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Higashigawa T, Ichikawa Y, Nakajima K, Kobayashi T, Domae K, Yamazaki A, Kato N, Ouchi T, Kato H, Sakuma H. Low energy virtual monochromatic CT with deep learning image reconstruction to improve delineation of endoleaks. Clin Radiol 2024; 79:e1260-e1267. [PMID: 39079807 DOI: 10.1016/j.crad.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 09/09/2024]
Abstract
AIM This study aimed to investigate the utility of low-energy virtual monochromatic imaging (VMI) combined with deep-learning image reconstruction (DLIR) in improving the delineation of endoleaks (ELs) after endovascular aortic repair (EVAR) in contrast-enhanced dual-energy CT (DECT). METHODS A total of 61 consecutive patients (mean age, 77 years; 46 men) after EVAR who underwent contrast-enhanced DECT were enrolled. Virtual monochromatic 40- and 70-keV images were reconstructed using DLIR (TrueFidelity-H) and conventional hybrid iterative reconstruction (IR). Contrast-to-noise ratio (CNR) of the EL on the venous-phase CT was calculated. Four different reconstructed image series (hybrid IR and DLIR at two energy levels, 40- and 70-keV) were displayed side-by-side and visually assessed for EL conspicuity on a 5-point comparative scale from 0 (best) to -4 (significantly inferior). Two experienced radiologists independently conducted a qualitative evaluation of the CT images. RESULTS A total of 30 out of 61 patients presented with an EL. On both 40- and 70-keV images, the CNR of the EL was significantly higher in DLIR than in hybrid IR (40-keV, 14.5 ± 7.3 vs 8.6 ± 4.2, P<0.001; 70-keV, 8.7 ± 4.5 vs 5.5 ± 2.6, P<0.001). The comparative scale of EL conspicuity in the 40-keV DLIR images (Observer1, -0.2 ± 0.4; Observer2, 0.0 ± 0.0) was significantly higher than 40-keV hybrid IR (Observer1, -0.5 ± 0.5; Observer2, -1.0 ± 0.0; P<0.05), 70-keV DLIR (Observer1, -1.8 ± 0.4; Observer2, -2.0 ± 0.0; P<0.001) and 70-keV hybrid IR images (Observer1, -1.8 ± 0.4; Observer2, -2.4 ± 0.5; P<0.001), respectively. CONCLUSIONS Using 40-keV VMI in combination with DLIR improves EL delineation after EVAR compared with the 70-keV VMI with hybrid IR or DLIR.
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Affiliation(s)
- T Higashigawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | - Y Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - K Nakajima
- Department of Radiology, Ise Red Cross Hospital, 471-2 1-Chome Funae, Ise, Mie 516-8512, Japan
| | - T Kobayashi
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - K Domae
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - A Yamazaki
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - N Kato
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - T Ouchi
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - H Kato
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - H Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Yu Q, Zangan S, La Rivière P, Landeras L, Funaki B. Vascular Plugs Improve Pulmonary Arteriovenous Malformation Occlusion over Coil Embolization Alone: A Proof-of-Concept Study Using Dual-Energy CT. J Vasc Interv Radiol 2024; 35:1492-1497.e5. [PMID: 38950821 DOI: 10.1016/j.jvir.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 06/10/2024] [Accepted: 06/23/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE To evaluate effectiveness of pulmonary arteriovenous malformation (PAVM) embolization using dual-energy computed tomography (CT) and spectral curve analysis by characterizing contrast enhancement and vascular perfusion as a surrogate of the degree of vascular occlusion after embolotherapy. MATERIALS AND METHODS Nine consecutive adult patients underwent embolization for 21 PAVMs (size range, 0.4-2.0 cm; 15/21 simple angioarchitecture) and subsequent postembolization chest dual-energy CT angiography. Twelve PAVMs were treated with vascular plugs with or without coils, whereas 9 PAVMs were treated with coils alone. Virtual spectral curves were generated using dual-energy image postprocessing in order to measure embolization effectiveness. RESULTS Complete occlusion of target PAVM was achieved in all cases on digital subtraction angiography (DSA) at the end of the embolization procedure. With a median follow-up of 12.7 months, the vascular plug group demonstrated significantly less vascular opacification compared with the coils-only group, as measured by opacification between upstream feeding artery and different downstream vasculature locations (Δslope1: median 79.1 vs 28.6; P = .003; Δslope2: 76.4 vs 28.6; P = .0197; Δslope3: 78.9 vs 28.6; P = .004). Persistence occurred in 3 PAVMs based on size criteria, which demonstrated higher vascular opacification by dual-energy CT (Δslope1: 72 vs 28.6; P = .253; Δslope2: 65.1 vs 32.7; P = .326; Δslope3: 72.9 vs 53.5; P = .733), although statistical significance was not reached. CONCLUSIONS Similar to emerging literature, dual-energy CT showed improved occlusion in PAVMs treated with vascular plugs compared with those treated with coils alone.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Steven Zangan
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Patrick La Rivière
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Luis Landeras
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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Morikawa K, Tanishima Y, Igarashi T, Ohki Y, Takahashi K, Kurogochi T, Yano F, Ojiri H. Evaluation of the Usefulness of Contrast-Enhanced Computed Tomography for the Early Detection of Anastomotic Leakage After Esophagectomy. J Comput Assist Tomogr 2024; 48:719-726. [PMID: 38346793 DOI: 10.1097/rct.0000000000001595] [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: 09/20/2024]
Abstract
OBJECTIVE Anastomotic leakage is one of the most severe complications after esophagectomy. However, a diagnostic gold standard for anastomotic leakage has not been established yet. This retrospective cohort study aimed to evaluate the potential use of routine postoperative contrast-enhanced computed tomography findings as an early predictor of anastomotic leakage in patients who underwent esophagectomy for esophageal cancer. METHODS This study included 75 patients who underwent Mckeown esophagectomy, of whom 22 developed anastomotic leakage after surgery. The computed tomography findings for this patient cohort were categorized into 3 grades based on mural enhancement patterns observed at the anastomotic site. Both semiquantitative and quantitative analyses were performed, and the interobserver agreement between the 2 experienced radiologists was assessed. RESULTS It was found that poor enhancement in both the early and portal venous phases (grade 2) had a robust association with the occurrence of anastomotic leakage. The computed tomography enhancement ratio that is used to estimate wall degeneration and ischemia was significantly higher in patients with anastomotic leakage. CONCLUSIONS Routine postoperative contrast-enhanced computed tomography could be beneficial for the early detection of anastomotic leakage, even in asymptomatic patients, after esophagectomy.
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Affiliation(s)
| | - Yuichiro Tanishima
- Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Keita Takahashi
- Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Kurogochi
- Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumiaki Yano
- Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Ronza FM, Di Gennaro TL, Buzzo G, Piccolo L, Della Noce M, Giordano G, Posillico G, Pietrobono L, Mazzei FG, Ricci P, Masala S, Scaglione M, Tamburrini S. Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia. Diagnostics (Basel) 2024; 14:1214. [PMID: 38928630 PMCID: PMC11202795 DOI: 10.3390/diagnostics14121214] [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: 05/10/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for the suspected diagnosis of vascular abdominal pathologies and the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extent and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases, helping clinicians and surgeons with appropriate management. CT (Computed Tomography) can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM = non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia.
