 70 keV MER, and the highest CNR is in the 65 keV MER. In terms of artifacts below the cranial calvaria and in the posterior fossa, certain MERs are superior to polyenergetic reconstruction (p < 0.001). The PCCT provided excellent image contrast and low-noise profiles for the differentiation of the grey and white matter. Only the artifacts below the calvarium and in the posterior fossa still underperform, which is attributable to the lack of an artifact reduction algorithm in image postprocessing. It is conceivable that the usual improvements in image postprocessing, especially with regard to glaring artifacts, will lead to further improvements in image quality.
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Sun X, Niwa T, Ozawa S, Endo J, Hashimoto J. Detecting lymph node metastasis of esophageal cancer on dual-energy computed tomography. Acta Radiol 2022; 63:3-10. [PMID: 33325727 PMCID: PMC9530532 DOI: 10.1177/0284185120980144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Using conventional computed tomography (CT), the accurate diagnosis of lymph
node (LN) metastasis of esophageal cancer is difficult. Purpose To examine dual-energy CT parameters to predict LN metastasis preoperatively
in patients with esophageal cancer. Material and Methods Twenty-six consecutive patients who underwent dual-energy CT before an
esophageal cancer surgery (19 patients with LN metastases) were analyzed.
The included LNs had a short-axis diameter of ≥4 mm and were confirmed to be
resected on postoperative CT. Their short-axis diameter, CT value, iodine
concentration (IC), and fat fraction were measured on early- and late-phase
contrast-enhanced dual-energy CT images and compared between pathologically
confirmed metastatic and non-metastatic LNs. Results In total, 51 LNs (34 metastatic and 17 non-metastatic) were included. In the
early phase, IC and fat fraction were significantly lower in the metastatic
than in the non-metastatic LNs (IC = 1.6 mg/mL vs. 2.2 mg/mL; fat
fraction = 20.3% vs. 32.5%; both P < 0.05). Furthermore,
in the late phase, IC and fat fraction were significantly lower in the
metastatic than in the non-metastatic LNs (IC = 2.0 mg/mL vs. 3.0 mg/mL; fat
fraction = 20.4% vs. 33.0%; both P < 0.05). Fat fraction
exhibited accuracies of 82.4% and 78.4% on early- and late-phase images,
respectively. Conversely, short-axis diameter and CT value on both early-
and late-phase images were not significantly different between the
metastatic and non-metastatic LNs (P > 0.05). Conclusion Using dual-energy CT images, IC and fat fraction are useful for diagnosing LN
metastasis in patients with esophageal cancer.
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Affiliation(s)
- Xuyang Sun
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsu Niwa
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Jun Endo
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Jun Hashimoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
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Huang R, Yan J, Geng H, Yu Q, Sun Z, Liu W, Zhang L, Li C, Li Y. Reduced-Dose Full-Body CT in Lymphoma Follow-up: A Pilot Study. Curr Med Imaging 2022; 19:77-90. [PMID: 35578866 DOI: 10.2174/1573405618666220516123155] [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: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND How to reduce the radiation dose received from full-body CT scans during the follow-up of lymphoma patients is a concern. OBJECTIVE The aim of the study was to investigate the image quality and radiation dose of reduced-dose full-body computerized tomography (CT) in lymphoma patients during the follow-up. METHODS 121 patients were included and divided into conventional CT group (group 1, 120-kVp, n = 61) or reduced-dose CT group (group 2, 100-kVp combined dual-energy CT (DECT), n = 60). 140-kVp polychromatic images and 70-keV monochromatic images were reconstructed from DECT. The abdominal virtual non-enhanced (VNE) images were reconstructed from monochromatic images. Two radiologists rated the overall image quality with a five-point scale and graded the depiction of lesions using a four-point scale. The objective image quality was evaluated using image noise, signal-to-noise ratio, and contrast-to-noise ratio. The radiation dose and image quality were compared between the groups. RESULTS The comparable subjective image quality was observed between 70-keV and 120-kVp images in the neck, while 120-kVp images showed better objective image quality. 70-keV images showed better objective image quality in the chest. While the subjective image quality of abdominal VNE images was inferior to that of true non-enhanced images, the improved objective image quality was observed in VNE images. In the abdominal arterial phase, similar subjective image quality was observed between the groups. Abdominal 70-keV images in the arterial phase showed improved objective image quality. Similar image quality was obtained in the abdominal venous phase between the groups. The effective radiation dose in group 2 showed a significant reduction. CONCLUSION The application of reduced-dose full-body CT can significantly reduce the radiation dose for lymphoma patients during the follow-up while maintaining or improving the image quality.
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Affiliation(s)
- Renjun Huang
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Jiulong Yan
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Hongzhi Geng
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Qiuyu Yu
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Zongqiong Sun
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Wenyan Liu
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Ling Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province 510060, P.R. China
- State Key Laboratory of Oncology in South Chinal, Guangzhou City, Guangdong Province 510060, P.R. China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province 510060, P.R. China
| | - Caixia Li
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
| | - Yonggang Li
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
- Institute of Medical Imaging, Soochow University, Suzhou City, Jiangsu Province 215000, P.R. China
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