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Affiliation(s)
| | | | - Gianfranco Buzzo
- Department of Diagnostic Imaging, AORN “S. Anna e S. Sebastiano”, 81100 Caserta, Italy
| | - Luciana Piccolo
- Department of Diagnostic Imaging, AORN “S. Anna e S. Sebastiano”, 81100 Caserta, Italy
| | - Marina Della Noce
- Department of Diagnostic Imaging, AORN “S. Anna e S. Sebastiano”, 81100 Caserta, Italy
| | - Giovanni Giordano
- Department of Diagnostic Imaging, AORN “S. Anna e S. Sebastiano”, 81100 Caserta, Italy
| | - Giuseppe Posillico
- Department of Diagnostic Imaging, AORN “S. Anna e S. Sebastiano”, 81100 Caserta, Italy
| | - Luigi Pietrobono
- Radiology I, Fondazion e IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesco Giuseppe Mazzei
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Paolo Ricci
- Unit of Emergency Radiology, Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, Italy
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Ibrahim YO, Maalej N, Masood Pirzada B, Younis Raja A, Anjum DH, Jan N, Behouch A, Ul Haq Qurashi A. Gold nanoparticles spectral CT imaging and limit of detectability in a new materials contrast-detail phantom. Phys Med 2024; 120:103326. [PMID: 38493584 DOI: 10.1016/j.ejmp.2024.103326] [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: 11/22/2023] [Revised: 01/20/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
This study involves the synthesis, characterization, and spectral photon counting CT (SPCCT) imaging of gold nanoparticles tailored for enhancing the contrast of small cancer lesions. We used the modified Turkevich method to produce thiol-capped gold nanoparticles (AuNPs) at different concentrations (20, 15, 10, 5, 2.5, 1.25, 0.6 mg/ml). We thoroughly characterized the AuNPs using Transmission Electron Microscopy (TEM), X-ray diffraction spectroscopy (XRD), Dynamic Light Scattering (DLS), and UV-visible absorption spectroscopy. To assess the AuNPs contrast enhancing performance, we designed and built a new material contrast detail phantom for CT imaging and determined the minimum detectable concentrations of AuNPs in simulated lesions of small diameters (1, 2, 3, and 5 mm). The synthesized AuNPs are spherical with an average size of approximately 20 ± 4 nm, with maximum UV absorption occurring at 527 nm wavelength, and exhibit a face-centered cubic structure of gold according to XRD analysis. The synthesized gold nanoparticles demonstrated high contrast in SPCCT, suggesting their potential as contrast agents for imaging cancer tissues. The AuNPs image contrast was directly proportional to the AuNPs concentration. We are the first to determine that the lowest visually distinguishable contrast was achieved at a gold concentration of 5 mg/ml for a 2 mm simulated lesion. For 1 mm size lesion the smallest visible concentration was 10 mg/ml. This newly developed phantom can be used for determining the minimal concentration required for various high-Z nanoparticles to produce detectable contrast in X-ray imaging for small-size simulated lesions.
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Affiliation(s)
- Yusuf O Ibrahim
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Advanced Materials Chemistry Centre (AMCC), Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Functional Biomaterials Group, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Nabil Maalej
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Functional Biomaterials Group, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Healthcare Engineering Innovation Group (HEIG), Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Bilal Masood Pirzada
- Department of Chemistry, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Advanced Materials Chemistry Centre (AMCC), Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Aamir Younis Raja
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Dalaver H Anjum
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Nila Jan
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Abderaouf Behouch
- Department of Physics, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Ahsan Ul Haq Qurashi
- Department of Chemistry, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Advanced Materials Chemistry Centre (AMCC), Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
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Yel I, D'Angelo T, Gruenewald LD, Koch V, Golbach R, Mahmoudi S, Ascenti G, Blandino A, Vogl TJ, Booz C, Bucolo GM. Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer. Diagnostics (Basel) 2024; 14:466. [PMID: 38472939 DOI: 10.3390/diagnostics14050466] [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: 01/31/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. MATERIALS AND METHODS 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. RESULTS A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) (p < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) (p = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. CONCLUSIONS DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy.
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Affiliation(s)
- Ibrahim Yel
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Leon D Gruenewald
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Vitali Koch
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Rejane Golbach
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giuseppe M Bucolo
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
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Jia Z, Guo L, Yuan W, Dai J, Lu J, Li Z, Du X, Chen W, Liu X. Performance of dual-layer spectrum CT virtual monoenergetic images to assess early rectal adenocarcinoma T-stage: comparison with MR. Insights Imaging 2024; 15:11. [PMID: 38228903 PMCID: PMC10792143 DOI: 10.1186/s13244-023-01593-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/09/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES To evaluate the image quality and utility of virtual monoenergetic images (VMI) of dual-layer spectrum computed tomography (DLSCT) in assessing preoperative T-stage for early rectal adenocarcinoma (ERA). METHODS This retrospective study included 67 ERA patients (mean age 62 ± 11.1 years) who underwent DLSCT and MR examination. VMI 40-200 keV and poly energetic image (PEI) were reconstructed. The image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor contrast of different energy levels were calculated and compared, respectively. Two radiologists independently assess the image quality of the VMIs and PEI using 5-point scales. The diagnostic accuracies of DLSCT and HR-MRI for ERA T-staging were evaluated and compared. RESULTS The maximum noise was observed at VMI 40 keV, and noise at VMI 40-200 keV in the arterial and venous phases showed no significant difference (all p > 0.05). The highest SNR and CNR were obtained at VMI 40 keV, significantly greater than other energy levels and PEI (all p < 0.05). Tumor contrast was more evident than PEI at 40-100 keV in the arterial phase and at 40 keV in the venous phase (all p < 0.05). When compared with PEI, VMI 40 keV yielded the highest scores for overall image quality, tumor visibility, and tumor margin delineation, especially in the venous phase (p < 0.05). The overall diagnostic accuracy of DLSCT and HR-MRI for T-stage was 65.67 and 71.64% and showed no significant difference (p > 0.05). CONCLUSIONS VMI 40 keV improves image quality and accuracy in identifying lesions, providing better diagnostic information for ERA staging. CRITICAL RELEVANCE STATEMENT Low-keV VMI from DLSCT can improve tumor staging accuracy for early rectal carcinoma, helping guide surgical intervention decisions, and has shed new light on the potential breakthroughs of assessing preoperative T-stage in RC. KEYPOINTS • Compared with PEI, low-keV VIM derived from DLSCT, particularly at the 40 keV, significantly enhanced the objective and subjective image quality of ERA. • Using VMI 40 keV helped increase lesion detectability, leading to improved diagnostic accuracy for ERA. • Low-keV VMI from DLSCT has shed new light on the potential breakthroughs of assessing preoperative T-stage in RC.
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Affiliation(s)
- Ziqi Jia
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Guo
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - WenJing Yuan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianHao Dai
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianYe Lu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - ZhiQiang Li
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohua Du
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Xu JJ, Ulriksen PS, Jawad S, Rohde YZ, Sejer M, Achiam MP, Resch TA, Lönn L, Hansen KL. Iodine density mapping for the diagnosis of acute bowel ischemia using fast kV-switching dual-energy CT. Abdom Radiol (NY) 2024; 49:312-319. [PMID: 37978076 PMCID: PMC10789852 DOI: 10.1007/s00261-023-04097-4] [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: 02/13/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To evaluate the diagnostic capabilities of a supplementary color ramped iodine density map compared to virtual monoenergetic images (VMIs) at 74 keV in the diagnosis of acute bowel ischemia (ABI). METHODS Data for this study were prospectively gathered and retrospectively evaluated. Patients referred to the Department of Diagnostic Radiology between October 2020 and August 2022 on the suspicion of ABI and underwent surgery < 12 h following fast kV-switching venous phase abdominal dual-energy CT (DECT) were consecutively included. Images were evaluated by two board-certified radiologists and two radiology residents. First round included only 74 keV VMIs resembling conventional 120 kVp images, and the second round included a supplementary iodine density map. Readers were asked to register presence of ABI as well as their confidence in their diagnosis based on a 5-point Likert scale. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each observer with the surgical findings as the gold-standard. McNemar's and Wilcoxon signed-rank test were used to compare registrations and diagnostic confidence across assessment rounds. RESULTS A total of 29 patients resulting in 31 DECT scans were included. Fourteen cases of ischemic/necrotic bowel were reported following surgery. Sensitivity and NPV were decreased with the use of supplementary iodine map images compared to 120 kVp-like images without supplementary iodine map images for three of four observers (round 1 range: 71.4-92.9% and 78.0-94.8%; round 2 range: 57.1-78.6% and 70.1-83.3%, respectively), while specificity and PPV were increased for three of four observers (round 1 range: 64.7-94.1% and 67.4-93.1%; round 2 range: 88.2-94.1% and 73.8-91.1%, respectively). However, no significant difference in ABI diagnosis or diagnostic confidence was found (p-value range: 0.07-1.00 and 0.23-0.58, respectively). CONCLUSION No significant difference for the diagnosis of ABI was found using supplementary iodine mapping. Our study may suggest a trend of increased specificity and decreased sensitivity, hence, the use of supplementary iodine mapping should be carefully considered.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark.
| | - Peter Sommer Ulriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Samir Jawad
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Yecatarina Zincuk Rohde
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Morten Sejer
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Michael Patrick Achiam
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
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Nehnahi M, Simon G, Moinet R, Piton G, Camelin C, Ronot M, Delabrousse É, Calame P. Quantifying iodine concentration in the normal bowel wall using dual-energy CT: influence of patient and contrast characteristics. Sci Rep 2023; 13:22714. [PMID: 38123632 PMCID: PMC10733335 DOI: 10.1038/s41598-023-50238-6] [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: 08/30/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to establish quantitative references of the normal bowel wall iodine concentration (BWIC) using dual energy CT (DECT). This single-center retrospective study included 248 patients with no history of gastrointestinal disease who underwent abdominal contrast-enhanced DECT between January and April 2022. The BWIC was normalized by the iodine concentration of upper abdominal organs (BWICorgan,) and the iodine concentration (IC) of the aorta (BWICaorta). BWIC decreased from the stomach to the rectum (mean 2.16 ± 0.63 vs. 2.19 ± 0.63 vs. 2.1 ± 0.58 vs. 1.67 ± 0.47 vs. 1.31 ± 0.4 vs. 1.18 ± 0.34 vs. 0.94 ± 0.26 mgI/mL for the stomach, duodenum, jejunum, ileum, right colon, left colon and rectum, respectively; P < 0.001). By multivariate analysis, BWIC was associated with a higher BMI (OR:1.01, 95% CI 1.00-1.02, P < 0.001) and with a higher injected contrast dose (OR: 1.51; 95% CI 1.36-1.66, P < 0.001 and 2.06; 95% CI 1.88-2.26, P < 0.001 for 500 mgI/kg and 600 mgI/kg doses taking 400 mgI/kg dose as reference). The BWICorgan was shown independent from patients and contrast-related variables while the BWICaorta was not. BWIC varies according to bowel segments and is dependent on the total iodine dose injected. It shall be normalized with the IC of the upper abdominal organs.
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Affiliation(s)
- Majida Nehnahi
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
| | - Gabriel Simon
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
| | - Romain Moinet
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
| | - Gael Piton
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
| | - Camille Camelin
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110, Clichy, France
| | - Éric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France
| | - Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHU Besançon, 25030, Besançon, France.
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
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10
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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11
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Franco PN, Spasiano CM, Maino C, De Ponti E, Ragusi M, Giandola T, Terrani S, Peroni M, Corso R, Ippolito D. Principles and Applications of Dual-Layer Spectral CT in Gastrointestinal Imaging. Diagnostics (Basel) 2023; 13:diagnostics13101740. [PMID: 37238224 DOI: 10.3390/diagnostics13101740] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The advance in technology allows for the development of different CT scanners in the field of dual-energy computed tomography (DECT). In particular, a recently developed detector-based technology can collect data from different energy levels, thanks to its layers. The use of this system is suited for material decomposition with perfect spatial and temporal registration. Thanks to post-processing techniques, these scanners can generate conventional, material decomposition (including virtual non-contrast (VNC), iodine maps, Z-effective imaging, and uric acid pair images) and virtual monoenergetic images (VMIs). In recent years, different studies have been published regarding the use of DECT in clinical practice. On these bases, considering that different papers have been published using the DECT technology, a review regarding its clinical application can be useful. We focused on the usefulness of DECT technology in gastrointestinal imaging, where DECT plays an important role.
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Affiliation(s)
- Paolo Niccolò Franco
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Chiara Maria Spasiano
- Department of Diagnostic Radiology, Istituti Clinici Zucchi, Via Zucchi 24, 20900 Monza, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Elena De Ponti
- Department of Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | | | - Marta Peroni
- Philips Healtcare, Viale Sarca 54, 20126 Milano, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine, Università Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20100 Milano, Italy
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12
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Schmidt SA, Beer M, Vogele D. [Update: Small bowel diseases in computed tomography and magnetic resonance imaging]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01139-2. [PMID: 37016034 DOI: 10.1007/s00117-023-01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/06/2023]
Abstract
CLINICAL/METHODICAL ISSUE Radiological procedures play a crucial role in the diagnosis of small bowel disease. Due to a broad and quite nonspecific spectrum of symptoms, clinical evaluation is often difficult, and endoscopic procedures require significant manpower, are time-consuming and expensive. In contrast, radiologic imaging can provide important information about morphologic and functional variations of the small bowel and help to identify various disease entities, such as inflammation, tumors, vascular problems, and obstruction. STANDARD RADIOLOGICAL METHODS The most common radiological modalities in small bowel diagnostics include ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluoroscopy. Each of these modalities has its own advantages and limitations, and the choice of imaging modality depends on clinical symptoms and suspected diagnosis in addition to availability. METHODOLOGICAL INNOVATIONS In recent years, significant progress has been made, especially in cross-sectional imaging modalities, as a result of new and further technical developments. PERFORMANCE These range from increasing detail resolution to functional and molecular imaging techniques that go far beyond simple morphology. In addition, information technology (IT) applications, which include artificial intelligence and radiomics, are assuming an increasing role. ACHIEVEMENTS Many of the methods mentioned are still in early stages and need to be further developed for daily practice, but some have already found their way into clinical routine. PRACTICAL RECOMMENDATIONS The aim of this work is to provide a review of the most important disease entities of the small intestine, including new and innovative diagnostic approaches.
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Affiliation(s)
- Stefan Andreas Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Daniel Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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13
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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14
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Cigarrán Sexto H, Calvo Blanco J, Fernández Suárez G. Spectral CT in Emergency. RADIOLOGIA 2023; 65 Suppl 1:S109-S119. [PMID: 37024225 DOI: 10.1016/j.rxeng.2022.11.002] [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: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 04/08/2023]
Abstract
Spectral CT technology is based on the acquisition of CT images with X-ray at 2 different energy levels which makes possible to distinguish between materials with different atomic numbers using their energy-dependent attenuation, even if those materials have similar density at conventional CT. This kind of technology has gained wide application due to the innumerable uses of their post-processing techniques, including virtual non-contrast images, iodine maps, virtual mono-chromatic images or mixed images without increasing radiation dose. There are several applications of spectral CT in Emergency Radiology that help in the detection, diagnosis and management of various pathologies such as differentiate haemorrhage from the underlaying causative lesion, diagnosis of pulmonary embolisms, demarcation of abscess, characterization of renal stones or reduction of artifacts. The purpose of this review is to provide the emergency radiologist a brief description of the main indications for spectral CT.
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15
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Deep learning image reconstruction to improve accuracy of iodine quantification and image quality in dual-energy CT of the abdomen: a phantom and clinical study. Eur Radiol 2023; 33:1388-1399. [PMID: 36114848 DOI: 10.1007/s00330-022-09127-1] [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: 07/21/2022] [Revised: 07/21/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the effect of deep learning image reconstruction (DLIR) on the accuracy of iodine quantification and image quality of dual-energy CT (DECT) compared to that of other reconstruction algorithms in a phantom experiment and an abdominal clinical study. METHODS An elliptical phantom with five different iodine concentrations (1-12 mgI/mL) was imaged five times with fast-kilovoltage-switching DECT for three target volume CT dose indexes. All images were reconstructed using filtered back-projection, iterative reconstruction (two levels), and DLIR algorithms. Measured and nominal iodine concentrations were compared among the algorithms. Contrast-enhanced CT of the abdomen with the same scanner was acquired in clinical patients. In arterial and portal venous phase images, iodine concentration, image noise, and coefficients of variation for four locations were retrospectively compared among the algorithms. One-way repeated-measures analyses of variance were used to evaluate differences in the iodine concentrations, standard deviations, coefficients of variation, and percentages of error among the algorithms. RESULTS In the phantom study, the measured iodine concentrations were equivalent among the algorithms: within ± 8% of the nominal values, with root-mean-square deviations of 0.08-0.36 mgI/mL, regardless of radiation dose. In the clinical study (50 patients; 35 men; mean age, 68 ± 11 years), iodine concentrations were equivalent among the algorithms for each location (all p > .99). Image noise and coefficients of variation were lower with DLIR than with the other algorithms (all p < .01). CONCLUSIONS The DLIR algorithm reduced image noise and variability of iodine concentration values compared with other reconstruction algorithms in the fast-kilovoltage-switching dual-energy CT. KEY POINTS • In the phantom study, standard deviations and coefficients of variation in iodine quantification were lower on images with the deep learning image reconstruction algorithm than on those with other algorithms. • In the clinical study, iodine concentrations of measurement location in the upper abdomen were consistent across four reconstruction algorithms, while image noise and variability of iodine concentrations were lower on images with the deep learning image reconstruction algorithm.
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16
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Imaging of Bowel Ischemia: An Update, From the AJR Special Series on Emergency Radiology. AJR Am J Roentgenol 2023; 220:173-185. [PMID: 35946859 DOI: 10.2214/ajr.22.28140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acute mesenteric ischemia is a life-threatening condition that results from abrupt reduction in or cessation of blood flow to the bowel. Characterized by nonspecific abdominal symptoms, mesenteric ischemia is infrequently encountered and commonly misdiagnosed, with potentially catastrophic consequences. Prompt clinical diagnosis and early implementation of therapeutic interventions are critical to improving patient outcomes. Because cross-sectional imaging plays a key role in the diagnosis of mesenteric ischemia, radiologists must be familiar with the varied imaging manifestations of intestinal ischemia. Thus, the objectives of this article are to review the various types and common causes of mesenteric ischemia and to describe its spectrum of multimodality imaging findings, with special attention to novel imaging techniques and emerging diagnoses.
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17
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Metal implants on abdominal CT: does split-filter dual-energy CT provide additional value over iterative metal artifact reduction? Abdom Radiol (NY) 2023; 48:424-435. [PMID: 36180598 PMCID: PMC9849167 DOI: 10.1007/s00261-022-03682-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess image quality and metal artifact reduction in split-filter dual-energy CT (sfDECT) of the abdomen with hip or spinal implants using virtual monoenergetic images (VMI) and iterative metal artifact reduction algorithm (iMAR). METHODS 102 portal-venous abdominal sfDECTs of patients with hip (n = 71) or spinal implants (n = 31) were included in this study. Images were reconstructed as 120kVp-equivalent images (Mixed) and VMI (40-190 keV), with and without iMAR. Quantitative artifact and image noise was measured using 12 different ROIs. Subjective image quality was rated by two readers using a five-point Likert-scale in six categories, including overall image quality and vascular contrast. RESULTS Lowest quantitative artifact in both hip and spinal implants was measured in VMI190keV-iMAR. However, it was not significantly lower than in MixediMAR (for all ROIs, p = 1.00), which were rated best for overall image quality (hip: 1.00 [IQR: 1.00-2.00], spine: 3.00 [IQR:2.00-3.00]). VMI50keV-iMAR was rated best for vascular contrast (hip: 1.00 [IQR: 1.00-2.00], spine: 2.00 [IQR: 1.00-2.00]), which was significantly better than Mixed (both, p < 0.001). VMI50keV-iMAR provided superior overall image quality compared to Mixed for hip (1.00 vs 2.00, p < 0.001) and similar diagnostic image quality for spinal implants (2.00 vs 2.00, p = 0.51). CONCLUSION For abdominal sfDECT with hip or spinal implants MixediMAR images should be used. High keV VMI do not further improve image quality. IMAR allows the use of low keV images (VMI50keV) to improve vascular contrast, compared to Mixed images.
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18
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Multi-Energy CT Applications. Radiol Clin North Am 2023; 61:1-21. [DOI: 10.1016/j.rcl.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Understanding CT imaging findings based on the underlying pathophysiology in patients with small bowel ischemia. Jpn J Radiol 2022; 41:353-366. [PMID: 36472804 PMCID: PMC10066158 DOI: 10.1007/s11604-022-01367-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
AbstractBecause acute small bowel ischemia has a high mortality rate, it requires rapid intervention to avoid unfavorable outcomes. Computed tomography (CT) examination is important for the diagnosis of bowel ischemia. Acute small bowel ischemia can be the result of small bowel obstruction or mesenteric ischemia, including mesenteric arterial occlusion, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. The clinical significance of each CT finding is unique and depends on the underlying pathophysiology. This review describes the definition and mechanism(s) of bowel ischemia, reviews CT findings suggesting bowel ischemia, details factors involved in the development of small bowel ischemia, and presents CT findings with respect to the different factors based on the underlying pathophysiology. Such knowledge is needed for accurate treatment decisions.
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20
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Cigarrán Sexto H, Calvo Blanco J, Fernández Suárez G. TC espectral en la urgencia. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Greffier J, Villani N, Defez D, Dabli D, Si-Mohamed S. Spectral CT imaging: Technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging 2022; 104:167-177. [PMID: 36414506 DOI: 10.1016/j.diii.2022.11.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
Spectral computed tomography (CT) imaging encompasses a unique generation of CT systems based on a simple principle that makes use of the energy-dependent information present in CT images. Over the past two decades this principle has been expanded with the introduction of dual-energy CT systems. The first generation of spectral CT systems, represented either by dual-source or dual-layer technology, opened up a new imaging approach in the radiology community with their ability to overcome the limitations of tissue characterization encountered with conventional CT. Its expansion worldwide can also be considered as an important leverage for the recent groundbreaking technology based on a new chain of detection available on photon counting CT systems, which holds great promise for extending CT towards multi-energy CT imaging. The purpose of this article was to detail the basic principles and techniques of spectral CT with a particular emphasis on the newest technical developments of dual-energy and multi-energy CT systems.
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22
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Nayab A, Wijdicks EF, Luetmer PH, Lehman VT. Value of dual energy CT in post resuscitation coma. Differentiating contrast retention and ischemic brain parenchyma. Radiol Case Rep 2022; 17:3722-3726. [PMID: 35965920 PMCID: PMC9363949 DOI: 10.1016/j.radcr.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Asra Nayab
- Division of Neuroradiology Department of Radiology, Mayo Clinic Rochester, MN, USA
- Radiology Education Office MA 2-00C Mayo Clinic 200 First Street SW Rochester, MN 55905, USA
- Corresponding author.
| | - Eelco F. Wijdicks
- Department of Neurology and Neurocritical Care, Mayo Clinic Rochester, MN, USA
- Division of Neurology and Neurocritical Care Mayo Clinic Rochester, MN, USA
| | - Patrick H. Luetmer
- Division of Neuroradiology Department of Radiology, Mayo Clinic Rochester, MN, USA
- Radiology Education Office MA 2-00C Mayo Clinic 200 First Street SW Rochester, MN 55905, USA
| | - Vance T. Lehman
- Division of Neuroradiology Department of Radiology, Mayo Clinic Rochester, MN, USA
- Radiology Education Office MA 2-00C Mayo Clinic 200 First Street SW Rochester, MN 55905, USA
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Fernández-Pérez GC, Fraga Piñeiro C, Oñate Miranda M, Díez Blanco M, Mato Chaín J, Collazos Martínez MA. Dual-energy CT: Technical considerations and clinical applications. RADIOLOGIA 2022; 64:445-455. [PMID: 36243444 DOI: 10.1016/j.rxeng.2022.06.003] [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: 05/02/2022] [Accepted: 06/20/2022] [Indexed: 06/16/2023]
Abstract
Although dual-energy CT was initially described by Hounsfield in 1973, it remains underused in clinical practice. It is therefore important to emphasize the clinical benefits and limitations of this technique. Iodine mapping makes it possible to quantify the uptake of iodine, which is very important in characterizing tumors, lung perfusion, pulmonary nodules, and the tumor response to new treatments. Dual-energy CT also makes it possible to obtain virtual single-energy images and virtual images without iodinated contrast or without calcium, as well as to separate materials such as uric acid or fat and to elaborate hepatic iron overload maps. In this article, we review some of the clinical benefits and technical limitations to improve understanding of dual-energy CT and expand its use in clinical practice.
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Affiliation(s)
- G C Fernández-Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Grupo Recoletas, Valladolid, Spain.
| | - C Fraga Piñeiro
- Técnico Aplicaciones Siemens Healthineers, General Electric Company, Spain
| | - M Oñate Miranda
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Díez Blanco
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
| | - J Mato Chaín
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
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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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25
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Virarkar MK, Vulasala SSR, Gupta AV, Gopireddy D, Kumar S, Hernandez M, Lall C, Bhosale P. Virtual Non-contrast Imaging in The Abdomen and The Pelvis: An Overview. Semin Ultrasound CT MR 2022; 43:293-310. [PMID: 35738815 DOI: 10.1053/j.sult.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Virtual non-contrast (VNC) imaging is a post-processing technique generated from contrast-enhanced scans using dual-energy computed tomography (DECT). It is generated by removing iodine from imaging acquired at multiple energies. Myriad clinical studies have shown its ability to diagnose the various abdominal and pelvic pathologies discussed in the article. VNC is also a problem-solving tool for characterizing incidentally detected lesions ("incidentalomas"), often decreasing the need for additional follow-up imaging. It also obviates the multiphase image acquisitions to evaluate hematuria, hepatic steatosis, aortic endoleaks, and gastrointestinal bleeding by generating image datasets from different tissue attenuation values. The scope of this article is to provide an overview of various applications of VNC imaging obtained by DECT in the abdomen and pelvis.
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Affiliation(s)
- Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mauricio Hernandez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Xu JJ, Lönn L, Budtz-Jørgensen E, Hansen KL, Ulriksen PS. Quantitative and qualitative assessments of deep learning image reconstruction in low-keV virtual monoenergetic dual-energy CT. Eur Radiol 2022; 32:7098-7107. [PMID: 35895120 DOI: 10.1007/s00330-022-09018-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/01/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate a novel deep learning image reconstruction (DLIR) technique for dual-energy CT (DECT) derived virtual monoenergetic (VM) images compared to adaptive statistical iterative reconstruction (ASIR-V) in low kiloelectron volt (keV) images. METHODS We analyzed 30 venous phase acute abdominal DECT (80/140 kVp) scans. Data were reconstructed to ASIR-V and DLIR-High at four different keV levels (40, 50, 74, and 100) with 1- and 3-mm slice thickness. Quantitative Hounsfield unit (HU) and noise assessment were measured within the liver, aorta, fat, and muscle. Subjective assessment of image noise, sharpness, texture, and overall quality was performed by two board-certified radiologists. RESULTS DLIR reduced image noise by 19.9-35.5% (p < 0.001) compared to ASIR-V in all reconstructions at identical keV levels. Contrast-to-noise ratio (CNR) increased by 49.2-53.2% (p < 0.001) in DLIR 40-keV images compared to ASIR-V 50 keV, while no significant difference in noise was identified except for 1 and 3 mm in aorta and for 1-mm liver measurements, where ASIR-V 50 keV showed 5.5-6.8% (p < 0.002) lower noise levels. Qualitative assessment demonstrated significant improvement particularly in 1-mm reconstructions (p < 0.001). Lastly, DLIR 40 keV demonstrated comparable or improved image quality ratings when compared to ASIR-V 50 keV (p < 0.001 to 0.22). CONCLUSION DLIR significantly reduced image noise compared to ASIR-V. Qualitative assessment showed that DLIR significantly improved image quality particularly in thin sliced images. DLIR may facilitate 40 keV as a new standard for routine low-keV VM reconstruction in contrast-enhanced abdominal DECT. KEY POINTS • DLIR enables 40 keV as the routine low-keV VM reconstruction. • DLIR significantly reduced image noise compared to ASIR-V, across a wide range of keV levels in VM DECT images. • In low-keV VM reconstructions, improvements in image quality using DLIR were most evident and consistent in 1-mm sliced images.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark.
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer L Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Peter S Ulriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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27
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Boyer S, Lombard C, Urbaneja A, Vogrig C, Regent D, Blum A, Teixeira PAG. CT in non-traumatic acute abdominal emergencies: Comparison of unenhanced acquisitions and single-energy iodine mapping for the characterization of bowel wall enhancement. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2022; 2:100010. [PMID: 39076837 PMCID: PMC11265197 DOI: 10.1016/j.redii.2022.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 07/31/2024]
Abstract
Objectives To evaluate the benefit of unenhanced CT and single energy iodine mapping (SIM) to conventional contrast-enhanced CT for bowel wall enhancement characterization in an acute abdomen setting. Methods CT images from 45 patients with a suspected acute abdomen who underwent abdominopelvic CT from April 2018 to June 2018 were analyzed retrospectively by two independent radiologists. These patients had been referred by emergency department physicians in a context of acute abdominal pain and had a confirmed etiological diagnosis. Three image sets were evaluated separately (portal phase images alone; portal phase images and unenhanced images, portal phase images, and single energy iodine maps). Diagnostic accuracy and confidence were assessed. Quantitative analysis of bowel wall enhancement was also performed. Results The number of correct diagnoses increased by 8% and 12% with unenhanced images and 6% and 13% with SIM for readers 1 and 2, respectively, compared to the portal phase only. There was an improvement in the confidence of the etiological diagnosis with the number of certain diagnoses increasing from 23% to 100%, which was statistically significant for reader 2 and of borderline significance for reader 1 (P = 0.002 and 0.052, respectively) when unenhanced phase and SIM were added. The inter-rater agreement improved when unenhanced and portal phase images were associated, compared to portal phase images alone (kappa = 0.652 [ICC=0.482-0.822] and 0.42 [ICC=0.241-0.607] respectively). Conclusion SIM and unenhanced images improve the reproducibility and the diagnostic confidence to diagnose ischemic and inflammatory/infectious bowel wall thickening compared to portal phase images alone. Summary sentence The analysis of unenhanced and SIM images in association with portal phase images improves the reproducibility and the radiologist's confidence in the etiological diagnosis of acute non-traumatic bowel wall thickening in adults.
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Affiliation(s)
- Sophie Boyer
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Charles Lombard
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Ayla Urbaneja
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Céline Vogrig
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Denis Regent
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
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Almeida I, Amorim J, Vasconcelos C. Ultrasound evaluation of bowel vasculopathy in systemic sclerosis but…. Eur J Intern Med 2022; 100:31-32. [PMID: 35422373 DOI: 10.1016/j.ejim.2022.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 12/18/2022]
Affiliation(s)
- Isabel Almeida
- Internal Medicine, UIC-Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Member of European Reference Network RITA and ReCONNECT, Responsible of the UIC Systemic Sclerosis Cohort, UMIB, ICBAS, Universidade do Porto, Portugal
| | - João Amorim
- Radiology, Radiology depatment, Centro Hospitalar Universitário do Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine, UIC-Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Member of European Reference Network RITA and ReCONNECT, UMIB, ICBAS, Universidade do Porto, Portugal.
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Reginelli A, Sangiovanni A, Vacca G, Belfiore MP, Pignatiello M, Viscardi G, Clemente A, Urraro F, Cappabianca S. Chemotherapy-induced bowel ischemia: diagnostic imaging overview. Abdom Radiol (NY) 2022; 47:1556-1564. [PMID: 33811514 PMCID: PMC9038829 DOI: 10.1007/s00261-021-03024-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
Cancer patients need multimodal therapies to treat their disease increasingly. In particular, drug treatment, as chemotherapy, immunotherapy, or various associations between them are commonly used to increase efficacy. However, the use of drugs predisposes a percentage of patients to develop toxicity in multiple organs and systems. Principle chemotherapy drugs mechanism of action is cell replication inhibition, rapidly proliferating cells especially. Immunotherapy is another tumor therapy strategy based on antitumor immunity activation trough agents as CTLA4 inhibitors (ipilimumab) or PD-1/PD-L1 inhibitors as nivolumab. If, on the one hand, all these agents inhibit tumor growth, on the other, they can cause various degrees toxicity in several organs, due to their specific mechanism of action. Particularly interesting are bowel toxicity, which can be clinically heterogeneous (pain, nausea, diarrhea, enterocolitis, pneumocolitis), up to severe consequences, such as ischemia, a rare occurrence. However, this event can occur both in vessels that supply intestine and in submucosa microvessels. We report drug-related intestinal vascular damage main characteristics, showing the radiological aspect of these alterations. Interpretation of imaging in oncologic patients has become progressively more complicated in the context of "target therapy" and thanks to the increasing number and types of therapies provided. Radiologists should know this variety of antiangiogenic treatments and immunotherapy regimens first because they can determine atypical features of tumor response and then also because of their eventual bowel toxicity.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy.
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Giuseppe Viscardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Alfredo Clemente
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
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30
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Sinha D, Kale S, Kundaragi NG, Sharma S. Mesenteric ischemia: a radiologic perspective. Abdom Radiol (NY) 2022; 47:1514-1528. [PMID: 33230592 DOI: 10.1007/s00261-020-02867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.
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31
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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32
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Wang TJ, Barrett S, Ali I, Khosa F, Nicolaou S, Murray N. Dual-Energy CT in the Acute Setting: Bowel Trauma. FRONTIERS IN RADIOLOGY 2022; 2:835834. [PMID: 37492664 PMCID: PMC10365276 DOI: 10.3389/fradi.2022.835834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 07/27/2023]
Abstract
Traumatic bowel and mesenteric injuries (TBMI) have significant morbidity and mortality. The physical examination is often limited and sometimes not feasible in the trauma patient. Multidetector CT (MDCT) detection of TBMI is challenging and can be life-saving. Dual-energy CT (DECT) utilizes iodine overlay, monoenergetic imaging, and metal artifact reduction to enhance the conspicuity of TBMI. DECT may improve the conspicuity of TBMI leading to increased diagnostic accuracy and confidence. The aim of the article is to review the state of the art and applications of DECT in bowel trauma.
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Cester D, Eberhard M, Alkadhi H, Euler A. Virtual monoenergetic images from dual-energy CT: systematic assessment of task-based image quality performance. Quant Imaging Med Surg 2022; 12:726-741. [PMID: 34993114 DOI: 10.21037/qims-21-477] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
Background To compare task-based image quality (TB-IQ) among virtual monoenergetic images (VMI) and linear-blended images (LBI) from dual-energy CT as a function of contrast task, radiation dose, size, and lesion diameter. Methods A TB-IQ phantom (Mercury Phantom 4.0, Sun Nuclear Corporation) was imaged on a third-generation dual-source dual-energy CT with 100/Sn150 kVp at three volume CT dose levels (5, 10, 15 mGy). Three size sections (diameters 16, 26, 36 cm) with subsections for image noise and spatial resolution analysis were used. High-contrast tasks (e.g., calcium-containing stone and vascular lesion) were emulated using bone and iodine inserts. A low-contrast task (e.g., low-contrast lesion or hematoma) was emulated using a polystyrene insert. VMI at 40-190 keV and LBI were reconstructed. Noise power spectrum (NPS) determined the noise magnitude and texture. Spatial resolution was assessed using the task-transfer function (TTF) of the three inserts. The detectability index (d') served as TB-IQ metric. Results Noise magnitude increased with increasing phantom size, decreasing dose, and decreasing VMI-energy. Overall, noise magnitude was higher for VMI at 40-60 keV compared to LBI (range of noise increase, 3-124%). Blotchier noise texture was found for low and high VMIs (40-60 keV, 130-190 keV) compared to LBI. No difference in spatial resolution was observed for high contrast tasks. d' increased with increasing dose level or lesion diameter and decreasing size. For high-contrast tasks, d' was higher at 40-80 keV and lower at high VMIs. For the low-contrast task, d' was higher for VMI at 70-90 keV and lower at 40-60 keV. Conclusions Task-based image quality differed among VMI-energy and LBI dependent on the contrast task, dose level, phantom size, and lesion diameter. Image quality could be optimized by tailoring VMI-energy to the contrast task. Considering the clinical relevance of iodine, VMIs at 50-60 keV could be proposed as an alternative to LBI.
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Affiliation(s)
- Davide Cester
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Dabli D, Frandon J, Belaouni A, Akessoul P, Addala T, Berny L, Beregi JP, Greffier J. Optimization of image quality and accuracy of low iodine concentration quantification as function of dose level and reconstruction algorithm for abdominal imaging using dual-source CT: A phantom study. Diagn Interv Imaging 2021; 103:31-40. [PMID: 34625394 DOI: 10.1016/j.diii.2021.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to assess the impact of advanced modeled iterative reconstruction (ADMIRE) algorithm and dose levels on the accuracy of Hounsfield unit (HU) measurement, image noise and contrast-to-noise ratio (CNR) in virtual monochromatic images (VMIs) with low iodine concentrations, and the accuracy of iodine quantification. MATERIALS AND METHODS A CT phantom was scanned with dual-source CT using abdomen-pelvis examination parameters at four dose levels: 5, 8, 11 and 20 mGy. Images were reconstructed using filtered-back projection (FBP) and ADMIRE levels 3 and 5 (A3-A5). HU accuracy was assessed calculating the root-mean-square deviation (RMSDHU). Image noise and CNR were computed on VMIs at 40/50/60/70 keV for 4 iodine inserts with 0.5, 1, 2 and 5 mg/mL concentrations. Accuracy of iodine quantification was assessed by the RMSDiodine and iodine bias (IB). RESULTS The RMSDHU decreased significantly as the dose levels increased compared to 5 mGy, except for 8 mGy with A3 (P = 0.380) and with A5 level (P = 0.945). Noise increased by 63.0 ± 3.0 (standard deviation [SD])% from 20 mGy to 5 mGy. Noise decreased significantly by -53.8 ± 0.9 (SD) % with A5 compared to FBP. The CNR decreased by -43.1 ± 6.5 (SD)% from 20 mGy to 5 mGy. It increased using ADMIRE, and as the ADMIRE levels increased. The RMSDiodine and IB decreased as the dose level increased, and this was similar for all reconstruction types. CONCLUSION ADMIRE strongly improves image quality in VMIs and slightly improves HU accuracy but does not affect the accuracy of iodine quantification.
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Affiliation(s)
- Djamel Dabli
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France.
| | - Julien Frandon
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Asmaa Belaouni
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Philippe Akessoul
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Takieddine Addala
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Laure Berny
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
| | - Joël Greffier
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nimes, EA 2994, France
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Adam SZ, Rabinowich A, Kessner R, Blachar A. Spectral CT of the abdomen: Where are we now? Insights Imaging 2021; 12:138. [PMID: 34580788 PMCID: PMC8476679 DOI: 10.1186/s13244-021-01082-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.
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Affiliation(s)
- Sharon Z Adam
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviad Rabinowich
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arye Blachar
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bowel Peristalsis Artifact on Dual-Energy CT: In Vitro Study on the Influence of Different Dual-Energy CT Platforms and Enteric Contrast Agents. AJR Am J Roentgenol 2021; 218:290-299. [PMID: 34406059 DOI: 10.2214/ajr.21.26345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. The value of dual-energy CT (DECT) for bowel wall assessment is increasingly recognized. Although technical improvements reduce peristalsis artifact in conventional CT, the effects of peristalsis on DECT image reconstructions remain poorly studied. OBJECTIVE. The purpose of this study was to evaluate the influence of different DECT scanners and enteric contrast agents on the severity of bowel peristalsis artifact in vitro. METHODS. To simulate bowel peristalsis, a 3-cm-diameter corrugated hollow tube representing the bowel was oscillated constantly in the z-axis within a larger water-filled cylinder. The bowel was serially filled with air, water, and iodinated or experimental dark contrast material and scanned on four different DECT platforms (spectral detector, rapid peak kilovoltage switching, split filter, and dual source) to reconstruct 120-kVp-like and iodine images. Two readers rated each image reconstruction for artifact severity from 0 (none) to 3 (severe) and recorded the degree to which iodine images depicted bowel wall hyperattenuation on 120-kVp-like images as artifactual. Artifact severity scores were compared by ANOVA with Bonferroni correction. RESULTS. Interrater agreement on artifact scores was excellent (intraclass correlation coefficient, 0.82 [95% CI, 0.79-0.84]). For 120-kVp-like images, mean peristalsis artifact scores were lower (all p < .001) for split-filter (1.47) and dual-source (1.86) scanners than for spectral-detector (2.58) and rapid-kilovoltage-switching (2.74) scanners. Compared with those on 120-kVp images, peristalsis artifacts on iodine images were less severe for spectral-detector (score, 1.03; p < .001) and rapid-kilovoltage-switching (2.09; p < .001) systems but more severe for dual-source (2.77; p < .001) and split-filter (2.62; p < .001) systems. Peristalsis artifact was rated less severe with experimental dark bowel contrast medium (score, 1.79) than with other bowel contrast agents (all p < .001). Iodine images helped identify bowel wall hyperattenuation as artifactual in 94.7% of reviewed cases for spectral-detector and 40.7% of cases for rapid-kilovoltage-switching scanners. CONCLUSION. For spectral-detector and rapid-kilovoltage-switching DECT, iodine images minimize peristalsis artifact, but for dual-source and split-filter DECT, mixed 120-kVp-like images are preferred. Compared with iodinated contrast material and water, experimental dark bowel contrast material reduces peristalsis artifact. CLINICAL IMPACT. Knowledge of the preferred images for reducing peristalsis artifact can lessen the effect of peristalsis on clinical DECT interpretation. Dark enteric contrast agents, when they become clinically available, may further reduce the effects of peristalsis.
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Dabli D, Frandon J, Hamard A, Belaouni A, Addala T, Beregi JP, Greffier J. Optimization of image quality and accuracy of low iodine concentration quantification as function of kVp pairs for abdominal imaging using dual-source CT: A phantom study. Phys Med 2021; 88:285-292. [PMID: 34358863 DOI: 10.1016/j.ejmp.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To determine the suitable kVp pair for optimal image quality of the virtual monochromatic images (VMIs) and iodine quantification accuracy at low concentration, using a third generation dual-source CT (DSCT). MATERIALS AND METHODS Multi-energy CT phantoms with and without body rings were scanned with a DSCT using four kVp pairs (tube "A"/"B" voltage): 100/Sn150, 90/Sn150, 80/Sn150 and 70/Sn150 kVp. The reference mAs was adjusted to obtain a CTDIvol close to 11 mGy. HU values accuracy (RMSDHU), noise (SD) and contrast-to-noise ratio (CNR) of iodine inserts of 0.5, 1, 2 and 5 mg/mL concentrations were assessed on VMIs at 40/50/60/70 keV. Iodine quantification accuracy was assessed using the RMSDiodine and iodine bias (IBiodine). RESULTS The RMSDHU decreased when the tube "A" voltage increased. The mean noise value increased significantly with tube "A" voltage (p < 0.001) but decreased between 80/Sn150 and 90/Sn150 kVp for the small phantom (1.1 ± 0.1%; p = 0.047). The CNR significantly decreased with tube "A" voltage (p < 0.001), except between 80/Sn150 and 90/Sn150 kVp for all inserts and between 90/Sn150 kVp and 100/Sn150 kVp for the 1.0 and 0.5 mg/mL inserts in the large phantom. In the small phantom, no significant difference was found between 80/Sn150 kVp and 90/Sn150 kVp for all inserts and between 80/Sn150, 90/Sn150 and 100/Sn150 kVp for the 1 and 0.5 mg/mL inserts. The RMSDiodine and IBiodine decreased as the tube "A" voltage of the kVp pair increased. CONCLUSION The kVp pair of 70/Sn150 led to better image quality in VMIs and sufficient iodine accuracy.
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Affiliation(s)
- Djamel Dabli
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France.
| | - Julien Frandon
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
| | - Aymeric Hamard
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
| | - Asmaa Belaouni
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
| | - Takieddine Addala
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
| | - Joël Greffier
- Department of Medical Imaging, CHU Nîmes, Univ Montpellier, Medical Imaging Group Nîmes, EA 2992, France
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Posada-Arango AM, García-Madrigal J, Echeverri-Isaza S, Alberto-Castrillón G, Martínez D, Gómez AC, Pinto JA, Pinillos L. Thrombosis in abdominal vessels associated with COVID-19 Infection: A report of three cases. Radiol Case Rep 2021; 16:3044-3050. [PMID: 34306276 PMCID: PMC8286875 DOI: 10.1016/j.radcr.2021.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
Hypercoagulability related to SARS-CoV-2 infection is one of the main extrapulmonary complications of COVID-19. We present three cases of intrabdominal thrombotic complications related to the state of hypercoagulability of COVID-19 and its tomographic features. Hypercoagulability state should be taking into account in the interpretation of radiological images in all infected patients with COVID-19.
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Affiliation(s)
- Ana María Posada-Arango
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
| | - Joaquín García-Madrigal
- Department of Radiology, Clinic Las Americas, Medellin, Colombia.,Department of Radiology, Clinic el Rosario, Medellin, Colombia
| | - Santiago Echeverri-Isaza
- Department of Radiology, Clinical Interventionist Las Americas and Hospital Pablo Tobon Uribe, Medellin, Colombia
| | | | - David Martínez
- Department of Radiooncology, Oncosalud- AUNA, Lima, Peru
| | - Andrea C Gómez
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Joseph A Pinto
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Luis Pinillos
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
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Low monoenergetic DECT detection of pyelonephritis extent. Eur J Radiol 2021; 142:109837. [PMID: 34339954 DOI: 10.1016/j.ejrad.2021.109837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether contrast enhanced DECT low monoenergetic can improve diagnostic conspicuity of inflamed kidney foci in acute pyelonephritis compared to conventional images. MATERIALS AND METHODS A retrospective study of 45 patients with clinical signs of acute pyelonephritis undergoing contrast-enhanced exams on a single source-DECT was conducted. Representative conventional and monoenergetic images were randomized and presented to four abdominal radiologists to determine their preference for inflamed kidney foci detection, and to determine the number of foci identified. Clinical impact of monoenergetic images was assessed using multivariant analysis. Contrast and signal to noise ratios were compared between the images using paired t-tests. RESULTS A greater number of foci were detected on the low energetic images for each patient (6.4 ± 5.3 vs. 4.2 ± 3.8, p < 0.02). Additionally, a consistent linear increase in the number of detected foci on the monoenergetic compared to the conventional images was seen (y = 0.10X + 0.36 R2 = 0.76). Most notably, in 16% of kidneys a clearly definable focus was detected only on monoenergetic images. SNR and CNR were increased by 2 and 1.5 fold for monoenergetic compared to conventional images (p < 0.001). Monoenergetic images were preferred by all readers for detecting inflamed foci (162/180 reads, P < 0.05), with 79% interreader reliability. CONCLUSION Low monoenergetic images enable increased detection of inflamed kidney parenchyma, and permit identification of pathologic foci some of which were not seen on the conventional images. Along with the strong preference of radiologists, these images should be considered beneficial for evaluating acute pyelonephritis.
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Iacobellis F, Narese D, Berritto D, Brillantino A, Di Serafino M, Guerrini S, Grassi R, Scaglione M, Mazzei MA, Romano L. Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review. Diagnostics (Basel) 2021; 11:diagnostics11060998. [PMID: 34070924 PMCID: PMC8230100 DOI: 10.3390/diagnostics11060998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
- Correspondence:
| | - Donatella Narese
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
| | - Daniela Berritto
- Department of Radiology, Hospital “Villa Fiorita”, Appia St., km 199,00, 81043 Capua, Italy;
| | - Antonio Brillantino
- Department of Emergency Surgery, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Roberta Grassi
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK;
- Teesside University School of Health and Life Sciences, Middlesbrough TS1 3BX, UK
- Department of Radiology, Pineta Grande Hospital, Domitiana St. km 30/00, 81030 Castel Volturno, 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, Bracci St. 10, 53100 Siena, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
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Abstract
PURPOSE OF REVIEW Recent advances in computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), and nuclear radiology have improved the diagnosis and characterization of small bowel pathology. Our purpose is to highlight the current status and recent advances in multimodality noninvasive imaging of the small bowel. RECENT FINDINGS CT and MR enterography are established techniques for small bowel evaluation. Dual-energy CT is a novel technique that has shown promise for the mesenteric ischemia and small bowel bleeding. Advanced US techniques and MRI sequences are being investigated to improve assessment of bowel inflammation, treatment response assessment, motility, and mural fibrosis. Novel radiotracers and scanner technologies have made molecular imaging the new reference standard for small bowel neuroendocrine tumors. Computational image analysis and artificial intelligence (AI) have the potential to augment physician expertise, reduce errors and variability in assessment of the small bowel on imaging. SUMMARY Advances in translational imaging research coupled with progress in imaging technology have led to a wider adoption of cross-sectional imaging for the evaluation and management of small bowel entities. Ongoing developments in image acquisition and postprocessing techniques, molecular imaging and AI have the strongest potential to transform the care and outcomes of patients with small bowel diseases.
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Editorial: Traversing through the small bowel and what not to miss. Curr Opin Gastroenterol 2021; 37:231-233. [PMID: 33654017 DOI: 10.1097/mog.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Lev-Cohain N, Sosna J, Meir Y, Dar G, Shussman N, Leichter I, Caplan N, Goldberg SN. Dual energy CT in acute appendicitis: value of low mono-energy. Clin Imaging 2021; 77:213-218. [PMID: 33992882 DOI: 10.1016/j.clinimag.2021.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the potential role of low monoenergetic images in the evaluation of acute appendicitis. METHODS A retrospective study of 42 patients with pathology proven acute appendicitis underwent contrast-enhanced-CT conducted on a single-source-DECT before surgery. Attenuation, SNR, and CNR were calculated on both monoenergetic and conventional images and compared to 24 abdominal CT-scans with normal appendix. Representative conventional and monoenergetic images were randomized and presented side-by-side to three abdominal radiologists to determine preferred images for detecting inflammation. Additionally, six individual acute inflammatory characteristics were graded on a 1-5 scale to determine factors contributing to differences between conventional and monoenergetic images by 2 abdominal radiologists. Paired t-tests, Wilcoxon and McNemar tests, and intra-observer error statistics were performed. RESULTS For the inflamed appendixes monoenergetic images had overall increased attenuation (average ratio 1.7; P < 0.05), signal-to-noise-ratio (6.7 ± 3.1 vs 4.2 ± 1.6; P < 0.001) and contrast-to-noise-ratio (12.1 ± 3 vs 9 ± 2.1; P < 0.001). Moreover, this increase was not found in normal appendixes (P < 0.001 vs p = 0.28-0.44). Subjectively, radiologists showed significant preferences towards monoenergetic images (P < 0.001), with inter-reader agreement of 0.84. Two parameters, diffuse bowel wall and mucosal enhancement, received significantly higher scores on monoenergetic images (average 4.3 vs. 3.0; P < 0.001 and 2.8 vs. 2.3 P < 0.03 respectively, with interobserver agreements of 62% and 52%). CONCLUSION Increased bowel wall conspicuity from enhanced attenuation, SNR, and CNR on low monenergetic CT images results in a significant preference by radiologists for these images when assessing acute inflamed appendixes. Thus, close inspection of low monoenergetic images may improve the visualization of acute inflammatory bowel processes.
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Affiliation(s)
- Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel.
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Yuval Meir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Gili Dar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Noam Shussman
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Isaac Leichter
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Nadia Caplan
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
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Hamid S, Nasir MU, So A, Andrews G, Nicolaou S, Qamar SR. Clinical Applications of Dual-Energy CT. Korean J Radiol 2021; 22:970-982. [PMID: 33856133 PMCID: PMC8154785 DOI: 10.3348/kjr.2020.0996] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 01/05/2023] Open
Abstract
Dual-energy CT (DECT) provides insights into the material properties of tissues and can differentiate between tissues with similar attenuation on conventional single-energy imaging. In the conventional CT scanner, differences in the X-ray attenuation between adjacent structures are dependent on the atomic number of the materials involved, whereas in DECT, the difference in the attenuation is dependent on both the atomic number and electron density. The basic principle of DECT is to obtain two datasets with different X-ray energy levels from the same anatomic region and material decomposition based on attenuation differences at different energy levels. In this article, we discuss the clinical applications of DECT and its potential robust improvements in performance and postprocessing capabilities.
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Affiliation(s)
- Saira Hamid
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada.
| | - Muhammad Umer Nasir
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron So
- Department of Medical Biophyics, Schulich School of Medicine and Dentistry Western University London, Ontario, Canada
| | - Gordon Andrews
- Department of Radiology, University of British Columbia Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Sadia Raheez Qamar
- Department of Medical Imaging, Sunnybrook Hospital, University of Toronto, Toronto, Canada
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Anglaret S, Dallongeville A, Beaussier H, Touloupas C, Boulay I, Tardivel AM, Béranger S, Silvera S, Chatellier G, Ronot M, Zins M. Influence of clinical suspicion on CT accuracy of acute mesenteric ischemia: Retrospective study of 362 patients. Eur J Radiol 2021; 138:109652. [PMID: 33740626 DOI: 10.1016/j.ejrad.2021.109652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) may be underdiagnosed when not clinically suspected before CT is performed. We assessed the influence of a clinical suspicion of AMI on the CT accuracy. METHOD This retrospective single-centre study included patients who underwent CT in 2014-2019 and had clinically suspected AMI and/or confirmed AMI. CT protocols were adapted based on each patient's presentation and on findings from unenhanced images. The CT protocol was considered optimal for AMI when it included arterial and portal venous phases. CT protocols, accuracy of reports, and outcomes were compared between the groups with and without suspected AMI before CT. RESULTS Of the 375 events, 337 (90 %) were suspected AMI and 66 (18 %) were AMI, including 28 (42 %) with and 38 without suspected AMI. These two groups did not differ significantly regarding the medical history, clinical presentation, or laboratory tests. The CT protocol was more often optimal for AMI in the group with suspected AMI (26/28 [93 %] vs. 28/38 [74 %], p = 0.046). Diagnostic accuracy was not different between groups with and without suspected AMI (26/28 [93 %] vs. 34/38 [90 %], p = 1.00). However, it was lower in the group without suspicion of AMI when the CT protocol was not optimal for AMI (27/28 [96 %] vs 7/10 [70 %], p = 0.048). CONCLUSIONS The negative influence of not clinically suspecting AMI can be mitigated by using a tailored CT protocol.
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Affiliation(s)
- S Anglaret
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - A Dallongeville
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - H Beaussier
- Unité de recherche clinique, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - C Touloupas
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - I Boulay
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - A M Tardivel
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - S Béranger
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - S Silvera
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - G Chatellier
- Unité de recherche clinique, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - M Ronot
- Imagerie médicale, Hôpital Beaujon AP-HP, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - M Zins
- Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
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Abstract
PURPOSE OF REVIEW The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill. RECENT FINDINGS Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing. SUMMARY Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.
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Abstract
Dual-energy CT (DECT) overcomes several limitations of conventional single-energy CT (SECT) for the evaluation of gastrointestinal diseases. This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging. A head-to-head comparison of technical specifications among DECT scanner implementations is provided. Energy- and material-specific DECT image reconstructions enable retrospective (i.e., after examination acquisition) image quality adjustments that are not possible using SECT. Such adjustments may, for example, correct insufficient contrast bolus or metal artifacts, thereby potentially avoiding patient recalls. A combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can be included in protocols to improve lesion detection and disease characterization. Relevant literature is reviewed regarding use of DECT for evaluation of the liver, gallbladder, pancreas, and bowel. Challenges involving cost, workflow, body habitus, and variability in DECT measurements are considered. Artificial intelligence and machine-learning image reconstruction algorithms, PACS integration, photon-counting hardware, and novel contrast agents are expected to expand the multienergy capability of DECT and further augment its value.
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Impact of Dual-Energy CT in the Emergency Department: Increased Radiologist Confidence, Reduced Need for Follow-Up Imaging, and Projected Cost Benefit. AJR Am J Roentgenol 2020; 215:1528-1538. [DOI: 10.2214/ajr.19.22357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gong H, Tao S, Rajendran K, Zhou W, McCollough CH, Leng S. Deep-learning-based direct inversion for material decomposition. Med Phys 2020; 47:6294-6309. [PMID: 33020942 DOI: 10.1002/mp.14523] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 09/16/2020] [Accepted: 10/24/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To develop a convolutional neural network (CNN) that can directly estimate material density distribution from multi-energy computed tomography (CT) images without performing conventional material decomposition. METHODS The proposed CNN (denoted as Incept-net) followed the general framework of encoder-decoder network, with an assumption that local image information was sufficient for modeling the nonlinear physical process of multi-energy CT. Incept-net was implemented with a customized loss function, including an in-house-designed image-gradient-correlation (IGC) regularizer to improve edge preservation. The network consisted of two types of customized multibranch modules exploiting multiscale feature representation to improve the robustness over local image noise and artifacts. Inserts with various densities of different materials [hydroxyapatite (HA), iodine, a blood-iodine mixture, and fat] were scanned using a research photon-counting detector (PCD) CT with two energy thresholds and multiple radiation dose levels. The network was trained using phantom image patches only, and tested with different-configurations of full field-of-view phantom and in vivo porcine images. Furthermore, the nominal mass densities of insert materials were used as the labels in CNN training, which potentially provided an implicit mass conservation constraint. The Incept-net performance was evaluated in terms of image noise, detail preservation, and quantitative accuracy. Its performance was also compared to common material decomposition algorithms including least-square-based material decomposition (LS-MD), total-variation regularized material decomposition (TV-MD), and U-net-based method. RESULTS Incept-net improved accuracy of the predicted mass density of basis materials compared with the U-net, TV-MD, and LS-MD: the mean absolute error (MAE) of iodine was 0.66, 1.0, 1.33, and 1.57 mgI/cc for Incept-net, U-net, TV-MD, and LS-MD, respectively, across all iodine-present inserts (2.0-24.0 mgI/cc). With the LS-MD as the baseline, Incept-net and U-net achieved comparable noise reduction (both around 95%), both higher than TV-MD (85%). The proposed IGC regularizer effectively helped both Incept-net and U-net to reduce image artifact. Incept-net closely conserved the total mass densities (i.e., mass conservation constraint) in porcine images, which heuristically validated the quantitative accuracy of its outputs in anatomical background. In general, Incept-net performance was less dependent on radiation dose levels than the two conventional methods; with approximately 40% less parameters, the Incept-net achieved relatively improved performance than the comparator U-net, indicating that performance gain by Incept-net was not achieved by simply increasing network learning capacity. CONCLUSION Incept-net demonstrated superior qualitative image appearance, quantitative accuracy, and lower noise than the conventional methods and less sensitive to dose change. Incept-net generalized and performed well with unseen image structures and different material mass densities. This study provided preliminary evidence that the proposed CNN may be used to improve the material decomposition quality in multi-energy CT.
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Affiliation(s)
- Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, 55901, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Rochester, MN, 55901, USA
| | | | - Wei Zhou
- Department of Radiology, Mayo Clinic, Rochester, MN, 55901, USA
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, 55901, USA
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Xu JJ, Taudorf M, Ulriksen PS, Achiam MP, Resch TA, Nielsen MB, Lönn LB, Hansen KL. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10100814. [PMID: 33066281 PMCID: PMC7602017 DOI: 10.3390/diagnostics10100814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn’s disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn’s disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Correspondence:
| | - Mikkel Taudorf
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Peter Sommer Ulriksen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Lars Birger Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
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